Colorado Medical Society v. Hickenlooper

2012 COA 121, 353 P.3d 396, 2012 WL 2928528, 2012 Colo. App. LEXIS 1135
Colorado Court of Appeals·Decided July 19, 2012·No. No. 11CA1005·Published·Cited by 6 cases

Opinions

Opinion by

Judge ROTHENBERG.*

T1 Plaintiffs, Colorado Medical Society and Colorado Society of Anesthesiologists {collectively, Doctors), appeal the district court's order dismissing their complaint for failure to state a claim against defendant, John Hickenlooper, in his official capacity as the Governor of Colorado (Governor). Inter-venors, Colorado Association of Nurse Anesthetists, Colorado Nurses Association, and Colorado Hospital Association (collectively, Nurses), joined the Governor's motion to dismiss.

T2 At issue in this case is whether Colorado law permits certified registered nurse anesthetists (CRNAs) to administer anesthesia without supervision by a physician, and therefore authorizes the Governor to opt out of the physician supervision requirement for purposes of the Social Security Act. We conclude the delivery of anesthesia by a CRNA without physician supervision is consistent with state law, and therefore the Governor had authority to opt out of the physician supervision requirement. Accordingly, we affirm the trial court's order.

I. Background and Procedural History

1 3 Under the Social Security Act, ambulatory surgical centers, hospitals, and critical access hospitals must fulfill certain conditions of participation to receive Medicare reimbursement. |One condition is that CRNAs administering anesthesia must be supervised by a physician. 42 C.F.R. § 416.42 (ambulatory surgical center) 42 C.F.R. § 482.52 (hospital); 42 C.F.R. § 485.639 (critical access hospital). .

[399] {4 However, states may opt out of the physician supervision requirement if "the State in which the [facility] is located submits a letter to [the Centers for Medicare and Medicaid Services] signed by the Governor, following consultation with the State's Boards of Medicine and Nursing, requesting exemption from physician supervision of CRNAs." 42 C.F.R. §§ 416. 482.52(c)(1), 485.639(e)(1). The letter from the Governor must attest that the Governor consulted the Boards and concluded that the opt-out "is in the best interests of the State's citizens" and "consistent with State law." 42 C.F.R.. §§ 416.42(c)(1), 482.52(c)(1), 485.639(e)(1).

15 Fifteen states other than Colorado have opted out of the federal requirement that CRNAs be supervised by physicians. They are Alaska, California, Idaho, Iowa, Kansas, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oregon, South Dakota, Washington, and Wisconsin. See Cal. Soc'y of Anesthesiologists v. Superior Court, 204 Cal.App.4th 390, 397 n. 4, 138 Cal.Rptr.3d 745, 748 n. 4 (2012).

¶ 6 On July 29, 2010, former Governor Bill Ritter, Jr. sent a letter to the Colorado Medical Board (Medical Board) and the Colorado Board of Nursing (Nursing Board) requesting advice whether an opt-out would be consistent with Colorado law and in the best interests of Colorado residents. In August 2010, both the Medical Board and the Nursing Board recommended the opt-out.

17 On September 27, 2010, Governor Rit-ter notified the Centers for Medicare and Medicaid Services by letter that he had consulted with the Medical Board and the Nursing Board and had determined the opt-out was consistent with Colorado law and in the best interests of Colorado citizens. Consequently, he exercised the opt-out as to all critical access hospitals in Colorado and thirteen specifically identified rural general hospitals. Later, he added a fourteenth rural general hospital to the opt-out.

{8 On September 28, 2010, the Doctors filed this action for declaratory relief contending the opt-out was inconsistent with Colorado law.. The Doctors also requested injunctive relief ordering the Governor to withdraw the opt-out. The Colorado Hospital Association, Colorado Nurses Association, and Colorado Association of Nurse Anesthetists intervened. Governor Hickenlooper filed a motion to dismiss, in which the inter-venors joined.

T9 On April 8, 2011, the district court granted the Governor's motion to dismiss and thus upheld his decision that Colorado statutes and regulations permit the delivery of anesthesia by a CRNA without physician supervision.

10 The Doctors now appeal. On appeal, amici curiae briefs were filed by the American Society of Anesthesiologists and American Medical Society supporting the position taken by the Doctors, and by the American Hospital Association supporting the position taken by the Governor and the Nurses.

II. Is the Governor's Decision Subject to Judicial Review?

111 Initially, we address a contention that was raised only by the Hospital Association: namely, that the Governor's decision to opt out of the Medicare requirement is a "decision committed to the political branches and is not subject to judicial review." We disagree.

$12 "The nonjusticiability of a political question is primarily a function of the separation of powers." Baker v. Carr, 369 U.S. 186, 210, 82 S.Ct. 691, 7 L.Ed.2d 663 (1962); see Lobato v. State, 218 P.3d 358, 368-71 (Col0o.2009) (applying the political question doctrine in Colorado). "A controversy is nonjusticiable-ie., involves a political question-where there is 'a textually demonstrable constitutional commitment of the issue to a coordinate political department; or a lack of judicially discoverable and manageable standards for resolving it. ...'" Nixon v. United States, 506 U.S. 224, 228, 113 S.Ct. 732, 122 L.Ed.2d 1 (1993) (quoting Baker, 369 U.S. at 217, 82 S.Ct. 691); see Gilligan v. Morgan, 413 U.S. 1, 9-10, 93 S.Ct. 2440, 37 L.Ed.2d 407 (1973) (discussing justiciability).

113 In Colorado, "[the judiciary's avoidance of deciding political questions finds its roots in the Colorado Constitution's provi[400] sions separating the powers of state government." Colo. Common Cause v. Bledsoe, 810 P.2d 201, 205 (Colo.1991) (citing Colo. Const. art. III; see Lobato, 218 P.3d at 368. "The three branches 'shall cooperate with and complement, and at the same time act as checks and balances against one another but shall not interfere with or encroach on the authority or within the province of the other." Lobato, 218 P.3d at 372 (quoting Smith v. Miller, 153 Colo. 35, 40-41, 384 P.2d 738, 741 (1963)).

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Colorado Medical Society v. Hickenlooper, 2012 COA 121, 353 P.3d 396, 2012 WL 2928528, 2012 Colo. App. LEXIS 1135 (Colo. Ct. App. 2012).

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