By Todd Primack, DO, FASA, Chair, Legislative and Practice Affairs Division
CSA leadership is engaged in an effort at the state and local levels concerning the delivery of anesthesia services in the San Joaquin Valley.
Recent investigations by the California Department of Public Health and Centers for Medicare and Medicaid Services demonstrated that patients were harmed, there was a lack of proper oversight of Certified Registered Nurse Anesthetists (CNRAs), and a lack of proper credentialing at Stanislaus Surgical Hospital and Doctor’s Medical Center in Modesto. Complaints were received about anesthesia-related medical errors, and the investigative surveys found fault with the medical credentialing process for CRNAs.
These investigations have received coverage in local, statewide, and national media – including in the Modesto Bee, Politico, Medscape, and Becker’s Hospital Review.
CSA engaged members of the state legislature to reiterate the critical importance of physician-led anesthesia care to ensure patient safety and positive patient outcomes. Although nurse anesthetists may be able to administer anesthesia without physician “supervision,” they cannot administer anesthesia independent of a physician, surgeon, dentist. Per California Business & Professions Code 2725(b) nurse anesthetists require a physician order to undertake “the administration of medications and therapeutic agents.”
Unfortunately, media accounts and some in the legislature have characterized the investigations and the subsequent communications by CSA and the California Association of Nurse Anesthesiology (CANA) as simply a “scope fight” between two groups of health care providers.
In internal and external communications, CANA has questioned the motivation of the CDPH investigation and the impartiality of the individual investigators themselves, expressed frustration that the attention garnered by the investigation will inhibit their ability to practice throughout the state.
The position of your leadership at the California Society of Anesthesiologists has been clear and consistent:
- State regulators have a critical role with respect to the oversight of medical practice and in ensuring patient safety.
- Nurse anesthetists are an essential part of the anesthesia care team, but physicians and nurses are not interchangeable. Physician leadership and involvement is consistent with both state law and clinical best practice AND essential to safe, effective, and efficient delivery of anesthesia care.
- Patients in all communities, of all income levels, including in rural or underserved areas, deserve access to physician-led anesthesia care.
CSA’s efforts have been focused on being “part of the solution” by providing education and information to policymakers and the public, and providing resources to anesthesia practice groups to help them develop and deliver anesthesia care models that are consistent with state law and clinical best practice.
During the month of July, individual CSA members will be meeting with their state legislators in their home districts to deliver these messages to legislators and their staff. Invariably, this issue will come up in your own personal and professional conversations at home, in the community and in your practice setting.
It is essential that all of us communicate a consistent and positive message when engaging in these interactions. I invite you to refer to the points above, all focused on protecting patient safety. To summarize:
- Regulators have a valuable role;
- CRNAs are an essential part of the care team;
- CSA is committed to being part of the solution, providing information to policymakers, the public and our partners in healthcare.
We are not condemning hospitals or surgery centers, and we are not disparaging nurse anesthetists. We aim to build constructive partnerships, share information, and serve as a resource to help healthcare facilities and policymakers as they strive to simultaneously increase access to care and uphold patient safety standards.
If you would like to find out how you can meet with your own legislators and/or obtain information to better inform your colleagues about the importance of physician-led care, please email me at toddoprimack@yahoo.com.
Thank you once again for the work you do to provide best-in-class care to your patients, in partnership with your colleagues on the anesthesia care team. Please remember: this isn’t a scope fight. If there is a fight, let’s ensure CSA is clearly on the side of our patients and their safety.