Please Support HB 1635.

I support this bill.

Thank you all for hearing the testimony on behalf of a fellow Certified Anesthesiologist Assistant (CAA). Virginia would largely benefit from an addition of midlevel practitioners in the field of anesthesiology. I have worked with many anesthesiologists and CRNAs, I respect what everyone can bring to the table. With healthcare being short of staff, more support and quality care for patients is needed. We appreciate your openness and ability to hear about the great profession of CAAs.

My name is Karen Kelly, and I am the President of the Virginia Affiliate of the American College of Nurse-Mdwives, I'm writing to urge support of HB1635, a bill that will expand access to high-quality maternity care by ensuring Licensed Certified Midwives (LCMs) have full practice authority in Virginia—aligning their scope with Certified Nurse-Midwives (CNMs). The United States faces a maternal health crisis, with rising mortality rates and significant racial disparities. Virginia is no exception. Midwifery care has been proven to improve outcomes, reducing unnecessary interventions while increasing access to safe, cost-effective, patient-centered care. According to the World Health Organization (WHO), midwives could provide up to 90% of sexual and reproductive care. Yet, outdated policies prevent midwives from practicing to their full scope, limiting access to care, especially in underserved communities. Virginia has come so far, yet policy improvements are still needed to ensure midwives can work to their full potential. This includes allowing midwives to practice within the full scope of their education and removing barriers that limit their ability to provide care independently. Restrictions such as required written practice agreements or co-location with physicians reduce the availability of midwifery services, particularly in areas facing provider shortages. In states with these requirements, midwives are often concentrated in settings where physician employment is available rather than in communities where demand for midwifery care is greatest. HB1635 removes these barriers for Licensed Certified Midwives, highly trained professionals who complete the identical masters or doctoral midwifery education, meet the same core competencies, and pass the same national certification exam as CNMs. These midwives are prepared to provide comprehensive midwifery care in all settings, yet current policy limits their ability to do so. By passing HB1635, Virginia will: -Expand maternal healthcare access in rural and urban areas experiencing provider shortages. -Support patient choice by increasing the availability of midwifery-led care. - Strengthen Virginia’s workforce by aligning LCM practice authority with CNMs, ensuring midwives can work where they are most needed. Midwifery and medicine are complementary disciplines, each contributing uniquely to the health and well-being of childbearing people. Ensuring midwives can practice to their full capacity will help address workforce shortages and expand access to high-quality care. Multiple scholarly articles have demonstrated that states that allow midwives to practice independently have a larger midwifery workforce. In these studies, independent practice was defined simply as no need to obtain a written practice agreement with a physician. For these reasons, we urge the committee to support HB1635 and remove the unnecessary barriers preventing midwives from delivering the care Virginians need. Thank you for your time and consideration.

I oppose this bill. AAs will not improve access to care and will not reduce costs for patients.

I oppose HB 1647 the licensing of Anesthesiologist Assistants (AAs) in the Commonwealth of Virginia. As a practicing Nurse Anesthetist (CRNA) for over 35 years living and working in Virginia, the licensing of AAs will not benefit the citizens of the Commonwealth due to the required supervision of AAs, the potential loss of training slots - currently, the CRNA Programs are having use out of state facilities for training to keep up with our healthcare needs - more in-state training slots are to keep our graduates, and the educational curriculum for AAs is similar in content to our Bachelor of Science in Nursing degree (BSN) - Registered Nurses in contrast to the doctorate-level educational CRNA programs. This bill will not increase access to care or provide more anesthesia providers for our fellow citizens undergoing surgical and diagnostic procedures.

I oppose HB 1647. Please vote NO. Optional: CAAs will not help our anesthesia workforce shortage.

I’m against fed ex drivers providing anesthesia

In opposition!

Oppose

Greetings! I am a doctorate prepared Certified Registered Nurse Anesthetist and I am writing to inform you why I do not support HB 1647. Licensing Certified Anesthesia Assistants "CAAs" does nothing to improve the anesthesia workforce problem; CAAs drive up costs and make it harder to train anesthesia providers. CAAs must be directly supervised by a physician anesthesiologist, making CAAs one of the costliest anesthesia providers with no scientific evidence of increased patient safety. CAAs have a scope of practice that is much more limited than a physician or a nurse anesthesiologist. Furthermore, a 2017 report from the Virginia Department of Health Professions found that CAAs reduce the number of clinical rotations available for anesthesia care providers and recommended against licensing CAAs in Virginia. Licensing CAAs will have an immediate negative impact, reducing the already limited training clinical rotation opportunities for Virginia's 400 CRNA students across the state. The proven and most effective way to immediately increase the number of anesthesia providers is to opt-out of medical direction for CRNAs. This allows physician anesthesiologists and nurse anesthesiologists cover their own rooms, instead of the unnecessary system currently in place in many institutions where there are two independently qualified anesthesia providers with the exact same scope of practice covering each case. This would provide a significant increase in anesthesia providers available immediately, without having to open training programs or offer licensing to a new type of provider. Please vote no on HB1647.

Opposition to licensing anesthesia assistants in Virginia.

I am writing to urge you to oppose HB1467, legislation that would allow Anesthesiologist Assistants to practice in Virginia. Licensing AAs will not address the workforce shortage we're currently experiencing and will not improve access to anesthesia care services. In 2017, the Board of Health Professions conducted a study to investigate the feasibility of licensing AAs in Virginia. After evaluating relevant education, training, examination, and continuing competency requirements, typical duties and functions, and the latest available anesthesia provider workforce data, the Board unanimously concluded that AAs do not qualify for licensure in Virginia. The study also recommended that six criteria be met before allowing AAs licensure in Virginia. Since that time, the criteria have not been met. Further, a 2024 report from the Joint Commission on Health Care again recommended studying the impact of bringing AAs to Virginia before considering immediately licensing them. Recommendations against licensing AAs include: -AA students would increase competition for already limited training sites and slots needed by Virginia's Anesthesiologist and Nurse Anesthetist students. -AAs can only practice with supervision from physician anesthesiologists, severely limiting the ability for AAs to help lessen the workforce shortage. -AAs are unlikely to locate in underserved and rural areas, places where anesthesia care is needed most, due to a lack of physician anesthesiologists required to supervise them. In short, legislation promoting AAs is bad medicine for Virginia because: AAs do NOT improve patient safety. AAs do NOT reduce costs. AAs do NOT improve access to anesthesia services. Please oppose HB 1467to ensure the best anesthetic care and access for all Virginians. Thank you.

I’m a in complete opposition of this bill.

I oppose HB 1647. Please vote NO. CAAs will not help our anesthesia workforce shortage.

I oppose HB 1647. Please vote NO. CAAs will not help our anesthesia workforce shortage.

I oppose this proposition. Anesthesia assistants should not be allowed in Virginia. They do not have the same training or scope of practice. CRNAs have been working for decades with an impeccable safety record. I believe allowing Anesthesia Assistants will undermine all this hard work. Please vote no.

Opposition to HB1647

Opposition

Opposed

I OPPOSE this bill. Thank you for your consideration.

1.) oppose HB 1647 2.) support HB 2391

The Commonwealth of Virginia does not deserve a decline in care of patients under anesthesia with the introduction of anesthesia assistants.

I oppose this CAA bill.

N/A

N/A

I oppose HB1647,HB2391

Oppose HB 1647 for patient safety.

in opposition

HB2391 I support this bill HB1647 I oppose this bill.

I oppose licensure of CAAs. I trained at a tertiary care, level 1 trauma center. We also had AA students at this training site. On day 1 of clinical, I had 7 years of critical care nursing experience (+ 5 years of prehospital EMS care) managing patients requiring mechanical ventilation, titrating vasoactive drips, and advocating for vulnerable patients and their families in critical care environments. I had lead over 50 codes and instructed new interns and medical residents that rotated through the cardiac ICU. On some days as charge nurse of a busy rapid response/code team, it was not unusual to respond to more than one cardiac arrest in a shift. On day 1 of clinical, I watched an AA student have his first patient conversation and encounter of his career, proceeding to insert an IV catheter in the wrong direction. Our training is not the same. I now practice in a rural, CRNA-only, critical access hospital, increasing access to care for those vulnerable populations I have spent a good portion of my life providing. On a daily basis, I deliver safe, equitable, and efficient anesthesia care independently, something that an AA—as evidenced in the title— cannot provide.

In the name of patient safety and healthcare accessibility, I vehemently oppose this bill

I oppose this bill

I oppose this bill.

Please oppose this bill. Please vote no

As a Student Registered Nurse Anesthetist (SRNA) studying at Mary Baldwin University, I strongly oppose the Passage of HB 1647. The passage of this bill would not increase access to anesthesia care to the residents of The Commonwealth of Virginia. Additionally, the passage of this bill would take clinical opportunities away from SRNAs like myself as Anesthesia Assistants cannot train SRNAs. This would force me to obtain clinical training in other states outside of Virginia, remove me from obtaining my training in the community I care deeply about severing, and directly increase the costs of completing my education.

HB 1647- I oppose this bill HB 2391- I support this bill

I oppose HB1647 because:CAAs do NOT improve patient safety. CAAs do NOT reduce costs.CAAs do NOT improve access to anesthesia services. I support HB2391 because this bill would empower CRNAs to practice to the full extent of their education and training, expand patient access to care, and help address Virginia’s healthcare workforce shortage.

I oppose this bill.

I oppose this bill

I oppose this bill.

As a CRNA constituent in the commonwealth I would like to voice my opposition to this bill. CAAs are not equivalent in education and years of clinical experience. They will not expand access, nor will they provide cost effective care as they need an MDA in order to practice. It is important to provide safe, cost effective care to our community, and CAAs can not equivalently provide that.

Please vote no on HB1647. This will reduce the quality and safety of the anesthesia provided to our residents here in VA.

Absolutely not! AAs are not a cost effective option for anesthesia care. They require a MD to be able to practice so you will be paying for 2 providers instead of one. CRNAs are a better option as they can practice independently at HALF the cost of an anesthesiologist. Remove their supervision restrictions and you will be paying for less than 1/3 of the MD with AA model PER PATIENT! Please oppose HB 1647.

On 1647 I ask you to oppose because CAA’s will not effectively address the anesthesia provider shortage. On 2391 I ask for support for removal of supervision

Strongly oppose. JCHC did NOT recommend licensure. CAAs will take clinical training pots for nurse anesthetist and physician training spots in the anesthesia specialty. Since these providers CANNOT practice without direct direction by a physician anesthesiologist, they WILL NOT serve to increase access to care in Virginia. Thank you.

I do not support this bill. Licensing AAs does not increase access to anesthesia care.

I OPPOSE licensure of certified anesthesiologist assistants.

I oppose HB 1647

Oppose the licensure of Certified Anesthesiologist Assistants (CAAs). Unfortunately, licensing CAAs does nothing to improve the anesthesia workforce problem; CAAs drive up costs and make it harder to train anesthesia providers currently licensed in Virginia. CAAs must be directly supervised by a physician anesthesiologist, making CAAs one of the costliest anesthesia providers with no scientific evidence of increased patient safety. Even more, a 2017 report from the Virginia Department of Health Professions found that CAAs reduce the number of clinical rotations available for anesthesia care providers and recommended against licensing CAAs in Virginia. Licensing CAAs will have an immediate negative impact, reducing the already limited training clinical rotation opportunities for Virginia's 400 CRNA students across the state.

Vote No-oppose licensure of CAAs

I support HB 2391 I oppose HB1647

Oppose licensure of CAAs

I oppose HB 1647 because they do not increase the efficiency of anesthesia like Nurse Anesthesiologists do.

Support HB 2391. Oppose HB 1647.

I oppose licensure of CAAs !

I oppose this bill.

I oppose the bill

I oppose the licensure of CAAs

I oppose this bill! I am a Georgetown graduate who lives currently northern Virginia and have been an ICU nurse for several years.

Please oppose this bill

Oppose licensure of CAAs (HB 1647)

OPPOSE the licensure of CAAs as they do not improve access to care, safety, or cost effectiveness related to anesthesia costs

As a healthcare provider, I oppose this bill. I would like to stay in the state to work, and this bill will impose that. Thank you!

I oppose HB 1647

I oppose this bill!

I oppose this bill.

I oppose the licensure of CAAs as a future SRNA and CRNA

As a healthcare provider, I oppose this bill.

I oppose this bill. Please vote no on HB 1647.

I OPPOSE licensure of CAAs.

I oppose this bill. It would add cost and compromise patient safety.

I support removal of supervision for CRNAs. I opposed licensure of CAAs.

Oppose licensure of CAAs

I oppose this bill. It does not reduce healthcare costs.

Oppose licensure of CAAs

As an aspiring CRNA, I strongly oppose the licensure of CAAs in Virginia.

I oppose this bill.

I oppose this bill

I oppose this bill. I do not live in Virginia, but my license and I work in Virginia

I OPPOSE the licensure of CAAs

Oppose

I oppose this!

I oppose this legislature.

I oppose this bill.

I oppose hb 1647

I oppose this bill

Oppose

I oppose this bill

As a CRNA, CAAs are an expensive way to provide anesthesia and will do little to to nothing to Allee the anesthesia shortage

I oppose this bill.

I support removal of supervision and I oppose licensure of CAAs

I oppose this bill.

I oppose this bill

Oppose

I oppose this bill.

I oppose this bill

Oppose this bill.

I oppose this bill

I oppose this bill.

I DO NOT SUPPORT THIS BILL! 👎🏼

Vote *NO* on HB 1647. It will not increase access to care and it displaces our current nurse anesthesia residents from learning sites.

Oppose

Oppose

I oppose this bill

I OPPOSE this bill

Oppose

I opposed this legislation

I oppose this bill.

I oppose this bill.

I support this bill

I oppose this bill

I oppose this bill

I OPPOSE this bill.

I support HB 2391 (Sickles) and I oppose HB 1647 (Hayes)

Oppose licensure of CAAs

I oppose this bill

I support HB 2391 and I oppose HB 1647

I oppose this bill

I oppose this bill!

OPPOSE!!!!

I support this bill.

