California Opt Out from Federal Anesthesia Rule Upheld


For Immediate Release
October 12, 2010
For more information
contact Armentia Snyder


Lower Court Dismisses Lawsuit Filed by State's Physicians
to Block Gov. Schwarzenegger's Action


Park Ridge, Ill. - Ruling in favor of Gov. Arnold Schwarzenegger and the California Association of Nurse Anesthetists (CANA), the California Superior Court in San Francisco on Friday affirmed that California state law does not require nurse anesthetists to be supervised by a physician. The court also ruled that the governor acted within his rights by opting out of the federal physician supervision requirement for these advanced practice registered nurses.
On October 8, 2010, the court granted summary judgment in favor of Gov. Schwarzenegger and CANA, affirming California’s opt-out of the federal supervision requirement in July 2009. The presiding judge found that the governor did not abuse his discretion in concluding that the opt out was consistent with state law, an important requirement for seeking an opt out from the Centers for Medicare & Medicaid Services (CMS).
The ruling went against the California Society of Anesthesiologists (CSA) and the California Medical Association (CMA), who filed the lawsuit in February 2010.  A written order reflecting the court’s findings and decision will not be finalized for several days. The CSA and CMA are reviewing their options, including appealing the ruling.  Meanwhile, California’s opt out remains in effect.
Certified Registered Nurse Anesthetists (CRNAs) are advanced practice registered nurses who personally administer approximately 32 million anesthetics to patients across the United States each year. Two recent national anesthesia studies confirmed the safety and cost-effectiveness of CRNAs, who practice in every type of setting in which anesthesia is delivered and are the sole anesthesia providers in most rural hospitals.
The federal supervision rule, however, is not a regulatory measure designed to ensure patient safety; in reality it is a requirement that hospitals must meet in order to receive Medicare reimbursement for anesthesia services, unless a state chooses to opt out of the rule as California has done.
California was the 15th state to opt out of the federal rule, following Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, and Wisconsin. Earlier this month, Colorado became the 16th opt-out state.
In the Interests of the People
When California opted out in July 2009, Gov. Schwarzenegger informed CMS of the opt out in a letter that stated that after “[h]aving consulted with the California Board of Medicine and California Board of Registered Nursing and having determined that this exemption is consistent with state law, I have concluded that it is in the interests of the people of California to opt out of this requirement.”
The CSA and CMA lawsuit had requested that the court require the governor “to withdraw the ‘opt-out’ letter” and “to take no further action to effect an opt out” of the federal regulation, and that the court “declare that, under California law, a CRNA is not authorized to administer anesthesia except under the supervision of a physician.” The court ultimately denied the physicians’ requests.
In the early stages of the lawsuit, the American Association of Nurse Anesthetists filed a declaration in the case in support of the governor’s and CANA’s position.
For additional information concerning state opt-outs, please visit
Information about the California Opt-Out Lawsuit
2010 Press Releases Archive