Two recent national anesthesia studies confirmed the safety and cost-effectiveness of CRNAs--- they practice in every type of setting in which anesthesia is delivered, and are the sole anesthesia providers in most rural hospitals. In fact, the US military has relied upon CRNA's exclusively throughout the history of anesthesia.
That's one reason, and the crunched economy another, that so many states are opting out of a federal Medicare clause that options employment of much higher-paid Anesthesiologist MD's--- doctors who typically consult but rarely administer anesthesia in most cases. Certified Registered Nurse Anesthetists (CRNAs) personally administer approximately 32 million anesthetics to patients across the United States each year.
The federal supervision rule is not a regulatory measure designed to ensure patient safety. It's simply a requirement that hospitals must meet in order to receive Medicare reimbursement for anesthesia services--- unless, that is, a state chooses to opt out of the rule.
This is what 16 states, including California, has done.
Ruling in favor of Gov. Arnold Schwarzenegger and the California Association of Nurse Anesthetists (CANA), the California Superior Court in San Francisco has affirmed that California state law does not require advanced-practice nurse anesthetists to be supervised by a physician.
Anesthesiologists have spent great sums lobbying against the opt-out, with fear campaigns against CRNA's that seemed to have had little impact. It's no secret among medical experts that Nurse Anesthetists pioneered anesthesia. In fact, the MD speciality Anesthesiologist did not exist until long after CRNA treatment had evolved.
California was the 15th state to opt out of the federal rule, following Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, and Wisconsin. Colorado recently became the 16th opt-out state.