Colorado seeks to end doctor oversight of nurse anesthetists

Proponents say rural access to health care will improve. But opponents say patient safety is at risk.

By Myrle Croasdale, AMNews staff. Oct. 13, 2003.

Colorado is on the verge of becoming the eighth state to take advantage of a federal offer to opt out of a Medicare rule that requires physician supervision of certified registered nurse anesthetists.

The Colorado Society of Anesthesiologists, which opposes the move, has filed a lawsuit in Denver District Court against Gov. Bill Owens alleging that an opt-out would violate the state's laws. The governor has asked the court to dismiss the case and has succeeded in removing what many consider to be the other big barrier to opting out by convincing the state health department to lift its requirement for physician supervision of CRNAs. The governor has yet to formalize the opt-out on the federal level.

The two sides in this struggle agree that Colorado's rural population needs better access to medical care. They disagree, however, on how to deliver it. Opponents say physician supervision of CRNAs is the safest approach to anesthesia and that lifting this requirement would compromise patient care. Proponents argue that CRNAs have an excellent safety record and that ending the oversight requirement would improve health care for Colorado's rural residents, because more physicians would be willing to do surgery in rural areas if they weren't required to sign off on the work of CRNAs.

While most state and national physician organizations, including the AMA, oppose relinquishing physician oversight of CRNAs, the Colorado Academy of Family Physicians board of directors is supporting the governor's proposal.