Top CSA Issues

The California Society of Anesthesiology is a trusted source of policy information to legislators and staff within the California State Legislature concerning the practice of physician-led anesthesiology.

Several key issues emerge each legislative session that impact how CSA members care of their patients, scope of practice, and operations of their business models. 

CSA’s objectives in the State Legislature are informed by the Legislative and Practice Affairs Division, chaired by Dr. Antonio Conte, and approved by the CSA Board of Directors.

CSA advocates work collaboratively with the California Medical Association and other members of “The House of Medicine” in Sacramento to advocate on behalf of the shared interests of patients and physicians.

Below are several issues of importance during the 2020-21 legislative session.  If you have additional questions, please contact CSA’s lobbyist, Bryce Docherty of KP Public Affairs, at

New toolkit available for CSA members – “Preventing Title Misappropriation and Inappropriate Scope Expansion”

CSA’s Practice Management Committee has created a new informational resource that can be used by anesthesiologists to help shape the policies and practices at your individual clinics/hospitals to ensure that labeling and scope for anesthesiologists is protected.

We have seen a series of efforts across the nation where nurse anesthetists have been trying to use the title of “anesthesiologist” and blur the lines between physician and nurse. This includes AANA formally changing its name to the American Association of Nurse Anesthesiology, which was sharply condemned by the ASA. Individual nurses have been adopting misleading titles and groups like New Hampshire Association of Nurse Anesthetists have tried to push the title protection issue in the courts.

These efforts to manipulate titles have serious implications for patient safety and the long-term trajectory of the anesthesiology specialty.  CSA is engaging on this issue on the legislative, regulatory and media fronts, and we want to also give you practical tools to make changes at your local level and in your facilities to counteract these patient safety issues.


Assemblymember Evan Low Introduces AB 562 to Address Burnout Experienced by California’s Frontline Health Care Workers during COVID-19 Pandemic

Frontline health care workers are experiencing unprecedented levels of burnout during the COVID-19 pandemic, but little action has been taken to address the devastating toll on these heroes, who are experiencing mental breakdowns, broken relationships, alcohol and substance abuse, and even committing suicide.

In an attempt to alleviate the burden so many frontline workers are facing — and will likely carry for months and years after the pandemic — Assemblymember Evan Low (D-Silicon Valley) has introduced AB 562 to establish a temporary mental health resiliency program to provide additional services to frontline COVID-19 providers.

“If the true measure of a society is how it treats its most vulnerable people, we should be equally concerned with how well we support heroes who have been working nonstop during a generational crisis,” Assemblymember Low said. “The pandemic has placed our nurses, physicians, and frontline health care workers under enormous stress, and they’ve been carrying this unbelievable burden for nearly a year. The trauma they’ve experienced will not just go away when vaccines become ubiquitous and the pandemic comes to an end. We need urgent action to support these heroes by expanding access to mental and behavioral health services.”

Within three months of enactment, AB 562 would require the Department of Consumer Affairs to work with relevant healing arts licensing boards and contract with one or more third-party vendors to provide free services to qualifying licensees. This would include in-person and telehealth services to support mental and behavioral health needs resulting from the COVID-19 pandemic. Other services would range from counseling and wellness coaching to providing online psychological distress self-assessments and other mental and behavioral health services and tools. AB 562 also includes important privacy protections for program participants, ensuring they will not be penalized simply for signing up.

UNAC/UHCP, which represents more than 32,000 California nurses and health care professionals, surveyed its members late last year and found that more than 10% reported a lack of mental health resources needed to cope during the pandemic. The poll was conducted before the deadliest surge in COVID-19 cases began in December 2020.

“What we’ve learned is the impact on frontline caregivers is devastating,” said Denise Duncan, a Registered Nurse and President of UNAC/UHCP, which is the sponsor of AB 562. “As we're honoring those who we’ve lost — our patients, our family members, and colleagues — I think it’s important for us to recognize that caregivers will have mental health needs going forward. We owe it to these heroes to provide mental health support if it is needed."

Additional supporters of AB 562 include the California Society of Anesthesiologists (CSA).

Dr. Christine Doyle, a physician anesthesiologist who works in Silicon Valley, noted that the experiences in a single shift can range from stressful to somber with little time to process what has occurred. She was forced to become an expert on personal protective equipment early on in the pandemic, as she made recommendations about PPE to state officials who were developing guidelines and constantly changing protocols for California health care systems.

“One anesthesiologist who was redeployed to the ICU then had to self-quarantine because the other ICU physician he was working with ended up COVID positive, and they had been sharing an office,” Doyle said. “We were working under immense stress every hour of the day due to the overload of patients requiring critical care while they simultaneously posed a deadly health risk to attending staff. The strain sticks with you regardless of the patient’s outcome.”

