California hospitals caught in the middle of anesthesiologist, CRNA debate

Two California hospitals are in the spotlight after they were cited for issues related to care by certified registered nurse anesthetists — adding fuel to an ongoing debate over physician and advanced practitioner care, The Modesto Bee reported June 24.

This year, the California Public Health Department surveyed Stanislaus Surgical Hospital and Doctors Medical Center, both based in Modesto, after reports of patient harm. Doctors Medical Center was cited for immediate jeopardy by CMS for allowing certified registered nurse anesthetists to oversee procedures they had not previously performed at the hospital. Inspectors also found flaws in the credentialing of 19 CRNAs. 

Stanislaus was also found to be out of compliance with certain Medicare conditions of participation, including the hospital's handling of patient emergencies after surgeries, infection prevention and control, sterilization processes, governance and unspecified issues related to the use of certified nurse anesthetists. Both hospitals have an opportunity to submit a correction plan.

At Stanislaus, dozens of CRNAs have been laid off, and at Doctors Medical, CRNAs were sent home and cannot return to work until the hospital submits its corrective plan. At both hospitals, hundreds of surgeries have been canceled or rescheduled, according to the report.

The surveys and citations have brought forward a well-established debate about the use of physicians and advanced practitioners in care. 

The California Society of Anesthesiologists published an alert June 11 over concerns for patient safety at the hospitals and called for hospitals to ensure patients "can access physician-led anesthesia care." The association said that in a survey at Straislaus, it found CRNAs were making questionable decisions in prescribing drugs, sloppy paperwork and improper communication about what drugs were given to patients. It also found that CRNAs were given full prescriptive and diagnostic authority at the hospital. The lack of supervision from anesthesiologists resulted in "possible avoidable situations where 10 patients experienced negative health outcomes following care provided by CRNAs and required transfer to a higher level of care," the survey said. The survey team wants to require physician supervision of CRNAs at a ratio of 1 to 4.

The California Association of Nurse Anesthesiology has criticized the survey. It told the Bee that it is concerned that there's been a larger movement of physician groups to "discredit CRNAs and take a larger portion of business back from them," the report said. Kaitlin Perry, a communications consultant working for the California Association of Nurse Anesthesiology, told Becker's that they are in conversation with California Public Health Department about their surveys that "caused facilities to unnecessarily change CRNA practices."

"We have not seen a drastic increase in patient harm since [the pandemic]," Ms. Perry told the Bee. "CRNAs are highly qualified and practice safely."

During the pandemic, CMS allowed CRNAs to practice without supervision in every state.

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