Delegates voice concerns regarding dangers of anesthesia bill which passes through House

CHARLESTON, WV (LOOTPRESS) — The House of Delegates met Wednesday to consider several bills, but it was House Bill 2613 — regarding the administration of anesthetics — that generated the most discourse during the session.

Introduced January 17, 2023, HB2613 would change and adjust §30-7-15 of the West Virginia Code to allow administration of anesthesia by a Certified Nursing Anesthetist (CRNA) in collaboration with a physician, podiatrist, or dentist.

The change would require qualified anesthesiology nurses to practice as a licensed professional nurse and as a licensed advanced practice nurse under the terms of the state article.

In addition, nurses would need to have successfully completed the training program of a Nursing Anesthesiologist School accredited by the Accreditation for Nurse Anesthesiology Training Programs Accreditation and be certified as Certified Nursing Anesthesiologists by the National Board of Certification and Recertification for Nurse Anesthetists.

The primary sponsor of the bill is Amy Summers (R – Taylor, 073), herself a Registered Nurse, who earned a BS in Nursing from West Virginia State University and an MS in Nursing, Leadership and Management from Western Governors University.

Deputy Majority Whip Delegate Adam Vance (R – Wyoming, 035) offered a hypothetical scenario in which a spinal blockage would need treatment during a cesarean section and asked if passage of this bill would allow a nurse to provide such treatment to carry out a situation without the presence of an anesthetist.

Delegate Summers clarified the distinction between a nurse and an anesthetist in terms of what the law allows, but confirmed that an anesthetist would be permitted by this law to provide care in such a situation.

“Not a nurse, no, but a board-certified anesthesiologist with much, much more training — yes — without the presence of the actual anesthetist, that’s right,” Delegate Summers said.

Regarding the bill, Delegate Vance called for a rejection due to the specific level of training required of the anesthesiologist and the potential risk of having a less qualified person intervene in delicate medical situations.

“I urge you to oppose this bill simply because an anesthesiologist is trained to that specific level to be able to provide care. I’m not taking anything away from the nurses, but [an anesthesiologist] has a PhD in the field, and I think he should say so,” said delegate Vance, continuing to share his own experience in high-stakes medical scenarios.

“My wife has had three cesareans and one small slip could have left her paralyzed with spinal blocks or epidurals, so I am calling for this bill to be rejected.”

Delegate Brandon Steele (R – Raleigh, 042) acknowledged his own experience as a patient in considering the bill, claiming that the extensive background of a board-certified anesthetist in the room not only gave him peace of mind, but also enabled his own care providers to understand, to effectively manage unforeseen developments in an unpredictable medical situation.

“This bill is a bit personal to me,” Delegate Steele began. “A few years ago I had to have surgery on both patella tendons at the same time. It was supposed to be a two and a half hour operation and when the surgeon opened up my knees he found the damage was much, much worse than he had originally anticipated. A 2 hour operation turned into a 5 1/2 hour operation and I had an anesthetist with me the whole time. This was during COVID but luckily I was somewhere where an experienced anesthetist was taking care of me. He had to make many changes in the middle of this operation to take me from 2 hours to 5 1/2 hours. This is a delicate science, it is not an exact science. It’s probably one of the more difficult areas for a doctor to do.”

Delegate Steele also raised an example from a local area that became the subject of national news. In this scenario, the improper administration of an anesthetic resulted in unfathomably dire consequences for a loved one in the community.

“There was a preacher in Wyoming County and I knew him by the name of Sherman Sizemore. Years ago he had to undergo heart surgery. He had been a minister for 45 years, preaching in a small church in Herndon, WV. Sherman walked in – he was a great man of God and everyone loved him – he went under the knife for heart surgery, his open heart surgery, which lasted about 3 hours maybe longer.

When treated, he was given the anesthesia that left him unable to move or communicate, but was not given the anesthesia that put him to sleep. So he spent the next few hours watching as he was operated on with his chest fully opened. It drove him crazy. After he was revived, he let her know about it. They checked everything and yes there was a problem and he wasn’t given the anesthetic he should have been put under so to speak. So right there, watching helplessly for hours as he was operated on – it was driving him insane.

