California Society of Anesthesiologists v. Brown
138 Cal. Rptr. 3d 745
Cal. Ct. App.2012Background
- Governor elected to opt out of federal physician supervision requirement for CRNAs to obtain Medicare reimbursements in California.
- Opt-out must be consistent with state law; California’s Nursing Practice Act and Nurse Anesthetists Act govern CRNA scope of practice.
- Governor attested to CMS that opt-out was consistent with state law after consulting state medical and nursing boards.
- Trial court upheld Governor’s attestation and declined mandamus/summary judgment; standard of review accorded deference to Governor under federal framework.
- California Court of Appeal applied de novo review to Governor’s discretion but gave deference to CMS framework and state-law interpretation; ultimately affirmed.
- Statutory interpretation focused on Nursing Practice Act § 2725(b)(2) which authorizes CRNAs to administer anesthesia ordered by a physician, without requiring supervision.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 2725(b)(2) authorizes CRNAs to administer anesthesia without physician supervision. | California Society of Anesthesiologists argues supervision is required. | Governor and respondents argue statute permits administration under physician order without supervision. | Yes; CRNAs may administer anesthesia under a physician’s order without supervision. |
| Whether the Governor’s attestation was consistent with California law. | Attestation conflicts with California law according to appellants. | Attestation aligned with California law per Nursing Practice Act and agency interpretations. | No abuse of discretion; attestation deemed consistent with state law. |
| What standard of review governs mandamus review of the Governor’s discretionary attestation? | Strict scrutiny of state-law interpretation is warranted. | Federal framework grants deference; defer to Governor’s discretion absent palpably unreasonable conduct. | Deferential review; reversal only for palpably unreasonable abuse of discretion. |
Key Cases Cited
- California Teachers Assn. v. Ingwerson, 46 Cal.App.4th 860 (Cal. App. 1996) (deference standard for discretionary acts; palpably unreasonable restriction deciding review)
- Lazarin v. Superior Court, 188 Cal.App.4th 1560 (Cal. App. 2010) (contextual deference in final responsibility for statutory construction)
- Professional Engineers in California Government v. Kempton, 40 Cal.4th 1016 (Cal. 2007) (final responsibility for statutory construction; amicus considerations)
- Yamaha Corp. of America v. State Bd. of Equalization, 19 Cal.4th 1 (Cal. 1998) (agency interpretation given great weight and respect)
- Bhan v. NME Hospitals, Inc., 772 F.2d 1467 (9th Cir. 1985) (federal antitrust discussion on physician-nurse practice context)
- Chalmers-Francis v. Nelson, 6 Cal.2d 402 (Cal. 1936) (pre-1974 understanding; legislative amendments overridden earlier views)
- Magit v. Board of Medical Examiners, 57 Cal.2d 74 (Cal. 1961) (pre-1974 authority relied upon by appellants)
- State ex rel. Harris v. PricewaterhouseCoopers, LLP, 39 Cal.4th 1220 (Cal. 2006) (Legislative Counsel opinions not binding when contradicted by statute)