By Katie Kerwin McCrimmon
A battle that has pitted doctors against nurse anesthetists has resulted in a win in the Supreme Court for the nurses and for rural Colorado hospitals.
“This is a victory for the citizens of Colorado with respect to access to health care,” said Lisa Pearson, president-elect for the Colorado Association of Nurse Anesthetists, and one of about six anesthetists staffing the operating rooms without doctor supervision at St. Thomas More Hospital in Canon City.
Pearson said there are more than 470 nurse anesthetists serving patients throughout the state. In rural areas, nurse anesthetists are allowed to practice without a doctor’s supervision. In urban areas, Pearson said it’s typical for a nurse anesthetist to staff most surgeries with supervision from an anesthesiologist.
“The nurse anesthetist is the one putting you to sleep, keeping you asleep, watching over you and waking you up,” Pearson said.
Doctors in Colorado, however, have waged a major battle against the anesthetists since 2010 when then-Gov. Bill Ritter allowed rural and critical care hospitals to get waivers that would allow them to collect Medicare payments if nurse anesthetists practiced without a doctor’s supervision. Gov. John Hickenlooper has continued to allow the nurses to practice without formal doctor supervision in rural areas, and the state and the Colorado Hospital Association joined the nurses in fighting the doctor groups. The Supreme Court ruling, however, doesn’t appear to be ending the fight for the doctors.
“Unfortunately, we are not done yet,” Dr. Randall M. Clark, Colorado’s representative on the board of the American Society of Anesthesiologists, said in a statement after Monday’s ruling.
He vowed to press on with legal battles and insisted that the “safety” of Colorado citizens is at stake.
“The safety of Colorado’s citizens undergoing anesthesia requires the underlying legal questions to be resolved,” Clark said.
Both nursing groups and hospital officials say there’s no evidence that patients get lower quality care from nurse anesthetists than they do from doctors.
“We’ve not had any patient safety issues and we’re still able to offer services in rural areas so people don’t have to drive from Salida to Pueblo for a colonoscopy,” said Gail Finley, vice president of rural health and regulatory policy for the Colorado Hospital Association.
“It’s not like in these rural communities, we’re doing liver transplants and brain surgeries.
“The big win out of this is that everything we put in place in 2010 is fine,” Finley said.
Consumers should not notice any differences in care, and rural facilities can still opt to use nurse anesthetists if they wish, Finley said.
John Gardner, CEO of the Yuma District Hospital, a small facility on Colorado’s eastern plains that relies solely on nurse anesthetists, said the attacks on nurses are petty.
“There certainly has not been a queue of anesthesiologists chomping at the bit to wait for these anesthetists to get kicked out,” Gardner said. “I would characterize it as a turf battle.”
His hospital has just 15 beds and primarily offers basic surgeries including colonoscopies and hysterectomies.
“It’s been really frustrating that this has even been at risk. From an economic perspective, it never made sense for an anesthesiologist to come out and practice in a rural area because the volume just isn’t there.”
Gardner called the Supreme Court ruling “a great relief.”
“We’ll keep serving the community the way we always have. This hospital has been here since the late ’40s and has never had an anesthesiologist,” he said.
“We use CRNAs (certified registered nurse anesthetists) exclusively in our surgery …. It’s the standard for anesthesia in most rural hospitals.”
Like the anesthesiologists, the Colorado Medical Society sent out a statement regarding the Supreme Court ruling that made it sound like they had won, claiming that nurse anesthetists are not allowed to practice independently in Colorado even though they are already doing so.
“Colorado Medical Society recognizes CRNAs as valuable members of the surgical care team,” Dr. Tamaan Osbourne-Roberts said in a written statement. “However, their training is shorter in duration, narrower in scope and less comprehensive than the medical training of physicians.”
Osbourne-Roberts and the Medical Society’s lawyer claimed that the governor’s interpretation of Colorado law was wrong.
The Supreme Court ruling centered on whether Ritter had abused his powers by allowing the opt-outs.
Two lower courts had ruled on the issue previously and had found that under Colorado’s Nurse Practice Act, nurse anesthetists are allowed to practice independently.
John Conklin, a lawyer for the Colorado Medical Society, contends that the Supreme Court ruling did not confirm that nurses are allowed to practice on their own and therefore implied that the Supreme Court ruling won’t be the final word on this issue.
“The Medical Society has always felt that the law requires physician supervision,” Conklin said.
He acknowledged that nurse anesthetists already practice independently across the state, but insisted “it’s a decision to be made on a case by case basis depending on a participating hospital.”
“Where physician supervision is available, it should be in place. Where it’s not available, that’s up to the facility how they want to handle it.”
So, unless more litigation surfaces or the doctor groups try to mount a challenge through new laws at the state legislature, nurse anesthetists are free to keep practicing on their own in underserved parts of the state.
“There so much pressure on us to keep people in our communities and keep taking good care of them,” said Gardner of the hospital in Yuma. “This helps us keep doing that.”