HB 109

Utah House of Representatives are currently in session.  And they have a bill in their hands that is so important to me and my family.  It's hard, and frustrating, to watch from a thousand miles away while a bunch of politians and lobbyists decide whether or not your husband's profession can practice in Utah.  There isn't a whole lot we can do.  Since we don't live in Utah, we can't write "our" representative.  We don't have one.  So basically, I am asking anyone and everyone who is willing to take a second to ask their reps to support HB 109. 
House Bill 109 would allow Anesthesiologist Assistants (AAs) to be licensed and practice in Utah.  This does not mean that any hospital or anesthesiologist or anyone for that matter, has to HIRE AAs.  It simply allows for the option.  I am almost flabbergasted that this is even a hard bill to pass.  But sure enough, it is.  In fact, this is the fourth year that HB 109 has been proposed for Utah law.  So, you might wonder, why hasn't it passed?  The answer is simple.  Nurse anesthetists.  As a group, they have large lobbying power and put lots of money into political activism.  They are a tough group to recon with.  AAs are essentially job competition for CRNAs.  And that my friends is where the political battle begins.  And because I would never ask you to blindly support a bill, here are the facts regarding AAs.

The duties of AAs are identical to those of Certified Registered Nurse Anesthetists (CRNA’s), despite different educational backgrounds.  In providing assistance to a supervising anesthesiologist, AA’s are trained to:

-          Assist the supervising anesthesiologist in developing and implementing an anesthesia care plan for a patient;

-          Obtain a comprehensive patient history, perform relevant elements of a physical exam, and present the history to the supervising anesthesiologist;

-          Pretest and calibrate anesthesia delivery systems and obtain and interpret information from the systems and monitors;

-          Assist the supervising anesthesiologist with the implementation of monitoring techniques;

-          Establish basic and advanced airway interventions, including intubation of the trachea and performing ventilatory support;

-          Administer intermittent vasoactive drugs and start and adjust vasoactive infusions;

-          Administer anesthetic drugs, adjuvant drugs, and accessory drugs;

-          Perform epidural anesthetic procedures, spinal anesthetic procedures, and other regional anesthetic techniques under the direction of the supervising anesthesiologist;

-          Administer blood, blood products, and supportive fluids;

-          Provide assistance to a cardiopulmonary resuscitation team in response to life-threatening situations

Opponents of this bill argue:

- They have no prior healthcare experience

Although AA's are not required to have previous healthcare experience before acceptance to an accredited AA program, the majority of AA students do have healthcare experience nonetheless. Anesthesia technicians, phlebotomists and even nurses are common applicants to AA school.  Physicians are also not required to have previous healthcare experience prior to medical school, yet during their training they gain the experience needed to become our healthcare professionals.  Similarly, AA’s gain sufficient healthcare experience during their training to be effective and safe anesthesia providers.  AA programs vary from 24-27 months with a minimum of 2,500 clinical hours.

- They can be admitted to AA school with any degree

Most AA students have received a bachelor's degree in a field of science. Some have received a non-science degree. However, all AA students are required to take pre-medical coursework, including the MCAT and/or GRE, just as medical school students are required to do.  Acceptance to AA school is very competitive; in fact it is comparable to medical school. Physicians are also able to receive bachelor’s degrees in non-science fields prior to medical school, yet they are our healthcare professionals.  The AA profession was designed to implement mid-level anesthesia providers into an anesthesia care team (ACT) that could go directly to medical school if necessary.  It is not uncommon for AA's to continue their education and become physicians.

- They are not able to work independently

The AA profession has been around for just over 40 years, whereas the CRNA profession began in the late 19th century.  In over 150 years, with over 35 times as many CRNA's as AA's, nurse anesthetists have been able to lobby for independent practice for quite some time. They can now work independently in 17 states.  Although AA's are as qualified as CRNA's to administer anesthesia, AA's do not seek independence as they believe it is important to work as a team under the supervision of a qualified anesthesiologist who has received a medical degree.  Being able to work independently is proof of successful lobbying, rather than exceptional ability.

-The AA education is inferior to that of Certified Registered Nurse Anesthetists (CRNAs)

The AA curriculum is taught by both practicing AA's as well as anesthesiologists at an accredited medical school and includes both didactic and clinical programs. The curriculum is reviewed by the CAAHEP and must pass stringent requirements.  Program lengths can vary from 24-27 months and include a minimum of 2,500 clinical hours.  Clincial rotations include cardiac, pediatric, obstetrics, regional anesthesia, trauma, etc.

AA’s have proven to be safe and efficient mid-level healthcare providers (you can look at the link below to see a study that proves as much).  Our purpose is not to suggest that CRNA's are not qualified to administer anesthesia.  We know and are friends with many CRNA's and they do a fantastic job.  We are expressing our concern that some people are spreading false perceptions (to our lawmakers) of AA's as being unqualified to administer anesthesia and keeping them out of Utah because of job competition.

http://www.lrc.ky.gov/lrcpubs/RR337.pdf