In an effort to bar nurse anesthetists from administering anesthesia without physician supervision in rural hospitals, two organizations representing Colorado doctors and anesthesiologists filed a lawsuit with the Denver District Court on Tuesday.

The Colorado Medical Society and the Colorado Society of Anesthesiologists moved to sue the state just a day after Gov. Bill Ritter announced his decision to opt out of the federal Medicare rule, which requires physician supervision for registered nurse anesthetists.

"Patient safety is and must always be one of our highest priorities," Ritter said in prepared remarks, arguing that nurse anesthetists provide safe care. "This decision upholds that core value while giving rural hospitals the flexibility they need to provide their rural patients with access to high quality health care."

The lawsuit adds to the controversy among industry professionals about the safety of anesthesia delivery with or without physician supervision.

The Colorado Medical Society, which represents 7,400 physicians and medical students throughout the state, cited two reasons for the lawsuit. The society finds that the opt-out rule is inconsistent with the state's "captain of the ship" doctrine.

"The 'captain of the ship' doctrine holds that it is the physician who is in charge in the operating room and therefore, legally responsible and liable for the acts and omissions of everyone else in the OR," Edie Sonn, senior director, public affairs, with the Colorado Medical Society, told DOTmed News.

The governor's decision to entrust anesthesia delivery to nurse anesthetists without physician supervision doesn't change the doctrine - the physician still retains the legal liability but is void of supervisory authority, said Sonn.

"Getting away from the legal argument, it's a recipe for a dysfunctional team in the operating room," she said.

The other basis for the lawsuit's legal rationale is the fact that the state classifies anesthesia delivery as a delegated medical function, which according to Colorado law is, "an action performed pursuant to a physician's order," said Sonn.

The medical society believes the opt-out puts the delivery of anesthesia outside the bounds of the state's definition of a delegated medical function.

In addition to the legal arguments, the medical society has "questions about the safest way of delivering anesthesia care," said Sonn.

The Colorado Society of Anesthesiologists said it filed the lawsuit because of patient safety concerns.

Dr. Daniel Janik, president of the Colorado Society of Anesthesiologists, told DOTmed News that the organization "felt compelled to take legal action" following the governor's decision to opt out the states' rural hospitals from the rule.

"I think we and the other physicians are the only people that have the depth of education and training to make medical decisions for patients in the operating room, which is a time when they're most vulnerable," said Janik. "Anesthesia is complex, it can be dangerous, but in the right situation it can be safe, and in the right situation means with a physician in charge."

The two groups also criticized the governor's decision to opt-out the hospitals he defined as rural in his letter to the Centers for Medicare and Medicaid Services.

"The governor's opt-out pertains not only to the critical access hospitals in the state but a host of other 'rural hospitals' that do indeed have significant numbers of anesthesiologists on staff," said Sonn.

Janik said nurse anesthetists are currently being supervised by physicians other than anesthesiologists, such as surgeons or family practitioners.

"While there may not be anesthesiologists in some of the rural hospitals, there still are physicians who we think have the appropriate scope of practice to make medical decisions," said Janik. "The administration of anesthesia is a practice of medicine, this is a delegated medical function."

Sonn said the medical society asked that the governor hold off on making the decision on the federal Medicare rule in order to bring all the stakeholders together to discuss an alternative.

"That didn't happen. We're very disappointed that it didn't," said Sonn.

In his letter to CMS, Ritter wrote that he "consulted with the Colorado Medical Board and Colorado Board of Nursing about issues related to access to, and the quality of, anesthesia services in Colorado."

In order to better explain what physician supervision entails, the two medical groups plan to work together on a comprehensive education and outreach plan for Colorado physicians.