I am writing to urge you to vote yes on SB882 to approve licensure for CAAs in Virginia. CAAs are an integral part of the anesthesia care team and are highly educated with great patient outcomes. Licensing CAAs in Virginia would expand access to anesthesia services within the state and help your constituents. Thank you.

I’m a CAA and I strongly urge you to support this bill for licensure of CAAs in Virginia!

I urge you to support the bill allowing for licensure of anesthesiologist assistants (CAAs) in the state of Virginia. Now more than ever, we have to stand united. CAAs can practice in any state via the VA network, and this has helped to alleviate the shortage of anesthesia providers in all states. However, with the new restrictions on federal employment opportunities, patients will go back to suffering from the reality of the anesthesiologist shortage. Allowing CAAs to practice throughout the state will be in the best interest of all constituents.

Good Morning, Madame Chair and members of the subcommittee. My name is Alan Alvarado, and I am a student anesthesiologist assistant finishing my studies at Case Western Reserve University’s Washington, D.C. campus. I am testifying today in strong support of SB 882. I have been a proud Virginia resident for over three years. Before pursuing this career, I served as a statistician for the Centers for Medicare and Medicaid Services and worked as an epidemiologist in state of Maryland. Virginia has become my home—I was recently married here, and my husband and I hope to grow our family in the years ahead. As a native Spanish speaker from Panama, I am passionate about providing high-quality, accessible anesthesia care, particularly in obstetric settings. Passing SB 882 would allow me to serve the patients of this state—the place where I have built my life—rather than being forced to relocate elsewhere. I am writing to you today from Children’s National, as I prepare for a pediatric case, because I believe in the importance of this legislation. I respectfully urge you to support SB 882 so that I, and others like me, can continue to serve the people of Virginia. Thank you.

My name is Arafat and I was raised in Fairfax county for over 20 years! I’m also a graduate of VCU (2012), GO RAMS! I’ve been working in Austin, Texas now and have been practicing for almost 8 years as C-AA. I am looking forward to return to the great state of Virginia if this bill passes! I still have my home in Herndon, Virginia and all the community members I grew up with are still in the area. Thank you all for supporting this bill and hoping to hear good news!

My name is Kevin Sistani, I am a practicing CAA from the DMV who trained in Washington, D.C. After 5 years of working in Missouri and Michigan, I have moved back home but currently commute into DC to work. Prior to my anesthesia training, I was fortunate enough to have worked in Vienna, and with immediate family members living and working all over Virginia, I truly can attest to the benefits that they have come to find in their own careers. My father recently retired, working for Fairfax County government for over 25 years and to this day maintains his pride and describes how fortunate he was to have served the commonwealth and the great citizens of Virginia. I am aware of the continuing need for skilled anesthesia providers in the state of Virginia, and with a favorable outcome I am anticipating practicing in Virginia and doing my best to provide for the citizens of the state which has already done so much for the community at large in our area. Washington, DC, North Carolina and 20 other states already license CAAs and as a profession we are recognized by Medicare, Tricare, and all commercial insurance payers as well as able to practice in any Veteran’s Affairs Hospital. The Virginia Joint Commission on Health Care unanimously recommended licensure of CAAs, as they recognize it will expand access to health care and bring more health providers to Virginia, which is currently experiencing a serious healthcare workforce shortage. CAAs are highly trained and educated advanced practice providers who works within the anesthesia care team to deliver safe and quality anesthesia care to patients. CAAs will not replace CRNAs or anesthesiologists, but will add another provider to the team and allow for more patients to access anesthesia care. As we look toward improving patient safety for all Virginians, I want to express my support for this bill. I have worked in various parts of the country and want to confirm that our training provides us with the tools to confidently care for patients and work within the Anesthesia Care Team model. I was fortunate enough to have been trained by some of the best and brightest anesthesia providers in the field by training in DC and was able to enhance my anesthesia skills in different settings and acuity levels since my graduation. The goal is to provide expanded and safe care throughout the country, and I am confident that with the passing of this bill I will be able to take my experience and provide for the Virginians who deserve safe and effective anesthetics.

