Court OKs nurse anesthetists to practice unsupervised

In the latest shift in physicians' fight to preserve their turf from encroachment by nurses, advocates of physician supervision of certified registered nurse anesthetists lost a battle on Oct. 8. That's when the San Francisco Superior Court ruled in favor of Gov. Arnold Schwarzenegger and the California Association of Nurse Anesthetists, affirming that California state law does not require nurse anesthetists be supervised by a physician.

The court's summary judgment affirmed California's opt-out of the federal supervision requirement. California initially opted out in July 2009, when the governor informed CMS of the opt-out in a letter.

The California Society of Anesthesiologists and California Medical Association lawsuit, which was filed in February 2010, called for the court to make the governor withdraw the opt-out letter and declare that under state law, a CRNA is not authorized to administer anesthesia except under the supervision of a physician. According to the CMA/CSA, the suit alleged that Schwarzenegger acted contrary to state law, which states that nurses who give patients anesthesia must be supervised by a licensed physician.

The judge didn't agree. He concluded that no state statute specifically stipulates that physicians must supervise nurse anesthetists who administer anesthesia and that federal regulations allow the governor discretion to opt out of the Medicare supervision rule and still follow state law.

The judge noted that current state law does not refer to supervision and that judicially adding a supervision requirement to the law would create ambiguity. State lawmakers may impose a supervision requirement if they wish. CSA noted that earlier court opinions came to a different conclusion.

A CMA press release echoes some of the ideas in an AMA press release last week that responded to an IOM report calling for nurses to play bigger roles in healthcare. Both press releases note that nurses are critical to the healthcare team, but don't have the same education and training as doctors, which must be code language physicians are increasingly deploying to tell nurses to stay off their turf. CSA and CMA may appeal the ruling.

California is one of 16 states that has opted out and allows CRNAs to administer anesthesia without physician supervision. Earlier this month, Colorado became the 16th opt-out state.

To learn more:
- read the press release from the California Association of Nurse Anesthetists
- here's the press release from the California Medical Association
- read the Becker's ASC Review article
- here's the SURGistrategies article

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