CRNA group urges AB 876 to codify delegation, medical‑staff voting and title; BRN cautions on statutory limits for regs

Melanie Rowe, practice director for the California Association of Nurse Anesthesiology, told the Board of Registered Nursing’s Certified Registered Nurse Anesthetist Advisory Committee on Sept. 18 that AB 876 — then on the governor’s desk — would, if signed, help codify elements of CRNA practice and urged further statutory and regulatory clarifications.

Rowe said AB 876 “gives clear authority to CRNAs to select and administer medications and therapeutic regimens in the course of carrying out an order for anesthesia services,” and she outlined three priorities not fully resolved in the bill: (1) explicit authority for CRNAs to delegate perioperative orders to registered nurses and other staff; (2) removal of regulatory limits that prevent nonphysician independent practitioners from serving as voting members of hospital medical staffs; and (3) adding the national professional title “CRNA” to the BRN’s regulatory definition of nurse anesthetists and recognizing NBCRNA certification.

Rowe described a recent event at Emmanuel Medical Center in which California Department of Public Health (CDPH) surveyors questioned a CRNA’s authority to order nursing actions in a recovery-room emergency. She said CDPH asked the hospital to remove CRNA authority to order nurses to carry out certain medications and treatments, which Rowe said caused unnecessary delay in patient care. "Regulatory uncertainty has created unnecessary delays for patients, including during patient emergencies when time is of the essence," Rowe said.

Executive Officer Laurie Melby told the committee that the BRN supported the bill in its initial form but that the bill language had been narrowed during legislative negotiations. Melby stressed the legal limit on what the BRN can do by regulation: "If it's not in statute, we cannot create new law with regulation. We simply have to clarify the current statutory language and provide some guidance if we can." She explained that BRN staff will review the final statutory language (if AB 876 is signed), consult the Department of Consumer Affairs’ regulatory attorney, and then draft regulations where statute allows.

Melby also explained that some issues raised by Rowe — notably medical-staff membership and voting rules in Title 22 — fall under the California Department of Public Health, not the Board of Registered Nursing, and thus would require changes to CDPH regulations or statute to change hospital medical-staff rules. She emphasized that the regulatory process includes public comment, Office of Administrative Law review and possible hearings, and that the timeline from statutory change to adopted regulation can take one to two years or longer if contested.

Public comment included Brian Toon, executive managing partner of Central California Anesthesiology Solutions, who said the ability for CRNAs to issue perioperative orders to RNs is a routine, decades‑long practice and that removing or weakening that authority could disrupt patient care. Toon said the Modesto/Emmanuel Medical Center incident demonstrated that confusion at the regulatory level can interrupt clinical operations and urged the BRN to pursue clarity.

Ending: Melby said BRN staff will evaluate the final bill language (if enacted) and pursue regulatory clarification to the extent statute permits, and she invited continued input from the advisory committee as regulations are drafted.