I am writing to urge you to oppose and vote "no" on HB1647, legislation that would allow Certified Anesthesiologist Assistants (CAAs) to practice in Virginia. Licensing CAAs will not address the workforce shortage we're currently experiencing and will not improve access to anesthesia care services. In 2017, the Board of Health Professions conducted a study to investigate the feasibility of licensing CAAs in Virginia. After evaluating relevant education, training, examination, and continuing competency requirements, typical duties and functions, and the latest available anesthesia provider workforce data, the Board unanimously concluded that CAAs do not qualify for licensure in Virginia. Further, a 2024 report from the Joint Commission on Health Care again recommended studying the impact of bringing CAAs to Virginia before considering immediately licensing them. Recommendations against licensing CAAs include: CAA students would increase competition for already limited training sites and slots needed by Virginia's Anesthesiologist and Nurse Anesthetist students. I am currently a nurse anesthesia student at Old Dominion University in Norfolk and I can wholeheartedly attest to this particular point. Even though we have a number of hospitals in the Hampton Roads area, training slots are limited and, in turn, the limitations on the number of training slots limits the size of the nurse anesthesia program at ODU. As examples, students in our program must travel outside of the Hampton Roads area to sites in Farmville, on the peninsula, in Roanoke, New Jersey, and even Ohio. CHKD, the local pediatric hospital in Hampton Roads, only takes 6-8 students per year, meaning that 20-22 of my classmates must travel to Nationwide Children’s in Ohio for their pediatric rotation. The increased competition related to the addition of CAA students would significantly affect our ability to train in our local hospitals and would further limit the ability for ODU to increase the size of the program to produce more Hampton Roads-trained certified registered nurse anesthetists (CRNAs). CAAs can only practice with supervision from physician anesthesiologists, severely limiting the ability for CAAs to help lessen the workforce shortage. CRNAs can practice under the supervision of any physician/surgeon, dentist, or podiatrist. The solution to the workforce shortage is for CRNAs to be able to practice in collaboration with, not under the supervision of, our physician colleagues which would allow more anesthesiologists to be assigned to their own operating room to provide anesthesia care to more patients, in lieu of unnecessarily supervising CRNAs, which would be a better utilization of talented anesthesia resources and increase the access to anesthesia services for patients. CAAs are unlikely to locate in underserved and rural areas, places where anesthesia care is needed most, due to a lack of physician anesthesiologists required to supervise them. In short, legislation promoting CAAs is bad medicine for Virginia because: CAA students would DECREASE access to clinical training sites. CAAs do NOT improve patient safety. CAAs do NOT reduce costs. CAAs do NOT improve access to anesthesia services. Please oppose and vote "no" on HB1647, legislation that would fail to help Virginians access anesthesia care.

I urge you to oppose House Bill 1647. CAAS does not improve patient safety, CAAs do not reduce costs, and CAAs do not improve access to anesthesia services. A 2024 Joint Commission on Health Care recommended that CAAs students would increase competition for the already limited training sites and slots needed by Virginia's anesthesiologist and Nurse Anesthesia students. CAAS can only practice under the supervision of a physician anesthesiologist, severely limiting the ability of CAAs to help lessen the workforce shortage. The introduction of CAAs is one of the strategies from Virginia physician anesthesiologists to limit the Nurse Anesthetist's Scope of Practice in Virginia. It is an obstacle for Nurse anesthetists to practice to the fullest extent of their education and training.

Oppose the introduction of AAs to VA. AAs will reduce access to anesthesia services and increase cost. When AAs are in an operating room then training sites for nurse anesthesiologists are eliminated. This reduces the number of nurse anesthesiologists trained. AAs only assist a physician anesthesiologist, and with the growing shortage of physician anesthesiologists the number of practices where an AA can function is limited. This assistant role is also expensive. Certified Registered Nurse Anesthesiologists -CRNAs- are a more viable solution to the shortage. CRNA educational programs are expanding quickly since the 2020 pandemic and are increasing the number of graduates every year. But if AAs begin to be placed into the clinical sites where CRNAs receive their training this educational expansion will be curtailed.

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. If the goal is truly to expand access to care and provide jobs for AAs, then fairness would dictate that CRNAs, who are already independently capable, should also be permitted to supervise AAs. This would align with the broader goal of addressing access to care where it is most needed, particularly in rural and underserved areas—locations where CRNAs already fill critical gaps in the healthcare system, far more effectively than MDAs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

I writing to strongly oppose HB 1647 - which would authorize the practice of Anesthesiologist Assistants (AAs) in Virginia. I am a Certified Registered Nurse Anesthetist (CRNA) with 25 years of experience in the field. This bill was introduced with the intent to address the workforce shortage; however, it will have the opposite effect. There are three highly regarded nurse anesthesia training programs in the Commonwealth, and each program has successfully implemented plans for enrollment growth. They've progressed toward addressing the workforce shortages and are poised and eager to contribute more. The major barrier they face is a lack of training opportunities, often at hospitals and major medical centers (versus rural areas and clinics). AA practice is limited to hospital facilities with physician anesthesiologists already because they are not trained to practice autonomously. If AAs are allowed to practice in Virginia, they will provide services at many sites where there are currently CRNA trainees who can not be trained or supervised by the AA. Each anesthetizing location staffed by an AA becomes a training slot that CRNA programs can't access. This bill will have an immediate, not a long-term, negative impact on the efforts already being made to address workforce needs. The net effect will be a step backward, not forward. Existing CRNA programs have committed to the trainees currently enrolled. Institutions of higher education will be forced to send CRNA trainees out of state to acquire the clinical experiences they need. Past experience with sending students out of state for training has shown that trainees are more likely to seek future employment outside state lines. With respect to the idea that as part of a long-term strategy to address anesthesia workforce needs, bringing AAs into Virginia will have a positive effect, the data does not bear that out. The number of AAs in the US pales in comparison to the number of CRNAs and physician anesthesiologists. Bringing AAs will deter CRNAs from working in the state. The net effect will be a loss and we'll be worse off in the future than we are now. Because AAs cannot practice in rural areas where there are no physician anesthesiologists at present, this bill would not help improve access to care. The Commonwealth of Virginia has committed much to developing and supporting CRNA programs in the state. HB 1647 will threaten the stability of those programs and hinder ongoing efforts to address the anesthesia workforce shortage. It will make things worse, not better. Please vote no on HB 1647.

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. If the goal is truly to expand access to care and provide jobs for AAs, then fairness would dictate that CRNAs, who are already independently capable, should also be permitted to supervise AAs. This would align with the broader goal of addressing access to care where it is most needed, particularly in rural and underserved areas—locations where CRNAs already fill critical gaps in the healthcare system, far more effectively than MDAs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

Oppose HB 1647 I am writing today to express my strong opposition to HB 1647. Licensing Anesthesia Assistants (AAs) in Virginia will not solve the anesthesia workforce shortage in Virginia. AA’s can only practice under the supervision of a physician anesthesiologist, limiting their ability to increase access to care. I am a nurse anesthetist practicing in a small rural Virginia hospital. Myself and 2 other Certified Registered Nurse Anesthetists (CRNAs) provide 100% of all anesthesia care at our facility, as well as covering the emergency department and intensive care unit for emergency procedures such as invasive lines and intubations. We provide these services 24 hours a day, seven days a week without supervision by a physician anesthesiologist. It is difficult for rural facilities to recruit anesthesia providers, in fact we have had an open position for nearly a year with zero applicants. AAs would NOT be able to fill this role as they are not independent anesthesia providers and must practice where physician anesthesiologist are. Just like many rural and underserved areas in Virginia, there are no physician anesthesiologist at my facility. Additionally, I am deeply concerned about the impact AAs would have on our limited training spots for future Nurse Anesthetists in Virginia. Our 3 existing Nurse Anesthesia programs in Virginia already must send Nurse Anesthetist students to states as far away as Ohio and New Jersey to train. Licensing AAs in Virginia would increase competition for already limited training spots and negatively impact the education of student Nurse Anesthetists. If we ever hope to ensure that rural and underserved communities in Virginia have access to safe, cost effective anesthesia care we MUST have highly-trained nurse anesthetists graduating from our nurse anesthesia programs to fill these positions. Allowing AAs to practice in Virginia would be disastrous for our Nurse Anesthesia programs and students. Jessica Ray DNP, CRNA

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. If the goal is truly to expand access to care and provide jobs for AAs, then fairness would dictate that CRNAs, who are already independently capable, should also be permitted to supervise AAs. This would align with the broader goal of addressing access to care where it is most needed, particularly in rural and underserved areas—locations where CRNAs already fill critical gaps in the healthcare system, far more effectively than MDAs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

Oppose HB 1647 Certified Anesthesiologist Assistants are NOT needed in Virginia. I came to this conclusion after reading the 2024 Virginia General Assembly's report from the Joint Commission on Healthcare titled STRATEGIES TO STRENGTHEN THE ANESTHESIA WORKFORCE IN VIRGINIA. This report states that "Between 2024 and 2036, the National Center for Health Workforce Analysis predicts a 24 percent increase in supply of CRNAs in Virginia, but only an 8 percent increase in demand. While Virginia does not currently have enough CRNAs to meet demand, the rapid increase in the number of CRNAs practicing in the state indicates a narrowing, rather than widening, gap between supply and demand" (page 12). There will be more than enough CRNAs in Virginia to meet the anesthesia provider needs in the future. The report also states that CAAs would not necessarily address short-term workforce issues as there are only approximately 4000 of them in total across the entire country (page 21). In addition, CAA practice in Virginia would also limit the clinical training sites available to student nurse anesthetists. CAAs have diminished scope of practice as compared to CRNAs and student nurse anesthetists may not train under them. As such, then, CAA practice in Virginia would be counter to the Commission's suggestion that Virginia develop strategies for additional capacity for CRNA training programs. Do not license a new anesthesia provider in Virginia. Vote NO on HB 1647.

I strongly opposed the implementation of CAAs. It will not increase access to care. This is an extremely limited group of providers. It would. Be better to empower existing providers like CRNAs than to bring in a provider that has limited data and growth.

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. If the goal is truly to expand access to care and provide jobs for AAs, then fairness would dictate that CRNAs, who are already independently capable, should also be permitted to supervise AAs. This would align with the broader goal of addressing access to care where it is most needed, particularly in rural and underserved areas—locations where CRNAs already fill critical gaps in the healthcare system, far more effectively than MDAs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

As a Certified Registered Nurse Anesthetist (CRNA) and educator, I strongly oppose HB1647. This bill will not alleviate the anesthesia workforce shortage in Virginia and may, in fact, harm patient care and the future of anesthesia training in our state. CAAs are one of the most expensive anesthesia providers, requiring both a physician anesthesiologist and an assistant to deliver care to a single patient. Unlike CRNAs, who practice independently in many settings, CAAs are entirely dependent providers and cannot expand access to anesthesia care, especially in rural and underserved areas. Simply put, this bill promotes an inefficient, costly model with no evidence of increased patient safety. Virginia currently has three CRNA training programs producing hundreds of highly trained anesthesia providers every year, yet zero programs for CAAs. Nationally, there are only 3,500 CAAs compared to over 65,000 CRNAs. Expanding CRNA opportunities is the most effective and immediate solution to workforce shortages, rather than introducing a dependent provider model that adds unnecessary costs to the system. Moreover, licensing CAAs in Virginia will reduce clinical training opportunities for CRNA students, as previously noted by the Virginia Department of Health Professions. This would create an unnecessary barrier for future anesthesia providers, worsening the workforce issue rather than solving it. The 2024 Joint Commission on Health Care report recommended further study on the impact of CAAs in Virginia before moving forward with licensure. Ignoring this recommendation and rushing to approve HB1647 is premature and unwise. To ensure safe, cost-effective, and accessible anesthesia care in Virginia, I urge lawmakers to oppose HB1647.

The introduction of CAA's into the Virginia healthcare systems will cost an unnecessary amount of money. The group (only ~3500 nationwide) is entirely dependent upon physician anesthesiologists & this makes zero financial sense. It's an unnecessary cost and adds to the issues with healthcare affordability that is already out of control.

I strongly oppose this bill as it does not directly address the current demand of our healthcare system. CRNA’s have a national workforce of almost 70,000 anesthesia providers that have been handcuffed by antiquated and bureaucratic legislation. If anything CRNAs should be provided the opportunity to practice to their full scope and given the chance will meet the demand and continue to provide high quality safe anesthesia care. Attempting to bring in a third anesthesia party that has a limited number of bodies and lacking infrastructure for licensing and training does not make fiscal sense. AAs are assistants to an already expensive provider in an already expensive model of anesthesia. If the physician anesthesiologist and nurse anesthesiologist were all hands-on administering anesthesia care we would see a dramatic impact on access and availability to anesthesia services. There is a much deeper problem to our healthcare system that is not caused by anesthesia on either side. Healthcare is highly inefficient and highly expensive and has had a history of a culture that is demeaning and oppressive. I truly believe if we could have our providers all work to their full scope of practice that we would find more candidates moving towards healthcare and medicine again. Again I strongly oppose HB 1647.

Please oppose HB 1647. We admittedly have an anesthesia provider shortage but bringing CAAs into the state will not solve the shortage, it will only intensify it. They require more supervision & have less training than the other two types of providers in this state, Anesthesiologists & Certified Registered Nurse Anesthetists, who, can both practice independently. Please support HB 2391 which lets CRNAs practices to the fullest scope of their license & will help alleviate our workforce shortage. The current language that governs the practice of CRNAs in Virginia is neither modern nor efficient. Under current law, supervision means that a medical doctor, podiatrist, or dentist must supervise a CRNA, yet these supervisors are not necessarily experts in anesthesia. It does not make practical sense to ask a surgeon to “supervise” another provider who is an expert in a different field. This supervision is in name only. We should remove it. Consultation is a much more appropriate definition of what is occurring on a daily basis in medical facilities all over the commonwealth. As to the question of efficiency or better yet, cost effectiveness, supervision is duplicative. In the case of an Anesthesiologist supervising a CRNA, two experts in anesthesia are being paid to take care of a patient when only one is necessary. Thank you.

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. If the goal is truly to expand access to care and provide jobs for AAs, then fairness would dictate that CRNAs, who are already independently capable, should also be permitted to supervise AAs. This would align with the broader goal of addressing access to care where it is most needed, particularly in rural and underserved areas—locations where CRNAs already fill critical gaps in the healthcare system, far more effectively than MDAs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. If the goal is truly to expand access to care and provide jobs for AAs, then fairness would dictate that CRNAs, who are already independently capable, should also be permitted to supervise AAs. This would align with the broader goal of addressing access to care where it is most needed, particularly in rural and underserved areas—locations where CRNAs already fill critical gaps in the healthcare system, far more effectively than MDAs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. If the goal is truly to expand access to care and provide jobs for AAs, then fairness would dictate that CRNAs, who are already independently capable, should also be permitted to supervise AAs. This would align with the broader goal of addressing access to care where it is most needed, particularly in rural and underserved areas—locations where CRNAs already fill critical gaps in the healthcare system, far more effectively than MDAs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. If the goal is truly to expand access to care and provide jobs for AAs, then fairness would dictate that CRNAs, who are already independently capable, should also be permitted to supervise AAs. This would align with the broader goal of addressing access to care where it is most needed, particularly in rural and underserved areas—locations where CRNAs already fill critical gaps in the healthcare system, far more effectively than MDAs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

I am writing in opposition of HB 1647. We do not need licensure of Anesthesiologist Assistants (AAs) in Virginia. We need more CRNAs and anesthesiologists who can provide anesthesia services independent of a physician anesthesiologist supervising. The practice of AAs is limited and this does not expand the number of providers for Virginians. Please vote no on HB 1647.

