Unsupervised Nurse Anesthesia – HB1322

Unsupervised Nurse Anesthesia – HB1322

Unsupervised Nurse Anesthesia – HB1322 600 800 Bo Frith

In one of the most blatant money grabs in recent legislative history, Virginia legislators are contemplating making it legal for patients to receive anesthesia without doctor supervision.

Why is this important?

Anesthesia is one of the most important and risky parts of a procedure. An anesthesiologist essentially gets a patient as close to death as possible and then brings him back to life. An anesthesia error can result in grave consequences, as we see in many cases. While a surgeon can botch an operation leaving you permanently injured, an anesthesia error can kill you.

The law

The proposed law is House Bill 1322. The law would remove the requirement for a doctor to be present and supervise anesthesia care. It would enable a nurse to provide anesthesia for any procedure with no doctor supervision. If this sounds insane, that’s because it is.

The current law in Virginia requires nurses who provide anesthesia services, certified registered nurse anesthetists (CRNAs), to be supervised by a physician. In order for a CRNA to provide anesthesia services, a CRNA must practice under the supervision of a licensed doctor of medicine, osteopathy, podiatry, or dentistry.[1]

Virginia’s current approach of doctor supervision is lenient compared to neighboring states. In Maryland, a doctor must be physically present at all times and it prioritizes consultation with an anesthesiologist.[2] In Tennessee, direct supervision by a physician physically present in the building is required.[3] Apparently unsatisfied with Virginia’s already lenient law, special interest groups are pushing for even more lenient safety standards.

Anesthesia provided by doctors is safer

Anesthesiologists have more extensive education and training than nurses. An anesthesiologist completes nearly double the education and ten times the clinical training of CRNAs.[4] An anesthesiologist’s education and training include 12 to 14 years following high school, including medical school and residency, and 12,000 to 16,000 hours of clinical training.[5] In contrast, a nurse anesthetist’s education and training ranges from four to six years after high school — less than half a physician’s training and an average of approximately 2,500 hours of anesthesia care training — less than one-fifth that of physicians.[6]

Medical literature does not suggest nurse anesthesiology is safer. A 2014 study found that there is no scientific evidence that care provided by a nurse anesthetist is as safe as physician-led anesthesia care.[7] Although the authors “hoped that this [the review] may lead to an increase in confidence in the skills of NPAs [nurse anesthetists] within the anesthetic community…”[8] their review provided no such support. Further, that study was conducted by an independent organization that received no funding from special interest groups.

Beware of spin

In recent months, special interests have written op-eds in Virginia papers to try to drum up support for the bill. In a January 21, 2023 opinion piece in the Richmond Times the author argues for passage of the proposed legislation.[9] Only at the end of the piece, in barely legible tiny font do you find the author is the president of the Virginia Association of Nurse Anesthetists.

In a December 2023 article in Cardinal News, the authors argue for no supervision by nurses (CRNAs) in providing anesthesia, claiming it will cut costs and address the lack of anesthesiologists in rural areas.[10] Putting aside the issue that if hospitals cannot attract anesthesiologists they should just pay them more, is the issue of bias. As before, only through close inspection will you realize one of the co-authors of the article is the president of the Virginia Association of Nurse Anesthetists.[11]

The studies the special interests cite are likewise highly dubious and clearly biased. They cite to a study in Health Affairs that found no measurable differences in the care provided by CRNAs and anesthesiologists.[12] Buried on the last page of the study, at the bottom before the citations, is the acknowledgment that the study was bought and paid for by the American Association of Nurse Anesthetists.[13]

They also cite to a study that found no difference in the rates of complications between anesthesia provided by CRNAs to those of doctors.[14] On the front page of the study is the acknowledgement that the sole funding came from the American Association of Nurse Anesthetists and the American Association of Nurse Anesthetists Foundation.[15]

Q: Why do special interests want the new law? A: Money

Special interests want this for one reason—money. Hospitals and hospital groups will save money on the reduced salaries of nurses to do the same services as doctors. The Bureau of Labor Statistics states the average annual pay for a CRNA is $200,000, whereas the average pay for an anesthesiologist is $330,000. [16] Hospital groups would save $130,000 per year per anesthesiologist they no longer have to hire under the new law.

Q: Why would legislators propose such a law? A: Money

Fairfax House of Delegates member Mark Sickles introduced HB 1322 – Certified registered nurse anesthetist; elimination of supervision requirement in January of 2024.[17] The bill is now pending in the subcommittee of Health Professions under the Committee on Health and Human Services.

