July 28, 2009
California Opts Out of Federal Physician Supervision Requirement
Governor Schwarzenegger submitted a letter to CMS requesting exemption from the federal requirement that anesthesia be administered by a nurse anesthetist who is supervised by a physician. It appears that the opt-out process occurred behind closed doors of the Governor’s office without consultation or input from any professional medical organization.
Federal law requires a governor to 1) consult with the medical and nursing boards about issues related to access to and the quality of anesthesia services in the State; 2) conclude that an opt-out is in the best interests of the State's citizens; and 3) attest that an opt-out is consistent with State law.
Consultation with the Medical Board of California (MBC) was at the administrative level only and not before the full Board. In a letter from the Executive Director of the MBC to the Governor, the Executive Director states that “it appears that a nurse anesthetist is required to have physician (dentist, podiatrist) supervision.” The California Society of Anesthesiologists (CSA) continues to maintain that independent practice by a nurse anesthetist is contrary to state law, despite the Governor’s opinion and current action. At no time were issues of access and the quality of anesthesia services in the state addressed, as is required by the federal regulation.
CSA is continuing to gather information on the process that led to the Governor’s letter and has sent a letter to the Governor outlining its objections to his position and actions on this issue (see http://www.csahq.org). CSA is also working with the California Medical Association and ASA on other potential courses of action.
California becomes the 15th state to opt-out, joining Iowa, Idaho, Nebraska, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota and Wisconsin.