I am writing in opposition to HB 1647, which would allow for licensure of anesthesia assistants in the state of Virginia. Licensure of a third anesthesia provider, one which cannot practice without supervision of an a physician anesthesiologist, would not increase the anesthesia workforce. There are less than 400 AAs in the country, and they make up a small percentage of anesthesia providers. They cannot practice outside of an anesthesia care team model, which means that they are predominantly limited to urban hospitals where there are physician anesthesiologists. An AA is not trained to the full scope of anesthesia practice and they cannot help alleviate the shortage of anesthesia providers in our most vulnerable communities, such as rural hospitals. In fact, adding licensure for AAs in Virginia would reduce the number of clinical training sites for both Certified Registered Nurse Anesthetist (CRNA) and physician anesthesiologist residents. This is because an AA cannot train or clinically supervise either of these practitioners. We need more training sites, not less, to expand our anesthesia workforce. Please vote NO on HB1647.

I am writing to support HB2391 & oppose HB1647. HB2391 allows Certified Registered Nurse Anesthetists (CRNAs) to practice independently, crucial for addressing healthcare workforce shortages in VA, especially in rural & underserved areas. This bill aligns with the VA Health Workforce Development Authority's (VHWDA) goals of addressing workforce shortages & supporting scope of practice changes. CRNAs, with proven training & experience, can immediately fill the gap, unlike Certified Anesthesiologist Assistants (CAAs), who require physician supervision & have no existing infrastructure in VA. Implementing HB1647, focusing on CAAs, diverts resources from effective solutions like CRNA autonomy. CAAs require direct supervision from Physician Anesthesiologists, who are already scarce in underserved areas. Establishing CAA licensure & regulatory frameworks demands significant investment & will delay addressing the urgent workforce shortages. In contrast, CRNAs already provide safe, high-quality, independent anesthesia care in 30+ states, represent >80% of anesthesia providers in rural areas, & reduce costs by eliminating the need for multiple providers. Although CAAs may contribute to anesthesia care delivery, there is insufficient evidence to conclusively state their presence has significantly reduced anesthesia provider shortages in states where they have long been authorized to practice. The further introduction of CAAs also will not address or aid in the projected shortage of Physician Anesthesiologists. In fact, the shortage of Physician Anesthesiologists alone is a massive barrier to support the claim of CAAs being the answer to this current shortage. Investing in CRNA autonomy is a more efficient use of resources, ensuring immediate impact on healthcare shortages & expanding access in underserved regions. HB2391 offers a proven, cost-effective solution, expanding CRNA capacity to immediately improve access & reduce costs, aligning with VHWDA's objectives. Conversely, HB1647 proposes a resource-intensive, long-term approach with little immediate benefit. VA should leverage its existing CRNA workforce rather than invest in CAAs, which would create redundancy & require significant resources for implementation. Supporting HB2391 promotes efficient use of resources & enhances healthcare access, addressing shortages effectively & promptly. From a cost-effectiveness perspective, HB2391 is superior as it leverages existing CRNA resources without requiring additional spending on new infrastructure or training programs. CRNAs practicing independently reduces the need for dual staffing, thereby immediately cutting healthcare costs for both hospitals & patients. Elimination of supervision requirements translates to direct financial savings & more efficient use of healthcare resources. This immediacy in implementing HB2391 ensures that VA can address current workforce shortages without delay, maximizing effectiveness of its budget & providing quicker access to necessary anesthesia services in underserved regions. HB2391 will significantly impact patient care in Virginia by enabling CRNAs to operate autonomously. This model speeds up anesthesia services, reduces delays, & enhances care quality & safety, especially in remote areas. By expanding skilled anesthesia care, the bill improves health outcomes & makes healthcare more accessible & equitable for all Virginia residents.

I am writing in opposition to HB 1647, which would allow for licensure of anesthesia assistants in the state of Virginia. Licensure of a third anesthesia provider, one which cannot practice without supervision of an a physician anesthesiologist, would not increase the anesthesia workforce. There are less than 400 AAs in the country, and they make up a small percentage of anesthesia providers. They cannot practice outside of an anesthesia care team model, which means that they are predominantly limited to urban hospitals where there are physician anesthesiologists. An AA is not trained to the full scope of anesthesia practice and they cannot help alleviate the shortage of anesthesia providers in our most vulnerable communities, such as rural hospitals. In fact, adding licensure for AAs in Virginia would reduce the number of clinical training sites for both Certified Registered Nurse Anesthetist (CRNA) and physician anesthesiologist residents. This is because an AA cannot train or clinically supervise either of these practitioners. We need more training sites, not less, to expand our anesthesia workforce. Please vote NO on HB1647.

I am writing in opposition to HB 1647 and support of HB2391. HB1647 - This bill is unnecessary and does not truly help facilitate improvement in the anesthesia workforce shortage. There are two issues the CAA provider type creates. First, for ever OR a CAA occupies, it creates one less training slot for Nurse Anesthesiology Residents. CAAs do not meet the training requirements necessary for Nurse Anesthesiology Residents and cannot offer training support for these providers. This is clearly outlined in the Council on Accreditation requirements for Nurse Anesthesia education and training. Secondly, every facility in other states that have introduced CAAs have experienced significant attrition of CRNAs due to the imbalance of workload. CAAs are limited in their scope of practice and cannot provide full coverage of all of anesthesia services. These services include obstetrics, pain management, and line placement in many states. The facilities often experience a greater loss of providers then they are able to attract with the legislative change. These unintended consequences are severe and not clearly disclosed to members of the committee. The HRSA workforce data is clear - physician Anesthesiologist wil sustained at least a 14% provider shortage for the next decade. A provider type that relies on a field with a know current and projected shortage should not be implemented as it is destined to fail in satisfying workforce demands. A nay vote for HB1647 is essential since it only negative impacts virginians. HB 2391 - This bill should be supported as it directly improves access to safe and affordable anesthesia care. Over 40 states have adopted this change and experienced a positive improvement in anesthesia staffing. Anesthesia care by CRNAs without supervision has proven to be as safe as physician anesthesiologist for decades. Removal of supervision provides facilities an option to improve workforce staffing immediately. I recommend a yea vote on this bill.

Anesthesiologist Assistants (AAs) are not a comprehensive solution to the anesthesia shortage for several reasons. Firstly, AAs must operate under the medical direction of a physician anesthesiologist, which limits their availability in solo practice environments and rural areas where anesthesiologists may be in short supply and where the greatest shortage in providers may be felt. This dependence on direct supervision restricts their capacity to address gaps in care, particularly in underserved regions where immediate access to anesthesia providers is crucial. Additionally, the integration of AAs into anesthesia teams may detract from the focus on expanding the roles of Certified Registered Nurse Anesthetists (CRNAs), who can practice independently in many states. CRNAs are better equipped to fill the void in anesthesia care due to their training in managing anesthesia autonomously. Furthermore, hiring AAs could lead to a misallocation of resources, potentially stunting the growth of CRNA and physician anesthesiologist training programs. Licensing AAs will do nothing to aid in the perceived provider shortage but will hinder progress and stress the system as stated above

Good afternoon! I am writing to express my opposition to HB 1647. I am a licensed practicing certified registered nurse anesthetist in the state of Virginia. CRNAs such as myself have been providing safe anesthesia care for over a hundred years. We were actually the first providers of specialized anesthesia care, even before MD anesthesiologists. The American Society of Anesthesiology is pushing their agenda to have certified anesthesia assistants licensed in Virginia in order to insure their own future livelihood due to the fact that CRNAs are increasingly working without medical supervision provided by anesthesiologists and working directly with surgeons. This eliminates the billing and salary of the MD/DO anesthesiologist, therefore saving the insurer and patient money at no increased risk to them. Certified anesthesia assistants cannot work without MD/DO supervision and must be supervised in a lower staffing ratio than CRNAs so this will increase the cost of delivery of anesthesia care. The fact that the ASA advocates for lower staffing ratios with CAAs versus CRNAs proves they feel that they must be monitored more closely due to their inferior level of training and experience versus that of CRNAs. There have been no studies that demonstrate CRNA only anesthesia care is less safe than that delivered by an MD/DO anesthesiologist or in a care team model. CAAs cannot practice without anesthesiologist supervision while CRNAs can practice under the surgeons supervision without an MD anesthesiologist present which means the MD/DO anesthesiologists fees and salary are eliminated as a cost to the insurer and patient. As a taxpayer in this country and the state of Virginia, I am advocating for quality anesthesia care in a fiscally responsible manner. CRNAs are the answer, not a CAA and MD model of care. CAAs lack healthcare experience prior to any anesthesia training and their training is not as extensive as that of CRNAs. Administration of safe anesthetic care requires adequate training and experience. CRNAs must have critical care nursing experience as well as their bachelors degree prior to even applying to the highly competitive CRNA programs in which the CRNAs also have a doctorate degree at the completion of their program. Please vote to oppose HB 1647 and keep certified anesthesia assistants out of Virginia so we can provide the safest and most cost effective anesthesia care to your constituents. Thank you!

The shortage of anesthesia providers would be more easily solved by allowing all trained professionals to work to the top of their training/credential. AAs would not be able to work independently and have shown to be a less cost effective /efficient mode of anesthesia delivery.

Good afternoon, my name is Bridget Wolfe. I am a CRNA and veteran living/working in Virginia. I respectfully request the delegates oppose HB 1647. This legislation will not address currently workforce issues in anesthesia care in Virginia nor improve access to care. This bill does not enhance patient safety, it does not decrease health care costs, nor does it expand access to anesthesia services because of the requirement of AAs to perform under the direct supervision of a physician anesthesiologist. Additionally, this bill would be detrimental to the CRNA students from established programs at Old Dominion, VCU, and Mary Baldwin University. AAs would take away clinical training opportunities for these students and physician anesthesiology residents. AAs are required to work under the direct supervision of a physician anesthesiologist at all times, thus defeating the alleged workforce issues by impeding training opportunities. Please oppose HB1647.

Dear Delegates, Removal of supervision as proposed in HB 2391 will increase access to care for all patients! Allowing physician anesthesiologists to actually provide direct patient care instead of “supervising “ CRNAs will have a tremendous impact on decreasing the workforce shortage. Maybe the 30 percent of nurse anesthetists who are registered in Virginia and do no work here will be inclined to stay in state. Licensing another anesthesia provider who must be directly supervised by a physician anesthesiologist is not the answer to the workforce shortage. Oppose HB1647! Respectfully, Dr. Cathy A Harrison, DNAP, CRNA

I strongly oppose this bill. AA’s will not increase access but will increase costs.

I oppose HB1647. I am in full support of HB2391!

I am writing to express my strong opposition to House Bill 1647, which proposes to license Certified Anesthesiologist Assistants (CAAs) in Virginia. This legislation will not address the current workforce shortage nor improve access to anesthesia care services for Virginians. In 2017, the Board of Health Professions conducted a thorough study on the feasibility of licensing CAAs in Virginia. After a comprehensive evaluation of education, training, examination, continuing competency requirements, typical duties, functions, and workforce data, the Board unanimously concluded that CAAs do not meet the qualifications for licensure in Virginia. The study outlined six specific criteria that should be satisfied before considering CAA licensure. To date, these criteria remain unmet. Furthermore, a 2024 report from the Joint Commission on Health Care reiterated the need for a comprehensive impact study before proceeding with CAA licensure. HB 1647 is detrimental to Virginia because licensing CAAs: Does NOT enhance patient safety. Does NOT lower healthcare costs. Does NOT expand access to anesthesia services. I urge you to oppose HB 1647, a bill that fails to address the real challenges in anesthesia care access and could potentially compromise patient safety.

Please oppose this bill regarding AA licensure. It was devastating for our anesthesia department in another state to license AAs. The safety of our patients was compromised and access to care was not increased; in fact, it was decreased because AAs need a physician to medically direct care. Thank you!

As a US Navy Veteran, CRNA, I strongly urge the opposition to HB 1647. This bill would take away the ability of the Virginia SRNA schools from placing qualified RN’s in clinical rotations in Virginia Hospitals.

Hello, I am writing in opposition of HB1647. The introduction of CAAs into Virginia does not address the workplace shortage and creates competition for training sites. Virginia has multiple large CRNA programs graduating providers with doctoral degrees in the nurse anesthesia field. Trainees from other states come here for clinical training as well. The introduction of CAAs into the state would push applicants of these doctoral programs to other states without this training competition concern.

Hi my Name is Cameron Lucchesi and I am a Nurse Anesthesia student at Old Dominion University graduating this May. I am speaking in opposition to HB 1647. As you know an anesthesiologist assistant must be directly supervised by an anesthesiologist which means they cannot train CRNA students in the operating room. This will have a negative impact on the number of training slots available in Virginia for CRNA students and will force Virginia CRNA programs to find more out of state clinical sites. Traveling to distant clinical sites poses significant challenges, especially for CRNA students with families. Currently, specialty rotations require students to be away from home anywhere from 3 to 9 months per year. As a husband and parent to a 3-year-old and a 1-year-old, I have personally experienced the difficulties of being away from home for clinical rotations. With CRNA programs already being so rigorous, we should be working to support students, not adding unnecessary burdens that make training even more challenging. Thank you for your time and consideration.

Oppose HB 1647 Good morning, Madame Chair Price. Thank you for allowing me to speak with you today. My name is Meredith Joyner, and I represent the Virginia Association of Nurse Anesthetists. Licensing AAs is detrimental to CRNA training slots. The last time there was a bill to license AAs was in 2017. The Department of Health Professions conducted a thorough study. It concluded that they should not be licensed mainly because they would increase the competition for an already limited residency and clinical rotation spots for physician anesthesiologists and CRNAs. This has not changed. In fact, it is increasingly difficult. Finding adequate training sites is already a challenge in Virginia. Currently, anesthesia programs are forced to send students out of state for training. When a CAA provides anesthesia in a room, a CRNA student cannot be placed in that room. Licensing AAs will immediately impact CRNA training. In fact, one program reported that as soon as AAs showed up in DC, CRNA students were forced out of the hospital. We have spoken to the three training programs in Virginia: Mary Baldwin, Old Dominion University, and VCU. These programs send their students to seven other states to fill the training slots for their students because the slots are not available in Virginia. We are currently training over 325 CRNA students. Mary Baldwin sends 20 students to North Carolina to train annually. Old Dominion send a majority of its students to North Carolina, New Jersey, and Maryland to train. More than half of the VCU nursing students must leave Virginia to receive adequate training and complete one or more clinical rotations in DC, Kentucky, North Carolina, Ohio, Tennessee, and West Virginia. I am holding letters from recent graduates who explain the hardships that it is on their families, financially and emotionally, to train in other states. These Virginians want to stay in the state and must leave their families to get adequate training to become a CRNA. One of the rate-limiting steps for training more CRNA students is finding clinical rotation spots. One of the programs reported that the Council on Accreditation for CRNAs approved five more spots for their training program. The program director noted that they could not accept these spots because they did not have the clinical rotation slots to adequately train more students. We must address this issue before licensing a third provider.

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 HB 1647, 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.

Thank you all for hearing the testimony on behalf of a fellow Certified Anesthesiologist Assistant (CAA). Virginia would largely benefit from an addition of midlevel practitioners in the field of anesthesiology. I have worked with many anesthesiologists and CRNAs, I respect what everyone can bring to the table. With healthcare being short of staff, more support and quality care for patients is needed. We appreciate your openness and ability to hear about the great profession of CAAs.

