The California Department of Public Health sent a letter to hospitals last week defining the scope of practice for certified registered nurse anesthetists, The Modesto Bee reported Sept. 16.
The letter comes after months of confusion with respect to guidance over the role of CRNAs in anesthesia services and surgical procedures. Federal and state surveys at Stanislaus Surgical Hospital in Modesto, Calif., found that CRNAs were given full prescriptive and diagnostic authority at the hospital and were in charge of anesthesia services, according to the report. This was addressed in January by inspectors, who issued a notice of violation and declared that the lack of CRNA oversight placed patients in jeopardy.
The survey concluded that the lack of oversight by CRNAs, who were working as independent contractors, was responsible for negative health outcomes of 10 patients who required transfer to a higher level of care.
In a Sept. 6 letter addressed to all general acute care hospitals, the health department clarified that the use of CRNAs in acute care hospitals must be approved by administration and must be at the discretion of physicians. The letter also said CRNAs may administer anesthesia medications ordered by physicians and are not authorized to practice medicine.
The letter contradicted claims by nurse advocates that California allows CRNA-only independent practices. A spokesperson for the California Society of Anesthesiologists said physician anesthesiologists are trying to portray the letter as a win for CRNAs, according to the report. The CANA said there is no evidence CRNA services are less safe for patients who receive services from physician anesthesiologists.
Earlier in 2024, the health department and federal regulators cited Doctor's Medical Center, also in Modesto, for not properly credentialing CRNAs who were working in operating rooms. The CRNAs were sent home from the hospital, and nearly 1,000 surgeries were canceled as a result.