California CRNAs Can Administer Anesthesia without Doctor Supervision

Court denies motion by CSA to overturn ruling allowing unsupervised certified registered nurse anesthetists to give anesthesia.

A motion filed by the California Society of Anesthesiologists (CSA) and the California Medical Association (CMA) in regards to the recent ruling to allow certified registered nurse anesthetists (CRNAs) to administer anesthesia without doctor supervision was denied.

The new rule was introduced after California Governor Arnold Schwarzenegger sent a letter to the Centers for Medicare and Medicaid Services that exercised the option to exempt the State of California from the requirement present in other states.

Due to the absence of a California State statute that specifically stipulates physician supervision of nurse anesthetists who administer anesthesia, the presiding judge ruled that federal regulations allow the Governor discretion to conclude that opting out of the Medicare supervision requirement is consistent with State law.

Likewise, with respect to the physician supervision issue, the judge ruled that current California State law does not refer to supervision and judicially interjecting a supervision requirement into the law would create ambiguity. The judge also stated that the Legislature has the ability to impose a supervision requirement into State law should it wish.

CSA notes that the Legislative Counsel, Attorney General opinions, and prior court opinions came to a different conclusion.

According to a press release, the CSA maintains that anesthesia care is best provided in a physician-led practice setting. The society is currently reviewing alternative strategies to reverse the governor's decision.

“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, in a press release. “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 by working with physicians to find innovative and efficient solutions to our state's health care concerns while maintaining the highest quality standards of health care.”

Last February, the CSA and CMA filed suit against California Governor Schwarzenegger in response to the Governor's letter to the Centers for Medicare and Medicaid Services (CMS), which requested that the state be allowed to opt out of the requirement that a physician be present to either administer or supervise anesthesia for Medicare patients. Under federal law, the CMS has the authority to approve the Governor's request for a Medicare opt out.

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