October 17, 2026
(SAN FRANCISCO, CA) – On October 1, the California Association of Nurse Anesthesiology (CANA) filed a complaint against the California Department of Public Health (CDPH) and the Office of Administrative Law (OAL), challenging CDPH actions that have inappropriately restricted Certified Registered Nurse Anesthetists (CRNAs) from serving on hospital medical staffs.
The complaint argues that California Business & Professions Code regulations governing medical staff membership are not consistent with state law, and exceed CDPH’s authority. Under Business & Professions Code §§ 2282(b) and 2283(a), hospital medical staffs are authorized to include as members any “licensed practitioners competent in their respective fields and worthy in professional ethics.”
“CDPH’s authority over hospital facilities does not grant it authority over the determination of which individual licensed practitioners the medical staff has deemed ‘competent in their respective fields and worthy in professional ethics,’” said Katherine Bowles, J.D., CANA Counsel. “That power lies entirely with the medical staff, established within California law as an independent, self-governing legal entity separate from the hospital and operating under a distinct regulatory framework.”
In addition to requested changes, CANA’s complaint also challenges CDPH's enforcement of the regulations, alleging that several 2024 citations were erroneously issued to rural and critical access hospitals that had credentialed CRNAs as independent practitioners on hospital medical staffs. At least two of the citations resulted in hospitals needlessly removing, without notice, all CRNAs from medical staff, thereby causing the cancellation of nearly 1,000 surgeries in underserved communities.
“Although state law allows for hospitals to choose who is on medical staff, the Department’s restrictive regulations interfere with that right. These structural barriers place an undue burden on hospital medical staff and have already caused dangerous disruptions in patient care,” said Alison Trejo, CANA Executive Director. “As we have for decades, CANA is requesting CDPH better align California regulation with state law to help prevent misinterpretations, improve governance, and enhance patient safety.”
In 1980, the California Legislature authorized hospital medical staffs to include as members any “licensed practitioners competent in their respective fields and worthy in professional ethics.” In 1983, DHS introduced two regulations which restricted medical staff membership to “physicians, dentists, podiatrist, and clinical psychologists.” CANA first petitioned DHS regarding this restriction in 1988.
In 1990, as DHS issued formal proposed rulemaking, California Attorney General Van de Kamp noted that state law “does not require that restriction,” meaning the state’s chief legal officer did not believe that DHS regulations were necessary to effectuate state law.
Despite broad agreement that medical staff shouldn’t be restricted, in 1993, the Office of Administrative Law adopted and filed regulations that limited medical staff membership to “physicians, dentists and podiatrists providing services in the outpatient unit…”
Following years of misinterpreted guidelines and inaction by CDPH, Mercy Medical Center of Mount Shasta petitioned the Department in 2018 to include CRNAs on their hospital medical staff. CDPH denied their petition because the rulemaking was still in the development phase and had not yet been finalized nor published for public comment.
Five years lapsed without the Department finalizing or publishing medical staff regulations.
In 2023, CANA submitted a petition to CDPH which challenged the restrictive list of health care providers who may serve as medical staff members; the petition was supported in public hearing by the California Association for Nurse Practitioners, California Association of Nurse Midwives, California Hospital Association, California Pharmacists Association, and the California Society of Health System Pharmacists.
In 2024, the American Nurses Association\California petitioned the California Department of Public Health; it too was supported by the professional associations who supported the 2023 CANA petition.
CDPH denied both the 2023 and 2024 petitions.
Following consistent communications from CDPH that rulemaking to update regulations governing medical staff were still in the development phase, several failed petitions, individual CRNAs being negatively impacted by CDPH overstepping its legislative authority, and ongoing requests by CANA and other professional associations to align the regulations with state law, CANA is now seeking a judicial determination to invalidate regulations 22 C.C.R. §§ 70701(a)(1)(e), 70703(a), 71503, 71529(b).
CANA’s Complaint for Declaratory Relief was filed in the Superior Court of the State of California for the County of San Francisco on October 1, 2026.
About the California Association of Nurse Anesthesiology
The California Association of Nurse Anesthesiology (CANA) represents CRNAs across the state. Since 1931, CANA has provided leadership, advocacy, and education to advance patient safety and support the nurse anesthesia profession. Learn more at www.canainc.org.