HonorHealth has been at the forefront of quality patient care. The system’s rigorous credentialling process seeks to provide the utmost protection for our patient community. As part of that protection, the HonorHealth bylaws have sought to provide validation as to the qualifications of practitioners working within the HonorHealth system. Credentialing has always been performed based upon knowledge, training and experience of the practitioner, not based upon political expediency or financial considerations. For example, HonorHealth has recently been a leader during the COVID pandemic crisis holding steadfast to the guidelines for vaccines and testing, and has continued to protect and advocate for safe reproductive healthcare in our community. 

Some hospital systems seek to maximize profits as their primary objective, much like healthcare insurance companies. In seeking to maximize profits, hospital systems often cave to forceful pressure and even fraudulent misrepresentation by nurses with PhDs as medical doctors, or in this case, CRNAs as medical doctors -with out medical school, residency, board certification and medical licensure. Everyone loses in the long run as this is a time tested battle that has been studied extensively. Complications, poor outcomes and lost lives of loved ones can severely damage a hospital’s reputation. 

Anesthesiologists are physicians who have more than twice the education and 10-12 x the clinical training hours than CRNAs. CRNAs are not trained to practice medicine or provide anesthesia care without physician direction. Anesthesiology is the practice of medicine, not nursing. The importance of physician involvement during anesthesia care was reiterated in a 2018 World Health Organization-World Federation of Societies of Anaesthesiologists (WHO- WFSA) article stating anesthesia is complex and hazardous and its administration “requires a high level of expertise in medical diagnosis, pharmacology, physiology, and anatomy...and views anesthesiology as a medical practice.” Death rates are 2.5/1000 higher with CRNAs within 30 days of admission and failure to rescue death rates are higher by 6.9/1000 with a complication with unsupervised CRNAs. The most recent study in JAMA 7-2022 looked at a data set consisting of 866,453 operations, in which 1,960 anesthesiologists provided care in 23 different hospitals with different CRNA staffing ratios and as the physician anesthesiologist involvement decreased, the 30 day morbidity and mortality increases by 14%. 

Our patient population is living longer, presenting with more significant comorbidities, and undergoing more invasive and complex procedures. CRNAs lack education and experience to provide care for complex, pediatric, cardiac, obstetric, pain management and non-operating room procedures. You don’t know what you don’t know. “Without physician involvement in care, many medical problems might be misdiagnosed or just plain missed and the non -physician may very well be totally unaware of anything “wrong” occurring at all! This is a risk in every specialty, but particularly problematic in areas of practice that may present the need for rapid and decisive application of medical knowledge. Procedural areas that are less time- urgent, such as most of primary care settings can certainly safely use physician extenders with less frequent and direct oversight. But, there are few practices, even in primary care that would not harm patients in greater numbers with no physician involvement.“ Dr Barry Glazer ASA Past President Indianapolis, IN. 

When complications occur, an anesthesiologist’s education and training can mean the difference between life and death which is why an ASA survey found 9 of 10 surgeons prefer a physician anesthesia provider for their patients as opposed to a nurse. 

We request that our bylaws pertaining to the practice of CRNAs continue to require medical direction by a board certified anesthesiologist at all HonorHealth facilities. We remain committed to fully supporting the HonorHealth bylaws as we seek to maintain the quality of care provided at HonorHealth (regardless of Arizona law) to protect patients from fraud, misinformation, misrepresentation, and patient harm.