California Anesthesiologists Claim "Team Approach" Is Necessary

A San Francisco court ruling that allows nurse anesthetists less supervision has some anesthesiologists upset.

A recent Superior Court ruling in San Francisco has some anesthesiologists upset, according to a press release from the California Medical Association.

The court ruled that California's nurse anesthetists are not required to be supervised by a physician when administering anesthesia. The ruling raises questions about how to protect patients' quality of care and whether the state legislature should intervene, according to the release.

The California Medical Association (CMA) is currently analyzing the opinion, and exploring all of its options, including appealing. In February, CMA and the California Society of Anesthesiologists (CSA) filed suit against Gov. Arnold Schwarzenegger over his decision to opt out of a federal requirement for physician supervision of anesthesia care for Medicare patients.

The suit alleged the governor acted contrary to California law, which states that nurses who give patients anesthesia must be supervised by a licensed physician to ensure it is done properly and safely.

“Nurses are highly valued members of a team of health care professionals that works closely together to give patients the best possible care,” said James Hinsdale, M.D., president of CMA, in a press release. “However, people must understand that nurses do not receive the same extensive training and education that doctors do and are not interchangeable substitutes for practicing physicians. Requiring physician supervision is one important element of ensuring the best quality of care.”

“For the Governor and Superior Court to decide for the people of California that it is perfectly safe to remove the medical and physician component from anesthesia care is absolutely irresponsible,” said Dr. Narendra Trivedi, president of the California Society of Anesthesiologists. “The Governor's plan goes against the belief of most practicing physicians and jeopardizes the quality of care that citizens of California will receive. The California Society of Anesthesiologists asks the Governor to put patients first and work with physicians to find innovative and efficient solutions to our state's health care concerns maintaining quality of health care.”

In June 2009, Schwarzenegger submitted a letter to the Centers for Medicare and Medicaid Services (CMS) requesting that California be allowed to "opt out" of the regulation that physicians directly supervise or administer all anesthesia for Medicare patients.

Medicare allows hospitals to opt out of physician supervision regulation, if the governor submits a request to CMS, provided that the governor consults with the state boards of medicine and nursing on issues relating to access to and quality of anesthesia services, concludes that the change is in the best interests of the state and declares that the action conforms with state law.

Source: California Medical Association, California Society of Anesthesiologists

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Do you feel the decision in California to allow nurse anesthetists to administer anesthesia without supervision is appropriate? Should other states pass a similar law?