In a continuing battle against the state's decision to opt out of a federal rule requiring physician supervision of nurse anesthetists, California physician groups are appealing an October 2010 court ruling in favor of the opt-out.

The California Society of Anesthesiologists and California Medical Association filed a writ petition in the First District Court of Appeal last week with the goal of overturning the San Francisco Superior Court's affirmation of former Gov. Arnold Schwarzenegger's decision to opt out of the federal CRNA supervision rule.

The groups sued the governor in February 2010, arguing that he violated state law by authorizing the opt-out. Fifteen other states have opted out of the federal rule, most citing the need to increase access to care for patients living in remote or rural areas where physicians are scarce.

In their appeal, the CMA and CSA argue that the governor was wrong to initiate the opt-out because California law requires physician supervision of nurse anesthetists. The Centers for Medicare and Medicaid Services provision letting governors opt-out of the supervision rule stipulates that they can only do so if it doesn't violate state law.

In a statement, leaders of both physician groups also argue that the opt-out could jeopardize the safety of patient care. "Nurses can be an integral part of a medical team if they work hand in hand and under the guidance of physicians, as they have for many decades," says CMA President James Hinsdale, MD. "But nurses are not trained to react to the myriad potential complications that can arise in the administration of anesthesia."

The California Association of Nurse Anesthetists counters the physician groups' claims that letting nurse anesthetists deliver anesthesia without clinical supervision would have safety implications. Phil Recht, counsel for the CANA and an attorney with Mayer Brown LLP, notes that that no safety incidents associated with the opt-out have been reported in California since it was authorized in the summer of 2009, or in any of the other 15 states that have opted out.

"We continue to think it was a proper decision both on the legal merits, but more importantly on the policy side," says Mr. Recht. "Nurse anesthetists have been critical providers of anesthesia care in California, particularly in rural areas, for decades."

Irene Tsikitas