A California appeals court this month ruled that certified registered nurse anesthetists in that state do not need physician supervision to do their jobs.
It's a clear victory for rural hospitals in California that have complained that requiring physician supervision of CRNAs adds unneeded costs and limits the range of surgery services they can provide.
The March 15 decision by the First District Court of Appeal in San Francisco really isn't a surprise. California is already one of 16 states that have opted out of a federal mandate that denies Medicare reimbursements to hospitals that allow CRNAs to work without physician supervision. Republican Gov. Arnold Schwarzenegger opted out in 2009, and his Democratic successor Jerry Brown supported the decision.
The suit was brought by the California Medical Association and the California Society of Anesthesiologists and it's not clear if they plan an appeal. CMA on its website says it is "disappointed with the decision" and is "exploring all legal, regulatory and legislative options."
Not surprisingly, California Hospital Association spokeswoman Jan Emerson-Shea told HealthLeaders Mediathat CHA was "very pleased by the decision."
There has been a lot of back-and-forth arguing between CRNAs, anesthesiologists, and CHA about whether or not patient safety is compromised when states opt out of the supervision requirement. Obviously, in a perfect world, it's always preferable to have the highest-trained medical professionals administering or supervising care.
It's not clear, however, if any studies show that patient care suffers when CRNAs provide unsupervised care.