April 2025 | Michael Fechter
Laura Molina, president of the Florida Association of Nurse Anesthetists, does most of her work out of state. She takes short-term contracts in states where she can sedate patients without a physician’s supervision.
Her organization has tried for years to get the Florida Legislature to grant similar autonomy to Certified Registered Nurse Anesthetists (CRNAs) like her. Anesthesiologists are among the specialties facing a shortage in the state, and Molina argues the autonomous practice could fill in some of the staffing gaps so procedures aren’t delayed.
“When, for example, a community hospital or rural hospital loses anesthesia, that means moms can no longer go there for epidurals and C-sections, and they might have to go multiple counties (away) to get those services,” she says. “It means that if your child needs their appendix out in the middle of the night, you might have to go multiple counties (away), or they might have to be medevacked elsewhere.”
States require varying degrees of CRNA supervision, with four requiring none.
That freedom carries risks, says Florida Society of Anesthesiologists President Asha Padmanabhan, pointing to a case last year in Modesto, Calif., in which the state issued an “immediate jeopardy” order on a hospital for allowing CRNAs to practice unsupervised. The hospital also had complaints involving anesthesia errors.
Anesthesiologists have significantly more training and education, she notes, making them better qualified to “act in the moment.” CRNA autonomy does not reduce costs or expand access to care, she says.
The proposed law doesn’t mandate that hospitals and surgery centers allow nurse anesthetists to work autonomously, Molina stresses. It gives them the option to set their own standards.
And the U.S. military grants CRNAs the power to act independently, something Molina says helped save her husband Camilo when he lost a leg to a land mine in Afghanistan. He endured a series of surgeries in a two-year recovery, and today is “a very independent cross-fit coach.” “And I know that without their care and the full team’s care, he wouldn’t have survived,” she says. “So he’s a big part of why this really matters to me because access to care really does affect your quality of life.”
State Rep. Mike Giallombardo (R-Cape Coral) sponsored an autonomy bill for the third straight time this session. He doesn’t expect it to get far, describing the resistance as “a turf battle” by anesthesiologists.
Given that, Padmanabhan says, more gains could be made if the CRNAs and anesthesiologists joined forces on other issues. “I mean, reimbursements are terrible, we’ve all seen that. Insurance companies are cutting way down. We’ve seen that. We could be together fighting those things instead of this annual battle of breaking the team model.”