Legislation has been filed in the NC Senate that puts patients at great risk. Senate Bill 240proposes to eliminate the requirement of physician supervision of nurse anesthetists (CRNAs). North Carolina law has always required physician supervision of nurse anesthetists providing anesthesia medical care. Unfortunately, this important patient safety standard is under attack.
Physician supervision is, and should remain, the law.
The North Carolina Medical Board has always required physicians to supervise nurse anesthetists providing anesthesia services – this helps ensure the safety of services provided. Physician anesthesiologists complete almost double the education and more than ten times the clinical training of nurse anesthetists.
In 1998 and again in 2005, the N.C. Attorney General concluded that North Carolina law requires “the anesthesia care of a patient [must] be under the supervision of a physician.”
In 2005 the N.C. Court of Appeals rejected a lawsuit by nurse anesthetists by finding that “physician supervision of nurse anesthetists providing anesthesia care . . . is a fundamental patient safety standard required by North Carolina law.”
The requirement of physician supervision is supported by multiple academic studies suggesting that physician involvement in anesthesia care improves patient outcomes. Additionally, every hospital in the state requires the supervision of nurses providing anesthesia services.
North Carolina law has always required physician supervision of nurse anesthetists. It should remain that way. We value the important contributions of CRNAs, but a physician-led care team provides the most effective — and safest — care for patients.
* Training Chart Courtesy of ASA “When Seconds Count”
Patient education is key when it comes to understanding the roles of various healthcare providers as well as the risks posed by medical treatment not overseen by a physician. A 2015 AARP Magazine Infographic provides patients with the fundamentals of physician office roles, calling attention to the dramatic differences in training between physicians and nurse practitioners.
The graphic reads, “The physicians are still the ones in charge — and those with the most training, as indicated by the length of their white coats, the longest of any health care professionals. MDs have 3 to 7 years of training after med school.”
View the graphic on the AARP website here.
What is Scope of Practice?
Professional scope of practice refers to a set of parameters placed into state law to define what acts a licensed healthcare provider may, or in some cases, may not perform.
As a result, the law does not limit what medical acts a physician may perform. The North Carolina Medical Board provides oversight to physician practice, ensuring the public is protected from any potentially harmful behavior.
Non-physician health care providers have a legislated scope of practice that places limitations on their practice. This may appear in one of many ways.
- As a definition in statute. For example 90-143 defines Chiropractic as “the science of adjusting the cause of disease by realigning the spine, releasing pressure on nerves radiating from the spine to all parts of the body, and allowing the nerves to carry their full quota of health current (nerve energy) from the brain to all parts of the body.” As a result activities outside of this defined scope are prohibited without legislative authority.
- As a specified list of permitted activities. For example 90-722 lists 5 categories of practice that a polysomnographic technologist may engage in. This list if further broken down into a very specified list of tests that may be performed by these practitioners.
- In the form of physician supervision. Physician assistants and advanced practice nurses are not limited by a definition of practice or list of tasks. However, each must practice with a supervising physician’s approval.
How is Scope of Practice Determined?
In North Carolina the legislature specifies the scope of practice of various healthcare providers within Chapter 90 of the General Statutes. These decisions are often based on the level of training of the healthcare provider, balanced with the potential for harm to patients.
Can a Licensing Board Make Changes to Scope of Practice?
Not in North Carolina. Statute often allows licensing boards to write rules to clarify acceptable practice guidelines. For example, the Medical Board and Board of Nursing have rules in place to determine what information must be included in a supervisory agreement between the two providers. However, a licensing board cannot allow its licensees to practice outside of the legislated scope of practice or eliminate the requirement for physician supervision.
Why Do Providers Need a Scope of Practice?
It is important that these permissions, and in some instances limitations, are specified within state law in order to protect patients from harm. Just as state law describes who can operate motor vehicles, it is also tasked with determining who is qualified to provide medical care.
Almost every year the NC General Assembly is faced with proposed legislation to license naturopaths to practice medicine in North Carolina. This session is no exception with Senator Stan Bingham filing SB 118 – Naturopathic Licensing Act, last week.
During past debates illegally practicing naturopaths have offered their services as a form of “primary care” – a thought that is troubling to our members. Many patients fail to ask questions regarding the qualifications of their health care provider. If naturopaths are able to use the title of doctor or physician when practicing this could further confuse the public, presenting the false perception of medical training.
Additionally, licensure of naturopaths as physicians is troubling because:
- ineffective naturopathic treatments may delay necessary or needed medical services and put patients at risk
- the lack of ethical standard for naturopaths could lead to patient exploitation through sales directly to patients of “naturopathic remedies”
- this bill places no limitations on naturopaths when it comes to providing mental health care, treating children, or even diagnosing cancer.
For these reasons the Coalition opposes SB 118 as introduced.