In January, the California Health Care Foundation conducted a survey of 1,202 nurses, nurse practitioners, physician assistants, and behavioral health specialists in California, and findings showed that 59% of respondents said they were “burned out” from their work; 83% of those surveyed said not enough was being done to address the problems facing health care workers.

"We need our health care providers to stay healthy and strong themselves so they can continue to provide the best care possible for their patients,” said Jeffrey Poage, MD, President of the California Society of Anesthesiologists. “This pandemic has created unimaginable stressors on the health care workforce, pushing us to work longer and harder and in tougher conditions than many of us have ever experienced. It has shone a bright spotlight on the need for better mental health and support systems for frontline workers, and this bill will create new tools to help with burnout, prolonged stress and trauma so that healthcare providers who are suffering can get help, recover, and move forward with renewed resiliency.”

Maria Nunez, a Registered Nurses in the Intensive Care Unit at St. Francis Medical Center in Lynwood, Calif., said the devastating toll of the pandemic — physically, mentally, and emotionally — is something many health care workers couldn’t have imagined

“The last year has been a big roller coaster,” Nunez said. “You come into this career and you’re expected to see death, but not to the degree we’ve seen in such a short time. In my 20 years as a nurse, I never thought we’d be in this situation. I can come into my ICU and have three patients and end my shift with none because they’ve all died.”

Nunez added that the services mandated in AB 562 would be “beneficial” for nurses and doctors as they try and recover from the trauma they’ve endured.

“Emotionally, it’s very draining. We’re there with these patients doing firsthand care and we’re the connection between them and their families,” she said. “I’m bilingual, so I serve as translator between the family and the physician, and when you have to tell them their loved one is deteriorating you become human, you start crying with the family and sharing their grief.”

AB 890 (Wood): Nurse Practitioner Expanded Authority
Analysis, Next Steps and Q&A


Governor Newsom has signed AB 890 (Wood), which expands the scope of practice of nurse practitioners (NPs) but not certified registered nurse anesthetists (CRNAs). This analysis

will examine the requirements for the expanded scope of practice and details of that expanded authority as it relates to anesthesia and pain management services.

It is important to note that AB 890 is not a mandate or requirement to utilize NPs as independent practitioners. The bill does not prohibit the supervision of NPs or otherwise seek to regulate or modify the operative law regarding the governance of nurse practitioners who do not receive additional training, testing and can demonstrate a safe “transition to practice.”

Current arrangements regarding the practice and supervision of NPs are not regulated or changed by AB 890.


 AB 2157 Passed Unanimously by California Senate

CSA Sponsored Legislation Heads to the Governor for Signature

The California Society of Anesthesiologists (CSA) is pleased to announce that AB 2157 (Wood) was passed unanimously by the California Senate on August 24, and now heads to Governor Gavin Newsom for his consideration. The Governor has until the end of September to sign or veto the bills passed by the state Legislature at the end of this 2019/2020 legislative session.

AB 2157, sponsored by CSA and authored by the Assembly Health Committee Chair Jim Wood, D.D.S. (D-Santa Rosa), passed out of both the Assembly and Senate with bipartisan and unanimous support. The legislation codifies recent sub-regulatory guidance issued by the California Department of Managed Health Care (DMHC) and provides better balance between physicians and health plans and/or insurers over billing and payment disputes for out-of-network health care services provided in an in-network facility.

“Unfortunately, we have seen a growing number of cases where AB 72 was used to make unreasonable demands on anesthesiology groups and even threaten cancelled contracts,” said Antonio Hernandez Conte, MD, Chair of Legislative and Practice Affairs for CSA. “That was unsustainable, and would effectively diminish patient access to anesthesiology services. We are pleased that AB 2157 will create a more level playing field so the IDRP can work as intended – keeping patients out of the middle of these contract disputes while at the same time supporting a process that ensures fair negotiations and protects patient access to care.”

Specifically, AB 2157 provides the following requirements for the Independent Dispute Resolution Process that can be triggered by AB 72 (Bonta) from 2016:

  • Ensures that information submitted through the IDRP must be kept confidential from either disputing party.
  • That the independent arbiter conducts a “de novo” review of the claim dispute based solely on the information and documents timely submitted into evidence by the parties.
  • That the independent arbiter assigns reviewers to each case based on their relevant education, background, and medical claims payment and clinical experience.

