16 States That Have Opted Out of Doctor Anesthesia Supervision

08 Nov

In the last post, we discussed the debate over allowing nurse anesthetists to administer anesthesia to patients without a doctor’s supervision. While that debate rages on, let’s take a closer look at the first five states to opt out of the federal requirement for doctor supervision of anesthesia provision:

1. Iowa – In 2001, the Centers for Medicare & Medicaid Services published its rule granting state governors the ability to opt out of the supervision requirement. Less than a month after that news, Iowa became the first state to take them up on the offer. At that time, 91 of 118 Iowa hospitals relied exclusively on Certified Registered Nurse Anesthetists (CRNAs) to provide anesthesia care.

2. Nebraska – The second state to opt out of the physician supervision requirement, Nebraska did so in February 2002. Nebraska Governor Mike Johanns sent a letter to CMS saying “it is in the best interest of the State’s citizens to exercise this exemption.”

3. Idaho – In March 2002, the state’s governor, Dirk Kempthorne, told Idahoans that their state would opt out of the physician requirement as a way of benefiting “Idaho’s citizens, rural communities and hospitals.”

4. Minnesota – In April 2002, Minnesota’s outspoken and colorful governor
Governor, Jesse Ventura, informed CMS in April 2002 that his state would opt out of the federal physician supervision requirement, saying his office consulted with medical and nursing boards, the attorney general and various other parties.

5. New Hampshire – Rounding out the first five states to opt out of the federal doctor supervision requirement is New Hampshire. Opting out in June 2002, Governor Jeanne Shaheen claimed that not doing so “may severely limit the ability of rural hospitals to treat emergencies and provide other services that require anesthesia care.”

The most recent state to opt out of the physician supervision requirement is Colorado. Just this past September, Colorado Governor Bill Ritter announced that his state would opt out following the controversial study published in the August 2010 issue of Health Affairs which claimed patients were not harmed when CRNAs provided anesthesia without physician supervision.

The other 10 states to opt of the supervision requirement were New Mexico, Kansas, North Dakota, South Dakota, Washington, Oregon, Alaska, Wisconsin, California, and Colorado.

California’s situation is particularly interesting since both the California Society of Anesthesiologists and California Medical Association filed a motion that sought to have Governor Schwarzenegger’s letter withdrawn. While the motion was denied this month, the CSA and CMA are considering further actions to appeal the ruling.