Dear members of the Health and Human Services Health Professions Subcommittee: My name is Amanda, and I am a Nurse Anesthesia student here in Virginia. I was raised just outside of Franklin, VA, near a little town called Sedley, and I have seen firsthand the challenges of accessing quality healthcare in rural areas. I am writing to express that I strongly oppose SB882, which seeks to license Certified Anesthesiologist Assistants (CAAs) in Virginia. Many rural hospitals across Virginia rely on CRNA-only anesthesia models because CRNAs are trained to practice independently. CAAs, however, require direct supervision from an anesthesiologist, meaning they cannot provide anesthesia services unless an anesthesiologist is physically present in the facility. This is similar to how a surgical assistant can not perform surgery without a surgeon present. However, would we train more surgical assistants to address a shortage of surgeons? No—we would invest in training more surgeons. Likewise, Virginia should focus on expanding the CRNA workforce rather than introducing CAAs, who would be unable to practice in many rural settings due to their supervision requirement. Additionally, licensing CAAs will negatively impact Virginia's Nurse Anesthesia training programs. CAA students would compete for already limited clinical training sites, reducing opportunities for CRNA students. Many CRNA students, including those with families, already struggle to find in-state training sites, often having to travel out of state for months at a time. This bill would only worsen that problem. Furthermore, in 2017, the Virginia Board of Health Professions unanimously concluded that CAAs do not qualify for licensure in the state, setting specific criteria that have yet to be met. Additionally, a 2024 Joint Commission on Health Care report recommended further study before considering licensing CAAs in Virginia. Moving forward with SB882 disregards these expert recommendations. Before supporting SB882, ask yourself: Will licensing CAAs actually improve anesthesia access in rural areas, or will it divert resources away from providers who can already meet these needs? Should we invest in a workforce that requires constant supervision, or should we prioritize training independent providers who can serve all Virginians, regardless of location? For these reasons, I urge you to oppose SB882. Instead, Virginia should focus on strengthening its existing CRNA workforce to ensure safe, effective, and accessible anesthesia care for all patients, especially in rural communities like mine. Thank you for your time and consideration of my comments.

My name is Nick Bontempo and I have been a practicing CAA since 2019. I am writing in support of SB882. Having trained in Washington, DC and lived in Alexandria, VA, I am aware of the continuing need for skilled anesthesia providers in the state of Virginia. CAA’s are highly trained advanced practice anesthesia providers who complete both a rigorous science based undergraduate degree followed by a masters program specifically trained in anesthesia practice. Working within the ACT model of anesthesia with the supervision and collaboration of physician anesthesiologists, we provide anesthesia care in a number of settings. Our goal is to provide expanded and safe care throughout the country.

Certified Anesthesiologist Assistants (CAA) provide safe, efficient, cost effective anesthesia care. Licensure of an additional anesthesia provider would decrease surgical wait times, increase access to care, and decrease the anesthesia shortage seen in Virginia. Admission to a graduate level AA program is highly competitive and requires the course work necessary for consideration to physician assistant programs and medical schools. AA students undergo graduate level training encompassing the physiology, pathophysiology, pharmacology, and airway management necessary to become safe anesthesia providers. Training involves comprehensive study in general and regional anesthesia through didactic courses, high fidelity simulation, and hands-on clinical experiences. AA programs are rigorously accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), ensuring a standardized and high-quality education for CAAs. The Standards and Guidelines for Anesthesiologist Assistant programs detail the profession's scope and the depth of training required. Similar to other anesthesia training programs, CAAs are required to complete a requisite number of supervised clinical experiences and more than 2000 anesthesia specific clinical hours. These clinical experiences encompass a broad range of procedures, including but not limited to the placement of arterial and central venous lines, spinal and epidural blocks, and peripheral nerve blocks. CAAs, alongside CRNAs and Physician Anesthesiologists, are trained in Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS), which are the national standards for emergency care. This training ensures that all anesthetic plans involve highly trained providers capable of effectively responding to and managing acute emergency situations in a coordinated team environment. As noted in the educational standards, CAAs are equipped to evaluate and treat life-threatening situations based on established protocols. I encourage you to support SB 882 to license certified anesthesiologist assistants in Virginia

As a lifelong resident of Virginia, a graduate of the University of Virginia, and a holder of a Master of Science in Anesthesia from Case Western Reserve University School of Medicine, I strongly support the licensure of Certified Anesthesiologist Assistants (CAAs) in our state. Virginia is facing increasing demands on its healthcare workforce, and the addition of CAAs will strengthen anesthesia care teams, ensuring safe and efficient delivery of anesthesia services. CAAs are highly trained, master’s-level anesthesia providers who work exclusively within the Anesthesia Care Team (ACT) model, a framework endorsed by The Joint Commission for its proven safety and effectiveness. Our specialized education equips us with the skills necessary to provide high-quality anesthesia care under the direction of physician anesthesiologists, enhancing patient outcomes and optimizing surgical efficiency. Granting licensure to CAAs in Virginia will not only expand our anesthesia workforce but also retain highly educated professionals like myself who have a strong commitment to serving this state. By allowing CAAs to practice, Virginia can attract great anesthesia providers while ensuring patient safety remains a top priority. I urge policymakers to support CAA licensure and recognize the essential role these skilled professionals play in strengthening our healthcare system. Sincerely, Timothy Olukanni

