COLORAOD: CRNA vs. Anesthesiologists

mwbeah · May 23, 2005

is anyone aware of the status of crna's attempt to work independently of anesthesiologist's in colorado? it stalled with the governor ... last i heard ... not sure what's going on now, and would like to know the latest, if possible.
thanks a million!!

under colorado law, the delivery of anesthesia care by nurse anesthetists is a delegated medical function that must be performed under physician supervision. the nurse practice act defines a "delegated medical function" as "an aspect of care which implements and is consistent with the medical plan as prescribed by a licensed or otherwise legally authorized physician, podiatrist or dentist ..." [c.r.s. section 12-38-103(4)].

mwbeah · May 23, 2005

What is Colorado's Current Law Regarding CRNA Supervision?

Colorado health facility licensure conditions of participation do not require CRNAs to be supervised by a physician in a hospital, ambulatory surgery center or Critical Access Hospital.

Additionally...

- Regardless of whether a state opts out of the federal supervision requirement, individual facilities may still require CRNAs to be physician supervised.

- The National Rural Health Association and the Colorado Rural Health Center (the state office of rural health) are on record supporting the opt out of the physician supervision requirement in order to ensure that anesthesia services are available in rural areas.

- CRNAs provide over 70% of the anesthesia in rural America, keeping the doors of operating rooms open in rural hospitals.

- CMS has found no compelling evidence that an across-the-board Federal physician supervision requirement for CRNAs leads to better outcomes.

U:\Lou Ann\CRNA Supervision\Fact Sheet.doc

deepz · May 23, 2005

Under Colorado law, the delivery of anesthesia care by nurse anesthetists is a delegated medical function that must be performed under physician supervision. ..........[C.R.S. Section 12-38-103(4)].

Don't know where you came up with this info, Mike, but it is way outdated.

To quote from Mark Oswald's (Pres CANA) letter to the Colorado Board of Health dated 21 MAY 2003:

".... As shown by the legislative history that accompanied the adoption of 12-38-111.6(8)©(II), CRS by the General Assembly in 1995, the "delegated medical function" argument put forward by the Colorado Society of orificethesiologists (CSA) was considered and rejected...."

The OP was referring, of course, to Gov Owens's promised Medicare Opt-Out letter to CMS. After the CSA sued him preemptively, citing 'potential adverse consequences on the incomes of Colorado anesthesiologists' or some such malarkey, Gov Owens has taken no further action. So, for reimbursement under Part A of Medicare, Colorado remains NOT an Opt-Out State.

There is no Colorado law or rule requiring CRNAs to be stupervised by a physician, nor is there ANY state which requires CRNAs to work under an MDA.

deepz

mwbeah · May 23, 2005

colorado governor bill owens' goal of opting out was stalled when the colorado society of anesthesiologists filed suit. subsequent to the filing of the lawsuit, the board of health eliminated the hospital requirements for physician supervision of nurse anesthetists who administer general or regional anesthesia. as of today the issue seems dormant until the governor acts at which time the csa will refile the appeal.

the wording of the nurse practice act has not changed, that information is the same. the only thing that has changed is in red and was previously stated by me in my second posting.

mike

mwbeah · May 23, 2005

colorado governor bill owens' goal of opting out was stalled when the colorado society of anesthesiologists filed suit. subsequent to the filing of the lawsuit, the board of health eliminated the hospital requirements for physician supervision of nurse anesthetists who administer general or regional anesthesia. as of today the issue seems dormant until the governor acts at which time the csa will refile the appeal.
the wording of the nurse practice act has not changed, that information is the same. the only thing that has changed is in red and was previously stated by me in my second posting.
mike

in other words, there was alot of "fur flyin..." but the wording on the books has not changed. (you can research for yourself). the "delegated medical" wording is still in the cbe regulations.

mike

deepz · May 23, 2005

.... the wording on the books has not changed. (you can research for yourself). ...

Unless you are in possession, Mike, as I am, of the spiral bound document "Amendments to Standards for Hospitals and Health Facilities, 6 CCR 1011-1, Chapter IV, General Hospitals, Section 7, Comments Submitted by The Colorado Association of Nurse Anesthetists, For Consideration by, The Colorado Board of Health, May 21, 2003" your own research seems to be lacking here.

