SB 1445 - This act provides that a certified registered nurse anesthetist ("CRNA") may select, issue orders for, and administer certain controlled substances for and during the course of providing anesthesia care to a patient in a licensed facility pursuant to state law. This act shall not be construed as authorizing a CRNA to prescribe such controlled substances and a CRNA shall not be required to obtain a certificate of controlled substance prescriptive authority from the Board of Nursing in order to exercise this prescriptive authority. This act is identical to SB 1247 (2026), SB 545 (2025), and SB 522 (2025), is substantially similar to a provision in HB 1981 (2026), in HB 831 (2025), and is similar to a provision in SB 910 (2024), HB 1561 (2024), and HB 1881 (2024). KATIE O'BRIEN

2026 Regular Session Introduced by Patty Lewis

Expands Missouri CRNAs' authority to independently select, order, and administer controlled substances, removing traditional physician oversight requirements for anesthesia-related medications.

Bill Combined w/SCS SBs 1247 & 1445

Legislative bill overview

SB 1445 expands the prescribing authority of Certified Registered Nurse Anesthetists (CRNAs) in Missouri by allowing them to independently select, issue orders for, and administer controlled substances. Previously, CRNAs typically operated under physician supervision or protocol-driven arrangements. This bill grants them autonomous prescribing privileges for certain controlled medications used in anesthesia practice.

Why is this important

This bill addresses workforce capacity in anesthesia services, particularly in rural or underserved areas where anesthesiologists may be unavailable. It could improve patient access to surgical procedures and reduce wait times. However, it represents a significant shift in scope of practice and supervision requirements that affects both healthcare delivery models and professional licensing frameworks.

Potential points of contention

Physician oversight concerns: Medical associations may argue that independent prescribing of controlled substances requires physician supervision for patient safety, particularly regarding drug interactions and complex medical histories

Controlled substance diversion risk: Expanded prescribing authority for controlled drugs raises regulatory questions about oversight, accountability, and potential drug diversion without traditional physician gatekeeping

Insurance and liability implications: Unclear how this affects malpractice liability, insurance coverage, and whether facilities/hospitals will assume additional risk by allowing autonomous CRNA prescribing authority