Gasline Newsletter May 2010

Volume 12, No. 1

CSA/CMA vs. Schwarzenegger

The request by the California Association of Nurse Anesthetists (CANA) to intervene as an interested party in this litigation was granted by the court earlier this month. However, the court also stated that no new issues should be raised as a consequence of that intervention. Preparation of our motions for summary judgment on the issue of the requirement for physician supervision of nurse anesthetists in California, and for a writ of mandate to require the Governor to withdraw the opt-out letter, is in the final stages and, if the motions have not already been filed by the time you read this, they will be filed in the next few days. The hearing date for these motions will be approximately three months from now because, by statute, the Governor is allowed approximately two months to prepare and file his response/opposition.


The ASA is opposing H.R. 4213, which would postpone a 21% proposed payment reduction for Medicare physician services. Among other shortcomings, the proposal does not address the problems inherent to the current SGR formula; projections indicate all physicians would experience a payment reduction of over 30% effective January 1, 2014. More information, including a link to the full content of the proposed legislation, may be found at the ASA website

CMS Updates Anesthesia Interpretive Guidelines

On May 21, 2010, the Centers for Medicare and Medicaid Services issued a clarification of the Hospital Interpretive Guidelines for Anesthesia Services released in December 2009. Transmittal 59, which provides some of the clarifications ASA sought makes two significant changes:

The definition of “immediately available” during the supervision of CRNAs and AAs now allows anesthesiologists to be considered “immediately available” if they are physically located in the procedure suite, rather than in the procedure room, as previously required.
The sentence that previously read, "For outpatients, the post-anesthesia evaluation must be completed prior to discharge.” has been deleted. The post-anesthesia evaluation does not need to be completed prior to discharge of the patient following outpatient surgery, but within 48 hours.
SB 726 on the Corporate Practice of Medicine up for Vote
CMA needs help in opposing legislation, SB 726, which would erode the ban on the corporate practice of medicine. This means that non-physician owned entities could employ physicians in certain situations. At this point the outcome is in doubt. It is important that legislators know the concerns of their physician constituents on this controversial bill. Please call your Assembly members this week and urge them to oppose SB 726. Please use the CMA Legislator Connect Hotline, 877-362-8455, so that the CMA can track the calls going to each Assembly Member.

Annual Meeting and HOD Wrap-up

The 2010 House of Delegates took place May 15 where three resolutions and a myriad board actions were considered. Two resolutions were adopted. Resolution 1 calls on the CSA to commit to establishing and maintaining a leadership role in the CMA Hospital Based Practice Forum body.

Resolution 2 addressed the CSA Deep Sedation Guidelines developed in 2007. The amended resolution empowers the CSA Board of Directors to review and consider adoption of the ASA “Advisory on Granting Privileges for Deep Sedation to Non-Anesthesiologists” as CSA policy, when the final draft of the document is considered at the ASA House of Delegates in October.

In addition, many changes to the CSA bylaws were adopted, and the 2010 – 2011 budget was approved.

Other noteworthy events were speeches by ASA President-elect Mark Warner, M.D., and Leffingwell Lecturer Mervyn Maze, MB, ChB, Chair of the UCSF Department of Anesthesia. Bulletin Editor Dr. Steve Jackson presented awards to Nitin Shah, M.D., for his two-year journal CME series on Critical Care and to Merlin Larson, M.D., for his contributions to the Guedel Memorial Anesthesia section of the CSA Bulletin.

Newly elected CSA officers

The House of Delegates elected several new Officers for 2010 – 2011, including President Narendra S. Trivedi, M.D.; President-Elect - Kenneth Y. Pauker, M.D.; Legislative and Practice Affairs Division (LPAD) Chair - Paul B. Yost, M.D., and LPAD Vice-chair, Legislative Affairs - Mark I. Zakowski, M.D.

UCSF Grand Rounds June 5

The UCSF Department of Anesthesia and Perioperative Care invites CSA members to Grand Rounds on Saturday, June 5 from 8 – 10 a.m. at the Medical Science Building at 513 Parnassus Avenue, Health Science West Room 303. Participants are eligible for two AMA PRA Category 1 CME Credits™. George Gregory, M.D., will moderate the program Controversies in Pediatric Anesthesia. Topics include “Infants and oxygen - Good or Bad?” by David Robinowitz, M.D.; “Sedation and the Brain” by Mervyn Maze, MB, ChB; “The Expremi: Long-Term Neurologic Outcome” by Claire Brett, M.D.; and “The Expremi: Long Term Pulmonary Outcome” by Danton Char, M.D. Contact Sharon Chune at or 415-476-6614 for directions and CME information.

District #12 - Ultrasound Guided Peripheral Nerve Block Workshop
On Saturday, June 26, 2010, from 8:30 a.m. – 4 p.m., a hands-on CME program, Ultrasound Guided Peripheral Nerve Block Workshop will take place at the Harbor-UCLA Professional Building. Members of District 12 and surrounding districts are invited. For program details and registration please click here.

2010-2011 CSA Member Dues

Dues notices were e-mailed last week with a message from CSA President Narendra Trivedi, M.D., urging renewal through the CSA Website. Please be sure to renew your membership on line prior to June 3rd, at which time paper dues invoices will be mailed to all members with an outstanding balance. Every advance payment saves the CSA printing and postage costs, which makes a difference in the bottom line. Pay your dues now by clicking here and enter your Username and Password. In the Members Area (on the right hand side), click Dues & Donations.

2010 CSA Fall Hawaiian Seminar

Registration is open for CSA’s 2010 Fall Hawaiian Seminar, November 1-5, in beautiful Kona, Hawaii. Ronald Pearl, M.D. chairs a program of fascinating speakers and topics you will not want to miss.

Spring 2010 CSA Bulletin Online

The Spring 2010 CSA Bulletin is now online. It can be accessed from the CSA Home Page for three months from the date of mailing until the next issue of the Bulletin is published. The Bulletin is also archived on the Web site by individual article. You can find current and archived issues under Publications on the left-side navigation of the CSA Web Site.

Narendra S. Trivedi, M.D.

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