(Sacramento, CA) – Today, the California Association of Nurse Anesthesiology (CANA) brought together legislators, health care experts, policymakers, and community advocates to tackle one of California’s most pressing public health challenges. CANA’s 2025 Opioid Epidemic Symposium: Identifying Obstacles, Inspiring Solutions featured powerful testimonials, practical strategies, and innovative approaches to help address the crisis in California, including the role of Certified Registered Nurse Anesthesiologists (CRNAs) in providing opioid-free pain management techniques.

“Today’s Symposium demonstrated the critical importance of partnerships to reduce care gaps and advance meaningful recovery policies,” said Emily Francke, CRNA and President of CANA. “California CRNAs are at the forefront of compassionate, evidence-based pain management, working collaboratively with physicians, policymakers, and community leaders to ensure patients receive exceptional care. By working together, we can expand access to innovative solutions, protect those at risk of substance use disorder (SUD), and save lives across the state.”

The all-day event, held during National CRNA Week (January 19-25) at the Secretary of State’s Auditorium, included expert policy panels focused on effective strategies to combat the opioid crisis and areas in need of improvement, such as empowering youth to make informed decisions and prioritize their mental well-being.

“My 14-year-old son tragically died in 2020 after unknowingly ingesting a counterfeit, fentanyl-laced pill,” said Amy Neville, President of the Alexander Neville Foundation. “Alexander’s story is a heartbreaking reminder of the opioid crisis’ widespread reach and that we must do more to protect our youth. Prevention and education are critical tools in this fight.”

The event also emphasized how California CRNAs can help prevent SUD by providing safe and effective opioid-free pain management solutions. A 2018 Stanford University School of Medicine study published in JAMA Internal Medicine found an alarming link between opioid prescriptions for routine procedures, like wisdom teeth extractions, and SUD risk in teens and young adults. By offering opioid-free pain management, in addition to Medication Assisted Treatment (MAT), CRNAs have the ability to help reduce the risk of long-term opioid misuse for first-time users and provide evidence-based recovery techniques for those living with SUD.

“The opioid epidemic impacts every community in California,” said Assemblymember Heath Flora (R-Ripon), Vice Chair of the Business and Professions Committee. “By empowering health care providers, like CRNAs, to expand access to proven care techniques and ensuring collaboration among our local leaders, we can bridge resource gaps, implement effective strategies, and better protect our neighbors – particularly those in rural and underserved regions of the state.”

Through open dialogue and innovative thinking, the Symposium encouraged diverse perspectives on tackling the opioid crisis.

“Every day I see firsthand the devastating toll the opioid epidemic takes on our communities. To truly combat this epidemic and seek justice for victims, we need comprehensive tools, including enhanced prevention efforts, effective treatment programs, and strong partnerships that prioritize public safety and the wellbeing of those impacted,” said Nina Salarno, Modoc County District Attorney and Founder of Crime Victims United. “Together, we can forge a path to recovery and resilience for our families and neighborhoods.”

By working together to implement sustainable, evidence-based solutions, California policymakers, health care providers, and community leaders can better address the immediate challenges of opioid misuse while promoting long-term recovery and prevention strategies.

“We cannot overstate the importance of meeting people where they are and providing the help they need when they need it – whether it’s treatment, recovery support, or lifesaving interventions,” said Shasta County Sheriff Mike Johnson. “This means balancing compassion with responsibility to ensure we’re offering the support needed to break the cycle of addiction while maintaining public safety.

(December 6, 2024)—Assemblymember Heath Flora (R-Ripon) today issued the following statement in response to revised guidance by the Centers for Medicare & Medicaid Services (CMS) for surveyors and health care providers regarding immediate jeopardy:

“On behalf of my constituents, I commend CMS’ decision to revise their immediate jeopardy (IJ) guidelines. By introducing more precise and evidence-based criteria, health care facilities in California can address safety concerns without undue overreach. The revisions promote fairness and accountability in regulatory oversight, and should help reduce the risk of arbitrary enforcement that can destabilize health care facilities and jeopardize access to care.