“AB 2157 is a smart and tailored approach to ensuring physicians are not artificially disadvantaged when going through the adjudication process. We are glad the Legislature understood the importance of this legislation and made it a priority in the midst of so many other legislative challenges for the state” added Dr. Hernandez Conte.

As author of the bill and Chair of the Assembly Health Committee, Assemblymember Wood provided critical stewardship of AB 2157 as it moved through the legislative process. His first-hand experience as a health care practitioner provided understanding on how the interactions between providers and insurance companies directly impact patient access and quality of care.

“We appreciated the opportunity to work with Assemblymember Wood and find a way to address this important issue – the contract negotiations between health plans and providers are complicated but have real world implications for our patients and the efficacy of our healthcare systems,” said Jeff Poage, MD, President of CSA.

CSA district directors and members throughout the state engaged in effective grassroots outreach and advocacy calls with key members of the Legislature to educate them about the importance of AB 2157. In particular, CSA District Directors Lawrence Ong, MD, Jeffrey Rusheen, MD, Robin Seaberg, MD, Sydney Thomson, MD, Christian Borhringer, MBBS, and Henry Gonzalez, MD were instrumental in leading virtual meetings and phone calls with key legislators – educating them about the importance of the bill and why it matters to their district and to the future of healthcare in California. Additionally, CSA greatly appreciates the involvement of so many more members who wrote letters or who joined legislative outreach phone calls as local constituents to provide additional grassroots support – including Folu Ani, MD, Robert Wong, MD, Puja Trivedi, MD, Jim Hlavacek, MD, Ellen Wang, MD, Larry Sullivan, MD, Michael Champeau, MD, Chien Chow, MD, as well as Ron Pearl, MD, President-Elect for CSA, Sunny Jha, MD, Director of the CSA Early Career Practice Forum and Felipe Perez, MD, Vice Chair for the CSA Legislative Affairs Committee.

“It was great to see CSA’s grassroots advocacy program in action and working effectively,” said Sydney Thomson, MD, Director for CSA District 3. “We were able to share our own experiences and inform policymakers how the legislation impacts our specialty, our practices and patient access to care. Building these channels for communication is so important not just for this piece of legislation, but for the overall CSA mission to positively impact public policy  - promoting patient safety, preserving physician-led anesthesia care, and increasing access to quality care in California.”

TAKE ACTION: Oppose Nurse Anesthetists Replacing Anesthesiologists in VA

The Department of Veterans Affairs (VA) has acted unilaterally to replace physician anesthesiologists with nurse anesthetists in VA facilities citing COVID-19. 

Please contact your lawmakers immediately to share your concerns and oppose this change.

Click here to take action

CSA Promotes Safe Dental Anesthesia 

In response to two highly publicized tragedies in which two young children died in California dental offices while undergoing anesthesia, the CSA has actively supported AB 2235, known as “Caleb’s Law”, authored by Assemblymember Tony Thurmond (D-Richmond). This new legislation seeks improved informed consent for parents of children scheduled to undergo dental procedures under anesthesia, along with improved data collection concerning critical incidents and adverse events.

Additionally, CSA leaders have actively engaged in stakeholder meetings at the Department of Consumer Affairs, and offered testimony on this important patient safety issue to the Dental Board of California (DBC).  On August 17, 2016, CSA submitted a letter (attached) outlining specific and stringent recommendations to the DBC on how to improve the permit process for provision of pediatric dental sedation and anesthesia, and how to improve safety in the delivery of anesthesia for pediatric dental and oral surgery care. The California component of the American Academy of Pediatrics (CA-AAP) submitted its own letter (attached) on this issue, in which it urged that the DBC “integrate into your subcommittee report, in full, the recommendations of the California Society of Anesthesiologists (CSA) in their August 17, 2016 letter of comment.” The DBC report and recommendations are expected to be available later this year.

CSA Endorses New Guidelines on Dental Sedation Personnel

AB 72 (Bonta) re: Out of Network Billing

CSA leaders and our lobbyists in Sacramento have been extremely active in advancing the principle of physician-led anesthesia care in the California Legislature. AB 72, aimed at protecting patients from “surprise bills” is headed to the Governor’s desk. The California Medical Association, informed by discussions with CSA and other hospital-based specialties, negotiated with health plans, labor and consumer groups to provide a more level playing field when a patient receives treatment at an in-network facility from an out-of-network provider.

Although CSA believes that AB 72 falls short of creating a real solution to the real problem of “surprise bills,” this legislation is a fairer way of addressing the problem that what CSA faced last year with AB 533. CSA will be deeply engaged in the administrative rule-making process in the next several months and years to ensure the proper definition of “average contracted rate” is adopted and implemented correctly. 

See also: ASA Grassroots Network