Protect Your Rights to Physician-Led Anesthesia Care

Patients in all communities, of all income levels, including in rural or underserved areas, deserve access to physician-led care. Yet there is increasing pressure to expand the scope of practice for mid-level healthcare providers in the name of expanding access to care. We have seen attempts by nurse anesthetists, who are currently required to practice under the prescriptive order of a physician, surgeon or dentist, to instead call for further expansion of their ability to practice without any physician oversight. But lowering patient safety standards in certain settings is not the solution – all patients deserve the safest protections and care by properly trained, credentialed practitioners.

To be clear, nurse anesthetists are an essential part of the physician-led anesthesia care team. But the risk comes when nurse anesthetists try to practice beyond their skills and training. Unfortunately, these risks became very clear recently at two hospitals in the Central Valley that were cited for closure and patient care violations by state and federal oversight agencies due to patient harms occurring from nurse anesthetist-led care.

Following the investigations and media coverage on patient harm resulting from nurse-only anesthesia care, guidance was issued by CDPH providing a “Reminder of Certified Registered Nurse Anesthetist Requirements”  in California.  The All Facilities Letter (AFL) clarifies the credentialing and privileging requirements for nurse anesthetists (CRNAs), and outlines the state and federal laws and regulations that form the foundation for these requirements and guide the scope-of-practice for CRNAs. An AFL is a formal communication from the California Center for Health Care Quality (CHCQ), Licensing and Certification (L&C) Program to health facilities licensed or certified by L&C.

This document provides important information on the state and federal laws and regulations, so that health care facilities can provide compliant, safe patient care.

There have been suggestions by CRNA advocates that the Medicare “opt-out” provisions in California allow CRNAs to replace anesthesiologists, who are physicians with advanced education and training in the delivery of anesthesia. However, the AFL confirms that CRNAs are not physicians, are not permitted to practice medicine, and must practice under the order of a physician, dentist or podiatrist.

The AFL issued on September 6, 2024 confirms the requirements for general acute care hospitals using CRNAs to provide anesthesia services, such as:

• Except as provided in California’s Business and Professions Code (BPC) section 2725, a CRNA is not authorized to practice medicine or surgery. (BPC section 2833.5)

• Use of CRNAs to provide anesthesia services in an acute care facility must be approved by the hospital administration and the appropriate committee and must be at the discretion of a physician, dentist, or podiatrist. (BPC section 2827)

• A CRNA may only administer anesthesia and anesthesia related medications ordered by a physician, dentist, podiatrist, or clinical psychologist. (BPC section 2725)

• A CRNA must be responsible for their own professional conduct and may be held liable for those professional acts. (BPC section 2828)

For additional information on scope and standards of practice for CRNAs, CDPH pointed to the Board of Registered Nursing’s  Summary of Select Nursing Practice Act Provisions Relating to CRNA Practice, and directed facilities to the CDPH District Offices for further questions on hospital requirements.