State Supreme Court Refuses To Bar Nurses From Giving Anesthetics

Last week, the state Supreme Court issued an order refusing to block specially trained nurses from administering anesthetics to patients without a physician's supervision, the San Francisco Chronicle reports.

The court unanimously denied review of a lawsuit opposing the practice.

According to the Chronicle, the order will have a significant effect on hospitals in rural areas where nurses frequently administer anesthesia without a physician present.

Background

According to federal law, hospitals that allow nurses to administer anesthesia without supervision cannot obtain Medicare reimbursements unless the governor opts out of the requirement after meeting with the state's medical board.

In 2009, then-Gov. Arnold Schwarzenegger (R) authorized nurse anesthetists to administer anesthesia without supervision. Gov. Jerry Brown (D) supports the authorization (Egelko, San Francisco Chronicle, 6/19).

The California Medical Association filed a lawsuit over Schwarzenegger's order (California Healthline, 3/19).

Debate Over Practice

Philip Recht -- a lawyer for the California Association of Nurse Anesthetists -- said allowing nurses to administer anesthesia without supervision "increases access and lowers the cost of anesthesia care and thus the services that depend on it, like surgery and childbirth."

According to nurses and hospitals, several studies have found that nurses can administer anesthesia as safely as physicians.

However, Curtis Cole -- a lawyer for the California Society of Anesthesiologists -- said the studies are misleading because "nurse anesthetists don't do the hard cases, like cardiac surgery" (San Francisco Chronicle, 6/19).

Long Do, an attorney representing CMA and CSA, said nurse anesthetists are "not trained and not capable of reacting to any number of problems that can come up when patients are given anesthesia."

Do noted that several other states that have opted out of the requirement have imposed strict limits on the types of procedures that nurse anesthetists can perform without supervision (California Healthline, 2/3/11).

Previous Court Action

In June 2010, a San Francisco judge upheld the decision to authorize nurse anesthetists to administer anesthesia without physician supervision.

The ruling was affirmed in March by the First District Court of Appeal. The court said state law explicitly authorizes nurses to administer medications that are ordered by a physician and does not require a doctor's supervision (San Francisco Chronicle, 6/19).