Does Hospital Plan to Give CRNAs Autonomy?
By David Doolittle


The Texas Society of Anesthesiologists (TSA) is questioning a Corpus Christi hospital’s decision to replace its long-time anesthesiology team with a group it says appears ready to give certified registered nurse anesthetists (CRNAs) more autonomy than Texas law allows.

Earlier this year, Christus Spohn Health System terminated its contract with Gulf Shore Anesthesiology, a group of 30 physician anesthesiologists and 15 nurse anesthetists who had been with the hospital for more than 60 years. The hospital then announced in May it had awarded the contract to EmergencHealth, whose business address is listed as a residence in the Dallas suburb of Southlake.

In announcing the contract, Christus Spohn described EmergencHealth as “a new physician-owned multi-disciplinary group” that “has hired many of the same providers who are currently working in the Coastal Bend.”

Both groups “share the same commitment to provide our patients with high-quality care and outstanding patient outcomes,” Christus Spohn spokesman Steven Alford told Texas Medicine Today.

But TSA has filed a complaint with the Texas Medical Board, asking for an investigation into whether any laws regarding CRNA physician supervision were violated

TSA’s concerns are based on EmergencHealth’s post to a job-recruiting website, which was originally posted June 14 but updated July 17. According to TSA, the post originally included language such as:

  • CRNAs will have autonomy with support if needed;
  • CRNAs will never be medically directed by an anesthesiologist; and
  • Christus Spohn has an exclusive contract with EmergencHealth.

The wording appeared to contradict Christus Spohn’s announcement, which stated in part that:

  • “The new contract is non-exclusive and pertains to unassigned and on-call services;”
  • “All current anesthesia providers may retain their privileges and can continue to practice within CHRISTUS Spohn Health System;”
  • “This anesthesia model is not new to the Coastal Bend and has been in place for many years across the U.S.”

A lawyer representing TSA says he has not seen the contract and could not comment on it. But he says the anesthesia care delivery model appears flawed, based on the original job posting.

“It is important to note that, according to the Texas Medical Board, anesthesiology is the practice of medicine, and nurse anesthetists provide anesthesia care only by virtue of delegation by a physician. CRNAs do not provide anesthesia ‘autonomously,’” TSA said in a separate statement. 

A lawyer for Christus Spohn directed questions about the job listing to EmergencHealth. 

“The EmergencHealth team is highly qualified and experienced; they are all appropriately boarded, credentialed and practice consistently with all applicable rules and regulations applicable to anesthesia providers,” the lawyer said. 

A call to Dallas emergency physician Jeffrey Link, MD — who is listed as EmergencHealth’s owner — at the number listed on the National Provider Identifier (NPI) Database has not been returned. According to the Database, EmergencHealth’s NPI was assigned in September of 2017.

TSA and the Texas Medical Association have heard recently of several other Texas hospitals that are considering similar changes in their anesthesia service. 

Texas Medicine Today will continue to follow and report on the situation.




Last Updated On

October 12, 2018

Originally Published On

July 26, 2018

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David Doolittle


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Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

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