My name is Arafat Alim and I was raised in Fairfax county pretty much my whole life. I graduated from the Case Western DC program (AA school) in 2017 and I’ve been working as C-AA for almost 8 years. I now live and work in Austin, TX and I’m very much looking forward to one day return back to my hometown in Virginia and back to my community there. This bill will allow C-AAs like myself to return to home to work in the great state of Virginia and be around my family and friends again!

Written Testimony in Support of Licensing Certified Anesthesiologist Assistants Honorable Delegates, 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, 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. Ultimately, I fell in love with the state of Virginia and all it has to offer and it lead 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 providing written testimony in strong support of HB 1647, 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. I, along with my other CAA colleagues, provide high quality and affordable, anesthesia care to our patients while working within the anesthesia care team model. 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 in the reputable Journal, Anesthesiology, 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.” 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. 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. Nicole Moore 7112 Tanworth Drive Springfield, VA 22152

Hi, My husband is stationed in Virginia and will be working for the National Guard Bureau for the remainder of his career. I currently work as an anesthesiologist assistant in the wonderful city of Saint Louis in a level 1 trauma center, however. Why? Certified anesthesiologist assistants can not work in Virginia. My story is not unique nor is it special. This is the reality of many CAAs that are forced to dedicate hours to their commute every day to cross state lines into both DC and North Carolina (or fly across the country) in order to help provide for their families while also ensuring their spouses are able to serve this nation. Our patients deserve the best anesthesia care irrespective of what state they dwell in and this too includes that of Certified Anesthesiologist Assistants, who already partake in the safe care of patients in neighboring districts and states. Sincerely, Maya Hartig, CAA

I am a Certified Anesthesiologist Assistant (CAA) with over seven years of experience providing anesthesia care in a level 1 trauma center in Washington, D.C. I fully support HB1647, which seeks to license CAAs in Virginia. I first learned about the CAA profession while shadowing an anesthesiologist at INOVA Fairfax. That experience inspired me to pursue this highly specialized field, and I am now proud to be part of an anesthesia care team model that delivers exceptional care to some of the sickest patients in the DMV. CAAs are rigorously trained, highly skilled anesthesia providers who work in collaboration with anesthesiologists to deliver safe, effective care. Numerous studies and regulatory reviews, including those conducted by the Virginia Joint Commission on Health Care (JCHC), have found no evidence questioning the safety or competence of CAAs. In fact, CAAs are recognized by Medicare, Tricare, and the VA system as trusted providers, and are licensed in 20 states and Washington, D.C. As a proud Virginia native—born and raised in Annandale, educated at Bishop Ireton High School in Alexandria, and a graduate of the University of Virginia—I have deep ties to this community. My family, my husband, and his family all reside in Northern Virginia, and I currently live in West Springfield. However, due to the lack of licensure for CAAs in Virginia, I am forced to commute into D.C. daily for work, despite my desire to serve patients in my home state. Virginia is facing a critical healthcare workforce shortage. The JCHC unanimously recommended licensure of CAAs, recognizing this step as a way to expand access to care and attract more providers to the state. HB1647 and its companion bill SB882 will not replace CRNAs or anesthesiologists but will add another skilled provider to the team, increasing patient access to anesthesia care and alleviating provider shortages. As a Virginian and dedicated healthcare professional, I urge you to support HB1647. This bill will allow me, and others like me, to contribute to Virginia’s healthcare workforce and ensure that patients receive the care they need and deserve. Thank you for considering this important step toward improving healthcare in our state.

My name is Nadia Yassawy and I am from Dumfries, Virginia and have lived in Virginia for 29 years. I attended Potomac Senior High School and George Mason University in Fairfax, Virginia for my undergraduate degree. 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 licenses 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 HB 1647 by Del. Hayes so that I can start working in my home state of Virginia to the full extent of my license.

I support HB1647. Anesthesiologist Assistants are highly skilled anesthesia providers that work in the anesthesia care team. AAs are safe and competent providers. There is no evidence that AAs are not safe. They take care of the most vulnerable populations in the trauma centers of Washington, DC. Most of the AAs currently working had to take the MCAT to enter their master’s program due to it being under medical schools and ran by Anesthesiologists. Many Virginia residents already receive care from AAs when they commute into DC. AAs will not replace CRNAs or Anesthesiologists. They are an addition to the healthcare workforce and an answer to anesthesia shortages. Please support this bill and help Virginia residents get access to the care they need and deserve.

Good evening, I am a constituent from West Springfield, I Virginia and I am writing to you to ask for your SUPPORT of HB 1647 for the licensure of Certified Anesthesiologist Assistants (CAA). My wife is a Certified Anesthesiologist Assistant and cannot return back home as their license isn’t recognized in our home state of Virginia. Mariana graduated from Fairfax county and is a Virginia native who wants work closer home! She graduated from Case Western University with a Master’s in Anesthesia to become a Certified Anesthesiologist Assistant. Mariana is a highly qualified advanced practice provider who specializes in anesthesia to ensure her patients receive high-quality and safe anesthetic care. She is trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques. She understands all the disease states, pharmacology and all other factors that can influence an anesthetic and ensure she provides high quality care to her patients. Please bring my wife’s job to Virginia by voting in SUPPORT of HB 1647. When she became a CAA, we dreamt of a simple life remaining home in Virginia where we both grew up and raising our family, but due to the legislative and political battles faced, she commutes over an hour to DC where she is certified, likely one of the most challenging places to work in the country in a level 1 trauma center. We have two little kids and one one the way and it truly would change our lives if she was given equal opportunity to work in VA - something already permitted in 20 other states. Thank you for your consideration. Please feel free to contact me if you have any questions or want to discuss this further. Adam Shoeb Adam.Shoeb@gmail.com

I have been a licensed CAA in Washington, D.C. for over four years at George Washington University Hospital. Our profession has successfully served in the Department of Anesthesiology for close to a decade, with the department continuing to expand our group due to the increasing demand for CAAs. We provide excellent anesthesia care for patients everyday. This bill should be passed in the state of Virginia to allow CAAs to continue to provide a high level of anesthesia care for patients under the supervision of anesthesiologists within the Anesthesia Care Team model.

I support this bill to help address the Anesthesia Shortage in Virginia. Certified Anesthesiologist Assistants can practice in Washington, Dc. I strongly feel an anesthesia team approach is the safest and most cost effective of providing anesthesia care for patients under the supervision of Anesthesiologist.

I support this bill.

Thank you all for hearing the testimony on behalf of a fellow Certified Anesthesiologist Assistant (CAA). Virginia would largely benefit from an addition of midlevel practitioners in the field of anesthesiology. I have worked with many anesthesiologists and CRNAs, I respect what everyone can bring to the table. With healthcare being short of staff, more support and quality care for patients is needed. We appreciate your openness and ability to hear about the great profession of CAAs.

I support this bill.

Thank you all for hearing the testimony on behalf of a fellow Certified Anesthesiologist Assistant (CAA). Virginia would largely benefit from an addition of midlevel practitioners in the field of anesthesiology. I have worked with many anesthesiologists and CRNAs, I respect what everyone can bring to the table. With healthcare being short of staff, more support and quality care for patients is needed. We appreciate your openness and ability to hear about the great profession of CAAs.

I support this bill.

Thank you all for hearing the testimony on behalf of a fellow Certified Anesthesiologist Assistant (CAA). Virginia would largely benefit from an addition of midlevel practitioners in the field of anesthesiology. I have worked with many anesthesiologists and CRNAs, I respect what everyone can bring to the table. With healthcare being short of staff, more support and quality care for patients is needed. We appreciate your openness and ability to hear about the great profession of CAAs.

Delegates, this bill will ensure manufacturers provide a mechanism for replacing or crediting expired medications. Studies suggest that the pharmaceutical industry as a average margin of 23% whereas others in the supply chain, such as independent pharmacies, have a margin of 2.3%. Retail settings are suffering which is leading to fewer personnel in those settings which is a safety risk. Additionally, medications prone to expiring are less likely to be stocked, which delays access to meds when a patient does require therapy. Please support HB2378.

I urge you to fully support HB2391 as presented by Delegate Sickles. Given the shortage of anesthesia providers here in Virginia, there is no reason to not expand the option for hospitals to staff their anesthesia departments in a way that allows budgetary flexibility while maintaining superlative care for patients. I think this is the important distinction to make here… HB 2391 provides the OPTION for CRNAs to practice to the full extent of their education and training rather than making a MANDATE that all hospitals must follow. And this is where the campaign of misinformation starts as the ASA and VSA will try to tell you that this is bad for patient care as it removes a physician anesthesiologist (MDA) from the process. They will go on to tell you that the ACT (anesthesia care team) model with physicians and CRNAs working in concert provides the safest and most cost-effective patient care. This is a disingenuous lie based on fearmongering about patient safety and a desire by the VSA to protect its perceived turf. For example… while I work now in the Veterans Health Care system where I provide independent anesthesia care and take solo call, I used to work for Carilion Clinic in Roanoke. Carilion has a large hospital in town, but also has 4 smaller, rural hospitals in the surrounding counties. The main Carilion hospital has CRNAs & MDAs working together in an ACT model under anesthesia direction. But the rural hospitals in Rocky Mount, Pearisburg, and Lexington have only CRNAs on staff working under the supervision of a non-anesthesia doctor. So, riddle me this - if the ACT model as touted by the VSA/ASA is so superior for Carilion’s patients… then why do the MDAs deem it only important at the larger urban facility and not at the smaller rural facilities? The answer lies in the realities of the payer mix. There exists a higher percentage of patients with higher paying, good insurance in Roanoke than in the rural areas so reimbursement is higher. If this issue was about the patient safety that an ACT purportedly provides, there would be MDAs in every OR in the state regardless of the reimbursement level. And this pattern is not localized to the Roanoke Valley region. Take a look across the state – or even across the country – and you will see that the predominant providers of anesthesia to large swaths of the population are CRNAs working independently under the “supervision” of a medical doctor that is, in reality, more of a de-facto system of consultation than true supervision. Furthermore, every single other advance practice nurse in the state of Virginia works in “consultation” with MDs as writ in the codes, while CRNAs continue to have “supervision” in the codes thanks to lobbying efforts of the VSA. So, all HB2391 is doing is asking that Virginia simply change the wording from “supervision” to “consultation.” This does not compel any facility that prefers to use an ACT model of anesthesia direction or supervision if they so choose. What it does, however, do is give all medical facilities in the state the ability to maintain excellent anesthetic care of their patients while proving staffing and budgetary flexibility to meet that shifting and evolving environment that health care is today. Please pass HB2391 to allow CRNAs to practice fully and independently in consultation with our physician colleagues to continue providing outstanding healthcare to all Virginians.

To provide better access to patients, I support removing supervision from this bill. CRNAs are skilled clinicians that provide top-notch care without a physician’s presence with data to support that. They are trained to work as independent providers unlike AAs or residents that need a physician with them to care for patients at critical aspects of the case.

I support!

Support allowing nurse anesthetists to practice to the full scope of practice

Greetings! I am a doctorate prepared Certified Registered Nurse Anesthesiologist and I am writing to inform you why I support HB 2391. The proven and most effective way to immediately increase the number of anesthesia providers is to opt-out of medical direction for CRNAs. This allows physician anesthesiologists and nurse anesthesiologists to cover their own rooms, instead of the unnecessary system currently in place in many institutions where there are two independently qualified anesthesia providers with the exact same scope of practice covering each case. This would provide a significant increase in anesthesia providers available immediately. Multiple studies have shown that there is no difference in safety between physician and nurse anesthesiologists, and anesthetic outcomes are essentially identical. Both provide excellent care. We could address the anesthesia provider shortage in a real and meaningful way practically overnight with HB 2391. Please vote yes on HB2391.

I am submitting this to urge each of you to support the passing of HB 2391. I am going to share the following data that I obtained from Medicaid healthcare solutions website. It does an excellent job of relaying the importance of independent CRNA practice and future projections and needs. “Certified Registered Nurse Anesthetists (CRNAs) are experiencing a surge in demand, with employment projections from the U.S. Bureau of Labor Statistics showing a 10% increase until 2033. This growth is driven by an aging population, greater emphasis on preventive care, and the unique role that CRNAs play in delivering anesthesia services, particularly in rural areas where they account for more than 80% of anesthesia providers in rural areas. Each year, CRNAs administer over 50 million anesthetics in the United States, playing a critical role in expanding access to anesthesia care. Approximately one-third of U.S. hospitals and more than two-thirds of rural hospitals rely exclusively on CRNAs for anesthesia services. This independence allows CRNAs to support a wide range of specialties, including general surgery, obstetrics, trauma, cardiac, and more. CRNAs are especially critical in serving medically underserved populations and military personnel, often working independently in rural areas where access to anesthesia care is limited. Their ability to practice independently is essential to meeting the growing demand for anesthesia services while alleviating staffing challenges in remote areas.” As the data that I shared from Medicus’s website states, CRNA’s are critical to the implementation of anesthetics administered everyday. A majority of the states in the US already have independent practicing CRNAs and Virginia is in the minority. The passing of this bill will better serve all the residents of Virginia by giving them improved and more reasonable access to anesthesia care each day. Please support the bill to allow independent. CRNA practice in Virginia. Thank you.

Support removing language for CRNAs

I am in support of removing supervision from the language for CRNAs.

I support HB 2391. Vote yes. This bill will allow CRNAs to practice to the fullest extent of their license, it will increase access to cost effective care.

I support HB 2391. Vote yes. This bill will allow CRNAs to practice to the fullest extent, it will increase access to care while promoting cost effective care.

I support this proposition.

Support HB2391

Support

Support

I support this bill. Thank you for your consideration.

I SUPPORT this bill to remove supervision for CRNAs

1.) oppose HB 1647 2.) support HB 2391

I approve this bill

CRNAs can provide safe and effective care for the population of our Commonwealth without supervision. It has worked in several other states and in our country’s military.

N/A

N/A

I oppose HB1647,HB2391

to support

HB2391 I support this bill HB1647 I oppose this bill.

I support the bill allowing CRNA to practice independently and the removal of supervision.

In the name of patient safety and healthcare accessibility, I support this bill

I support this bill

I support this bill.

I urge SUPPORT for HB 2391 - the removal of supervision requirements for CRNAs - and in doing so I would like to repeat that this bill is not about introducing new models or unproven solutions; it is about maximizing the use of a safe, reliable, and cost-effective provider group that is already an integral part of Virginia’s healthcare system.

As a CRNA, I support this bill. Removing supervision would increase access to affordable healthcare to Virginians. It would decrease healthcare costs and allows. Jan is to practice at the full scope of their licenses

HB 1647- I oppose this bill HB 2391- I support this bill

I oppose HB1647 because:CAAs do NOT improve patient safety. CAAs do NOT reduce costs.CAAs do NOT improve access to anesthesia services. I support HB2391 because this bill would empower CRNAs to practice to the full extent of their education and training, expand patient access to care, and help address Virginia’s healthcare workforce shortage.

