Lawmakers asked to wake up and look at anesthesia laws during upcoming Session

Health care provider groups want lawmakers to examine how anesthesia and other pain-numbing services are delivered to hospitalized Florida patients.

Three different types of health care providers are authorized to administer anesthesia in Florida: anesthesiologist assistants, certified registered nurse anesthetists and anesthesiologists. They all have different roles and educational and training backgrounds, but they all have their eyes on bills filed in the Florida House and Senate for consideration in the Legislative Session that begins Jan. 11, 2022.

SB 1336 by Sen. Dennis Baxley modernizes laws regarding the regulation of anesthesiologist assistants. Created in statute with the support of the Florida Medical Organization 19 years ago, AAs are considered physician extenders and must work under the direct supervision of anesthesiologists.

There are 509 AAs licensed and actively working in Florida, according to the most recent Florida Department of Health annual report.

Lobbyist Brecht Heuchan says there has never been an effort to alter the law in that time.

“It’s a virgin statute. It’s never been touched,” Heuchan told Florida Politics. The Florida Academy of Anesthesiologist Assistants hired Heuchan to help pass the bill.

Baxley’s proposal still requires AAs to work under the direct supervision of anesthesiologists, but provides for more flexibility allowing anesthesiologists to be located on the same premises and be reasonably available when needed. Current law requires anesthesiologists to be in the same surgical or obstetric suites as the procedure being performed. Additionally, the anesthesiologists need to be immediately available at all times.

Baxley’s proposed changes intend to help increase AAs’ footprint in hospitals.

“We just want the modernization of language to allow the appropriate engagement of our profession into the market in Florida,” said Jeff Carroll, an anesthesiologist assistant and immediate past president of the Florida Academy of Anesthesiologist Assistants.

Baxley’s bill has language clarifying that hospitals may not deny clinical privileges, except for cause, to anesthesiologist assistants who have applied for clinical privileges and are supervised by on-staff anesthesiologists. Hospitals have 90 days to review the applications.

The language is similar, but not identical, to current law for physician assistants, another physician extender profession regulated by the state’s medical boards. The PA law doesn’t include a 90-day time restriction, however.

Carroll called the time restrictions “appropriate.”

Leo Rodriguez, president of the Florida Society of Anesthesiologists and a physician, said the association wants to see Baxley’s bill pass.

“We support this expansion because it allows expanded access without fundamentally altering the physician-led model of delivering anesthesia care to patients,” he said in a statement to Florida Politics. “This model is proven to not just be the safest model, but also the most cost effective as well.”

Anesthesia can be considered local when an anesthetic is injected into a specific body area to numb that area by preventing the nerves from sending pain signals, or regional, such as a spinal or epidural block, which is injected near a cluster of nerves.

The state medical boards also acknowledge “conscious sedation” when anesthesia is administered intravenously. There is also general anesthesia administered with a gas through a mask and/or intravenously and makes the patient unconscious and unable to feel pain.

Jacksonville attorney and longtime Tallahassee lobbyist Chris Nuland predicted certified registered nurse anesthetists will oppose SB 1336.

Nuland represents physician specialty groups before Florida legislative and regulatory boards, but he is not registered to lobby for anesthesiologists for the 2022 Legislative Session.

“It’s primarily about making AAs more commercially viable in the marketplace, and that’s its real intention. I would expect CRNAs to oppose it for that reason. But it’s certainly not aimed at CRNAs,” Nuland said.

According to a statewide association group, there are about 5,400 CRNAs in Florida, representing about 3,800 of the providers. Unlike AAs, CRNAs are not required to work under the direct supervision of anesthesiologists. But they are required to work under the direct supervision of a physician.

Senate Health Care Policy Committee Sen. Manny Diaz has filed SB 986, which would delete the direct supervision requirements for CRNAs to administer anesthesia, including in Florida hospitals. Its House counterpart, HB 437, is filed by Rep. Rob Rommell.

The bills would replace direct supervision requirements and allow CRNAs to enter into collaborative agreements with physicians. The Florida Legislature in 2020 agreed to expand the scope of practice for Florida pharmacists who entered into collaborative agreements with physicians. The Board of Pharmacy passed rules authorizing the agreements after consulting with the state’s medical boards.

While anesthesiologists support the AA bill, they do not support the CRNA bill.

“We oppose any bill, this one included, that seeks to remove the physician anesthesiologist as the leader of the anesthesia care team,” Rodriguez said. “The bill only calls itself ‘collaborative,’ but in truth it clouds who is truly the decision-maker during the provision of anesthesia care to a patient. For both safety and cost reasons, it is proven that physician-led anesthesia care is the proven model that works best.”

Meanwhile, the Florida Hospital Association and the Safety Net Hospital Alliance of Florida have recently leased reports showing a pending nursing shortage and a physician shortage in the state.

“We are very interested in legislation that allows trained health care professionals to work at the top of their licenses subject to other standards and requirements established by the hospital and through medical staff bylaws,” FHA President Mary Mayhew said in a statement to Florida Politics. “As we confront one of the worst health care workforce shortages our hospitals have ever experienced, it is imperative that we maximize the skills of trained health care teams.”