California Supreme Court Affirms Lower Courts' Unanimous Decisions: Nurse Anesthetists Can Practice Without Physician Supervision

For Immediate Release
June 22, 2012
For More Information, Contact
Phil Recht, CANA
Phone: 213-229-9512
Sonoma, Calif.―In a resounding victory for the state’s nurse anesthetists, hospitals, and the patients they serve, the California Supreme Court has decided not to review California’s 2009 opt-out from Medicare’s facility reimbursement rule requiring physician supervision of Certified Registered Nurse Anesthetists (CRNAs), closing the book on a series of failed legal challenges by physician groups that began shortly after the exemption took effect.
A petition for review brought by the California Society of Anesthesiologists (CSA) and California Medical Association (CMA) was denied by the Supreme Court, following unanimous decisions by the trial and appellate courts to uphold former Gov. Arnold Schwarzenegger’s opt-out from the Medicare reimbursement rule. The lower courts had found California law to not require physician supervision of CRNAs; thus, the opt-out was consistent with state law, and the governor’s actions met Medicare’s requirements for opting out.
“CRNA supervision is a Medicare condition of reimbursement to healthcare facilities, and California has never required supervision of nurse anesthetists,” said Joseph Janakes, CRNA, MSN, president of the California Association of Nurse Anesthetists (CANA). “The courts’ affirmation of the opt-out is worthy of celebration because it allows healthcare facilities to participate in Medicare and Medi-Cal without the unnecessary restriction of CRNA supervision. This facilitates access to safe, cost-effective anesthesia care for all Californians, especially in rural and other medically underserved communities.

“California’s nurse anesthetists look forward to continuing our strong, collaborative relationship with the state’s surgeons, anesthesiologists, and other doctors to provide the best possible care to patients,” Janakes said.
Janakes added that the state’s CRNAs have done their part to affirm the governor’s decision: Since the opt-out took effect nearly three years ago, there have been no anesthesia-related deaths or injuries linked to the removal of the federal physician supervision requirement.

California was the 15th state to opt out of the federal supervision requirement for CRNAs after the Bush Administration, in late 2001, issued the rule allowing states to opt out of the requirement. Two states have followed—Colorado and Kentucky—bringing the total number of opt-out states to 17.
In 2010, a landmark national study using data from the first 14 opt-out states confirmed that patients are equally safe regardless of whether a nurse anesthetist is supervised by a physician. None of the states that opted out imposed limits of any kind on the types of procedures CRNAs can perform without supervision.
The opt-out was strongly supported by the California Hospital Association throughout the court challenges by the CSA and CMA.
About the California Association of Nurse Anesthetists
First established in 1931, the California Association of Nurse Anesthetists, Inc. (CANA) is the professional organization representing CRNAs in California. CRNAs work independent of anesthesiologists in a wide variety of practice settings in more than 80 percent of California’s counties that provide surgical and obstetrical services.  California also has seven rural counties that depend solely on nurse anesthetists.  Today, CANA serves as a leader in its ongoing mission to advance patient safety and foster access to the highest quality anesthesia services in California.
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