The Virginia Public Access Project lists the following top donors to Del. Mark Sickles[18]:

$319,507         Dominion Energy

$254,481         Democratic Party of Virginia

$62,992           Virginia Auto Dealers Assn

$61,297           Virginia Hospital & Healthcare Association

$53,550           Intl Brotherhood of Electrical Workers

$50,000           One Virginia PAC

$41,158           Virginia Health Care Association

$40,500           Dixon, Dan R

$40,424           Virginia Bankers Assn

$38,500           Mid-Atlantic Laborers’ Political Education Fund

$31,250           Virginia Dental Assn

$30,250           HCA Healthcare

Three of his top twelve all-time donors are hospital groups. What’s the saying about how you don’t want to know how the sausage gets made?

Your help

We urge you to contact your elected representatives in Richmond to discourage them from supporting this terrible legislation. Only if citizens get involved and voice their displeasure can we ensure the law will be stopped.


[1] Shafer, Robert. Virginia Patients Deserve The Best Quality Care — Wherever They Live. Cardinal News (Jan. 24, 2024). Available at https://cardinalnews.org/2024/01/24/virginia-patients-deserve-the-best-quality-care-wherever-they-live/?utm_source=ActiveCampaign&utm_medium=email&utm_content=State%20would%20gain%20power%20to%20approve%20large%20solar%20and%20wind%20projects%20over%20local%20objections%20under%20proposed%20legislation&utm_campaign=Monday%2C%20January%2015%2C%202024.

[2] Id.

[3] Id.

[4] Nurse anesthetist care not equal to physician anesthesiologist-led care, comprehensive evidence-based review finds, American Society of Anesthesiologists calls for further examination. ASA (Aug. 19, 2014). Available at https://www.asahq.org/about-asa/newsroom/news-releases/2014/08/nurse-anesthetist-care-not-equal-to-physician-anesthesiologist-led-care.

[5] American Society of Anesthesiologists Urges Congress to Block VA Nurses’ Efforts to Remove Anesthesiologists from Veterans’ Care. ASA (Sept. 18, 2023). Available at https://www.asahq.org/about-asa/newsroom/news-releases/2023/09/asa-urges-congress-to-block-va-nurses-efforts-to-remove-anesthesiologists-from-veterans-care.

[6] Id.

[7] Lewis, SR. Physician anesthetists versus non-physician providers of anesthesia for surgical patients. Cochrane Database of Systematic Reviews  (2014). Available at https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010357.pub2/epdf/full

[8] Id. at 4.

[9] Joyner, Meredith. A Simple Change Can Improve Health Care. Richmond Times (Jan. 21, 2023). Available at https://richmond.com/opinion/column/column-a-simple-change-can-improve-health-care/article_d9c50d56-9848-11ed-8a11-2b4e25b6cccc.html.

[10] Helvey, Michael and Hirsch, Maria. In Rural Virginia, Certified Registered Nurse Anesthetists Play a Critical Role. Cardinal News (Dec. 20, 2023). Available at https://cardinalnews.org/2023/12/20/in-rural-virginia-certified-registered-nurse-anesthetists-play-a-critical-role/.

[11] Id. Maria Hirsch is the president of the Virginia Association of Nurse Anesthetists. Available at https://cardinalnews.org/author/maria-hirsch/.

[12] Dulisse, Brian. No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians. Health Affairs (Aug. 2010). Available at https://wiana.starchapter.com/images/downloads/Documents/health_affairs_article.pdf.

[13] Id. at 1475.

[14] Negrusa, Brighita. Scope of Practice Laws and Anesthesia Complications. Medical Care (Oct. 2016) Available at https://journals.lww.com/lww-medicalcare/Abstract/2016/10000/Scope_of_Practice_Laws_and_Anesthesia.4.aspx.

[15] Id. at 913.

[16] Munday, Rebecca. CRNA vs. Anesthesiologist: What’s the Difference? Nurse Journal (Aug. 29, 2023). Available at https://nursejournal.org/resources/crna-vs-anethesiologist/.

[17] Virginia’s Legislative Information Session (LIS). Accessed Feb. 2, 2024. Available at https://lis.virginia.gov/cgi-bin/legp604.exe?241+sum+HB1322.

[18] Mark Sickles Top Donors. VPAP (Accessed Feb. 2, 2024). Available at https://www.vpap.org/candidates/399/top_donors/.

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