Concluding that physician supervision of certified registered nurse anesthetists (CRNAs) is not in the interests of the people of California, Governor Arnold Schwarzenegger opted out of a Medicare provision that requires just such supervision.

Medicare does offer states the right to opt out of this requirement, but only if certain conditions are met. Last year, the Governor sent a letter to the Centers for Medicare & Medicaid Services, and exercised the exemption, concluding it was "in the interests of the people of California."

To block this move, the California Medical Association and the California Society of Anesthesiologists have filed a lawsuit in the Superior Court of the State of California in and for the County of San Francisco. The physicians’ groups’ claim Schwarzenegger’s opting out violates state laws that specifically prohibit nurse anesthetists from providing anesthetics without supervision. The CMA and CSA also say that any opt-out has to comply with state “scope-of-practice” laws and that the state medical board must be consulted on this and on any issue with potential public benefit.

According to the lawsuit, before 2001, CRNAs had to be supervised by a physician, without exception. In 2001, however, a federal regulation provided the option of an opt-out if certain conditions were met. It is also noted that the Nursing Practice Act requires physician supervision for CRNAs.

CMA’s General Counsel, Francisco Silva, said in AMNews that California law is clear.

"California [through state law] has made the choice that physician supervision is required to address those patient safety concerns," said Francisco Silva, the CMA's general counsel.

The lawsuit contends that not only patients, but anesthesiologists and other physicians may be at special risk due to the opt-out, because of liability and responsibility questions.

According to a CMA representative, no hearings have been scheduled.