Clearly the Office of the Colorado Attorney General states "...the delivery of anesthesia care by a nurse anesthetist rests soundly within the independent scope of CRNA practice." --Darlene H. Harney, Asst Atty Gen, writing to Fred Miles, Esq, of the law firm Miles, McLaren & Peters, dated 28 OCT 99

Now, you assert in this thread post #2 that anesthesia by a CRNA is a delegated function and requires stupervision, but then in post #3 you seem to say the opposite. WTF?

deepz

eethrnurse90 · May 24, 2005

The OP was referring, of course, to Gov Owens's promised Medicare Opt-Out letter to CMS. After the CSA sued him preemptively, citing 'potential adverse consequences on the incomes of Colorado anesthesiologists' or some such malarkey, Gov Owens has taken no further action. So, for reimbursement under Part A of Medicare, Colorado remains NOT an Opt-Out State.

Deepz,

This answered my question. The last we'd heard in the newspapers, Governor Owens had stalled out and not done anything else. I didn't know if there was still an active campaign to convince him to progress. It would benefit the rural population in eastern Colorado, as well as other rural areas, of course.

You mentioned Mark Oswald as being the president of CANA. I met the former president on a flight once, a woman. Do you know her name?

mwbeah · May 24, 2005

Unless you are in possession, Mike, as I am, of the spiral bound document "Amendments to Standards for Hospitals and Health Facilities, 6 CCR 1011-1, Chapter IV, General Hospitals, Section 7, Comments Submitted by The Colorado Association of Nurse Anesthetists, For Consideration by, The Colorado Board of Health, May 21, 2003" your own research seems to be lacking here.
Clearly the Office of the Colorado Attorney General states "...the delivery of anesthesia care by a nurse anesthetist rests soundly within the independent scope of CRNA practice." --Darlene H. Harney, Asst Atty Gen, writing to Fred Miles, Esq, of the law firm Miles, McLaren & Peters, dated 28 OCT 99
Now, you assert in this thread post #2 that anesthesia by a CRNA is a delegated function and requires stupervision, but then in post #3 you seem to say the opposite. WTF?
deepz

Exactly my point, there is different language depending on the source. This is why the CSA is able to give us a hard time.

Mike

deepz · May 24, 2005

Exactly my point, there is different language depending on the source. This is why the CSA is able to give us a hard time.
Mike

Well, I'm just left to guess, Mike, that you are one of those folks who find it awfully hard to admit that they're mistaken.

You asserted:

"Under Colorado law, the delivery of anesthesia care by nurse anesthetists is a delegated medical function that must be performed under physician supervision."

You are wrong. CRNA anesthesia is not a delegated medical function.

Among the hundreds of pages in the aforementioned 'Comments' submitted by the COANA to the Bd of Health was a letter from lawyer Deborah E. Smith, representing a hospital with contracted CRNAs, to the Colorado State Board of Nursing, asking among others this specific question:

"Is the administration of anesthesia an independent nursing function or a delegated medical function?" ---dated 18 DEC 98

To which Patricia F. Uris, RN, PhD, Program Administrator, Colorado Board of Nursing, replied specifically:

"The delivery of anesthesia care, including the selection and administration of anesthetic agents, is the independent practice of nurse anesthesia." ---dated 30 AUG 99

Therefore NOT a delegated medical function, NOT requiring stupervision. Can it possibly be expressed any more clearly than by the head of the Board of Nursing?

!

mwbeah · May 24, 2005

Well, I'm just left to guess, Mike, that you are one of those folks who find it awfully hard to admit that they're mistaken.

Where did that come from????? Is it always your nature to be rude to people? I do not believe any of my postings in this thread resulted in type of personal attack. Seems like you got issues.

I was trying to show the initial poster the conflicting information on purpose so he would be prompted to come back with exactly what you asked... i.e "WTF".

I have to say your use of the language does not represent our cause well.

Mike

mwbeah · May 24, 2005

Also, if you goto the current website which has the colorado nurse practice act posted, it does not differentiate (AT ALL) for CRNAs. It groups them with advanced practice nurses and collectively uses the phrase "medically delegated" whatever you have in front of you still doesn't change the language in the nurse practice act and that is what needs to happen. Until that time, the CSA can bring the issue to court as much as they want. Which is what they will do as soon as the Governor seeks to formally opt out.

Mike