CMA Says Court Ruling on Nurse Anesthetists Is Off Base



If opinion stands, patients could receive anesthesia without a physician supervising, which would undermine quality of care

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Andrew LaMar


Sacramento – A San Francisco Superior Court has ruled that California’s nurse anesthetists are not required to be supervised by a physician when administering anesthesia, raising questions about how to protect patients’ quality of care and whether the state Legislature should intervene.

The California Medical Association (CMA) is analyzing the opinion, handed down on Friday, 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. “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.

The California Medical Association represents more than 35,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California.

The California Society of Anesthesiologists represents 4,000 anesthesiologists practicing in California who are dedicated to the art and science of anesthesia practice and the highest quality of patient care.