I am in support of HB 2391. As a CRNA, this legislation will allow me to practice in various facilities where access to care has been limited to the full extent of my education and training.

I support this bill

Support House Bill 2391 to remove supervision of CRNAs in Virginia. Support of this bill expands patient access to safe, high-quality anesthesia care, particularly in rural and underserved parts of Virginia.

I support this bill.

I support this bill

On 1647 I ask you to oppose because CAA’s will not effectively address the anesthesia provider shortage. On 2391 I ask for support for removal of supervision

I’m a veteran and Certified Registered Nurse Anesthetists. I was trained to work independently and was deployed on the USS Harry S Truman as the sole Anesthesia Provider for more than 5000 sailors. I’ve also worked independently overseas and at the Naval Hospital in Portsmouth, VA. As a veteran, due to the lack of Anesthesiologists in Virginia, veterans cannot obtain necessary care at the Hampton VA Medical Center, even though all the CRNAs there have worked independently in the past. Please remove supervision for CRNAs so that we can provide the care that Virginians need and deserve. This would also reduce the shortage of Anesthesia Providers in general so that we can work alongside our fellow Anesthesiologists just as we have in military practice and numerous other states.

As a Student Registered Nurse Anesthetist studying at Mary Baldwin University, I Support the Passage of HB 2391. The passage of this bill will improve access to anesthesia care to the residents of The Commonwealth of Virginia, and keep future CRNAs like myself in the Commonwealth by allowing CRNAs to practice to the fully extent of our education and training.

As a CRNA in the commonwealth, I fully support the removal of supervision for CRNAs. We have been practicing for over 150 years providing safe, compassionate care to our patients. This provides cost effective access, especially in rural and underserved areas. Our communities will benefit from this bill. Thank you for your attention to this.

I am in support of this bill.

I support HB 2391 I oppose HB1647

Please vote yes on HB2391. This will give the CRNAs in Virginia autonomy to provide high quality anesthesia to our residents.

I support the removal of supervision

I support this bill. Please vote yes to HB 2391

Support HB 2391. Oppose HB 1647.

I support this bill

I support this bill to remove supervision of CRNA practice. I practice in a CRNA-only, critical access facility, and surgeons and practitioners rely on my expertise for airway management and peri-operative care.

Opposing this bill!

I support removal of supervision for CRNAs. I opposed licensure of CAAs.

Support HB 2391. Oppose HB 1647.

I support this bill.

Vote *YES* on 2391 to increase access to care in Virginia

I support this bill to provide more anesthesia providers in remote areas of Virginia

I support HB 2391

Strongly support. Removal of unnecessary supervision will attract more CRNAs to practice in Virginia and help improve access to care. Thank you.

I support HB 2391

As a CRNA, CAAs are an expensive way to provide anesthesia and will do little to to nothing to Allee the anesthesia shortage

Support removal of supervision (HB 2391)

I support removal of supervision and I oppose licensure of CAAs

I support this BILL!!!

I support this bill.

I support HB 2391

Support removal of supervision

Support removal of supervision. Thank you!

SUPPORT!!

I support the removal of supervision.

I an my family, all support HB 2391! Please give us access to the healthcare providers that serve the rural communities of VA!

I suppor this bill.

Support removal of supervision please

I support this bill!

Support removal of supervision

As a healthcare provider that wants to stay in Virginia, I support this bill.

I support this bill.

I am in support of this bill.

Support to remove supervision

Please SUPPORT HB 2391 to remove supervision

I support this bill. This directly affects my job and ability to provide care to the patients I serve.

I’m in SUPPORT of removal of supervision.

Support

Support this legislature

I support the removal of supervision as a future SRNA and CRNA

Support!

I support this bill.

I support this legislation.

I support this bill.

I support this bill

I fully support this bill to remove supervision. Thank you for your consideration.

I support this!

I support this Bikl

I support the removal of supervision. I am a CRNA here in the state of VA

I approve

I support HB 2391

I support this bill!

Please support!!!

I support this bill.

I support this bill.

Support

I support this bill

I support HB 2391 (Sickles) and I oppose HB 1647 (Hayes)

I support this

I support this bill

I support this bill!

I support HB 2391 and I oppose HB 1647

As an SRNA, I support this bill.

I support this bill

I support this bill.

I support the removal of supervision.

I support this bill

I support this bill.

I support this bill

Support

I support this bill

I SUPPORT THIS BILL!!!

I support this bill

Support

I support this bill.

I support this bill.

I support this bill

I support this bill

I support this bill.

I support this bill

I support this bill.

I support this bill!

I support this bill.

I support this bill

I fully support HB2391, as introduced by Delegate Sickles. This bill is essential to expanding access to high-quality, cost-effective anesthesia care in Virginia, particularly in underserved and rural areas. By removing barriers to the full practice of Nurse Anesthesiologists (CRNAs), the state can utilize an already well-established, highly trained workforce that has been safely and independently delivering anesthesia care for over a century. CRNAs are unique in their ability to work independently and without supervision, as demonstrated by extensive data and the practice models in numerous states across the country. This independence not only improves access to care but also reduces costs by eliminating the need for duplicative supervision. Unlike dependent providers, such as Anesthesiologist Assistants (AAs), CRNAs are a proven solution that is already embedded in Virginia’s healthcare infrastructure. Expanding their scope by removing barriers does not introduce a new or untested model; it simply leverages an existing, cost-effective resource. Importantly, HB2391 focuses on empowering facilities to make decisions about their anesthesia delivery models based on local needs. It ensures that decisions are not dictated by government mandates or influenced by lobbying efforts from small, niche provider groups. CRNAs have the training and experience to independently meet the demands of every community in Virginia, from urban centers to the most rural settings, without requiring additional oversight or costly dependency structures. This bill is not about introducing new models or unproven solutions; it is about maximizing the use of a safe, reliable, and cost-effective provider group that is already an integral part of Virginia’s healthcare system. CRNAs are uniquely positioned to address the anesthesia workforce needs of the state, making HB2391 a logical and practical choice to expand access to care.

I am writing to express my strong support for HB2391, which would change the language of Virginia regulations to align with what is already happening across the Commonwealth of Virginia. Certified Registered Nurse Anesthetists (CRNAs) are highly trained, skilled, and safe providers who provide anesthesia care throughout the state. This bill is about transparency for CRNAs like me who are already practicing in environments where they are "supervised" by surgeons, dentists, or podiatrists. The current language serves as a strong barrier to facilities and providers that might otherwise want to work in such arrangements but have concerns of liability stemming from the responsibility to 'supervise' an area of clinical care in which they have no training or expertise. The bill could, therefore, offer a strategy that might contribute to addressing the workforce shorter. Finally, as a full-time educator, I hear directly from CRNA trainees each year that Virginia's current regulatory and practice environment are reasons they seek employment outside of state lines. This is another way this bill could address the anesthesia workforce shortage. Please vote yes on this bill. Sincerely, Nickie Damico, PhD, CRNA

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

Support for Removing Barriers to CRNA Care I fully support HB2391, as introduced by Delegate Sickles. This bill is essential to expanding access to high-quality, cost-effective anesthesia care in Virginia, particularly in underserved and rural areas. By removing barriers to the full practice of Nurse Anesthesiologists (CRNAs), the state can utilize an already well-established, highly trained workforce that has been safely and independently delivering anesthesia care for over a century. CRNAs are unique in their ability to work independently and without supervision, as demonstrated by extensive data and the practice models in numerous states across the country. This independence not only improves access to care but also reduces costs by eliminating the need for duplicative supervision. Unlike dependent providers, such as Anesthesiologist Assistants (AAs), CRNAs are a proven solution that is already embedded in Virginia’s healthcare infrastructure. Expanding their scope by removing barriers does not introduce a new or untested model; it simply leverages an existing, cost-effective resource. Importantly, HB2391 focuses on empowering facilities to make decisions about their anesthesia delivery models based on local needs. It ensures that decisions are not dictated by government mandates or influenced by lobbying efforts from small, niche provider groups. CRNAs have the training and experience to independently meet the demands of every community in Virginia, from urban centers to the most rural settings, without requiring additional oversight or costly dependency structures. This bill is not about introducing new models or unproven solutions; it is about maximizing the use of a safe, reliable, and cost-effective provider group that is already an integral part of Virginia’s healthcare system. CRNAs are uniquely positioned to address the anesthesia workforce needs of the state, making HB2391 a logical and practical choice to expand access to care.

I am writing today to voice my strong support for HB 2391 that modernizes the language of the laws governing the practice of Certified Registered Nurse Anesthetists (CRNAs). I am a Certified Registered Nurse Anesthetist (CRNA) who practices at a small, rural hospital in Lexington, Virginia. Myself and 2 other CRNAs are the sole anesthesia providers at our hospital. Not only do we administer anesthesia for every surgery performed here, but we are also called upon to sedate patients in the emergency department, place emergency lines in the ICU, and many other duties. We are the only professionals in the building who are trained in anesthesia. Our amazing surgeons, hospitalists, and emergency room physicians are experts in their respective fields; however, they have not studied nor have they ever practiced anesthesia. Yet, because of statutes in Virginia they are “supervising” our practice. This makes absolutely no sense. Furthermore, the physicians supervising us generally have no input into my anesthetic care, as it is not their specialty. The reality is that they are supervising in name only and there is no real utility to these requirements. Even worse we are the only Advanced Practice Registered Nurses in Virginia that have these archaic requirements. In fact, the entire country is moving away from requiring supervision of CRNAs. Virginia is one of the few states left with these laws. HB 2391 will remove practice barriers and improve access to care for patients in Virginia. Jessica Ray DNP, CRNA

Support for Removing Barriers to CRNA Care I fully support HB2391, as introduced by Delegate Sickles. This bill is essential to expanding access to high-quality, cost-effective anesthesia care in Virginia, particularly in underserved and rural areas. By removing barriers to the full practice of Nurse Anesthesiologists (CRNAs), the state can utilize an already well-established, highly trained workforce that has been safely and independently delivering anesthesia care for over a century. CRNAs are unique in their ability to work independently and without supervision, as demonstrated by extensive data and the practice models in numerous states across the country. This independence not only improves access to care but also reduces costs by eliminating the need for duplicative supervision. Unlike dependent providers, such as Anesthesiologist Assistants (AAs), CRNAs are a proven solution that is already embedded in Virginia’s healthcare infrastructure. Expanding their scope by removing barriers does not introduce a new or untested model; it simply leverages an existing, cost-effective resource. Importantly, HB2391 focuses on empowering facilities to make decisions about their anesthesia delivery models based on local needs. It ensures that decisions are not dictated by government mandates or influenced by lobbying efforts from small, niche provider groups. CRNAs have the training and experience to independently meet the demands of every community in Virginia, from urban centers to the most rural settings, without requiring additional oversight or costly dependency structures. This bill is not about introducing new models or unproven solutions; it is about maximizing the use of a safe, reliable, and cost-effective provider group that is already an integral part of Virginia’s healthcare system. CRNAs are uniquely positioned to address the anesthesia workforce needs of the state, making HB2391 a logical and practical choice to expand access to care.

As an experienced Certified Registered Nurse Anesthetist (CRNA) and nurse anesthesia educator, I strongly support HB2391. This bill represents a critical step forward in improving access to safe, cost-effective anesthesia care across Virginia. CRNAs are highly trained, autonomous providers who deliver high-quality anesthesia care with or without physician oversight. We are the backbone of anesthesia services, particularly in rural and underserved areas where physician anesthesiologists may not be readily available. Unlike dependent providers, CRNAs are educated to make independent clinical decisions, ensuring timely, efficient, and safe patient care. HB2391 supports expanding CRNA practice to the full extent of our education and training. This not only improves patient access to care but also addresses the anesthesia workforce shortage more effectively than any other proposed solution. With over 2,300 CRNAs currently practicing in Virginia and hundreds of new graduates entering the workforce annually from our state’s three top-tier nurse anesthesia programs, CRNAs are well-positioned to meet the growing demand for anesthesia services. Moreover, CRNAs are cost-effective providers. The most efficient anesthesia delivery model is one where CRNAs practice autonomously, reducing the need for costly supervision without compromising patient safety. Numerous studies have shown that CRNAs provide care with outcomes comparable to those of physician anesthesiologists, making us both a safe and financially responsible choice for healthcare systems. As a CRNA who also educates future anesthesia providers, I see firsthand the rigorous training our students undergo—thousands of hours of clinical experience and years of critical care nursing before even entering anesthesia school. This depth of knowledge and skill ensures CRNAs are fully prepared to manage complex patient cases independently. HB2391 is a win for patients, healthcare systems, and Virginia’s workforce. It empowers CRNAs to practice at the top of our license, improves access to anesthesia care, reduces healthcare costs, and strengthens the healthcare workforce across the Commonwealth. I urge legislators to support HB2391 for the health and well-being of all Virginians.

Dear Delegates: As a Certified Registered Nurse Anesthetist (CRNA) with extensive clinical experience, I am writing to express my strong support for House Bill 2391, which would remove the current requirement for physician supervision in anesthesia care. CRNAs are highly trained advanced practice nurses who complete rigorous educational programs and thousands of hours of clinical training. We have been providing safe, high-quality anesthesia care to patients for over 150 years. Research has consistently shown that CRNAs provide anesthesia care that is just as safe and effective as physician anesthesiologists, with comparable patient outcomes. HB 2391 would modernize Virginia's healthcare laws to align with the evolving healthcare landscape and the growing need for accessible, cost-effective care. This bill would particularly benefit rural and underserved communities where healthcare provider shortages are most acute. By allowing CRNAs to practice to the full extent of their education and training, we can improve access to essential surgical and anesthesia services in these areas. The current supervision requirement creates unnecessary administrative barriers without improving patient care. Many states have already removed such requirements, and studies have shown no decrease in quality or safety of care. In fact, during the COVID-19 pandemic, Virginia temporarily waived these requirements, demonstrating that CRNAs can safely provide independent care when needed. I urge you to support HB 2391 to improve healthcare access and allow qualified CRNAs to practice to the full extent of their training. I would be happy to provide additional information or discuss this matter further.

Support for Removing Barriers to CRNA Care I fully support HB2391, as introduced by Delegate Sickles. This bill is essential to expanding access to high-quality, cost-effective anesthesia care in Virginia, particularly in underserved and rural areas. By removing barriers to the full practice of Nurse Anesthesiologists (CRNAs), the state can utilize an already well-established, highly trained workforce that has been safely and independently delivering anesthesia care for over a century. CRNAs are unique in their ability to work independently and without supervision, as demonstrated by extensive data and the practice models in numerous states across the country. This independence not only improves access to care but also reduces costs by eliminating the need for duplicative supervision. Unlike dependent providers, such as Anesthesiologist Assistants (AAs), CRNAs are a proven solution that is already embedded in Virginia’s healthcare infrastructure. Expanding their scope by removing barriers does not introduce a new or untested model; it simply leverages an existing, cost-effective resource. Importantly, HB2391 focuses on empowering facilities to make decisions about their anesthesia delivery models based on local needs. It ensures that decisions are not dictated by government mandates or influenced by lobbying efforts from small, niche provider groups. CRNAs have the training and experience to independently meet the demands of every community in Virginia, from urban centers to the most rural settings, without requiring additional oversight or costly dependency structures. This bill is not about introducing new models or unproven solutions; it is about maximizing the use of a safe, reliable, and cost-effective provider group that is already an integral part of Virginia’s healthcare system. CRNAs are uniquely positioned to address the anesthesia workforce needs of the state, making HB2391 a logical and practical choice to expand access to care.

