In a victory for nurse anesthetists, a California Superior Court judge has rejected a petition filed by two medical groups who say that allowing unsupervised advanced practice nurses to administer anesthesia puts patients at risk.
The California Medical Association and the California Society of Anesthesiologists in February sued California Gov. Arnold Schwarzenegger for opting out of the Medicare requirement that physicians supervise nurse anesthetists when Medicare patients are involved.
The doctors' groups argued that the governor failed to follow steps required by Medicare regulations that required him to consult with state boards of medicine and nursing in waiving the federal requirement.
"It's a patient safety issue when you have absolutely no supervision from a physician; it's very risky," Francisco Silva, general counsel for the two groups, said in a February during the court case.
The CMA says the ruling is "raising questions about how to protect patients' quality of care and whether the state Legislature should intervene."
"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."
The news that the court had sided with the governor came in a statement from the American Association of Nurse Anesthetists, which supported the governor's action and filed a court declaration in support.
A statement on the California Society of Anesthesiologists' website said that the two groups "are reviewing options for further action, including appealing the ruling."
The website also said: "The ruling was based on the presiding judge's conclusion that given the absence of a State statute that specifically stipulates physician supervision of nurse anesthetists who administer anesthesia, federal regulations allow the Governor discretion to conclude that opting out of the Medicare supervision requirement is consistent with State law.
Brennan Cassidy, MD, a former president of the CMA, said earlier this year that "If the governor had followed the law, he would have seen that reducing the standards for anesthetists could have a detrimental impact on patient safety. As doctors, our No. 1 priority is the health and safety of our patients and that's why the governor is taking a step in the wrong direction."
Hospitals and ambulatory surgical settings in underserved and rural areas of the state favor the opt-out in the belief that if a physician's presence is required every time a nurse anesthetist begins anesthesia, many surgical and other procedures requiring pain mitigation would be delayed or would have to be rescheduled in other locations.
California's governor joined 14 other states, many of them rural, in opting out of the provision, and since then, Colorado has also used the provision. The other states are Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota and Wisconsin.
The California Hospital Association called the court's decision "a huge victory for certified registered nurse anesthetists and hospitals across California, particularly those in rural and underserved areas."
"Although much is touted about potential danger to patients, there are multiple studies that were recently published to directly counter this assertion," said Jana DuBois, CHA's VP and Legal Counsel. "In fact, a recent report issued August 10th by the U.S. Health Care Workforce concluded its analysis of Medicare data spanning from 1999?2005, and found no evidence to support that CRNA delivery of anesthesia without direct supervision resulted in increased inpatient deaths or complications."
When the physician groups filed its case in February, comments from some physicians who said that nurse anesthetists and advanced practice nurses aren't trained to work without supervision provoked angry objections.
Nurse anesthetists said there was no research suggesting surgical patients are less safe without physician supervision. On the contrary, peer reviewed research suggests that they are quite safe, they said.
The opt-out provision was put in place during the administration of President Bill Clinton in 2001.
See also:
Nurse Anesthetists Battle Overlooks Rural Doctor Shortage
Nurse Anesthetists Say They Practice Safely Without Physician Supervision
Doctors Sue To Stop Nurse Anesthetists From Administering Anesthesia