Colorado Court Rules in Favor of Nurse Anesthetists’ Independence

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In a victory for nurses, a Colorado appeals court ruled July 19 that certified registered nurse anesthetists (CRNAs) in Colorado can provide anesthesia services to Medicare patients without physician supervision at designated health care facilities.

Nurses represented by the Colorado Nurses Association, Colorado Association of Nurse Anesthetists and Colorado Hospital Association beat back a legal challenge from two state physicians’ organizations, which opposed the Colorado governor’s 2010 decision that allowed CRNAs to practice independently of physician supervision. The nurses groups were “interveners” in the legal action, which was filed against the Colorado governor.

The American Nurses Association (ANA) identifies elimination of scope of practice barriers as one of its top priorities. As a founding member of the Coalition for Patients’ Rights®, ANA is actively involved in the coalition’s efforts to protect consumers’ rights to access the health care professionals of their choice, including advanced practice registered nurses (APRNs).

Medicare rules require ambulatory surgical centers, hospitals and critical access hospitals to meet certain conditions to receive Medicare reimbursement, including the requirement that CRNAs administering anesthesia be supervised by a physician. However, state governors can request to opt out of that requirement after consulting with the state boards of medicine and nursing. Colorado’s governor requested the Centers for Medicare and Medicaid Services (CMS) to allow all Colorado critical access hospitals and 14 rural general hospitals to opt out of the provision.

Fran Ricker, executive director of the Colorado Nurses Association, said the ruling will increase patients’ access to anesthesia services, particularly in rural areas where there may be 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. “This is not a matter of CRNAs only serving as a substitute in the absence of anesthesiologists.” The Colorado court concluded 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 is among 16 states to opt out of the CRNA supervision requirement. All but one of those states is in the Midwest or West, large states with vast rural areas where CRNAs may be the most accessible option for anesthesia services.