Opting out: Liability and policy implications of eliminating the medicare crna supervision requirement

Journal of Legal Medicine

Volumn 25, Issue 2, 2004, Pages 229-248

  Poirier, Nicole B ^a,b  

^a S Illinois University School of Law   (United States)

^b SOUTHERN ILLINOIS UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EMPLOYEE; HEALTH CARE ACCESS; HEALTH CARE POLICY; HEALTH CARE QUALITY; HOSPITAL MANAGEMENT; HUMAN; LAW SUIT; LEGAL ASPECT; LEGAL LIABILITY; MEDICAL PRACTICE; MEDICARE; NOTE; PHYSICIAN; ECONOMICS; FINANCIAL MANAGEMENT; GOVERNMENT; HEALTH CARE MANPOWER; HOSPITAL SUBDIVISIONS AND COMPONENTS; NURSE ANESTHETIST; POLICY; REVIEW; UNITED STATES;

CONTRACT SERVICES; HEALTH MANPOWER; HUMANS; LIABILITY, LEGAL; MEDICARE; NURSE ANESTHETISTS; ORGANIZATIONAL POLICY; PERSONNEL ADMINISTRATION, HOSPITAL; STATE GOVERNMENT; UNITED STATES;

EID: 3142779418     PISSN: 01947648     EISSN: None     Source Type: Journal    
DOI: 10.1080/01947640490457505     Document Type: Note

References (148)