This great man of God – for 40 years pastor in the church in Wyoming County, whom everyone loved, who nobody could say anything bad about – committed suicide in his 70’s because he had just gone insane. That’s what we’re talking about here today,” Delegate Steele continued, insisting that West Virginia residents be given that right to choose in relation to their own medical care.

“When I think back to being in that hospital bed during COVID, I couldn’t let any family in. I was there alone; I was in the hospital for weeks; I was in a wheelchair for months; I lay helpless. If I had come for this operation and there had been a nurse there to do it, not a doctor – what would have happened if I had asked, ‘No, I want a doctor?’ Would that have been honored? “No, we don’t have to. The nurse is fine.’

I didn’t have my family there to stand up for me. I didn’t have anyone. No one was allowed to be there, I was there alone. I think of people who may not be as vocal as I am or unable to raise an objection as well as I can that your vote today is for their ability to raise that objection. So many people come into the hospital that they are unable to object and today we’re being asked to do it for him. I’m asking you tonight, for people like me, give them that voice back. Just looking at the public opinion about it and what we have, I just think it’s a bit too dangerous and I can’t support it.”

Spokesman Pro Tempore Paul Espinosa (R – Jefferson, 098) acknowledged that while most patients would prefer access to the highest level of care possible, that access is not necessarily available within the state due to the shortage of active medical professionals throughout western Virginia.

“I think most of us would probably like to have an anesthesiologist on hand if warranted. But it doesn’t look like that’s really the reality in West Virginia,” Delegate Espinosa said, asking for more information about these resources.

“13 hospitals in our state do not have an anesthesiologist,” said the deputy spokesman delegate Matthew Rohrbach (R – Cabell, 026,) points to a general lack of resources at this state level, which regularly results in an anesthetist’s expertise being lost regardless.

“I honestly suspect most of them are places that an anesthetist probably can’t go to and are financially viable. Well that’s the reality of where we live folks. Some of us do not represent counties. A lot of people sitting here are preparing to vote on this. So the reality is that 13 hospitals in this state that do surgeries don’t have anesthesia by an anesthesiologist and I think it’s unlikely that that’s going to change anything. So what we’re really doing is codifying what we’ve already been doing for the last three years by order of the executive branch.”

Delegate Joe Ellington (R – Mercer, 038), himself a practicing physician with a PhD from Duke University, brought an insider’s perspective to the idea presented in the bill and discussed the long-term implications of its possible implementation.

Specifically, Delegate Ellington acknowledged that the number of anesthesiologists across the state of West Virginia – which is generally already too small to provide adequate care in many regions – would continue to decline as certification is no longer required to do so function of the position. In addition, it was pointed out that the passage of the bill could exacerbate the already tight supply situation in rural areas where medical facilities are difficult to staff.

“My concern is that all these hospitals are starting to say, ‘We’re not going to have an anesthesiologist to cover this, we’re monitoring it.’ The only place you’re going to have in the next 10 years is probably the teaching and college centers in the state, and it’s difficult to recruit people to come back here,” Ellington said. “You’re going to see that expanding and that’s my prediction for that and I just want you to take that into account.”

It is noteworthy that while Delegate Ellington did not discuss what his vote on the bill would be and made it clear that he was not trying to influence the decision of other delegates in any way, he himself would ultimately vote against HB 2613.

Addressing her fellow delegates at the end of the debate on the bill, delegate Summers stated:

“I’ll just say one thing, in my 37 years of experience as a nurse I could tell you all sorts of stories to support any position I want to support. But that is not what this bill is about. This bill is all about bringing our laws in line with what CNAs are trained to do. All I ask is that we urge the Greens to align their scope with our laws.”

House Bill 2613 was finally sent to the Senate after passing the House by 77 votes in favor and 21 against, and 2 voting delegates were presumed absent.

Additional LOOTPRESS coverage of the ongoing WV Legislative sessions can be found here here.