Colorado Physicians Sue to Require Medical Direction of CRNAs

September 30, 2010 — A long-simmering turf war between anesthesiologists and certified registered nurse anesthetists (CRNAs) across the country erupted this week into a legal battle in Colorado. As it is with healthcare in general, the conflict centers on matters of quality and quantity — quality of care for patients, quantity of dollars for providers.

The Colorado Medical Society and the Colorado Society of Anesthesiologists yesterday sued Colorado Gov. Bill Ritter Jr. over his decision, announced earlier in the week, to opt out of a Medicare requirement that a CRNA must work under physician supervision for his or her work to be reimbursed. The Centers for Medicare and Medicaid Services gave states this option in 2001, and Colorado is the sixteenth state to exercise it. Most are Western and Great Plains states, where remote rural hospitals may lack an anesthesiologist to supply the supervision.

In their lawsuit, filed in a state circuit court, the Colorado physicians contend that Gov. Ritter’s opt-out decision “will diminish patient safety” and violate the state’s “captain of the ship” doctrine, which puts surgeons in charge of operating room personnel. Seeking a reversal of the governor’s action, the Colorado physicians also contend that the opt-out is contrary to state law, which they say classifies administration of anesthesia by a nurse as a “delegated medical function.”

CRNAs counter that patient care does not suffer when members of their profession work without physician oversight.

“The evidence shows that physician supervision does not have an impact on quality of care,” Paul Santoro, CRNA, and president of the American Association of Nurse Anesthetists (AANA), told Medscape Medical News.

Other states than Colorado that have bailed out of the physician supervision requirement for CRNAs are Alaska, California, Idaho, Iowa, Kansas, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oregon, South Dakota, Washington, and Wisconsin. Colorado’s opt-out is confined to critical-access hospitals and specified rural hospitals.