1. Gene A. Blumenreich, CRNAs as Independent Practitioners, American Association of Nurse Anesthetists, at http://www.aana.com/legal/legbrfs/2002/ 021b02.asp (Feb. 2002).
2. I b i d.
3. Gene A. Blumenreich, Surgeon's Liability for Negligence of CRNAs: A Recent Case, American Association of Nurse Anesthetists, at http://www.aana.com/ legal/legbrfs/1989/041b89.asp (Apr. 1989).
4. See Simmons v. Tuomey Reg'l Med. Ctr., 533 S.E.2d 312, 316 (S.C. 2000).
5. Marjorie C. Makar, Nursing in Florida: The Path to Professional Liability, 70 FLA. B.J. 18 (1996); Reed v. Granbury Hosp., 117 S.W.3d 404, 415 (Tex. App. 2003).
6. Simmons, 533 S.E.2d at 316.
7. Id. at 316-17. See also Thomas D. Masterson, Establishing the Hospital's Vicarious Liability for Hospital-Based Physicians, 2 ANN. 2002 ATLA-CLE 2455 (2002).
8. Id. at 316-17. See also Thomas D. Masterson, Establishing the Hospital's Vicarious Liability for Hospital-Based Physicians, 2 ANN. 2002 ATLA-CLE 2455 (2002).
9. Mejia v. Community Hosp. of San Bernadino, 122 Cal. Rptr. 2d 233, 235-36 (Cal. App. 2002).
10. RESTATEMENT (SECOND) OF AGENCY § 227 (1957).
11. See Harris v. Miller, 438 S.E.2d 731, 737-38 (N.C. 1994).
12. Mejia, 122 Cal. Rptr. 2d at 236; Harris v. Miller, 438 S.E.2d 731, 738 (N.C. 1994); Lewis v. Physicians Ins. Co., 627 N.W.2d 484, 494 (Wis. 2001).
13. Makar, supra note 5, at 18; Breeden v. Anesthesia West, P.C., 656 N.W.2d 913, 919-20 (Neb. 2003); RESTATEMENT (SECOND) OF TORTS § 419 (1965) (stating common-law rule that employer is not liable for physical harm caused to another through acts or omissions of independent contractor except as provided in sections 410-429).
14. Mejia, 122 Cal. Rptr. 2d at 236.
15. Shofner v. Baptist Healthcare Affiliates, No. 96-CI-00044, 2003 WL 22025906, at *2 (Ky. App. Aug. 29, 2003).
16. Id. at *4.
17. I b i d.
18. RESTATEMENT (SECOND) OF TORTS § 409 cmt. b (1965).
19. Shofner, 2003 WL 22025906, at *4.
20. I b i d.
21. Breeden, 656 N.W.2d at 920; RESTATEMENT (SECOND) OF TORTS § 409 cmt. b (1965).
22. Breeden, 656 N.W.2d at 920.
23. Id. See also RESTATEMENT (SECOND) OF TORTS § 424 cmt. b (1965).
24. Breeden, 656 N.W.2d at 921.
25. I b i d.
26. I b i d.
27. Id. at 920.
28. Masterson, supra note 7.
29. Breeden, 656 N.W.2d at 921 (stating surgeons and other physicians have a nondelegable duty); Neff v. Wenzl, No. A-01-290, 2002 WL 31414447, at *6 (Neb. App. 2002) (stating physician has nondelegable duty).
30. Masterson, supra note 7.
31. RESTATEMENT (SECOND) OF TORTS § 424 cmt. b (1965).
32. I b i d.
33. Id. § 429.
34. Thompson v. Nason, 591 A.2d 703 (Pa. 1991).
35. Niece v. Elmview Group Home, 929 P.2d 420, 430 (Wash. 1997); Shields v. St. Joseph Hosp., 2002 WL 31546127, at *2 (Me. Super. Oct. 24, 2002) (declining to recognize corporate liability against hospital).
36. 40A AM. JUR. 2D Hospitals and Asylums § 47 (2003).
37. Mejia, 122 Cal. Rptr. 2d at 237. See also Garret v. L.P. McCuistion, 30 S.W.3d 653, 656 (Tex. App. 2000) (requiring affirmative conduct by hospital to constitute holding itself out).
38. Mejia, 122 Cal. Rptr. 2d at 237.
39. See id. at 236-37.
40. Id. at 237-38.
41. Id. at 238.
42. Ward v. Lutheran Hosp., 963 P.2d at 1034-35 (Alaska 1998); Simmons, 533 S.E.2d at 321-22.
43. See, e.g., Ward, 963 P.2d at 1034-35; Simmons, 533 S.E.2d at 321-22.
44. See Mejia, 122 Cal. Rptr. 2d at 237.
45. Shofner, 2003 WL 22025906, at *5.
46. I b i d.
47. Mejia, 122 Cal. Rptr. 2d at 237; Jackson v. Power, 743 P.2d 1375 (Alaska 1997).
48. Osborne v. Adams, 550 S.E.2d 319, 321 (S.C. 2001). See Breeden v. Anesthesia West, 656 N.W.2d 913, 921 (Neb. 2003). See also Williams v. St. Claire Med. Ctr., 657 S.W.2d 590, 596 (Ky. App. 1983); Simmons, 533 S.E.2d at 322; Irving v. Doctors Hosp. of Lake Worth, Inc., 415 So. 2d 55, 60-61 (Fla. App. 1982).
49. Osborne, 550 S.E.2d at 321.
50. Fletcher v. South Peninsula Hosp., 71 P.3d 833, 845 (Alaska 2003).
51. RESTATEMENT (SECOND) OF TORTS § 424 (1965).
52. 840 So. 2d 309 (Fla. App. 2003).
53. Id. at 309.
