Controversy in California: Should CRNAs Be Supervised?
Californian hospitals and nurse anesthetists generally agree with Gov. Arnold Schwarzenegger’s decision last summer to opt out of a Medicare provision requiring physician supervision of certified registered nurse anesthetists (CRNAs) in hospitals, but a couple of state physician organizations do not. Whereas the former group says opting out will ensure patient access to anesthesia services, the latter group says lack of physician oversight puts patients at risk.
The California Society of Anesthesiologists (CSA) and the California Medical Association (CMA) feel so strongly about this that, on Feb. 2, they took the matter before the San Francisco County Superior Court. The two physician organizations maintain in the petition that Gov. Schwarzenegger did not follow protocol for opting out of the Medicare provision.
The Centers for Medicare & Medicaid Services (CMS) permits state governors to invoke the federal opt-out final rule (Nov. 13, 2001 Federal Register) by simply writing a letter certifying that:
- State boards of medicine and nursing were consulted;
- It is in the state citizen’s best interest; and
- It is consistent with state law.
CSA and CMA contend in the CSA/CMA vs. Schwarzenegger case that the governor did none of the above. “Based on the information we have received to date, it appears the Governor has violated every aspect of this regulation,” CMA states in Resolution OMSS 02-09, which was published prior to litigation.
CMA contends that CRNA supervision “has been a long-standing public safety requirement deemed appropriate by California law” (HOD 602a-08); and that opting out of the physician supervision requirement will not increase access, improve patient outcomes, or produce cost savings.
“Maintaining physician supervision of anesthesia is important for the safety of care delivered to all patients,” said CSA President Dr. Linda Hertzberg in a press release issued the same day as the petition.
Since the Nov. 13, 2001 CMS rule, 14 other states have opted out from the federal supervision requirement. California is the 15th and most recent state to exercise this right.
CMA says that, “in the event that we are not successful [in litigation], another avenue would be to request that the federal government rescind the opt out option.”