GREAT IDEA! With soaring costs of healthcare today, this is an excellent decision to support as it removes unnecessary expenditures without any compromise in safety. CRNA's train for 3 years to be independent practitioners capable of providing anesthesia for all types of procedures, so why does Virginia require them to be supervised? States nearby are not doing this. My fear is that this will prove an attractive option for graduating students to take jobs elsewhere, exacerbating healthcare inequities around the state. Physician anesthesiologists want a controlling market share & this greed is at the expense of patients.

I fully support HB2391, as introduced by Delegate Sickles. This bill is essential to expanding access to high-quality, cost-effective anesthesia care in Virginia, particularly in underserved and rural areas. By removing barriers to the full practice of Nurse Anesthesiologists (CRNAs), the state can utilize an already well-established, highly trained workforce that has been safely and independently delivering anesthesia care for over a century. CRNAs are unique in their ability to work independently and without supervision, as demonstrated by extensive data and the practice models in numerous states across the country. This independence not only improves access to care but also reduces costs by eliminating the need for duplicative supervision. Unlike dependent providers, such as Anesthesiologist Assistants (AAs), CRNAs are a proven solution that is already embedded in Virginia’s healthcare infrastructure. Expanding their scope by removing barriers does not introduce a new or untested model; it simply leverages an existing, cost-effective resource. Importantly, HB2391 focuses on empowering facilities to make decisions about their anesthesia delivery models based on local needs. It ensures that decisions are not dictated by government mandates or influenced by lobbying efforts from small, niche provider groups. CRNAs have the training and experience to independently meet the demands of every community in Virginia, from urban centers to the most rural settings, without requiring additional oversight or costly dependency structures. This bill is not about introducing new models or unproven solutions; it is about maximizing the use of a safe, reliable, and cost-effective provider group that is already an integral part of Virginia’s healthcare system. CRNAs are uniquely positioned to address the anesthesia workforce needs of the state, making HB2391 a logical and practical choice to expand access to care.

Please oppose HB 1647. We admittedly have an anesthesia provider shortage but bringing CAAs into the state will not solve the shortage, it will only intensify it. They require more supervision & have less training than the other two types of providers in this state, Anesthesiologists & Certified Registered Nurse Anesthetists, who, can both practice independently. Please support HB 2391 which lets CRNAs practices to the fullest scope of their license & will help alleviate our workforce shortage. The current language that governs the practice of CRNAs in Virginia is neither modern nor efficient. Under current law, supervision means that a medical doctor, podiatrist, or dentist must supervise a CRNA, yet these supervisors are not necessarily experts in anesthesia. It does not make practical sense to ask a surgeon to “supervise” another provider who is an expert in a different field. This supervision is in name only. We should remove it. Consultation is a much more appropriate definition of what is occurring on a daily basis in medical facilities all over the commonwealth. As to the question of efficiency or better yet, cost effectiveness, supervision is duplicative. In the case of an Anesthesiologist supervising a CRNA, two experts in anesthesia are being paid to take care of a patient when only one is necessary. Thank you.

Support for Removing Barriers to CRNA Care I fully support HB2391, as introduced by Delegate Sickles. This bill is essential to expanding access to high-quality, cost-effective anesthesia care in Virginia, particularly in underserved and rural areas. By removing barriers to the full practice of Nurse Anesthesiologists (CRNAs), the state can utilize an already well-established, highly trained workforce that has been safely and independently delivering anesthesia care for over a century. CRNAs are unique in their ability to work independently and without supervision, as demonstrated by extensive data and the practice models in numerous states across the country. This independence not only improves access to care but also reduces costs by eliminating the need for duplicative supervision. Unlike dependent providers, such as Anesthesiologist Assistants (AAs), CRNAs are a proven solution that is already embedded in Virginia’s healthcare infrastructure. Expanding their scope by removing barriers does not introduce a new or untested model; it simply leverages an existing, cost-effective resource. Importantly, HB2391 focuses on empowering facilities to make decisions about their anesthesia delivery models based on local needs. It ensures that decisions are not dictated by government mandates or influenced by lobbying efforts from small, niche provider groups. CRNAs have the training and experience to independently meet the demands of every community in Virginia, from urban centers to the most rural settings, without requiring additional oversight or costly dependency structures. This bill is not about introducing new models or unproven solutions; it is about maximizing the use of a safe, reliable, and cost-effective provider group that is already an integral part of Virginia’s healthcare system. CRNAs are uniquely positioned to address the anesthesia workforce needs of the state, making HB2391 a logical and practical choice to expand access to care.

Support for Removing Barriers to CRNA Care I fully support HB2391, as introduced by Delegate Sickles. This bill is essential to expanding access to high-quality, cost-effective anesthesia care in Virginia, particularly in underserved and rural areas. By removing barriers to the full practice of Nurse Anesthesiologists (CRNAs), the state can utilize an already well-established, highly trained workforce that has been safely and independently delivering anesthesia care for over a century. CRNAs are unique in their ability to work independently and without supervision, as demonstrated by extensive data and the practice models in numerous states across the country. This independence not only improves access to care but also reduces costs by eliminating the need for duplicative supervision. Unlike dependent providers, such as Anesthesiologist Assistants (AAs), CRNAs are a proven solution that is already embedded in Virginia’s healthcare infrastructure. Expanding their scope by removing barriers does not introduce a new or untested model; it simply leverages an existing, cost-effective resource. Importantly, HB2391 focuses on empowering facilities to make decisions about their anesthesia delivery models based on local needs. It ensures that decisions are not dictated by government mandates or influenced by lobbying efforts from small, niche provider groups. CRNAs have the training and experience to independently meet the demands of every community in Virginia, from urban centers to the most rural settings, without requiring additional oversight or costly dependency structures. This bill is not about introducing new models or unproven solutions; it is about maximizing the use of a safe, reliable, and cost-effective provider group that is already an integral part of Virginia’s healthcare system. CRNAs are uniquely positioned to address the anesthesia workforce needs of the state, making HB2391 a logical and practical choice to expand access to care.

I strongly oppose HB1647, as written and introduced by Delegate Hayes. This bill does not serve the best interests of Virginia or its residents. Authorizing and funding the implementation of Anesthesiologist Assistants (AAs), a provider group with fewer than 4,000 practitioners nationwide, is not a practical solution when compared to the existing workforce of over 73,000 Nurse Anesthesiologists (CRNAs) and 55,000 Physician Anesthesiologists (MDAs). AAs represent a mere 3% of the anesthesia profession and are dependent providers by definition—highlighted by the inclusion of “assistant” in their title. Instead of introducing a new and limited provider group, Virginia should focus on leveraging the providers already available within the state. For example, HB2391, introduced by Delegate Sickles, aims to eliminate barriers to practice for CRNAs, a proven solution that increases access to care, particularly in underserved areas. In contrast, HB1647 primarily serves the interests of the physician anesthesiologist lobby by providing an anti-competitive advantage, rather than addressing genuine healthcare needs. If the goal is truly to expand access to care and provide jobs for AAs, then fairness would dictate that CRNAs, who are already independently capable, should also be permitted to supervise AAs. This would align with the broader goal of addressing access to care where it is most needed, particularly in rural and underserved areas—locations where CRNAs already fill critical gaps in the healthcare system, far more effectively than MDAs. The reality is that HB1647 has little to do with improving access, reducing costs, or benefiting patients. Instead, it centers on maintaining control and protecting the financial interests of the physician anesthesiologist lobby. If we truly prioritize the healthcare needs of Virginians, the focus should be on removing barriers for CRNAs, not introducing a small, dependent, and costly provider group.

I am writing to support HB2391 & oppose HB1647. HB2391 allows Certified Registered Nurse Anesthetists (CRNAs) to practice independently, crucial for addressing healthcare workforce shortages in VA, especially in rural & underserved areas. This bill aligns with the VA Health Workforce Development Authority's (VHWDA) goals of addressing workforce shortages & supporting scope of practice changes. CRNAs, with proven training & experience, can immediately fill the gap, unlike Certified Anesthesiologist Assistants (CAAs), who require physician supervision & have no existing infrastructure in VA. Implementing HB1647, focusing on CAAs, diverts resources from effective solutions like CRNA autonomy. CAAs require direct supervision from Physician Anesthesiologists, who are already scarce in underserved areas. Establishing CAA licensure & regulatory frameworks demands significant investment & will delay addressing the urgent workforce shortages. In contrast, CRNAs already provide safe, high-quality, independent anesthesia care in 30+ states, represent >80% of anesthesia providers in rural areas, & reduce costs by eliminating the need for multiple providers. Although CAAs may contribute to anesthesia care delivery, there is insufficient evidence to conclusively state their presence has significantly reduced anesthesia provider shortages in states where they have long been authorized to practice. The further introduction of CAAs also will not address or aid in the projected shortage of Physician Anesthesiologists. In fact, the shortage of Physician Anesthesiologists alone is a massive barrier to support the claim of CAAs being the answer to this current shortage. Investing in CRNA autonomy is a more efficient use of resources, ensuring immediate impact on healthcare shortages & expanding access in underserved regions. HB2391 offers a proven, cost-effective solution, expanding CRNA capacity to immediately improve access & reduce costs, aligning with VHWDA's objectives. Conversely, HB1647 proposes a resource-intensive, long-term approach with little immediate benefit. VA should leverage its existing CRNA workforce rather than invest in CAAs, which would create redundancy & require significant resources for implementation. Supporting HB2391 promotes efficient use of resources & enhances healthcare access, addressing shortages effectively & promptly. From a cost-effectiveness perspective, HB2391 is superior as it leverages existing CRNA resources without requiring additional spending on new infrastructure or training programs. CRNAs practicing independently reduces the need for dual staffing, thereby immediately cutting healthcare costs for both hospitals & patients. Elimination of supervision requirements translates to direct financial savings & more efficient use of healthcare resources. This immediacy in implementing HB2391 ensures that VA can address current workforce shortages without delay, maximizing effectiveness of its budget & providing quicker access to necessary anesthesia services in underserved regions. HB2391 will significantly impact patient care in Virginia by enabling CRNAs to operate autonomously. This model speeds up anesthesia services, reduces delays, & enhances care quality & safety, especially in remote areas. By expanding skilled anesthesia care, the bill improves health outcomes & makes healthcare more accessible & equitable for all Virginia residents.

Dear Sir or Madam, I am writing in support of HB2391, which would remove supervision language from the regulations governing Certified Registered Nurse Anesthesia (CRNA) practice. I have received care from CRNAs multiple times in settings that only have CRNAs for anesthesia care. I have received excellent, professional care in all of these situations from CRNAs. They do not need supervision to provide anesthesia care. If we had all CRNAs working and all physicians who give anesthesia actually doing it, we would have plenty of anesthesia providers in this state.

Dear Delegates, I am a Certified Registered Nurse Anesthetist (CRNA) practicing in Southwest Virginia for over 20 years; 30+ years in practice total. I have practiced in the military, trauma centers, and single-OR facilities during my career, both with and without physician anesthesia. I urge you to support HB2391, Removal of Supervision for Certified Registered Nurse Anesthetists, I practice in three CRNA-only hospitals in rural SW Virginia. At these facilities, CRNAs are the only anesthesia providers, in part due to the rural location, the surgical case type and volume, and the poor payor mix. The CRNAs who practice in these locations work with surgeons in a manner that is consultation, versus “supervision”. Virginia is one of a handful of states that still has archaic supervision language, which leads to a perception of liability for the CRNA actions when working with a surgeon in these CRNA-only settings. This perception can lead to difficulty recruiting additional surgeons to these vitally important rural facilities. Our relationship with surgeons/proceduralists is of a consultative manner. For example, this week I had a patient who presented to surgery whom I found to be in a new-onset atrial fibrillation when I performed the pre-anesthesia assessment. I informed the surgeon of this new condition, consulted with the cardiologist at the facility to determine the safety of proceeding with the elective surgery. Additionally, I educated the patient and his wife in his risk of stroke and symptoms of a stroke. The patient was seen by cardiology, found to be low risk to continue with anesthesia and also prescribed blood thinners for postoperative treatment. I was the person responsible for this patient’s referral and anesthesia care. The surgeon deferred to my plan and the specialist’s recommendation to proceed. This situation is a common example of our relationship with the surgeons which are “:supervising” our practice. The surgeons expect us to be the anesthesia experts and they trust our training and experience to keep their patients safe under anesthesia. We have an anesthesia provider shortage in this country, in part due to the unnecessary supervision language found in some states, and even more healthcare facilities. If each anesthesia provider practiced to their full scope and training, we would have many more patients who could receive anesthesia care than what we see today. CRNAS have the experience, training, and education to provide anesthesia care in a consultative role. We have the most training of any advanced practice nurse and have been administering anesthesia for over 170 years in the United States. Let’s support this bill and remove the word “supervision” from our regulations governing CRNA practice. Thank you, Maria Hirsch, DNAP, CRNA, FAANA Roanoke, VA

I am writing in opposition to HB 1647 and support of HB2391. HB1647 - This bill is unnecessary and does not truly help facilitate improvement in the anesthesia workforce shortage. There are two issues the CAA provider type creates. First, for ever OR a CAA occupies, it creates one less training slot for Nurse Anesthesiology Residents. CAAs do not meet the training requirements necessary for Nurse Anesthesiology Residents and cannot offer training support for these providers. This is clearly outlined in the Council on Accreditation requirements for Nurse Anesthesia education and training. Secondly, every facility in other states that have introduced CAAs have experienced significant attrition of CRNAs due to the imbalance of workload. CAAs are limited in their scope of practice and cannot provide full coverage of all of anesthesia services. These services include obstetrics, pain management, and line placement in many states. The facilities often experience a greater loss of providers then they are able to attract with the legislative change. These unintended consequences are severe and not clearly disclosed to members of the committee. The HRSA workforce data is clear - physician Anesthesiologist wil sustained at least a 14% provider shortage for the next decade. A provider type that relies on a field with a know current and projected shortage should not be implemented as it is destined to fail in satisfying workforce demands. A nay vote for HB1647 is essential since it only negative impacts virginians. HB 2391 - This bill should be supported as it directly improves access to safe and affordable anesthesia care. Over 40 states have adopted this change and experienced a positive improvement in anesthesia staffing. Anesthesia care by CRNAs without supervision has proven to be as safe as physician anesthesiologist for decades. Removal of supervision provides facilities an option to improve workforce staffing immediately. I recommend a yea vote on this bill.

