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.
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