Hospital cited for 'immediate jeopardy' for CRNA use in sedations 

Modesto, Calif.-based Doctors Medical Center has been cited for immediate jeopardy by CMS for using certified registered nurse anesthetists to sedate and monitor surgical patients.

The hospital has been canceling and rescheduling dozens of procedures as the California Department of Public Health investigates complaints, the agency confirmed to Becker's on May 30.

According to an internal update sent to hospital medical staff obtained by The Modesto Bee, the use of CRNAs has been put on hold as they were granted privileges for procedures they had not previously performed at the center. The medical center was found at fault for its credentialing process for CRNAs and will redo the process.

"CDPH teams are on site at Doctors Medical Center in Modesto to investigate practices that may not be compliant with state and federal requirements," a spokesperson for the department told Becker's.

CMS and the state health department will not lift the immediate jeopardy until the hospital's plan for mitigating the problem is approved. Physicians have said the complaints are about anesthesia-related medical errors, according to the Bee. 

"We are collaborating with the California Department of Public Health on our action plan to address the items identified by the CDPH and will await a follow-up survey," the hospital said in a statement shared with the newspaper, adding that patient safety is the hospital's top priority. 

Doctors Medical Center has a contract with Fresno, Calif.-based Valley Regional Anesthesia Associates for providing anesthesia. The contract has been criticized by anesthesiologists who claim CRNAs are used as a cost-saving measure, according to the Bee

"No further information will be available until those investigations are complete," the CDPH spokesperson said. "CDPH is monitoring this facility and providing oversight, in collaboration with the Centers for Medicare & Medicaid Services, to ensure the facility is in compliance with requirements and practices so it can provide safe, high-quality care to patients that need it."

"California has been a Medicare opt-out state since 2009, meaning that CRNAs do not require physician supervision as a condition of Medicare payment," a spokesperson for the American Association of Nurse Anesthesiology said in a statement shared with Becker's. "The more than 3,000 CRNAs who practice in the state are highly qualified healthcare professionals who, through education, licensing, and certification, are recognized as autonomous providers of anesthesia services... Any attempt to denigrate or disregard the education and training that CRNAs undergo to provide such vital patient care not only defies California state laws but also ignores a wealth of research validating the safety and efficacy of CRNA practice."

The AANA added that CRNAs deliver anesthesia throughout all counties in California, and four counties only have CRNAs as anesthesia providers. 

Becker's also reached out to CMS and Doctors Medical Center for comment on this story and will update it if new information becomes available.

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