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 letter 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 come 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, saying it corrects inaccurate suggestions that CRNAs can replace anesthesiologists under the state's Medicare "opt-out" provision. In 2010, the state obtained an exemption from the federal rule requiring the physician supervision of CRNAs for Medicare participation.
"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," California Society of Anesthesiologists Division Chair Todd Primack, DO, said in a Sept. 13 statement.
Both the American Association of Nurse Anesthesiology and its California chapter have pushed back on the claim that CRNAs must be supervised by physicians or be part of physician-led care teams. While CRNAs are permitted to provide care only within their scope of practice, they are not legally required to be supervised by a physician in California, the association said in response to the state letter.
AANA President Janet Setnor, MSN, CRNA, said nurse anesthetists have practiced independently in California since 2010 under the state's Medicare "opt-out" provision, "delivering high-quality, cost-effective care, particularly in rural and underserved areas."
"It's a dangerous and a malicious lie when you put out information like that to scare the public," Ms. Setnor told Becker's. "We don't need to have this head-butting contest of who is better than whom. If we could just figure out a way to work collaboratively together, that would be the most successful and advantageous for our patients."
The association has defended the quality of CRNA care, citing studies that show no evidence of CRNA services being less safe than those provided by physicians.