1,000 California surgeries cancelled amid CRNA credentialing confusion

Editor's Note

A CMS citation for immediate jeopardy this past June allegedly resulted in the cancellation of nearly 1,000 surgeries at Doctors Medical Center in Modesto, California, according to a July 30 article in Becker’s ASC Review.

Citing a July 26 letter from California Assemblymen Heath Flora and Juan Alanis obtained by Becker’s, the article describes how the hospital’s misunderstanding of certified registered nurse anesthetist (CRNA) credentialing guidance is leading other facilities to enact CRNA supervision to ward off the same negative consequences.

The June citation was issued for the alleged use of CRNAs to sedate and monitor surgical patients. However, the California Department of Public Health (CDPH) alerted the hospital on June 2 that it misunderstood the guidance regarding CRNA credentialing, Becker’s reports. The misunderstanding led to a requirement for hospitals to wait for certain documentation before onboarding or hiring CRNAs.

Addressed to California Health and Human Services Agency Secretary Mark Ghaly, MD, the letter cites a “domino effect” in the region, including the cancellation of more than 1,000 surgeries. Most—80%—affected Californians with Medicare and Medi-Cal coverage, Becker’s reports.

"Given there has been conflicting messaging from agencies, leaders and facilities in the region need affirmation of the applicable state and federal laws and the Nursing Practice Act that CDPH and the survey teams should be relying on," the letter said. "This will ensure patients’ access to vital services will not be unnecessarily interrupted in the future."

The Becker’s article also details statements by The American Association of Nurse Anesthesiology, The American Society of Anesthesiologists, and the CDPH, as well as the experience of a second California hospital found to be out of compliance with Medicare conditions of participation.