54. CAL. HEALTH & SAFETY CODE § 1250 (West 2000 & Supp. 2004) (general acute care hospital defined as a health facility having basic medical services including, among other things, medical, nursing, surgical, and anesthesia); 24A S.C. CODE ANN. REGS. 61-16, § 613 (1992) (with one exception, hospitals required to maintain a perpetually open emergency room); ALASKA ADMIN. CODE tit. 7, § 12.105 (a general acute care hospital must provide surgical, anesthesia, perinatal, medical, nursing, pharmaceutical, dietetic, and so on).
55. Masterson, supra note 7.
56. Gurevitz v. Piczon, 42 Pa. D. & C. 4th 308, 323 (Pa. Com. Pl. 1999).
57. 42 U.S.C. § 11135 (West 1995).
58. Gurevitz, 42 Pa. D. & C. 4th at 323.
59. 42 U.S.C. § 1320c-3(A)(1)(B); Masterson, supra note 7; Gurevitz, 42 Pa. D. & C. 4th at 308.
60. Masterson, supra note 7.
61. I b i d.
62. Id. See also 42 C.F.R. § 482.23 (E) (2003).
63. Osborne, 550 S.E.2d at 322.
64. Jackson, 743 P.2d at 1382-83.
65. 2003 WL 22023474 (Fla. App. 2003).
66. Id. at * 6.
67. I b i d.
68. Id. at *4.
69. I b i d.
70. Gurevitz, 42 Pa. D. & C. 4th at 318.
71. Id. at 318-19.
72. 591 A.2d 703 (Pa. 1991).
73. Thompson, 591 A.2d at 707.
74. Long v. Hacker, 520 N.W.2d 195, 201 (Neb. 1994).
75. 2002 WL 31623678, at *2 (Wash. App. 2002).
76. I b i d.
77. Id. at *3.
78. Id. at *4.
79. Bordelmay v. Keystone Health, 789 A.2d 748, 751 (Pa. Super. Ct. 2001). But see Battaglia v. Alexander, 93 S.W.3d 132, 143 (Tex. App. 2002).
80. Bordelmay, 789 A.2d at 752.
81. American Association of Nurse Anesthetists, Quality of Care in Anesthesia, at http://www.aana.com/ crna/prof/quality_intro.asp (last visited Jan. 25, 2004).
82. Gene A. Blumenreich, Anesthesia - It's Finally the Practice of Medicine (Apr. 1999), at http://www. aana.com/legal/legbrfs/1999/041b99.asp.
83. 905 S.W.2d 811, 816 (Tex. App. 1985).
84. Id. at 818-19, 822.
85. Id. at 820.
86. 657 S.W.2d 590, 591 (Ky. App. 1983).
87. I b i d.
88. Id. at 597.
89. Id. at 594.
90. Id. at 596.
91. Id. at 597.
92. 949 F.2d 1079 (10th Cir. 1991).
93. I b i d.
94. 227 F. Supp. 2d 1183, 1194 (D.N.M. 2002).
95. I b i d.
96. Jackson County Hosp. v. Aldrich, 835 So. 2d 318 (Fla. App. 2002).
97. Id. at 326.
98. I b i d.
99. Id. at 322.
100. Id. at 331.
101. Id. at 330.
102. See id. at 332 (Miner, J., dissenting).
103. I b i d.
104. I b i d.
105. OKLA. STAT. ANN. tit. 59, § 567.3A (West 2000 & Supp. 2004); ALA. CODE § 34-21-81 (1997); 225 ILL. COMP. STAT. 65/15-25 (West Supp. 2003).
106. Drennan, 905 S.W.2d at 822.
107. Id. at 811.
108. Medicare and Medicaid Programs: Conditions of Participation Anesthesia Services, 42 C.F.R. § 482.52 (2003).
109. I b i d.
110. States that Have Opted-Out of the CRNA Supervision Rule Under CoPs, at http://www.cms.hhs.gov/ cop/ld.pdf (last updated Nov. 20, 2003) (Alaska, Idaho, Iowa, Kan., Minn., Neb., N.H., N.M., N.D., and Wash.); American Association of Nurse Anesthetists, Governor of Oregon Removes Physician Supervision for Nurse Anesthetists (Dec. 11, 2003), at http://www.aana.com/press/2003/121103.asp (Oregon). See also Oregon Rural Health Association, Opt Out Letter (Dec. 5, 2003), at http://orha.org/optoutLetter.pdf; American Society of Anesthesiologists, at http://www.asahq. org/Washington/summary2003.htm.
111. States that Have Opted-Out of the CRNA Supervision Rule Under CoPs, at http://www.cms.hhs.gov/ cop/ld.pdf (last updated Nov. 20, 2003) (Alaska, Idaho, Iowa, Kan., Minn., Neb., N.H., N.M., N.D., and Wash.); American Association of Nurse Anesthetists, Governor of Oregon Removes Physician Supervision for Nurse Anesthetists (Dec. 11, 2003), at http://www.aana.com/press/2003/121103.asp (Oregon). See also Oregon Rural Health Association, Opt Out Letter (Dec. 5, 2003), at http://orha.org/optoutLetter.pdf; American Society of Anesthesiologists, at http://www.asahq. org/Washington/summary2003.htm.
