2023 Legislative Update
AzSA President’s Message to every Arizona Anesthesiologist
AzSA Leadship has been working diligently on behalf of every Arizona Anesthesiologist and, equally as important, safe patient care. We have created this document summarizing AzSA’s work during the 2023 legislative year.
CRNA Independent practice – Defeated
Senator Janae Shamp introduced SB1259 (nurse anesthetists; clinical rotations; appropriations), a bill that was supported by the CRNA Association. This bill attempted to eliminate a long established and well tested model for physician involvement in anesthesia care provided by nurse anesthetists. There is no clinical benefit to reducing standards, and it would not address access to care issues in rural and underserved communities. Instead, allowing independent practice for CRNAs would lead to a proliferation of clinics and med spas performing complex pain procedures and sedation without any physician present. After months of lobbying, the problematic provision of the bill was stripped and only the workforce funding was allowed. We are confident the legislation will be back in future years, which has underscored the importance of educating lawmakers and the public about the serious consequences of this concept.
AAs – Did Not Pass
With the strong support of the ASA and ArMA, Representative Beverly Pingerelli introduced HB2457 (anesthesiology assistants; licensure). This bill which would have created licensure for Anesthesiology Assistants (AAs) and allowed them to practice in Arizona. AAs are highly trained advanced practice providers who work successfully under physician anesthesiologist supervision in 19 other states. Arizona’s healthcare workforce shortage means long hours for clinicians and terrible delays for patients, leaving health systems with no choice but to hire expensive traveling practitioners to address the dire needs. The only opposition to the legislation came from the CRNA Association, who feared the competition another provider would bring. After months of intense lobbying, the bill unfortunately did not pass the Senate. We remain committed to bringing AAs to Arizona and will continue to support the concept in future legislative sessions.
APRN Compact – Amended and Passed
Senator Shamp also introduced SB1334 (advanced practice nurses; compact), which establishes a compact for advance practice registered. While compacts are generally good policy, it initially included language that overrode state laws regarding supervision for APRNs. The AzSA and ArMA successfully amended the legislation to state that the APRN Compact does not supersede state law related to the applicable APRN-prescribed scope of practice.
Sunrise Process Elimination – Defeated with Governor Veto
A coalition of mid-level providers led by the Arizona CRNA Association teamed up to repeal the remaining provisions of Arizona’s Sunrise Review Process with HB2529/SB1248 (scope of practice; sunrise; repeal), introduced by Representative Steve Montenegro and Senator TJ Shope, respectively. The Sunrise Review Process is designed to deliver to the legislature and the public a data-informed analysis of a proposed scope of practice expansion. While it was significantly scaled back in 2018, it remains an essential tool for lawmakers to make educated, careful decisions. The physician community was united in the belief that there is a direct correlation between public health and safety and ensuring that medical professionals have the necessary education and clinical experience to practice safely in Arizona. Although the bill did pass out of the legislature, largely along partisan lines, we were able to secure a veto by Governor Hobbs. We remain firmly committed to protecting patient safety but will work within the healthcare community to explore thoughtful reforms to the Sunrise Process that respect this goal.
Dental Anesthesia Bill – Amended and Passed
This new law pertains to dental anesthesia requirements in the State of Arizona. SB1602 was introduced by Senator Shamp and originally contained language that would have allowed the Nursing Board to
unilaterally issue CRNAs permits to provide anesthesia in dental offices without Dental Board oversight. A multispecialty group of stakeholders convened a workgroup on this bill and were ultimately successful in removing the Nursing Board language. The new law adds a definition of “qualified anesthesia provider” to include a dentist with a permit, a physician with anesthesiology residency training, or a nurse anesthetist. This law refers only to anesthesia given in dental clinics or offices. The law also requires that a dental office or clinic where anesthesia is administered must contain equipment, supplies, and protocols (including advanced cardiac life support and airway management) for emergency response and requires that the dentist and the anesthesia provider (physician or nurse anesthetist) submit a report to the State Board of Dental Examiners within 7 business days of any death or incident requiring emergency medical response occurring during or after the administration of anesthesia. The law also makes it the responsibility of the Board of Dental Examiners to issue registration to administer general anesthesia and sedation in dental offices to dentists, physician anesthesiologists, and nurse anesthetists.
On behalf of AzSA, thank you for your membership and committment.