EDMOND — A bill that will dramatically decrease rural Oklahomans’ access to quality health care is moving forward in the state Legislature. Senate Bill 1133, by Rep. John Trebilcock, R-Broken Arrow, and Sen. Clark Jolley, R-Edmond, would remove certified registered nurse anesthetists’ ability to help Oklahomans manage chronic pain, something these graduate degree-trained providers have been doing for decades.
The state’s 500-plus nurse anesthetists are as well-trained in pain management as general-practice physicians and are equally able to offer Oklahomans with arthritis and debilitating injury a measure of relief. Yet any physician, regardless of training, will be able to provide pain management, while nurse anesthetists will not.
If SB 1133 passes, Oklahoma will become the first state to prohibit nurse anesthetists from practicing chronic pain management.
The bill’s supporters have yet to make a public-health case for its passage. Complaints against nurse anesthetists for providing pain management are nonexistent, and even rural doctors acknowledge that they often would be unable to offer pain management without nurse anesthetists.
Many of the state’s counties have no anesthesiologist. Nurse anesthetists practice in every one of the state’s 77 counties. Forty-one counties have nurse anesthetists only. Seventeen have nurse anesthetists and anesthesiologists. Overall, nurse anesthetists perform roughly 70 percent of anesthesia in the state. In rural areas it’s more like 85 percent.
If SB 1133 becomes law, Oklahomans with debilitating pain will have to drive hundreds of miles in some cases to reach the state’s population centers for treatment. For someone who can barely walk, this is quite a hardship. After receiving referrals, these Oklahomans will have to build relationships with new health care providers.
Contrary to some of the misinformation surrounding the bill, nurse anesthetists do not solicit patients. Every patient who receives their services has received a physician’s referral. Proper oversight is already there: If doctors didn’t trust the services nurse anesthetists provide, they wouldn’t refer patients to them.
The bill’s supporters claim that the law is needed to prevent the unauthorized practice of medicine, but the unauthorized practice of medicine already is prohibited by law. An attorney general opinion in 2008 rightly found that pain management is not considered the unauthorized practice of medicine. SB 1133 is an attempt to get around that opinion.
The state Board of Nursing has no complaints against nurse anesthetists for practicing pain management. If they aren’t providing sub-standard health care, it’s clear that this bill is little more than a money grab in the growing field of pain management. The ultimate cost will be to Oklahomans: Nurse anesthetists are able to provide care for far cheaper than physicians and are able to offer it closer to where patients live. Driving to Tulsa and Oklahoma City isn’t an option for someone with chronic pain, yet that is what many will face should SB 1133 pass.
The nurses are paid at 80 percent of the Medicare rate, while anesthesiologists are paid at 120 percent. Because many pain-management cases involve work-related injuries and are paid by Medicaid, the state will bear the increased cost at a time when it can ill-afford to do so.
It’s easy, yet misleading, to dismiss SB 1133 as one of the many scope-of-practice issues that appear in the Legislature. Oklahoma’s nurse anesthetists aren’t asking for an expansion of their responsibilities as has been the case with other health care providers in the past. Nurse anesthetists simply seek to provide the care they are trained and qualified to provide and have been providing for decades to the public’s benefit.
Oklahoma legislators, especially those who represent rural areas, should do the right thing and preserve their constituents’ access to quality pain management.
DON MORDECAI is president of the Oklahoma Association of Nurse Anesthetists and VICTOR LONG is past president, government relations chairman of the Oklahoma Association of Nurse Anesthetists.
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