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Nurse Anesthetists' Scope of Practice Challenged Again in CA

Cheryl Clark, for HealthLeaders Media, February 3, 2011

California physicians are appealing the latest court decision that upheld the right for nurse anesthetists to administer anesthesia without physician supervision, an issue that has pitted nurses and doctors against each other in a nationwide turf battle. 

Under Medicare rules, state governors can opt out of federal requirements that a physician must supervise nurse anesthetists when they insert anesthesia drugs in federally reimbursed patients. Former Gov. Arnold Schwarzenegger exercised that option in June of 2009, one of 16 governors to waive the rule to date.

The governor did so on the basis that in many rural and underserved areas of California, physicians are too busy, unavailable, too expensive, or too far away to perform or supervise the procedure, especially during patient emergencies, leaving some hospitals no option to send their patients elsewhere.

Additionally, there has been no official study suggesting that nurse anesthetists' administration of anesthesia without supervision has caused harm.

But the California Medical Association and the California Society of Anesthesiologists disagreed and challenged Schwarzenegger's decision on Feb. 2 last year.

Late last year, however, a San Francisco Superior Court refused to block the governor's decision, and nurse anesthetists were free to proceed with independence.

Now the CMA and CSA are fighting back with an appeal of the court's refusal, and say they will take it to the California Supreme Court if necessary.

"Nurse anesthetists can be helpful and they are very helpful and they can administer anesthesia," says Long Do, attorney representing the two physicians groups. "But they're not trained and not capable of reacting to any number of problems that can come up when patients are given anesthesia.

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2 comments on "Nurse Anesthetists' Scope of Practice Challenged Again in CA"


Karin Wille (2/9/2011 at 12:27 PM)
I work in a rural hospital and we have a CRNA who routinely and expertly handles any and all types of emergencies. When we bring in new surgeons, they are usually leary of working with "just" a CRNA, but once they have been in the OR with him one time, they are confident in his abilities and no longer feel the need for a physician anesthetist. Our CRNA has been our primary anethesia provider for both emergency situations and during surgery for well over 10 years with NO incidents. CRNAs are highly trained, highly skilled, and do provide excellent care.

Patti A. Sims, CPMSM, CPCS (2/4/2011 at 3:36 PM)
As a patient, I would only want a physician to administer my anesthesia. I would only allow a CRNA if they are under the supervision of a physician. There may be some benefit in rural areas to a CRNQ working without supervision, but as a patient would not support non-supervised CRNA's.