The Centers for Medicare and Medicaid Services (CMS), through an 1135 blanket waiver, temporarily waived requirements under 42 CFR §482.52(a)(5), §485.639(c)(2), and §416.42 (b)(2) that a certified registered nurse anesthetist (CRNA) be under the supervision of a physician in sections §482.52(a)(5) and §485.639(c)(2). CRNA supervision will be at the discretion of the hospital and state law. This waiver applies to hospitals, CAHs, and Ambulatory Surgical Centers.
In California, nurse anesthetists are governed by the Nurse Anesthetist Act. (Business & Professions Code §§2825 et seq.) A “nurse anesthetist” is a “person who is a registered nurse, licensed by the board [of Registered Nursing] and who has met standards for certification from the board” (Business & Professions Code §2826). Although physicians continue to be responsible for a patient’s care and retain control over the actions of nurses involved in the surgery, including the nurse anesthetist, the California Court of Appeal in California Society of Anesthesiologists v. Brown (2012) 204 Cal.App.4th 390, interpreted Business & Professions Code §2725 to allow CRNAs to administer anesthesia in California on a physician’s order but without physician supervision.
CMA’s position is that physician supervision of CRNAs is a critical component of the Nursing Practice Act and CRNAs cannot practice independently without physician supervision. In fact, despite the recent Court of Appeal decision, a CRNA cannot administer anesthesia absent a physician’s order made on an individual basis, based upon a physician’s judgment as to the course of treatment necessary for that particular patient. Further, according to the Attorney General, CRNAs cannot administer anesthetics pursuant to a “standardized procedure,” but rather require specific orders from a supervising physician. As California's Nurse Anesthetist Act has not been waived, all existing supervision requirements remain in place.