A state court of appeal has ruled that nothing in California law requires nurse anesthetists to be supervised by physicians when administering anesthesia to patients. The ruling came without regard for the numerous concerns and objections raised by the California Medical Association (CMA) and the California Society of Anesthesiologists (CSA).
The court’s ruling lets stand a 2009 decision by former Governor Arnold Schwarzenegger to exempt California from federal rules requiring physician supervision of nurse anesthetists in Medicare participating hospitals. According to the court, any concerns “that a physician’s practical, ethical and legal responsibilities for his or her patient’s care will be jeopardized by the use of unsupervised certified registered nurse anesthetists to administer anesthesia” should be resolved “with the Legislature, not this court.”
CMA and CSA challenged Schwarzenegger’s decision in court because they believe it is inconsistent with California law, which requires that a physician always retain responsibility and control over the medical care of his or her patient. Physician supervision over nurse anesthetists is necessary within this framework, according to CMA, to ensure that the medical professional with the best training and the most clinical experience remain involved through all aspects of anesthesia care. Although nurse anesthetists can and do administer anesthesia, physicians are the most qualified to monitor the effects of the anesthesia, and to react immediately when medically necessary.
Despite the recent court ruling and Schwarzenegger’s opt-out decision, hospitals in California still have the authority to require physician supervision of nurse anesthetists at their facilities. Furthermore, medical staffs at hospitals may also be able to implement a supervision requirement within the scope of their self-governance rights over the professional work in a hospital.
While disappointed with the decision, CMA remains undeterred and committed to protecting the quality and safety of all medical care provided to Californians. CMA is analyzing the opinion and exploring all legal, regulatory and legislative options.
Contact: Samantha Pellon, (916) 551-2872 or spellon@cmanet.org.