Nearly 1,000 surgeries have been allegedly canceled after Modesto, Calif.-based Doctors Medical Center was cited in June for immediate jeopardy by CMS, according to a July 26 letter from California Assemblymen Heath Flora and Juan Alanis obtained by Becker's.
In June, Doctors Medical Center was cited for immediate jeopardy by CMS, allegedly for using certified registered nurse anesthetists to sedate and monitor surgical patients.
On July 2, the California Department of Public Health alerted the hospital that it misunderstood the guidance regarding CRNA credentialing, according to the letter.
The misunderstanding led to a requirement for hospitals to wait for certain documentation before onboarding or hiring CRNAs, according to the letter.
According to the letter, addressed to California Health and Human Services Agency Secretary Mark Ghaly, MD, the "impacts of this 'misunderstanding' and the misplaced actions of the CDPH Fresno survey team requiring supervision of CRNAs are still being felt in the region," adding that facilities have enacted CRNA supervision out of concern for being negatively impacted like the DMC Modesto.
"Given there has been conflicting messaging from agencies, leaders and facilities in the region need affirmation of the applicable state and federal laws and the Nursing Practice Act that CDPH and the survey teams should be relying on," the letter said. "This will ensure patients’ access to vital services will not be unnecessarily interrupted in the future."
The actions have "created a domino effect in the region," the letter added, as 1,000 surgeries were canceled with 80% of those affecting Californians with Medicare and Medi-Cal coverage.
The American Association of Nurse Anesthesiology issued a statement July 25 saying that the move created "havoc for both the facilities and impacted patients."
"The impact of politics on patients’ access to necessary surgeries is intolerable and must stop," the statement said, and the AANA is "Calling for an immediate investigation into the nature of these surveys and statements made by the surveyor… Numerous peer-reviewed studies have shown that CRNAs are safe, high-quality, and cost-effective anesthesia professionals who should practice to the full extent of their education and abilities."
"The American Society of Anesthesiologists commends the California Department of Public Health and the Centers for Medicare and Medicaid for their work to identify certified registered nurse anesthetist patient safety deficiencies in two California hospitals," ASA President Ronald Harter, MD, said in a statement shared with Becker's. "...ASA’s concerns about the safety of anesthesia delivered by a CRNA without the involvement of a physician are informed by extensive independent literature and are underscored by this recent unfortunate situation."
The ASA statement added that the formal CDPH report said that the patients at the hospital did not have an anesthesiologist providing care, "requiring transfer of nine patients to a higher level of care."
Modesto, Calif.-based Stanislaus Surgical Hospital was also found to be out of compliance with certain Medicare conditions of participation following a survey from the California Public Health Department after reports of patient harm. According to The Modesto Bee, dozens of CRNAs have been laid off at the hospital and hundreds of surgeries have been canceled or rescheduled.
Becker's has reached out to the CDPH and Doctor's Medical Center Modesto and will update the story if more information becomes available.