In Reply: In response to Dr
Owens, we want to reiterate that our data collection included not only
NPC organizations but also the Health Policy Tracking Service at the
National Conference of State Legislatures and the Internet Web sites of
individual states. From these sources we concluded that CRNAs have the
authority to practice independent of physician supervision in 18
states. However, Owens cites the technical report prepared by Squires,
Sanders, and Dempsey, LLP, for the American Society of
Anesthesiologists as showing that only New Hampshire allows CRNAs to be
independent of physician involvement. While New Hampshire is alone in
not placing some oversight limitation on CRNAs, the limitations imposed
in 17 other states do not preclude CRNAs from practicing independently.
Some of these limitations constrain their practices to specific
guidelines and privileges; some mandate that CRNAs maintain
collaborative and collegial relationships with a physician, dentist, or
podiatrist; and some mandate that a physician be the director of the
hospital anesthesia service. None of these stipulations creates the
requirement for physician supervision of CRNAs. Moreover, even among
the states that have such a requirement, the supervising physician is
often the operating surgeon, dentist, or podiatrist rather than an
anesthesiologist.