New Jersey anesthesiologists win scope-of-practice battle

Physicians must supervise anesthesia during office-based surgeries in New Jersey.

By Myrle Croasdale — Posted Jan. 17, 2005

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The Superior Court of New Jersey Appellate Division recently upheld tighter office anesthesia regulations for the supervision of nurse anesthetists set by the New Jersey State Board of Medical Examiners.

The New Jersey Assn. of Nurse Anesthetists sued to have the rules overturned, and the group is now asking the Supreme Court of New Jersey to hear the case. The court is expected to decide in the first half of the year whether it will do so. Meanwhile, the regulation, which had been suspended pending the appellate court's ruling, will go into effect Feb. 1.

Ervin Moss, MD, executive medical director for the New Jersey State Society of Anesthesiologists, said the court's decision would make the state one of the safest for in-office surgeries. "New Jersey is the first in the United States to established standards for offices that are the same as the standards for ambulatory care centers and hospitals," he said.

Ray Cantor, director of governmental affairs for the Medical Society of New Jersey, said the regulation requires two physicians to be on hand, the one performing the surgery and the other either administering the anesthesia or supervising the nurse anesthetist.

"This is one of those scope-of-practice victories that are rare to achieve, and it's very good for patient safety," he said. "That's the bottom line."

Cantor said the law applies only to offices with a single surgical suite, since those with two or more are regulated by the state's department of health. Until now, single surgical suites were not regulated at all, he said.

The regulations require that either an anesthesiologist or a physician with anesthesia privileges supervise certified registered nurse anesthetists during office surgeries. In addition, the supervising physician may not be the one performing the procedure.

Under the regulation, physicians who do not have hospital privileges for anesthesia can apply to the board of medical examiners for alternative privileging.

In addition, every three years, physicians must complete a specific number of continuing medical education hours in anesthesia to maintain their privileges. The amount of CME required varies depending on the type of anesthesia being administered.

"We haven't heard any outcry from our physicians," Cantor said. Instead, almost a thousand physicians applied for alternative privileging to meet the requirements after the regulation was first adopted in 1998. Now that the court has ruled, Cantor expects more to apply.

Nurses protest

Mitch Tobin, director of state government affairs for the American Assn. of Nurse Anesthetists, said there's no evidence patient safety is jeopardized when CRNAs handle anesthesia during office surgeries. He said the rule would put many of the state's 400 nurse anesthetists out of a job.

"The practical effect is that in many instances, the only physician who would qualify to supervise is an anesthesiologist, and that essentially disenfranchises nurse anesthetists from working in office surgery in New Jersey," he said. "The New Jersey office rules are definitely the most restrictive in the country."

Key to the court's decision was its determination that administering anesthesia was the practice of medicine and that regulating this practice was within the authority of the board of medical examiners.

The New Jersey State Society of Anesthesiologists, the Medical Society of New Jersey and the American Society of Anesthesiologists filed amicus briefs in support of the medical examiners, Dr. Moss said.

Physician supervision of nurse anesthetists has been an issue in many states in recent years, particularly rural ones. Twelve states now permit CRNAs to work in hospitals without physician supervision when caring for Medicare patients.

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