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Court: Colorado CRNAs can practice independently

Tuesday July 24, 2012
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The Colorado Court of Appeals has upheld a lower-court decision affirming that state law does not require certified registered nurse anesthetists to be supervised by a physician.

The court likewise ruled that former Gov. Bill Ritter acted within his rights in September 2010 when he opted out of the federal physician supervision requirement for nurse anesthetists at critical access hospitals and 14 general hospitals in rural areas.

The ruling upholds the previous decision in favor of Gov. John Hickenlooper, the Colorado Association of Nurse Anesthetists, the Colorado Nurses Association and the Colorado Hospital Association. It dismisses the lawsuit filed in September 2010 by two physicians’ organizations, the Colorado Society of Anesthesiologists and the Colorado Medical Society.

Scott Shaffer, CRNA, president of CoANA, said the association is pleased that the lower court upheld what "has always been the scope of practice" for Colorado nurse anesthetists, according to a news release.

A district court granted summary judgment on March 31, 2011, affirming Colorado’s opt-out of the federal supervision requirement. The judge stated that in Colorado, the administration of anesthesia by CRNAs is an independent nursing function and does not require physician supervision, an important condition for seeking an opt-out from Centers for Medicare & Medicaid Services rules requiring physician supervision in hospitals that receive Medicare reimbursements.

The ruling is particularly important for rural communities given that CRNAs are the sole provider of anesthesia services in more than 70% of the state’s hospitals, according to a news release from the American Association of Nurse Anesthetists.

CRNAs personally administer approximately 32 million anesthetics to patients across the United States each year, according to the AANA. The association said two recent national anesthesia studies confirmed the safety and cost-effectiveness of CRNAs, who practice in every type of setting in which anesthesia is delivered and are the sole anesthesia providers in most rural hospitals.

Fran Ricker, executive director of the Colorado Nurses Association, said the ruling will increase patients’ access to anesthesia services, especially in rural areas that potentially have a shortage or absence of anesthesiologists to meet patients’ needs.

"Substantive studies have shown that CRNAs provide safe, high-quality care to patients and have inherent value as a provider in their own right," Ricker said in a news release. "This is not a matter of CRNAs only serving as a substitute in the absence of anesthesiologists."

She noted the court’s conclusion that "CRNAs who administer anesthesia are conducting independent nursing functions within the scope, role and population focus that the Nursing Board has approved for them. They are not conducting delegated medical functions and therefore do not require physician supervision."

Colorado was the 16th of the 17 states that have opted out of the federal rule, joining Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California and Kentucky.


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