Gov. Ducey Ignores Nearly Two Thousand Letters from Physicians and the Public Demanding He Protect Patient Safety

Gov. Doug Ducey has ignored more than 1700 letters from the medical community and the public strongly urging he protect Arizona patients by making his decision to “opt-out” of the Centers for Medicare & Medicaid Services’ physician supervision requirement temporary.

This dangerous decision by the governor, which actively dismantles the anesthesia care team model in Arizona by allowing nurse anesthetists to administer anesthesia without physician supervision, is not limited to the state’s response to the COVID-19 pandemic. Only 28% of Arizona voters support the governor’s opt-out of this federal regulation that requires nurse anesthetists to administer anesthesia under the supervision of a physician.

The Arizona Society of Anesthesiologists (AzSA) and the American Society of Anesthesiologists (ASA), in addition to the majority of Arizonans, strongly oppose the governor’s opt-out. A spring 2020 survey of 600 registered voters in Arizona clearly found voters in the state want a physician to supervise nurse anesthetists and handle medical complications in an anesthesia emergency.  

• An overwhelming 80% of Arizona voters want a physician handling medical complications or anesthesia emergencies during surgery.
• When provided with the education and training associated with a physician anesthesiologist and a nurse anesthetist, 74% of voters want to have a physician anesthesiologist administer anesthesia.
• 76% noted that it is extremely or very important that a nurse administering anesthesia or responding to an emergency during surgery work under the supervision of a physician.
• Only 28% support Gov. Ducey’s opt-out decision, which was made without input from the public, medical boards, or the state’s medical community.

Gov. Ducey has refused numerous, separate requests to meet with his physician constituents on this patient safety concern. His office neither consulted the medical community while the decision was being made, nor notified the physician community before the decision was made public.

AzSA and ASA urge Arizonans to call the governor’s office and demand that the opt-out only temporarily suspends physician supervision requirements while the state tackles the COVID-19 pandemic.

Elsewhere in the country, governors have authorized similar changes, but only on a temporary basis until the COVID-19 emergency orders expire.

To protect Arizona patients and to better align with other states and the federal government, Gov. Ducey must clarify that this opt-out is temporary. Otherwise, a permanent change directly opposes what Arizona voters want from their health care system, lowering the standard of care and jeopardizing the lives of Arizonans.

“Physician involvement in surgical anesthesia ensures patients receive safe, high-quality care.  The people of Arizona deserve no less. More importantly, it is what the people of Arizona want for their health care,” said AzSA President William Thompson, M.D.

Physician anesthesiologists have up to 14 years of postgraduate medical education and residency training, which includes 12,000 -16,000 hours of clinical training, nearly seven times more training than nurse anesthetists.

The United States Department of Veterans Affairs’ (VA) Quality Enhancement Research Initiative (QUERI) could not discern “whether more complex surgeries can be safely managed by CRNAs.”

Additionally, there are no cost savings for patients in Arizona to receive anesthesia care solely by a nurse anesthetist. Physician supervision of anesthesia ensures patients receive safe, high-quality care. AzSA and ASA urge the governor not to permanently lower the standard of care in Arizona. It provides no benefit and can mean the difference between life and death.

The survey was conducted by TelOpinion Research. The individuals interviewed were randomly selected from the latest list of registered voters in Arizona and the results represent a cross-section of voters across the state. The margin of error associated with a study of this size is +/-3.9%.