The California Medical Association and California Society of Anesthesiologists have filed a lawsuit in state court against Gov. Arnold Schwarzenegger, claiming that he violated state law by authorizing nurse anesthetists to administer anesthesia without the supervision of a physician.

Gov. Schwarzenegger submitted a request to the Centers for Medicare and Medicaid Services in June 2009 to exempt California from a federal rule requiring CRNAs to administer anesthesia only under physician supervision. The 2 physician groups argue that, in doing so, the governor failed to meet the criteria of the 2001 rule change that allowed governors to opt out of the physician supervision requirement. Specifically, they allege that he did not properly consult with the state nursing and medical boards and that his opt-out letter contradicts existing state law requiring physician supervision of CRNAs.

The groups first petitioned Gov. Schwarzenegger to withdraw his opt-out letter, but the governor refused. They're now asking the court to mandate that he withdraw the letter and "take no further action to effect an opt-out." The governor maintains that he acted lawfully in requesting the opt-out. "We are confident that the Administration would prevail in any challenge on this issue, which maintains patient safety at a lower cost to consumers," Schwazenegger administration spokesman Mike Naple tells HealthLeaders Media.

Wanda Wilson, CRNA, PhD, MSN, executive director of the American Association of Nurse Anesthetists, says the physician groups' assertion that the governor "had no authority to submit" the opt-out letter to CMS is "completely contrary to what the rule itself says." In a statement, Ms. Wilson says, "California does not have a state law, rule or regulation requiring supervision of nurse anesthetists."

Irene Tsikitas