Certified Registered Nurse Anesthetists (CRNAs) in California are advocating against changes imposed in the wake of ‘Immediate Jeopardy’ violations leveled against two Modesto-based hospitals. The hospitals allegedly allowed CRNAs to operate outside their jurisdiction, which drew the firms into hot water.
The two facilities in question, Stanislaus Surgical Hospital and Doctors Medical Center, have landed under the microscope for reportedly allowing CRNAs to independently order and administer anesthesia drugs, a violation according to the California Department of Public Health (CDPH) acting on behalf of the Centers for Medicare & Medicaid Services (CMS). The two bodies hold that CRNAs are not permitted to order medications or plan treatments without the supervision of a physician.
Rejecting the accusations, the California Association of Nurse Anesthesiology (CANA) fervently contests the CDPH’s findings. The association references a 2009 ruling that absolved CRNAs from requiring physician oversight, arguing that this ruling remains in effect. Following the citations, hundreds of surgical procedures have been postponed or cancelled, after both hospitals suspended CRNA practice.
In both August 2023 and January 2024, Stanislaus Surgical Hospital received two ‘Immediate Jeopardy’ citations. It was reported that a CRNA modified a physician’s order, changing from general anesthesia to a higher-risk spinal anesthesia and sedation for a surgical procedure, later resulting in adverse health outcomes for several patients. The CDPH highlighted various issues, including infection prevention, control and sterilization process concerns, alongside a lacking adherence to hospital policy stipulating physician oversight of anesthesia. Consequently, in February 2024, Stanislaus Surgical Hospital suspended the practice of CRNAs at the facility.
The controversy spread to the Doctors Medical Center in May 2024 when it too received an ‘Immediate Jeopardy’ sanction. At this hospital, the concern was regarding CRNAs used to monitor and sedate surgical patients. The hospital has since frozen CRNA practice and has begun revising its credentialing procedures for CRNAs.
CANA is now requesting the CDPH to investigate these citations and the effects of CRNA departures on surgical cancellations in this area which is already affected by a healthcare shortage. The California Society of Anesthesiologists (CSA) presented an opposing viewpoint, advocating for physician-led anesthesia care and emphasizing the importance of physician involvement to ensure patient safety.
Neither hospital has responded to requests for comment about the situation, highlighting a complex and evolving scenario where stakeholders of all levels have a vested interest.
Source: https://www.medpagetoday.com/special-reports/features/110908