A panel of state legislators is wading into a battle between doctors and a group of registered nurses. The Iowa Board of Medicine is proposing that only doctors provide certain pain management treatment for patients.
Today, certified registered nurse anesthetists — C.R.N.A.’s — are providing chronic pain care in 91 of Iowa’s 117 hospitals. But Board of Medicine legal affairs director Kent Nebel says chronic pain care is a rapidly growing field that requires new scrutiny.
"There are far more complex, I would say, dangerous procedures performed now than there were 20 years ago," he says. "…It’s not clear whether the C.R.N.A.’s and other health care providers that are involved in this care, whether that education is keeping up with the technology and the complexity and the danger of the procedures that are being performed." Dr. Richard Rosenquist, director of the "Center for Pain Medicine" at the University of Iowa Medical School, supports the change, too.
"So if you think about who’s going to be performing these procedures, if I sit down with you and say, ‘By the way one the potential risks of this procedure is a stroke, a spinal cord injury, or death,’ you’d like to have somebody who’s really well trained in doing those procedures."
But Jim Carney, a lobbyist for the Iowa Association of Nurse Anesthetists, says if only doctors are allowed to administer certain chronic pain treatments, rural Iowans will suffer because fewer doctors are available in rural areas and it’s certified registered nurse anesthetists who provide the care for chronic pain.
"No matter what the Medical Society says, they are the backbone of anesthesia care in this state," Carney says. Carney questions the rational for the change. "It is an unreasonable, capricious action by the board without any empirical data (or) studies of any kind to support it," Carney says. "There isn’t anything on a quantitative, scientific basis that shows the services performed by C.R.N.A.’s are not safe and efficacious."
Members of the Legislature’s Administrative Rules Review Committee say they share Carney’s concerns and they’ve asked the Iowa Board of Medicine to submit more documents before implementing any policy change.