I am asking you to SUPPORT this bill and allow expansion of anesthesia care in your state. CAAs are highly skilled, rigorously trained advanced practice providers who provide excellent care throughout the anesthesia care team (ACT) model. The ACT, led by a physician anesthesiologist, is the safest method to provide anesthetic care to patients of all ages and sizes. They are recognized by the American Society of Anesthesiologist as a safe and effective member of the ACT. By passing this bill, you will expand the care of patients in your state as well as welcoming VA natives back into the state as licensed CAAs.

Please support the licensure efforts for Certified Anesthesiologist Assistants!

I am Dr. Emil Kurian. As an anesthesiology resident finishing residency at John’s Hopkins in Maryland, I have seen firsthand the benefits of the ACT model. The field of anesthesiology has a large demand for qualified, experienced anesthetists who are able to care for patients under the care of physician anesthesiologists. As an anesthesiologist I would be happy to supervise with CAAs. I believe the state of Virginia would benefit from the introduction of CAAs. Together CAAs and anesthesiologists can provide safe care for patients.

CAAs have been shown to be a safe and effective anesthesia provider in the Anesthesia Care Team Model. This model is the gold standard for providing the best possible outcomes and highest level of anesthesia care for patients across the country. They are an equal provider to CRNAs and are used interchangeably in facilities where both providers practice. (See attached anesthesia safety study by Stanford) CAAs already serve citizens of Virginia who travel to Washington DC for medical care. There is no reason CAAs shouldn’t be able to provide that same care within the borders of Virginia, especially with so many of those providers living and paying taxes in Virginia. The entire nation is experiencing a critical anesthesia staffing shortage. CAAs can help alleviate some of this and provide the highest level of care to patients in need.

I have worked with many AAs in Washington DC and they have been excellent part of an anesthesia care team. They provide excellent care for patients, and contribute to patient well being. It would be a benefit to both patients and physicians in the commonwealth if they are allowed to practice.

I fully support SB882 regarding the licensure of Anesthesiologist Assistants in the state of Virginia. This bill, if passed, will help meet nationwide anesthesia provider shortages by providing safe, cost effective, and top-quality anesthesia providers to Virginia.

I am Dr. Christopher Kurian. As an Anesthesiologist who completed residency at Harvard, I have seen patients with complex medical history. The Anesthesia Care Team (ACT) model has been proven to be a safe & efficient want to deliver anesthesia. I believe anesthesiologist & CAAs can work together to provide excellent care to Virginians. I am in support of bringing CAAs to Virginia.

My name is Ashley Mathew, I am CAA practicing at GW University Hospital. As an anesthetist for the last 2.5 years I have a big believer in the ACT model. Physician anesthesiologist and CAAs working together safe and efficient care for patients. In addition, I think make CAAs would be open to moving to the beautiful Virginia if they were able to practice there.

Please consider passing this legislation to allow the practice of certified anesthesiologist assistants in Virginia. CAAs are excellent support for hospital systems and undergo rigorous training to make them competent providers of anesthesia. Allowing CAAs to practice brings jobs to Virginia, will help alleviate staffing issues in hospitals, and will improve patient outcomes in hospitals.

Hello, my name is Se Chang. I have been a Certified anesthesiologist assistant (CAA) since 2020. As a Virginia resident since 2006, having attended high school, college, and graduate school while being a Virginia resident. I strongly support the bill SB 882 to license Certified Anesthesiologist Assistants (CAAs) in Virginia. Currently, I must commute to D.C. from Alexandria for work due to the lack of CAA licensure in our state. This not only impacts my personal life but also deprives Virginia of the valuable services CAAs provide. My long term desire is to be able to work in my home state. CAAs are highly trained, physician anesthesiologist-supervised anesthesia professionals who enhance access to safe, quality care. Licensing CAAs in Virginia will improve healthcare access, particularly in underserved areas, and offer cost-effective solutions. It will also allow professionals like myself to contribute to the healthcare system within our own community. I urge you to support this important legislation. As far as CRNAs and CAAs are concerned. Our training and pathways to becoming anesthetists may be different, but our day to day jobs are not different in the facilities that I am currently credentialed to work at. The CRNAs and CAAs at my facility have the same job description and we treat each other with respect. Both the American Society of Anesthesiologist (ASA) and American Academy of Anesthesiologist Assistants (AAAA) are against the vision of American Association of Nurse Anesthesiology (AANA) to give nurse anesthetists the title of Nurse Anesthesiologist. As a CAA, I fully recognize the need for a direct Physician Anesthesiologist (MD or DO) supervision and team model for the safety of patients.

