(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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