Removing outdated and unnecessary supervision requirements for Certified Registered Nurse Anesthetists (CRNAs) is crucial for addressing the provider shortage in anesthesia care. These supervision regulations often limit CRNAs’ ability to practice to the full extent of their training and expertise, creating barriers to accessibility in regions that need them the most, particularly in rural and underserved areas. By granting CRNAs the autonomy to manage anesthesia care independently as they are trained to do, healthcare systems can significantly increase the availability of qualified providers, enabling them to respond more effectively to patient needs. Independent practice also allows CRNAs to fill gaps in care without being constrained by the presence of a supervising physician. This shift could alleviate the burden on anesthesiologists, allowing them to provide anesthesia care as well. Furthermore, allowing CRNAs' to perform at the full scope of their licensure and practice could lead to better integration of anesthesia services within healthcare teams, optimizing outcomes and improving patient access to care. Ultimately, eliminating unnecessary supervision not only empowers Healthcare facilities but also strengthens the overall anesthesia workforce, making significant strides toward solving the provider shortage crisis.

Good afternoon! I am writing to express my support of HB 2391 which will remove supervision requirements for certified registered nurse anesthetists (CRNA). I am a licensed, practicing CRNA in Virginia and have been a Virginia resident for my entire life. I became a registered nurse in 1995 and began working in critical care at that time and worked as a critical care RN for 20 years prior to going back to school to become a CRNA. I had extensive experience in critical care in a few different ICUs including those of large teaching hospitals. That experience was invaluable in my CRNA training program. My CRNA program training was extensive and in depth focused specifically on providing research based safe anesthesia care. My program was 28 months long and very intensive. It was the most challenging endeavor I have undertaken in my life thus far. As difficult and intense as it was, I wouldn’t change it at all as I felt well prepared to go out and deliver safe, cost effective anesthesia care for the past 10 years and counting. CRNAs deliver safe anesthesia care and when we work without supervision, we are delivering it in a much more cost effective manner as there is not the increased cost to the patient or insurer for the services of an MD/DO for supervision. There has never been a study that demonstrated that supervised anesthesia care is safer than that of CRNA only delivered anesthesia care while it is definitely more cost effective. CRNAs are the first providers of specialized anesthesia care going as far back as the Civil War. We were providing this care way before physician anesthesiologists. As a taxpayer in this country and the state of Virginia, I want my healthcare tax dollars to be spent in a fiscally responsible manner. Removing the supervision requirement for CRNAs provides this cost effectiveness as no increased risk to the patients. I support HB 2391 and am asking for your support as well. Thank you!

Dear Delegates, Removal of supervision as proposed in HB 2391 will increase access to care for all patients! Allowing physician anesthesiologists to actually provide direct patient care instead of “supervising “ CRNAs will have a tremendous impact on decreasing the workforce shortage. Maybe the 30 percent of nurse anesthetists who are registered in Virginia and do no work here will be inclined to stay in state. Licensing another anesthesia provider who must be directly supervised by a physician anesthesiologist is not the answer to the workforce shortage. Oppose HB1647! Respectfully, Dr. Cathy A Harrison, DNAP, CRNA

Dear Delegates, As a CRNA who has cared for patients in the Commonwealth of Virginia for 47 years, I urge you to support HB1647 and oppose SB 2391. It is time for our state to move into the 21st century and embrace the efficiency driven model of anesthesia care. If every licensed anesthesia provider in the state provided direct patient care, the workforce shortage would be solved. Licensing AAs is burdensome and they can only be supervised by physician anesthesiologists. They aren’t the solution! Respectfully, Dr. Cathy A Harrison, DNAP, CRNA

I oppose HB1647. I am in full support of HB2391!

As a Certified Registered Nurse Anesthetist (CRNA) practicing in Virginia, I am writing to support House Bill 2391. This vital legislation will empower CRNAs to practice to the full extent of their comprehensive education and training, significantly expanding patient access to safe, high-quality anesthesia care and helping to alleviate Virginia's healthcare workforce shortage.

My name is Bridget Wolfe. I am a CRNA and veteran living in Warrenton, Virginia and working in the community hospital (Fauquier Health). I respectfully request your support for HB2391. Support of this bill enhances access to care for Virginians. It would allow CRNAs to practice in more autonomously which can increase the availability of anesthesia services where there may be a shortage of physicians. Reducing supervision requirements may lower healthcare costs by enabling CRNAs to provide anesthesia services independently potentially decreasing the financial burden on healthcare systems and patients. CRNAs are well educated and highly trained professionals capable of delivering safe and effective anesthesia care. Studies have shown that anesthesia care provided by CRNAs is comparable in quality and safety to that provided by physician anesthesiologists. This bill acknowledges the expertise and capabilities of CRNAs, recognizing their critical role in patient care. The Virginia Association of Nurse Anesthetists support HB2391 emphasizing that it maintains the collaborative relationship between CRNAs and physicians while enhancing the efficiency of anesthesia delivery in the Commonwealth. Support of HB2391 can contribute to a more flexible, efficient and accessible healthcare system in Virginia.

Huge supporter of HB2391. This simply makes sense for the patients of Virginia!

As a US Navy Veteran, CRNA, and business owner, I urge those to support HB 2391. This bill eliminates the word supervision to accurately describe the CRNA role in Virginia. CRNA’s provide anesthesia services safely and where physician anesthesiologists aren’t available.

I am writing in favor of HB2391. Certified Registered Nurses Anesthetists provide safe and competent care to patients with a track record of over 50 million anesthetics a year. They are integral to reaching our rural populations and increasing access to safe anesthesia care.

Please see the attached.

Good morning, Madame Chair Price. Thank you for allowing me to speak today. My name is Meredith Joyner, and I am a long-standing CRNA in Virginia. I represent the Virginia Association of Nurse Anesthetists. This bill language successfully passed the House in 2024 and was sent to the JCHC for a study. The JCHC studied anesthesia services in Virginia, and the information in the report was favorable for eliminating barriers for CRNAs. Virginia is one of the few states that still uses the word supervision. Forty-three do not use it. The Virginia Department of Health Professions found that Virginia is an anomaly compared to other states. This bill is about updating the code to match what is happening in Virginia facilities. There are hospitals and facilities throughout Virginia where CRNAs are the only anesthesia providers. We CONSULT daily with our physician colleagues. This bill is not about scope of practice, as the JCHC reported that a CRNA's scope of practice aligns with that of a physician anesthesiologist. We are trained to perform the same procedures and techniques. The report found no safety difference between the care provided by a physician anesthesiologist and a CRNA. This bill is about recognizing the 2300 Virginia CRNAs as anesthesia experts. This bill is about removing the word supervision. It is the first step to opt out of federal supervision requirements like 25 other states. Virginia CRNAs are safe, cost-effective providers and should be recognized as an anesthesia experts. The word supervision is a barrier to this recognition. The correct word is consultation. I have letters from over 30 physicians and dentists who practice daily with CRNAs who agree this term is outdated and needs to be updated. Today you will hear from two surgeons who work daily with CRNAs, who agree supervision is outdated. We have an educator who will speak to the effects of this word on job selection for the students. The students want to work where there are no barriers to practice. And you will hear from a CRNA who is at a Virginia hospital where CRNAs are the only ane anesthesia providers. I appreciate you allowing me to speak today and I’m happy to answer any questions. “The following key excerpts from the JCHC report are critical to understanding the value CRNAs bring to addressing patient needs in Virginia as anesthesia experts: Literature suggests there is no difference in patient safety or patient outcomes with CRNAs compared to anesthesiologists. Stakeholders agreed that both anesthesiologists and CRNAs provide safe, effective, and high-quality anesthesia services to patients after completing thousands of hours of education and training. Stakeholders agree that more restrictive supervision requirements for CRNAs would be detrimental to efforts to address anesthesia workforce shortages, particularly for remote or rural facilities in Virginia which use proceduralists as CRNA supervisors and may not have physician anesthesiologists on staff. Evidence indicates that less restrictive CRNA supervision requirements present a low risk of harm to patients and a possible benefit to the anesthesia workforce. Stakeholders interviewed nearly unanimously supported increasing the capacity of Virginia’s physician anesthesiology residency programs and CRNA doctoral training programs as a strategy to address provider shortages.

Thank you all for hearing the testimony on behalf of a fellow Certified Anesthesiologist Assistant (CAA). Virginia would largely benefit from an addition of midlevel practitioners in the field of anesthesiology. I have worked with many anesthesiologists and CRNAs, I respect what everyone can bring to the table. With healthcare being short of staff, more support and quality care for patients is needed. We appreciate your openness and ability to hear about the great profession of CAAs.

Comments Document

I have attached written comments in opposition to HB 2391.

Hello, I am Stephanie Hagmaier, a nurse anesthestist. Over the past eight years, I’ve partnered with the state of Virginia to provide safe, office based sedation for special needs adults, even traveling to them if necessary. Whereas the alternatives are physical restraint or an absence of dental care entirely, we see first-hand, and hear continuously from family and caregivers, the significant difference that our approach makes for these individuals. Despite our success, Virginia law continues to overly and unnecessarily restrict our scope of practice. These restrictions affect all Virginians but especially my patients and their caregivers. The “supervision” that is provided is largely an artificial ideation applied to protect special-interest profits. It is in no way clinically based. In my practice, I am the airway and anesthesia expert. The notion that my “supervising” dentist would substitute their clinical judgment for mine is not only unrealistic in practice but also incredibly dangerous for our patients. The CRNA “supervision” requirement is a barrier to care for all Virginians especially the underserved, impoverished individuals and communities in our state and should be removed from the law. CRNAs should be empowered to provide all necessary care within the scope of their training and practice regulations. Sincerely, Stephanie Hagmaier, CRNA

Please Vote YES on HB2391. This bill is important for the expansion of DBHDS dental care to homebound families that receive the Medicaid Waiver. IF we don't have the ability to sedate disabled individuals safely in their homes for access to dental care in the home, then they will never be able to receive this important healthcare benefit. The pushback on this is strictly "turf" protection by other professionals. However, the same professionals trying to stop this for Certified Nurse Anesthetists are not willing to be the ones to make house calls or volunteer their time to provide these important services. Certified Nurse Anesthetists are the only Nurse Practitioner category without the ability to practice without direct and present supervision. These providers are highly skilled and trained and should be able to practice so that we can ensure this important service can be provided to home-bound Medicaid recipients. This was promised by Virginia under the DOJ permanent injunction. I have personal experience with the importance of this access for a disabled loved one. Dental care in-home services must be able to be expanded and this is a first step. VOTE YES on HB2391

I support this bill.

Thank you all for hearing the testimony on behalf of a fellow Certified Anesthesiologist Assistant (CAA). Virginia would largely benefit from an addition of midlevel practitioners in the field of anesthesiology. I have worked with many anesthesiologists and CRNAs, I respect what everyone can bring to the table. With healthcare being short of staff, more support and quality care for patients is needed. We appreciate your openness and ability to hear about the great profession of CAAs.

I support this bill.

I'm writing to oppose HB2605, the Medical Conscience Protection Act. The medical profession includes a sworn oath to heal and help people, and this should be without exception. It is unjust and cruel to place the opinions of the health care professional above the needs of the patient. Survival and wellbeing goes beyond personal beliefs. This bill is not, as it attempts to be framed, in support of ethics, but in fact would create unethical and deadly situations. Denial of health care is a deliberate and immoral choice to endanger a patient. This simply should not be allowed when lives are at stake. I ask that the committee truly considers the impact such a bill could have, and recognizes that it is unjust and should not pass.

In my opinion, HB 2605 could charitably described as poorly considered. The patient's right to receive medical treatment should always be considered to "trump" the doctor's (personal, political, or religious) misgivings. Otherwise, you run into absurdities. Christian Scientists lack belief in the efficacy of medical treatment. Should doctors of that denomination should therefore be allowed to simply hand their patients a copy of "Science and Health with Key to the Scriptures" and tell them to pray their problems away? Of course not. Neither should this bill allow doctors to deny their patients care consistent with best practices, no matter how politically controversial such care may be. One can also consider the bill from the perspective of possible fraud. When you agree to become someone's doctor, you agree to give care in accordance with the best possible medical practices. This bill would allow doctors to break this compact under purely arbitrary criteria! Imagine, if you will, a dishonest doctor which takes the money of patients, but finds a "moral objection" to virtually any medical care or procedure that they find overly taxing. This is the sort of scenario that this bill allows. I trust that I have alerted the reader to the dangers of this bill and some of the reasons why it cannot be allowed to pass.

Thank you all for hearing the testimony on behalf of a fellow Certified Anesthesiologist Assistant (CAA). Virginia would largely benefit from an addition of midlevel practitioners in the field of anesthesiology. I have worked with many anesthesiologists and CRNAs, I respect what everyone can bring to the table. With healthcare being short of staff, more support and quality care for patients is needed. We appreciate your openness and ability to hear about the great profession of CAAs.

This is my full presentation which I couldn’t complete this morning at the subcommittee meeting chaired by Delegate Price: I’m Scott Armistead, a family doctor from Richmond, who served an underserved population in Pakistan for 16 years. When I returned to Richmond, I found some things had changed in my profession. Doctors were encouraging their children not to go into medicine, people were leaving the work force, and there was a significant shortages of primary care physicians. I noticed the burgeoning problem of physician burnout, more properly understood as moral injury. While there are many causes, I think one reason for this burnout is violation of conscience. To illustrate I would like to share my own story. Upon returning to Richmond I worked in primary care for the underserved, and with refugees and immigrants from all over the world. In 2019, after the introduction of a general intake form for all new patients which went into great detail about with whom (male, female, trangender male, transgender female) and in what form – oral, anal, vaginal – one was sexually active, I, knowing how many of my patients from honor/shame cultures might be offended I questioned the clinic leadership about the cultural competency of this explicit form. Then, when some of my medical students told me they were being instructed to introduce themselves with their pronouns when talking to patients and ask how the patients would like to be identified, I questioned this new patient interview policy, as a matter of cultural competency and forced speech. When I questioned the use of this language that could be insensitive to patients and the consciences of students, I got in trouble and was forbidden from working with medical students in the clinic. My contract was not renewed. As one working with medical students all the time, I have become very concerned about the future of my profession, whether these future physicians will be allowed to flourish in an environment that welcomes a plurality of voices and in which they can practice according to their deeply-held, conscience-informed beliefs.

The bill is poorly written and puts medical providers who are sworn to do no harm into the position of policing and putting those patients in critical physical care into legal jeopardy. It undermines the critical trust needed between the medical profession and patients jeopardizing that long standing trust with negative results for healthcare. As a woman, I find it particularly concerning to create such a negative impact on trust of healthcare providers.

