Opinion
AB 985 will help expand access to safe anesthesia care
Image by Drazen ZigicOPINION – Anesthesiologists are known as the “guardians of the operating room” ensuring that every patient undergoing surgery receives the highest standard of care. But our role goes far beyond just administering anesthesia — we are responsible for diagnosing difficult cases and responding in real time to any complications that may arise. Patients trust us with their lives during their most vulnerable moments, and we take that responsibility seriously.
Commitment to the highest standard of quality care is our North Star, shaping every decision we make for our patients. We need policy changes that uphold safety and quality care as they work to address California’s anesthesia workforce challenges. Legislative proposals should never gamble with patient lives.
With increasing demand for surgical procedures, an aging patient and physician population, and a sharp rise in non-operating room anesthesia (NORA) services, California’s anesthesia workforce is facing an uphill battle. Facilities have reported staffing shortages that jumped from 35% in early 2020 to 78% in late 2022. This shortage threatens to delay surgeries and limits access to critical treatments. While addressing this workforce issue is imperative, how we do so will determine whether patient safety remains at the heart of our healthcare system.
The solution is clear: AB 985 provides a responsible, effective, and immediate way to address the shortage without sacrificing patient safety. The proposed legislation from Patrick Ahrens (D-Silicon Valley) authorizes Certified Anesthesiologist Assistants (CAAs) to practice within the Anesthesia Care Team (ACT) model. CAAs are highly trained anesthesia professionals who work under the direct supervision of physician anesthesiologists. This team-based approach ensures that a physician is always available to intervene in emergencies or complex cases, something independent practice models cannot provide.
CAAs are highly trained anesthesia professionals. They enter the operating room with a premedical background, a bachelor’s degree, and a rigorous graduate-level education culminating in a master’s degree. Their training includes extensive didactic and clinical preparation in anesthesia care, as well as advanced patient monitoring techniques. This structured and standardized education ensures that CAAs are well-equipped to support physician anesthesiologists in providing safe, high-quality care.
The benefits of integrating CAAs into California’s healthcare system are well-documented. Unlike alternative proposals (like AB 876- Flora) that remove physician oversight and compromise patient safety, AB 985 strengthens our anesthesia workforce without lowering standards of care. AB 876, which seeks to unsafely expand scope of practice for nurse anesthetists and limit access to anesthesiologists, risks creating a two-tiered system where only those with means can access physician-led anesthesia care. Rather than lowering the bar for patient safety, California must focus on solutions that expand access while upholding the highest standards of care.
AB 985 would bring California in line with 19 other states and the District of Columbia, where CAAs already play a crucial role in expanding anesthesia access. Additionally, CAAs are already trusted providers within the Veterans Administration system, demonstrating their effectiveness in a diverse array of healthcare settings.
Let’s be clear: CAAs do not replace nurse anesthetists or anesthesiologists, but they do offer another staffing option to immediately increase the anesthesia workforce in California. CAAs function like Physician Assistants, and their profession is recognized by the American Medical Association, private health insurance companies, and the federal government through Medicare and the military health system.
As an anesthesiologist, I know firsthand how important it is to have a well-supported team in the operating room. California lawmakers must take action to protect patients by passing AB 985. This bill is a balanced, research-backed solution that increases access to anesthesia care without lowering the bar for safety. By enacting AB 985, California would align itself with national best practices, safeguard the future of physician-led anesthesia care, and ensure that all patients—regardless of socioeconomic status—receive the highest standard of care. Now is the time to adopt proven solutions that address the workforce shortage without compromising safety. The health and well-being of Californians depend on it.
Dr. Christina Menor is the president-elect of the California Society of Anesthesiologists.
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Dr. Menor has intentionally misstated the intention of Flora’s AB 876 as seeking to “unsafely expand scope of practice for nurse anesthetists.” AB 876 is NOT a scope bill and in no way expands the scope of practice of CRNAs. AB 876 is a clarification bill that updates the language of the Nurse Anesthetist Act to reflect state and federal statutes, as well as caselaw supporting Nurse Anesthesia practice over the past 40 years. Under AB 876, Nurse Anesthetists will continue to practice in a variety of care models including an anesthesia care team alongside physician anesthesiologists or independently in a CRNA only model. Both models exist in California presently and both models will continue to exist after AB 876 passes.
What Dr. Menor has left out of her false depiction of AB 876 is the reason why this bill is essential to Californians now. In 2024 the misinterpretation of the Nurse Anesthetist Act was used as grounds to remove CRNAs from multiple hospitals and surgical centers. As a result, over a thousand surgeries were delayed, transferred or canceled, 80% of whom were medicaid and medicare patients. Dr. Menor states that AB 876 will “limit access to anesthesiologists,” yet in reality the bill seeks to guarantee access to safe anesthesia care by making the language of existing law as precise as possible, so surgical cases will never be canceled again due to misinterpretation.
Dr. Menor claims AB 876 will end up “lowering the bar for patient safety” because it supports CRNA practice to continue as it has for the past 80+ years. In that time, CRNAs have established an irrefutable safety record backed by numerous research studies that have shown CRNAs provide anesthesia care as safely and effectively as physician anesthesiologists, even in complex cases. CRNAs undergo six to eight years of rigorous academic and clinical training and must pass a national certifying exam. As of 2025 all CRNAs in California will graduate with a doctoral degree. Similar training is required of physician anesthesiologists, who are not required to be board certified. When compared to the education requirements of a CAA, “a bachelor’s degree, and a rigorous graduate-level education culminating in a master’s degree,” it is no wonder that CRNAs practice independently without physician supervision in California, whereas CAAs must have direct supervision by a physician anesthesiologist at all times.
When it comes to patient safety, AB985 is shockingly barren. AB 985 lacks any requirement for CAA training, credentialing, background checks or continued education requirements. When patient safety is in question, clearly AB 985 is not going to provide any safeguards against untrained, uncredentialed, and potentially criminal individuals from providing your anesthesia. How can anyone support this empty, alarming, and problematic piece of legislation?
In response to Dr. Menor’s article, if Certified Anesthesia Assistants (CAAs) must work under the direct presence and supervision of a physician anesthesiologist, and are unable to practice independently, how does AB 985 provide a solution to upholding safety and quality of anesthesia care, and the expansion of access to care? It does NOT, and having CAAs in California does NOT!
There are already a number of rural and underserved areas of California where physician anesthesiologists are non-existent. Therefore, CAAs cannot practice in those communities either where Californians have a need of access to healthcare.
What AB 985 WILL provide is a more expensive alternative to anesthesia care cost by having to reimburse two anesthesia providers (physician anesthesiologist and CAA) versus just one qualified and independent provider. In addition, this team model of physician/CAA is one of the costliest anesthesia delivery modes that neither shows any evidence of increasing patient safety nor quality of anesthesia care.
Under federal law, CAAs can work in a 4:1 ratio with a physician anesthesiologist, yet at these ratios, failed medical direction occurs in 99% of cases. One study found physician anesthesiologists did not meet TEFRA rules with just 35% for 2:1 and 99% for 3:1 ratios.1 This places healthcare facilities at significant risk for medical fraud and reduced revenue.
Therefore, AB 985 is NOT the proper solution, but rather it creates more of a problem in California’s existing healthcare crisis.
1. Epstein R, Dexter F. (2012). Influence of supervision ratios by anesthesiologist on first case starts and critical portions of anesthetics. Anesthesiology, 116(3):683-691.