Can CRNAs operate independently of an anesthesiologist?

A Texas CRNA may practice independent of an anesthesiologist. There are no Texas state laws or regulations requiring physician supervision of CRNA practice, including CRNA practice in an office based setting. A CRNA may not order the drugs and devices necessary for the administration of an anesthetic or anesthesia-related services without proper delegation from the operating physician or an anesthesiologist.  The delegating order may be an order for “Anesthesia per CRNA” and does not have to specify the drug, dose, or technique/route of administration. Pursuant to the physician’s order, and in accordance with the facility policies or medical staff bylaws, the CRNA may select, obtain, and administer those drugs and apply the medical devices appropriate to accomplish the order and maintain the patient within a sound physiological status.[1]

CRNAs practice under authority delegated by a physician. The delegating physician may be an anesthesiologist, or often it is the operating physician who delegates to a CRNA. Under Texas law, a physician who properly delegates anesthesia-related tasks to a CRNA is not required to supervise the CRNA’s performance of those tasks. Unless the delegating physician has reason to believe the CRNA lacked competency, a physician is not liable for an act of a CRNA solely because the physician signed an order authorizing the CRNA to order drugs and devices necessary for the CRNA to administer an anesthetic or anesthesia-related service ordered by the physician.[2] 

Since Texas is not an “opt-out” state for the purposes of Medicaid reimbursement for anesthesia services, federal regulations limiting coverage and conditional hospital participation in Medicare and Medicaid programs currently require a CRNA to be supervised by the operating physician when the CRNA administers anesthesia. Again, the operating physician “supervising” a CRNA for the purposes of Medicaid reimbursement is not required to be an anesthesiologist.

[1] Tex. Occupations Code §157.058.

[2] Tex. Occupations Code §157.060.