On June 30, 2021, House Bill 4359 was presented to Governor Gretchen Whitmer for signature. The bill will expand the scope of practice for certified registered nurse anesthetists ("CRNA") in Michigan; making them solely responsible for the planning and administration of anesthesia care without physician involvement. This bill provides essential flexibility regarding physician supervision of CRNAs and brings Michigan in line with most other states.
History of House Bill 4359
The bill was introduced by Representative Mary Whiteford (R-Casco Township) on February 24, 2021, and referred to the Committee on Health Policy. Representative Whiteford was a former nurse and introduced the bill because nurses expressed to her that any physician can permit to administer anesthesia under Michigan's current system. Before the bill passed, supervision did not have to come from an anesthesiologist, but rather from any MD, even with no experience in anesthesia. However, there has been less consensus across the medical community. On March 3, 2021, physicians with the Michigan State Medical Society and the Michigan Society of Anesthesiologists voiced opposition to the legislation for concerns about removing physician supervision in every anesthetic. The bill was passed in both the House and Senate and supported by the Michigan Health & Hospital Association ("MHA"). It is now before Governor Whitmer for approval.
Changes to the Public Health Code
The Public Health Code would be amended to do the following:
- Include in the definition of "prescriber" a registered professional nurse who held a specialty certification as a nurse anesthetist when he or she was engaging in the practice of nursing and providing certain anesthesia and analgesia services.
- Prescribe the scope of practice for a registered professional nurse who held a specialty certification as a nurse anesthetist.
- Allow a healthcare facility to adopt policies relating to the provision of anesthesia and analgesia services.
- Require a healthcare facility to ensure that a registered professional nurse, or employer of said nurse, maintains malpractice insurance if the facility used the nurse to perform the anesthesia and analgesia services described in the bill.
- Specifying that new or additional third-party reimbursement or mandated worker's compensation benefits for anesthesia and analgesia services provided under the bill by a registered professional nurse holding a specialty certification as a nurse anesthetist is unnecessary.
Impact on CRNAs
In addition to performing duties within the scope of the practice of nursing, CRNA responsibilities would include expanded anesthesia and analgesia services if performed following the American Association of Nurse Anesthetists Standards for Nurse Anesthesia Practice. These responsibilities include the development of a plan of care, the performance of all patient assessments and procedures, along with selection, ordering, or prescribing, and the administration of anesthesia and analgesic agents.
Under the bill, CRNAs now must meet one of the following requirements to practice anesthesia care without supervision:
- Have a minimum of three years of experience practicing in the specialty field of nurse anesthetist, along with a minimum of 4,000 hours practicing in a healthcare facility; or
- Hold a Doctor of Nurse Anesthesia Practice degree or Doctor of Nursing Practice degree.
In addition, CRNAs must be collaboratively practicing in a patient-centered care team, including a licensed physician that is immediately available in person or through telemedicine to address any urgent or emergent clinical concerns. However, if the CRNA practices pain management in a freestanding pain clinic, they must be under the supervision of a physician.
Impacts on Michigan Healthcare System and Physician Liability
The impact of this new legislation could be vast. Patients in rural settings can be provided anesthesia care more easily than before. One hope is that allowing CRNAs to work without the supervision of a physician addresses issues of disparity by providing the services to patients at a much lower cost. The new system created under the bill will also benefit supervising physicians. Before this bill, those supervising physicians, who had no experience in anesthesia, were potentially liable for the CRNA's care in an area of medicine in which they had no training. Their liability exposure now has likely decreased without diminishing the level of care afforded to the patient. Overall, the results of House Bill 4359 are a win for the healthcare system and community at large.
For more information regarding the legal impact on physicians and CRNAs relating to House Bill 4359, please contact the Medical Malpractice Team at Rhoades McKee.
This alert was drafted with assistance by Rhoades McKee Law Clerk, Jennifer Lewis (University of Notre Dame JD, '22).
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