CMA and the California Society of Anesthesiologists (CSA) filed a lawsuit last week asking a court to overturn a decision by Governor Arnold Schwarzenegger to opt out of the federal requirement for physician supervision of anesthesia care for Medicare patients. This would enable hospitals to allow nurses to administer anesthesia on Medicare patients without physician supervision.

Governor Schwarzenegger in June 2009 requested and received an exemption from the federal Medicare requirement that physicians supervise nurse anesthetists. The exemption was requested without input from any professional medical organization and with blatant disregard for state law that requires physician supervision of nurse anesthetists.

Although, federal regulations do authorize physician supervision exemptions in certain circumstances, CMA firmly believes that the Governor’s action is invalid for a number of reasons. Federal regulations require that governors seeking exemptions first consult with their medical and nursing boards about issues related to access to and quality of care. Governors must also attest to the fact that the exemption is consistent with state law, including state scope of practice laws.

“If the governor had followed the law, he would have seen that reducing the standards for anesthetists could have a detrimental impact on patient safety,” says CMA President Brennan Cassidy, MD. “As doctors, our No. 1 priority is the health and safety of our patients and that’s why the governor is taking a step in the wrong direction.”

Physicians should be aware that despite the exemption, hospitals in California still have the authority to require physician supervision of nurse anesthetists. Hospitals must affirmatively opt-out of the supervision requirement. The Centers for Medicare and Medicaid Services (CMS) has clearly stated that even in the event an exemption is granted, no hospital would ever be prohibited from requiring physician supervision.

For more information on the scope of practice of nurses, see CMA On-Call document #1615, “Nurses.” On-Call documents are free to members. Nonmembers can purchase On-Call documents for $2 per page in the CMA bookstore.

Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.