We believe the ACT model with physician led care is the best course of action in treating patients. We strongly encourage everyone to take a look at SB882

Hello, My name is Manar Masood and I am a recent graduate of the Emory Master of Anesthesiology Program! I am writing to express my support for AAs working in the state of Virginia. I am originally from Illinois, where we are not yet licensed to work; last year, however, my sister was very interested in attending George Mason and moved to start her education there. I no longer had any reason to return to Illinois, so I began to look for jobs near where my family was now planning to live. If you look at the map of where we can practice, you would notice that we have opened three states in the last three years. We have a strong presence in the South from Texas to the Carolinas, and we have worked for years in D.C. and in the Midwest. We provide the safest form of anesthesia care in the Anesthesia Care Team Model, under the medical direction of an anesthesiologist. The anesthesiologist and AA work together to provide the most thorough care, at the highest standard achievable. This is the standard that all Virginians, now including my family, deserve. As time goes on, the shortage of healthcare personnel, including in anesthesia, will worsen. Under the Anesthesia Care Team Model, we can start to address hospital staffing needs WITHOUT having to sacrifice patient care, which is paramount and utterly critical to the Anesthesia Care Team. All citizens of Virginia deserve to be taken care of at the highest standard. Thank you for your time!

I am in support of this bill. I am an anesthesiologist assistant living and working in Washington DC, but my family dream is to move to eastern Virginia to practice, live, and grow our family. But I cannot do that because Virginia does not have licensure for anesthesiologist assistants, so I cannot work. If this bill passes, we would move within the year.

Hello, my name is Samuel Vargas, current Certified Anesthesiologist Assistant in the North East Georgia area. I support SB882. I work in a level 1 trauma setting which utilizes over a hundred of my anesthetist colleagues. CAA make up the the majority of the anesthetist utilized in our hospital system with the remaining anesthetist pool being made of our CRNA colleagues. With the ongoing shortage of healthcare personnel in every state, allowing us to be licensed in your state will allow relief to granted to countless hospitals in the state of Virginia. Me and my colleagues are doing it here in Georgia, allow us to provide safe and effective anesthesia care for you in Virginia. Thank you, Samuel Vargas CAA

My name is Daphne Tolentino, and I am from Alexandria, Virginia and have lived in Virginia for 17 years. I am a Certified Anesthesiologist Assistant (CAA) and I cannot practice in my home state because my license isn’t recognized currently in Virginia; I currently reside in Virginia but must commute into Washington, DC every day in order to work. Eighteen states, the US territory of Guam and neighboring Washington, DC license CAA’s and we are recognized by government programs such as Medicare, Tricare, and are allowed to practice in any VA hospital. I am asking you to vote in SUPPORT of SB 882 so that I can start working in my home state of Virginia. I am a highly qualified advanced practice provider who trained extensively in the delivery and maintenance of quality anesthesia care, as well as advanced patient monitoring techniques to ensure we provide high quality care to our patients. I want to provide this care to the citizens of Pennsylvania, my own friends and family, which would be allowed if SB 882 is passed. I graduated from Case Western Reserve University’s School of Medicine with a (Master of Medical Sciences in Anesthesiology or Master’s of Science in Anesthesia) degree and then passed a board certifying exam to become an Anesthesiologist Assistant. I have been practicing for 18 years and I currently practice at MedStar Washington Hospital Center in Washington, DC. Ultimately, passing SB 882 and allowing the licensure and practice of CAAs in the Commonwealth of Virginia will also greatly improve the free market economy for anesthesia services in Virginia. Adding another qualified anesthesia provider to practice in the state creates equal opportunity and provides an opportunity to reduce the burden of the healthcare workforce shortage being experienced by all Virginians. As a CAA of 18 years and a Virginia resident, I strongly encourage your support of CAA legislation, so Virginia patients can benefit from the highly trained care that CAAs provide in conjunction with Physician Anesthesiologists. I would love to be able to continue to settle down in Virginia and take care of patients in my own state, as well as raise a family in the state I consider home. Thank you for your consideration. Please feel free to contact me if you have any questions or want to discuss this further. Thank you Daphne Tolentino CAA

