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Lawmakers weigh changing CRNA 'supervision' language to 'in consultation with'
Summary
Representative Penza proposed replacing 'supervision' with 'in consultation with' for certified registered nurse anesthetists (CRNAs), arguing the change would increase rural access and reduce costs; members urged clearer statutory definitions and stakeholder talks with anesthesiologists before session.
Representative Penza introduced an interim study proposal to change state law governing certified registered nurse anesthetists, proposing to "remove the word supervision and replace with, in consultation with, a licensed physician," and said the language reflects how CRNAs routinely work when anesthesiologists are not present. The sponsor told the committee the change is intended to increase access to care and lower costs for Arkansans, particularly in rural hospitals.
The proposal cites federal supervision language from 1981 (HCFA, now the Centers for Medicare and Medicaid Services) and notes that many states either do not include supervision in nurse practice acts or have opted out of CMS supervision requirements. "Removing the confusing supervision language will increase access to care and decrease health care costs to Arkansans and our rural hospitals," the presenter said.
Members pressed the sponsor on outreach and statutory clarity. Representative Boyce asked whether the sponsor had tried to convene anesthesiologists and CRNAs before running the bill; the sponsor said past sessions failed to reach agreement but expressed willingness to meet. Senator Chesterfield raised liability concerns, asking, "Without the required supervision, the liability ... would be increased for the individual who is administering the anesthesia." A CRNA respondent answered that CRNAs "carry the same amount of liability insurance as the surgeon and anesthesiologist" and said that liability already exists for both specialties.
Senator Hickey and others urged the bill drafters to define what "in consultation with" means, warning that without a definition it could amount to nominal or remote oversight. The bill sponsor said he would try to convene stakeholders and pointed to Oklahoma's recent experience removing supervision as an example of a negotiated opt-out.
The committee did not take a vote on the proposal during the meeting. Representative Penza and other members said they would attempt to schedule meetings with anesthesiologists and relevant stakeholders before the legislative session to clarify liability, define "in consultation with," and seek compromises that could reduce contention.
The interim study proposal remains under consideration pending stakeholder discussions and potential clarifying language to define the scope and limits of "in consultation with."
