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Pennsylvania Act 60
Pennsylvania Act 60 of 2021 Solidifies the Anesthesia Care Team into Law
By JOSEPH F. ANSWINE, MD, FASA
Act 60 was signed into law by Governor Wolf on June 30, 2021. It provides statutory recognition of nurse anesthetists in Pennsylvania.
Prior to Act 60, Pennsylvania was one of only two states (the other being New York) that did not recognize certified registered nurse anesthetists (CRNAs) in statute.
Interestingly, it does not give them the designation of “advanced practice nurse” because that designation does not exist in current law in our state.
It also strengthens the anesthesia care team consisting of a physician and CRNA. As stated in the law: A certified registered nurse anesthetist shall have the authority to perform anesthesia services in cooperation with a physician, podiatrist or dentist involved in a procedure for which anesthesia care is being provided if the anesthesia services are performed under the OVERALL
DIRECTION of any of the following:
A physician licensed by the State Board of
Medicine or the State Board of Osteopathic
Medicine who has completed an accredited residency training program in anesthesiology.
A physician licensed by the State Board of
Medicine or the State Board of Osteopathic
Medicine who is performing the procedure for which the certified registered nurse anesthetist is performing anesthesia services.
A podiatrist licensed by the State Board of
Podiatry who is performing the procedure for which the certified registered nurse anesthetist is performing anesthesia services.
Overall direction is defined in the law as “oversight of anesthesia services and medical management of patient care by a qualified individual who is present and available onsite, but not necessarily present in the same procedure room as a certified registered nurse anesthetist performing anesthesia services for the duration of the services provided.”
For decades, anesthesiologists and nurse anesthetists in Pennsylvania have attempted to convince legislators to pass legislation into law to provide statutory recognition of nurse anesthetists, and to place oversight of anesthesia care by a physician from Department of Health regulation into law. Until now, nurse anesthetists have not been recognized for their excellent abilities as anesthesia providers in statute in Pennsylvania. Furthermore, no law stated that a patient receiving anesthesia must be under the direction of a physician, dentist, or podiatrist whether in a hospital, surgical center, or office. Both have been made into bills (dozens of them) only to be defeated at some point in the process over decades of legislative sessions in Pennsylvania. They were defeated because the anesthesiologists and nurse anesthetists have not agreed on these issues and have been able to convince members of the legislature to defeat the bills. Anesthesiologists were concerned that giving the nurse anesthetists titling in law would open the door for independent practice, and the nurse anesthetists were concerned that putting physician oversight into law would restrict their ability to practice in the state.
However, the current leadership of the Pennsylvania Society of Anesthesiologists (PSA) and Pennsylvania Association of Nurse Anesthetists (PANA) put differences aside to agree to support legislation that provides statutory recognition of the great skills of the nurse anesthetists and to place the overall direction of the anesthesia care by a physician, dentist, or podiatrist from regulation into law.
Senate bill 416, now act 60 of 2021, accomplishes both.
This was not an easy process, and it took a lot of man-hours debating the points and getting approval from each society’s membership. But, in the end, years of struggle between the groups finally has come to an end and patients undergoing the risky process of anesthesia in Pennsylvania are the beneficiaries.
The efforts to pass such legislation is by no means a small feat, but rather a long steady diligent course taken up by physicians, nurses, legislators and ultimately the Governor. To put this into perspective, the Pennsylvania Medical Society and all its resources continue to struggle to maintain physician oversight of the care of nurse practitioners and physician assistants. But direct physician involvement of anesthesia care is now a statutory requirement.
For over 27 years, I have participated in what seemed to be endless attempts to solidify this accomplishment. I commend the current leadership and members of the PSA, PANA, legislators, and the governor in our state for setting differences aside and putting patients first.
