The California Department of Public Health has stepped in amid an ongoing debate between physicians and certified registered nurse anesthetists about CRNAs' role in hospitals, The Modesto Bee reported Sept. 16.
In a Sept. 6 letter to hospitals, the health department outlined state and federal requirements for using CRNAs to provide anesthesia services. The department clarified that CRNAs are not permitted to practice medicine or surgery but can perform certain medical functions, such as administering treatments, drawing blood and responding to health changes, under standardized procedures developed in collaboration with physicians and health systems.
The letters also states that:
- Anesthesia care must be provided under the direction of a qualified physician.
- Use of CRNAs must be approved by hospital administration.
- CRNAs can administer anesthesia drugs only when ordered by a physician.
- Contracted CRNAs are subject to the bylaws of hospitals where they are administering anesthesia.
The health department's guidelines seek to resolve confusion over CRNAs' roles and comes after two hospitals in Modesto were cited for deficiencies related to care provided by CRNAs.
The California Society of Anesthesiologists applauded the state's letter, with Division Chair Todd Primack, DO, telling The Modesto Bee: "CRNAs play a vital role in the anesthesia care team in California, but it's important to recognize that physician leadership remains essential to ensure patient safety and compliance with state and federal regulations."
The California Association of Nurse Anesthesiology has defended the quality of CRNA care, citing studies that show no evidence of CRNA-provided services being less safe than those provided by physicians. While CRNAs are permitted to provide care only within their scope of practice, they are not required to be supervised by a physician in California, the association said in response to the state letter.
"It is the Nursing Practice Act that gives CRNAs legal authority to administer anesthesia after a physician orders a course of treatment that includes anesthesia," a spokesperson for the association told The Modesto Bee.
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