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(SACRAMENTO, CA) – Recent surveys overseen by the California Department of Public Health (CDPH) have prompted significant concerns from Certified Registered Nurse Anesthetists (CRNAs), legislators, and health care advocates across the state. Reports indicate that a surveyor contracted by CDPH misrepresented state and federal laws regarding CRNA practice, causing significant disruptions in anesthesia services, especially in underserved regions.

“The CDPH’s lack of oversight of their surveyors reflects a troubling disregard for established CRNA practices and patient care standards in California. It is critical for the Department to address these biased surveys and prevent further harm to the public,” said Sandra Bordi, DNP, CRNA, FAANA, President, California Association of Nurse Anesthesiology (CANA).

The improper survey activities in question pressured hospitals to reduce scope of CRNA practice and, in the case of one hospital, led to the unnecessary cancellation, delay, and/or transfer of more than 1,000 surgeries, majority of which affected Medi-Cal and Medicare beneficiaries. While the California Board of Registered Nursing (BRN) is the only state agency with governance over CRNA scope of practice, the Centers for Medicare and Medicaid Services (CMS), California Health and Human Services Agency (CalHHS), and CDPH have failed to adequately respond to requests for clarification and have ignored repeated requests for an investigation into the survey process.

“Documents received from a Public Records Act (PRA) request of the CDPH made clear that CRNAs were terminated or replaced by physician anesthesiologists without warning or opportunity to be heard at Stanislaus Surgical Hospital. Based on these documents, CRNAs had actually been absent from the hospital for approximately six months when the final inspection report in July 2024 resulted in the hospital’s termination of Medicare enrollment. It’s therefore incorrect to state that the hospital closed as a result of the care provided by CRNAs,” said Katherine A. Bowles, Director, Fennemore.

In California, CRNAs have been allowed to practice independently, without physician supervision, since the 1980s, a policy reinforced by the California Court of Appeal in 2012 and supported by the Nursing Practice Act and Business and Professions Code 2725. Despite these laws and regulations, including a September 6, 2024, All Facilities Letter, hospitals and facilities continue to remain confused due to CDPH’s apparent regulatory capture by physician anesthesiologists, as well as a lack of urgency by California government agencies to correct the narrative.

“After reviewing documents received from the PRA request, we, unfortunately, are confident that the CDPH surveys were not only misinformed but also resulted in significant and unnecessary disruptions for health care facilities and their patients. California statute, and supporting regulations, clearly support CRNAs’ independent practice – actions contradicting these facts are detrimental to anesthesia care in the state,” concluded Bordi.

The current situation in California highlights a broader effort by special interests to target and discredit CRNAs and other advanced practice providers. CDPH’s actions seemingly align with a campaign to revert California to a physician supervision model, which threatens to reduce the number of qualified providers and puts even more strain on the state’s severe health care workforce shortage.

CRNAs play a crucial role in ensuring affordable health care across California, especially in underserved and rural areas. It is imperative that CMS, CalHHS, CDPH, and the BRN promptly address these issues to prevent further disruptions and to maintain the strength and accessibility of California’s health care system. Immediate corrective action is necessary to support CRNAs in continuing to deliver essential services and to uphold the integrity of our health care infrastructure.

About CANA

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.

The shortage of anesthesia providers has plagued healthcare across the country, driven by ongoing issues on the supply and demand ends of the spectrum.

As a result, many healthcare facilities —  particularly in rural communities — have turned to clinical staffing models that rely more heavily on certified nurse anesthetists for their anesthesia coverage.   

However, Anthem Blue Cross Blue Shield will reduce QZ services performed by CRNAs to 85% of the physician fee schedule starting Nov. 1. 

This sparked criticism from the American Association of Nurse Anesthesiology, which specifically mentioned the effect of this new policy on rural communities. 

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