112. States that Have Opted-Out of the CRNA Supervision Rule Under CoPs, at http://www.cms.hhs.gov/ cop/ld.pdf (last updated Nov. 20, 2003) (Alaska, Idaho, Iowa, Kan., Minn., Neb., N.H., N.M., N.D., and Wash.); American Association of Nurse Anesthetists, Governor of Oregon Removes Physician Supervision for Nurse Anesthetists (Dec. 11, 2003), at http://www.aana.com/press/2003/121103.asp (Oregon). See also Oregon Rural Health Association, Opt Out Letter (Dec. 5, 2003), at http://orha.org/optoutLetter.pdf; American Society of Anesthesiologists, at http://www.asahq. org/Washington/summary2003.htm.
113. 42 C.F.R. § 482.52 (2003).
114. Gene A. Blumenreich, CRNAs as Independent Contractors (Feb. 2002), at http://www.aana.com/ legal/legbrfs/2002/021b02.asp.
115. Jackson, 743 P.2d at 1383.
116. Denton Reg'l Med. Or. v. LaCroix, 947 S.W.2d 941, 951 (Tex. App. 1997); Bryant v. United States, No. CIV 98-1495 PCT RCB, 2000 WL 33201357, at *3 (D. Ariz. 2000); Williams, 657 S.W.2d at 597.
117. Blumenreich, supra note 111.
118. I b i d.
119. See generally id.
120. I b i d.
121. Masterson, supra note 7.
122. I b i d.
123. Medicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services, 66 Fed. Reg. 56762, 56763 (Nov. 13, 2001).
124. I b i d.
125. Governor Will Allow Anesthesia Nurses to Work Alone, Associated Press Newswires (New Hampshire, June 11, 2002); David Hendee, Nurse Anesthetists Freed from Doctor Oversight, OMAHA WORLD-HERALD (Nebraska), Feb. 23, 2002.
126. Governor Will Allow Anesthesia Nurses to Work Alone, Associated Press Newswires (New Hampshire, June 11, 2002); David Hendee, Nurse Anesthetists Freed from Doctor Oversight, OMAHA WORLD-HERALD (Nebraska), Feb. 23, 2002.
127. Drennan, 905 S.W.2d at 822.
128. Governor Opts Out of Nurse Anesthetists Supervisory Rule, Associated Press News wires (Nov. 2, 2002) (Santa Fe, NM).
129. Hendee, supra note 122; Glenn Howatt, Doctors, Nurses In Anesthesia Turf Fight, STAR TRIB. (Minneapolis, MN), Mar. 15, 2002, at 7B; Governor Opts Out, supra note 124.
130. Hendee, supra note 122; Glenn Howatt, Doctors, Nurses In Anesthesia Turf Fight, STAR TRIB. (Minneapolis, MN), Mar. 15, 2002, at 7B; Governor Opts Out, supra note 124.
131. Hendee, supra note 122; Glenn Howatt, Doctors, Nurses In Anesthesia Turf Fight, STAR TRIB. (Minneapolis, MN), Mar. 15, 2002, at 7B; Governor Opts Out, supra note 124.
132. Governor Will Allow, supra note 122.
133. I b i d.
134. I b i d.
135. Id. See also Governor Opts Out, supra note 124.
136. Governor Will Allow, supra note 122; Anesthesiologists Poll Finds Opposition to New Policy, Associated Press Newswires (July 8, 2002); Christopher Pierce, Governor's Medical Ruling Misses Boat, IDAHO STATESMAN, Apr. 22, 2002, at 9.
137. Governor Will Allow, supra note 122; Anesthesiologists Poll Finds Opposition to New Policy, Associated Press Newswires (July 8, 2002); Christopher Pierce, Governor's Medical Ruling Misses Boat, IDAHO STATESMAN, Apr. 22, 2002, at 9.
138. Governor Will Allow, supra note 122; Anesthesiologists Poll Finds Opposition to New Policy, Associated Press Newswires (July 8, 2002); Christopher Pierce, Governor's Medical Ruling Misses Boat, IDAHO STATESMAN, Apr. 22, 2002, at 9.
139. Governor Opts Out, supra note 124.
140. Michael Pine et al., Surgical Mortality and Type of Anesthesia Provider, 71 AANA J. 109 (Apr. 2003), available at http://www.aana.com/press/2003/ 041103_pine.asp.
141. Medicare and Medicaid Programs, supra note 120.
142. Masterson, supra note 7.
143. RESTATEMENT (SECOND) OF TORTS § 424 cmt. b (1965).
144. Williams, 657 S.W.2d at 591.
145. Mejia, 122 Cal. Rptr. 2d at 237; Jackson, 743 P.2d at 1376 (holding disclaimer may not be sufficient).
146. Breeden, 656 N.W.2d at 921.
147. Alexander v. Crowder, 1999 WL 33492607 (Harris County Tex. Dist. Ct. 1999) (granting $3.6 million verdict with 30% apportioned to CRNA); Crosslin v. Hah, 1999 WL 33490813 (Orange County Tex. Dist. Ct. 1999) (awarding a verdict with 30% apportioned to CRNA). See also Ojeda v. Shropshire, 2002 WL 32133005 (Tarrant County Tex. Dist. Ct. 2002) (granting a verdict with 10% liability apportioned to CRNA); Rodriguez v. Yoakum County Hosp., 2000 WL 33719847 (Yoakum County Tex. Dist. Ct. 2000) (awarding $50,000 with CRNA apportioned $30,000).
148. Bird, 949 F.2d at 1081.