A legal challenge against California health regulators could have implications for Valley hospitals, particularly rural facilities relying on certified registered nurse anesthetists to provide surgical care.
The California Association of Nurse Anesthesiology (CANA) has filed a complaint against the California Department of Public Health (CDPH) and the Office of Administrative Law, alleging state regulators improperly restrict certified registered nurse anesthetists (CRNAs) from serving on hospital medical staff.
The lawsuit challenges regulations the association argues conflict with state law, which allows hospital medical staff to include licensed practitioners deemed competent in their fields.
The dispute has already affected Central Valley hospitals, particularly Doctors Medical Center and Stanislaus Surgical Hospital in Modesto, where state investigators in 2024 raised questions about CRNA credentialing and supervision.
CANA stated that enforcement actions resulted in the removal of nurse anesthetists from medical staff, leading to the cancellation of nearly 1,000 surgical procedures in underserved communities.
Similar enforcement actions could disrupt surgical services in the Fresno area, particularly at rural hospitals with limited anesthesia staffing.
The controversy also involved CDPH’s Fresno survey team, which was identified in a 2024 letter from state lawmakers raising concerns about enforcement practices.
Although no hospitals in Fresno, Kings, Madera or Tulare counties have been identified as receiving the disputed citations, the outcome could affect how hospitals in the region credential anesthesia providers, particularly smaller facilities facing staffing challenges.
“Although state law allows for hospitals to choose who is on medical staff, the Department’s restrictive regulations interfere with that right,” said Alison Trejo, CANA executive director. “These structural barriers place an undue burden on hospital medical staff and have already caused dangerous disruptions in patient care.”
CANA argues the regulations exceed CDPH’s authority by restricting decisions that should belong to individual hospital medical staff.
The association previously petitioned the department to revise the regulations in 2023, with additional efforts supported by several statewide health care organizations in 2024.
Both petitions were denied.
The complaint, filed in San Francisco Superior Court, seeks a judicial determination invalidating the disputed regulations.