I oppose HB2605 as I believe that individuals have a right to expect their health care follow standardized best known practices and treatment rather than be up to the whims of a single professional that they go to. Even in the most charitable reading of this bill I disagree with the ability for a health care provider to broadly deny any medical treatment that they have a personal opinion against. The health care community is large and varied and it is important that a patient knows that they will get the best possible care rather than rolling the dice with which doctor they happen to see. Especially since many people do not have the ability to easily "shop around" for alternative opinions. I think this is a dangerous and ridiculous idea that medical professionals don't need to follow best known practices if they don't feel like it and directly goes against the hippocratic oath. In a more realistic sense it is clear what purpose this bill actually serves. This is a religious or personal exemption to treat some patients differently than others. It clearly opens up the door for unequal treatment for patients on the basis of their identity whether consciously or not. It is undeniably targeting women and LGBT minorities as those people's rights to healthcare are seen by the public eyes as "questionable" despite any scientific evidence showing the opposite. The goal of healthcare is to save and improve people's lives and that should be the only goal in making these decisions. An individual's religious beliefs or personal disagreement with someones "lifestyle" should NEVER be a part of the decision making process when it comes to something as important as healthcare. A bill like this will absolutely lead to people dying due to not getting the healthcare they need, it is not a matter of "if" but "how many". I vehemently oppose this bill as it codifies broad discrimination in healthcare which will undeniably lead to needless harm and death of many citizens justified by personal beliefs and backed up by the power of the state. Strike down this bill now if you do not want blood on your hands.

Hello, As a constituent of Virginia with extensive experience in the medical field, I believe this bill to be a poorly constructed attempt at veiled political grandstanding. Health professionals have an obligation to uphold the wellbeing of their patients, and allowing legal protections for professionals to practice their personal politics as opposed to gold standard well-researched medicine is not the action of a Virginia house that values it's constituents access to quality medical care. Injecting medicine with subjective identity politics is not only unjust but a slippery slope who's precedent could have real impacts on the health of a variety of people even outside the intended minority parties that are so obviously targeted by this bill. Allowing medical professionals the space and legal protection to be the judge of what is "morally right" and alter the lives of people based on these opinions that will thus have no oversight is dangerous and very likely may lead to unintended side effects. I urge this body to keep polarized identity politics out of medicine, and leave it to be a field driven by objective science used in accordance with the Hippocratic Oath. Thank you.

This bill, which has the would extend legal protection to medical professionals, defined very broadly, to deny legal medical treatment on the basis of any individual medical professional's personal opinion of the morality of the treatment. This is very dangerous for patients of marginalized background. This leaves leeway for human rights violations.

I oppose HB2605 as I believe it codifies discrimination as permissible, and has the potential to cause widespread discrimination against a variety of groups, including women and children.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA+ people. This bill would enable doctors to refuse treatment that is necessary to save lives, particularly for women and transgender individuals. It would also disproportionately affect individuals with limited access to healthcare who may not have many options in which medical professionals they see to seek treatment. I believe this bill would inhibit the freedoms of many Virginians and it should not be passed into state law.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA people.

This bill would be funny if it wasn't so dangerous. If politicians wish to assist people with medical training who do not wish to practice medicine, they should invest in job retraining programs instead of trying to pass legislation to force practices, hospitals, and the public to not merely accommodate but protect and reward lying down on the job. Even if you were to prove that you could read minds and be absolutely certain a refusal that you found ludicrous was just an affectation to get out of work, some traditions have strongly-held beliefs that lie outside the medical mainstream: the Jehovah's Witnesses famously consider blood transfusion immoral (https://www.jw.org/en/bible-teachings/questions/bible-about-blood-transfusion/). Some people, regardless of political leaning, believe the world is too overpopulated and some sacrifices should be made, or they believe intervening in disease progression will weaken the human race and it would be wrong to interfere. Beliefs vary widely. What anyone thinks of as "common sense" depends a great deal on how you were raised and what you've seen in life. We already have a robust system of medical ethics for practitioners. If individuals find they no longer have the stomach for science-based medicine due to a change in personal convictions, then they are at a fork in the road and they are responsible for choosing their path. People in other professions do this every day. As I said, provide job retraining if you want to help. This bill will only protect the lazy, the selfish, and the uncommitted at the expense of everyone else.

The duty of medical professionals should be to ensure the well-being of their patients. Any doctor who refuses a necessary treatment because it offends their personal morality is no longer fulfilling their duty of care and should be held accountable. The implications of such a bill are frightening. Could a doctor whose personal beliefs forbid alcohol consumption refuse treatment for a patient with cirrhosis? Could a vegan doctor refuse treatment for stomach cancer because their patient routinely ate red meat? Could a doctor refuse to honor a patient’s do-not-resuscitate order and prolong their suffering due to personal moral beliefs? It’s possible. Yes, we all know that the target of this bill is trans people, since anti-trans bills are the current fad among state legislators who have no real ideas about how to improve the lives of working people in their states. But the people harmed by this kind of legislation will extend way beyond the intended targets.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA people. Medical professionals must provide treatment based on objective metrics and accepted best practices of the AMA. There is no reason for them to be provided a religious exemption that allows them to withhold medically necessary care. This bill is dangerous and I strongly encourage you to vote NO.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA people. Transition and gender affirming care are critically important and life saving treatments that medical providers must provide to protect lives.

I oppose HB2605 as it is discriminatory to women, children, and LGBTQIA people. This is one of those insidiously dangerous bills that purports to sound like a reasonable thing until one considers what it would allow for those medical professionals who are anti-abortion or anti-lgbtqia, for example, to legally withhold medical care for legal medical services. It begs the question as to what problem is it trying to solve?

I oppose HB2605 as it is not only discriminatory to women, children, and LGBTQIA people, but it denies access to health coverage and discriminates individuals based on sex and gender. This discrimination is blatantly unconstitutional because sex and gender expression are protected under the law, and namely the Affordable Care Act.

I write to ask you to Vote NO on HB 2605, Medical Conscience Protection Act, established. This bill allows medical professionals to deny legal medical care if they do not agree with the patient's choice --- yet every patient has the right to health care without fear of discrimination, prejudice or persecution. Denial of medical care is a violation of that. I am concerned for the health and well-being of all persons. This bill sets a dangerous precedent where vulnerable populations may be singled out and unable to find essential medical services that they need. Please vote NO on HB2605.

This bill is just another tired attempt to erode abortion and LGBTQ rights in Virginia. I oppose HB2605 on these grounds, it provides far too wide grounds to effectively deny individuals care that they are entitled to.

I oppose the language and underlying intent of HB2605. It discriminates against women, children, LGBTQIA people, and others in the Commonwealth. Please do not support this insidious bill.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA people. We cannot allow medical professionals who are anti-abortion or anti-lgbtqia, for example, to legally withhold medical care for perfectly legal medical services. I have a lot of questions about why anyone would be a medical professional and not treat all people equally.

Oppose HB 2605. Women, children, and LGBTQIA individuals will be vulnerable to “legal” discrimination with this bill. If only legislators could “walk a mile in their shoes” they would see the potential harm and Oppose this bill. Respectfully submitted,

I oppose HB2605. “All men/women are created equal.” This seems pretty straight forward. This translates into “all discrimination against women, children, and LGBTQIA people is WRONG”. HB2605 would result in such discrimination,

HB2605 is discriminatory to women, children, and LGBTQIA people. Every competent medical provider knows that transition and gender affirming care are critically important and life-saving treatments; the idea that they are harmful is a political idea with no basis in reality, medical science, or medical practice. A bill cannot give a carveout for medical providers to effectively harm and kill people in a demographic they do not like. Medical providers must provide treatment that protects lives.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA people.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA people. Transition and gender affirming care are critically important and life saving treatments that medical providers must provide to protect lives.

I oppose HB2605. It is not a doctor’s place to use “morality” as a justification for potentially causing devastating harm to, and discrimination against women, children, and transgender people in Virginia. It is a doctor’s place to treat patients according to modern day medical standards backed by peer review. Keep your arbitrary version of morality out of VITAL patient care, where lives are at stake. Children deserve vaccines. Transgender people deserve gender affirming care. Women deserve reproductive rights. Doctors swear an oath to do no harm. Denying care is doing harm. If you can’t handle a serious job that requires you to be objective, like being a doctor, go back to medical school or consider joining the circus.

Why should a medical professional’s personal belief have any bearing on legal medical treatment someone needs? If I’m bleeding out due to an incomplete miscarriage and about to die, a medical professional can decide not to due a D&E because of their own personal beliefs? Regardless of the fact that a D&E (abortion) is a legal procedure in Virginia? And scientific backing proves that it would be the only procedure to save my life? I am an adult woman who can make her own informed decisions? What if a medical professional decides they don’t want to prescribe me birth control or insert an IUD because of their religion. My bodily autonomy and freedom of choice to have a legal, safe procedure is restricted or denied? What if someone believes that a disabled child shouldn’t be alive? Can they deny lifesaving treatment to a child regardless of the wishes of the family? Can a doctor who doesn’t support transgenderism decide they don’t want to treat a transgender person? Can a white supremacist decide not to treat a person of color, a Muslim or Jew? It’s ridiculous in the Commonwealth of Virginia in 2025 our lawmakers chose to put forth obviously regressive bills (and quite frankly, stupid) instead of work to solve the myriad problems plaguing our state. I work with people with dementia and their caregivers as a social worker. Everyday, I see people struggling to access medical care, struggling to pay bills, pay for homecare for their loved ones, pay for a long term care facility, etc. Elderly people who spent their whole adult lives paying into the system, so they can live peacefully, safely & well after retirement, get denied necessary services and die alone on their homes, starving, neglected, and forgotten.Yet, you are proposing legislation that further restricts medical care. All because you hate gay & trans people and women more than anything else.

I oppose HR2605 because it is the sort of bill that purports to do one thing, but is actually just a blatant tool for discrimination against women, children, and the LGBTQIA+ community. I would like to think our elected representatives are clever enough to spot such a trick and not fall for it.

The duty of a medical professional is to provide care in accordance with the consent of the patient and the accumulated knowledge and best practices of medical science, not to make decisions about whether to deny necessary and potentially life-saving care for personal reasons. This bill is an invitation for a small group of ideologically-motivated medical professionals to endanger their patients with impunity. It is extremely dangerous and alarming that this is even under consideration.

I strongly oppose HB2605, as it allows for blatant discrimination to be carried out against women, lgbtqia people, and children.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA people. This is one of those insidiously dangerous bills that purports to sound like a reasonable thing until one considers what it would allow for those medical professionals who are anti-abortion or anti-lgbtqia, for example, to legally withold medical care for legal medical services. It begs the question as to what problem is it trying to solve?

I am submitting my comments to oppose HB2605. VA Commonwealth residents have the right to seek medical care where they will be seen and treated in a timely and conscientious manner by health care professionals for any medical condition for which the treatment sought is lawful in the Commonwealth. Health care professionals have options to mitigate or avoid being in a position where they are asked to provide a legal treatment on which they personally disagree. The patient , particularly in an emergency situation has very few options or flexibility when seeking medical treatment. The burden of minimizing or eliminating such personal conflict at the moment of legal treatment falls fully upon the health care professional, not the patient. What the health care professional's personal opinion or belief is irrelevant and subservient to legal medical treatment. A healthcare worker should not be allowed to substitute their moral and ethical judgement for that of the patient, the patient's guardians when applicable, or the professional judgement of the patient's medical professionals. This bill would condone wholesale denial of legal medical care to women, children, and LGBTQ people just to name a few and make medical and healthcare treatment less available for our most vulnerable members of the Commonwealth.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA people. This is one of those insidiously dangerous bills that purports to sound like a reasonable thing until one considers what it would allow for those medical professionals who are anti-abortion or anti-lgbtqia, for example, to legally withold medical care for legal medical services. It begs the question as to what problem is it trying to solve? As a trans and queer person, this is an attack on my rights to received medical care and education.

Oppose HB2605 on the basis it would put women, children and folks in the lgbtq community at risk of discrimination.

I oppose HB2605 as its discriminatory to women, children, and LGBTQIA people.

I oppose HB2605 as discriminatory to women, children, and LGBTQIA2S+ people.

I write in opposition to HB2605. Residents of the Commonwealth have the right to expect that they will be medically treated in a timely and conscientious manner by health care professionals for any medical condition for which the treatment sought is lawful in the Commonwealth. Health care professionals have myriad options to mitigate or avoid being placed in a position where they are asked to provide a legal treatment on which they personally disagree. The patient has very few if any options or flexibility when seeking legal treatment. The burden of minimizing or eliminating such personal conflict at the moment of legal treatment falls fully upon the health care professional, not the patient. The health care professional's personal opinion or belief is irrelevant to legal medical treatment and cannot be permitted to substitute for the moral and ethical judgement of the patient, the patient's guardians when applicable, or the professional judgement of the patient's medical professionals. This bill would condone wholesale denial of legal medical care to women, children, and lgbtqia people just to name a few.

As this bill proceeds through the legislative process, it is likely to garner support from Republicans and resistance from Democrats. Can we put aside our partisan viewpoints long enough to consider this question- If a legislator feels he/she cannot support this bill, will they then not vote their conscience and vote to oppose it? That free expression of voting "no" is a choice directed by conscience. So my second and final question is, should not everyone be given the right to obey their conscience on a host of weighty and ethical healthcare issues?

Good morning. Thank you for your consideration of this bill. My name is Luke Anzaldi and I am a medical student in another state, a graduate of UVA and a native of Arlington. I humbly ask that you vote this bill out of committee and to the Senate. Medical ethics is a complex, imperative component of what I am learning as a medical student, and it's important that current and future healthcare providers have protections in place for their right of conscience. I should not have to experience pressure to violate my beliefs, or worry about discrimination or retaliation due to my conscientious objection. Unfortunately, this is something that I, and many of my classmates, frequently experience, and it is my hope that Virginia will take the right step towards combating this harmful culture. As someone who has always longed to return home to serve my fellow Virginians, it would be a shame to have to choose against a field of practice, an employer, or even a state due to the lack of protections for my conscience as a provider. Please do not continue to exacerbate the critical shortage of manpower in the medical field by not passing these protections. The people of Virginia deserve greater access to care, and you can help them by advancing this bill. The freedom to operate according to my ethical and religious beliefs is not a detractor to my patient care -- it empowers this care. These beliefs are the very foundation of my drive to humbly serve, to "do no harm", and practice with the utmost beneficence. If not for these beliefs that I hold, I would not be pursuing a career in medicine. I would not be striving to serve all people, from all backgrounds and beliefs. I hope you will see my story and know that there are thousands more who haven't even voiced their support for this bill. Please do what is right for Virginians -- Virginian doctors, nurses, PAs, PTs, and Virginian patients -- and advance this bill.

Medical professionals (myself included) dedicate their lives to providing compassionate care, and protecting their right to act in accordance with their deeply held beliefs is essential for maintaining integrity in the practice of medicine. This bill strikes a necessary balance between patient access to care and the rights of health care providers to conscientiously object to participating in procedures or services that conflict with their values. Additionally, the protections for reporting violations of laws or ethical guidelines strengthen accountability within the medical field, ensuring that professionals can speak out without fear of reprisal. The private right of action further reinforces these safeguards, providing recourse for individuals harmed by violations of conscience protections. By enacting this bill, lawmakers affirm the importance of personal conscience in the medical profession and uphold the principles of freedom and integrity that are foundational to our society. I urge you to support this vital legislation.