February 06, 2011
Area(s) of Interest: Scope of Practice 


The California Medical Association (CMA) and the California Society of Anesthesiologists (CSA) are appealing a court decision that allows nurse anesthetists to administer anesthesia without physician supervision. The appeal raises questions about how to protect patients undergoing surgery and the ability of physicians to provide quality medical care.

In June 2009, Gov. Schwarzenegger exempted California from federal rules requiring physician supervision over nurse anesthetists. Nurses and hospitals hailed the decision as a cost-saving measure, especially in rural counties. The San Francisco Superior Court refused to block the governor's decision in a lawsuit filed by CMA and CSA, ruling last October that Schwarzenegger acted consistently with California law.

The appeal argues California law permits nurse anesthetists to administer anesthesia, but only under physician supervision. CMA and CSA believe surgical patients will receive safer and higher-quality care from physicians, as opposed to unsupervised nurse anesthetists.

"Nurses can be an integral part of a medical team if they work hand in hand with and under the guidance of physicians, as they have for many decades," said James Hinsdale, M.D., president of CMA. "But nurses are not trained to react to the myriad potential complications that can arise in the administration of anesthesia. Patients place thorough trust in their physicians when they must undergo surgery. Requiring physician supervision is one important element of ensuring the best quality of care."

"For the governor and Superior Court to decide for the people of California that it is perfectly safe to remove the medical and physician component from anesthesia care is absolutely irresponsible," said Narendra Trivedi, M.D., president of CSA. "The governor's plan goes against the belief of most practicing physicians that nurses should be supervised by the physician ordering the treatment, in this case anesthesia, and potentially jeopardizes the quality of care that citizens of California will receive."

Schwarzenegger submitted a letter to the Centers for Medicare & Medicaid Services (CMS) requesting that California be allowed to "opt out" of the regulation that physicians directly supervise or administer all anesthesia for Medicare patients. The exemption was requested without input from any professional medical organization and with blatant disregard for state law that requires physician supervision of nurse anesthetists.

Medicare allows hospitals to opt out of the physician supervision regulation, if the governor submits a request to CMS, provided that the governor consults with the state boards of medicine and nursing on issues relating to access and quality, concludes that the change is in the best interests of the state and declares that the action conforms with state law.

Physicians should be aware that despite the exemption, hospitals in California still have the authority to require physician supervision of nurse anesthetists. Hospitals must affirmatively opt out of the supervision requirement. CMS has clearly stated that even in the event an exemption is granted, no hospital would ever be prohibited from requiring physician supervision.

Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.