My name is Akash Sinha and I am a certified anesthesiologist assistant practicing in Washington, DC. I am the immediate past president of Virginia Academy of Anesthesiologist Assistants, currently the Chief Anesthetist at George Washington University Hospital and work part time at Children’s National Hospital. I have lived in Virginia for 4 years and plan on staying here long term since my partner is from Norfolk, VA. I currently must commute across state lines to work in Washington, DC as Virginia doesn’t recognize my license or skill set at this time. I am here to testify in strong support of SB 882, legislation that would authorize the licensure and regulation of certified anesthesiologist assistants, also known as CAA’s. Passing this bill would provide the residents of Virginia access to the benefits CAAs currently provide—benefits that patients in 23 jurisdictions already receive today. The Joint Commission on Health Care unanimously supported licensure of CAAs as Virginia is experiences a healthcare workforce shortage and CAAs could add an additional provider to the workforce. I completed my anesthesia training with Case Western Reserve University’s School of Medicine at their DC location, graduating with a Master of Science in Anesthesia. After graduation, I, along with all other CAAs, took a national certification exam and continue to submit continuing medical education and take recertification exams as laid out by our certifying body. All CAAs possess a premedical undergraduate background and complete a comprehensive didactic and clinical program at the graduate school master’s degree level. The typical CAA master’s program is 24 to 28 months. We are trained extensively in the delivery and maintenance of safe and quality anesthesia care as well as advanced patient monitoring techniques. My profession has been serving patients for over 50 years. CAAs are recognized by the Centers of Medicare and Medicaid (CMS), Tri-care, and all major commercial insurance payors. CMS recognizes CAAs as qualified non-physician anesthesia providers, just like our CRNA counterparts. CAAs are as safe and effective as nurse anesthetists. I have worked alongside CRNA’s, and most people don’t know who is a CAA or CRNA without asking, as we have the same job responsibilities and duties, and work together cohesively. As a CAA of 6 years, and a Virginia resident, I strongly encourage your support of CAA legislation, so Virginia patients can benefit from the highly trained and safe anesthesia care CAAs provide. I would love to be able to continue to settle down here with my partner who would like to be close to their family in Norfolk. Thank you for your consideration.

My name is Nicole Moore. I am a certified anesthesiologist assistant and the current president of the American Academy of Anesthesiologist Assistants, but more importantly I am a Virginia resident and have lived in Virginia for the past 10 years. I moved here for graduate school to become a Certified Anesthesiologist Assistant and fell in love with the state, ultimately leading me to stay. I met my now husband, who served in the Navy for 10 years, here and we are looking forward to starting a family here, near his family and work. I currently must commute across state lines to Sibley Memorial Hospital in Washington, DC as Virginia doesn’t recognize my license or skill set at this time. I am here to testify in strong support of SB 882, legislation that would authorize the licensure and regulation of certified anesthesiologist assistants, also known as CAA’s. Passing this bill would provide the residents of Virginia access to the benefits CAAs currently provide—benefits that patients in 23 jurisdictions already receive today. The Joint Commission on Health Care unanimously supported licensure of CAAs as Virginia is experiences a healthcare workforce shortage and CAAs could add an additional provider to the workforce. I completed my anesthesia training with Case Western Reserve University’s School of Medicine at their DC location, graduating with a Master of Science in Anesthesia. After graduation, I, along with all other AAs, took a national certification exam and continue to submit continuing medical education and take recertification exams as laid out by our certifying body. All AAs possess a premedical undergraduate background and complete a comprehensive didactic and clinical program at the graduate school master’s degree level. The typical AA master’s program is 24 to 28 months. We are trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques. We understand the disease states, pharmacology and all other factors that can influence an anesthetic and ensure we provide high quality care to our patients. My profession has been serving patients for over 50 years. CAAs are recognized by the Centers of Medicare and Medicaid (CMS), Tri-care, and all major commercial insurance payors. CMS recognizes AAs as qualified non-physician anesthesia providers, just like our CRNA counterparts. AAs are as safe and effective as nurse anesthetists. In my current practice I work alongside CRNA’s, and most people don’t know who is an AA or CRNA without asking, as we have the same job responsibilities and duties, and work together cohesively; giving each other breaks and relieving one another at the end of a shift. There is no peer-reviewed or other credible evidence of any sort that the care provided by an anesthesiologist assistant is less safe than that of a nurse anesthetist. In October of 2018, there was a study published that concluded “The specific composition of the anesthesia care team was not associated with any significant differences in mortality, length of stay, or inpatient spending.” As a CAA of 8 years, and a Virginia resident, I strongly encourage your support of CAA legislation, so Virginia patients can benefit from the highly trained care CAAs provide. I would love to be able to continue to settle down here and raise my children in the state I consider home. Thank you for your consideration