Colo. court: Nurses can provide anesthesia

Hospitals argue move necessary; critics view it as cost-cutting move

DENVER – The Colorado Court of Appeals ruled Thursday that advanced-practice nurses can administer anesthesia without a doctor’s supervision, a ruling that prompted a warning by doctors that patients could suffer serious medical complications and receive inadequate care.

The court ruling came in response to a lawsuit filed by the Colorado Society of Anesthesiologists and the Colorado Medical Society seeking to stop the change.

Hospitals said the move was necessary because there aren’t enough doctors, and the crisis will get worse as the country adapts to new health-care laws that open the doors to millions of new patients.

Dr. Randall Clark, spokesman for the Colorado Society of Anesthesiologists, countered that the ruling provides an opportunity for hospitals to cut costs by turning over more responsibility to nurses to perform advanced medical treatment without supervision.

“This definitely affects patient care,” Clark said. “There is a danger of cardiac arrest and neurological injury while using anesthesia. We should focus on the patients rather than lowering the standard of care by taking physicians out of the equation.”

Hospitals say the ruling will not jeopardize patient care, and cutting costs will help patients. The practice has been approved by state officials.

The lawsuit came after the Colorado Medical Board and Colorado Board of Nursing recommended the state opt out of a provision of the Social Security Act that required surgical centers, hospitals and other facilities to provide doctor supervision for certified registered nurse anesthetists.

Federal law allows states to opt out by sending a letter to the Centers for Medicare and Medicaid Services signed by the governor in consultation with regulators attesting that the new policy is in the best interest of citizens and consistent with state law.

In 2010, former Gov. Bill Ritter consulted regulators and recommended the changes. The appeals court ruled that the new policy is consistent with state law, which gives the responsibility of regulating nurses to the nursing board. Fifteen other states have also adopted the policy.

Fran Ricker, executive director of the Colorado Nurses Association, which represents 1,400 of the 50,000 nurses across the state, said the ruling will improve patient care, especially in rural areas where anesthesiologists are in short supply and specially trained nurses can fill the void.

“It’s impossible to comply with the current law because some hospitals have no anesthesiologist in the first place,” she said.

Doctors say Colorado law has long held the surgeon to be the “captain of the ship” in the operating room and responsible for supervising everyone, including a nurse anesthetist when an anesthesiologist is not available. Doctors say they will now be held responsible for the actions of practitioners they do not control.

Kari Hershey, attorney for the Colorado Medical Society with 7,000 members statewide, said the ruling doesn’t make sense because surgery can’t begin without a surgeon.

“We work best in partnership with our nursing colleagues. It needs to be a team environment,” Hershey said.

Colorado Hospital Association President Steven J. Summer said nurses who are properly trained can provide critical health care in a system that is still trying to determine the ramifications of health-care changes ordered by Congress and the Obama administration.

“Such providers, including advanced practice nurses and others, are needed to help fill a substantial gap in health care access in underserved regions of our state, and the court has affirmed their right to do so,” Summer said in a statement.

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