For surgeons & physicians
A board-certified CRNA manages the anesthetic from preoperative assessment through recovery, inside your workflow — in your office suite, your surgery center, or the hospital OR — so you can stay focused on the procedure.
Concerned about liability? Read what Texas law actually says →
How it works
Your case mix, volume, patient population, and how sedation is handled today.
A walkthrough of equipment, emergency medications and protocols, recovery space, and accreditation before the first case.
Shared criteria for who belongs in your setting, and a preoperative assessment for every patient.
Block days, recurring days, or case by case — built around your clinic calendar.
Office-based anesthesia
I don't transport controlled substances between sites, so your office stores and supplies all anesthesia medications. Billing is set per practice in the services agreement.
Safety
Every patient gets a preoperative assessment. Health history, airway, and the procedure itself decide whether the office, a surgery center, or a hospital is the right setting.
Surgeon liability
Retiring the “captain of the ship” myth.
Working with a CRNA does not make you liable for the anesthetic. Courts ask one question: who controlled the act that went wrong? That standard is identical whether your anesthesia provider is a CRNA or an anesthesiologist.
I hear the “captain of the ship” concern often, usually from surgeons who were told that CRNA-only anesthesia puts their license and assets on the line. You deserve the actual law, so here it is, with sources you or your attorney can check.
The claim is that a surgeon is automatically responsible for everything in the OR, so working without an anesthesiologist means absorbing the anesthesia risk. The phrase “captain of the ship” comes from a 1949 Pennsylvania case, McConnell v. Williams, decided when charitable immunity often shielded hospitals and plaintiffs needed someone else to sue.
That world is gone. Hospitals can be sued, anesthesia providers carry their own coverage, and many courts that have examined the doctrine have narrowed or abandoned it. Texas abandoned it outright in 1977.
A surgeon is liable for anesthesia negligence in two situations: the surgeon was personally negligent, or the surgeon controlled how the anesthetic was performed. Provider type is not part of the test.
Texas rejected “captain of the ship” in 1977. In Sparger v. Worley Hospital, the Texas Supreme Court refused to make a surgeon liable as a matter of law for OR staff he did not control. A surgeon's vicarious liability is judged by the same agency rules that apply to any other employer. The companion case, Ramon v. Mani, confirmed it the same day. Both cases involved OR nurses' sponge counts, but the rule they set applies to everyone in the room.
Texas law lets you order anesthesia without directing it. Under Texas Occupations Code §157.058, a physician in a hospital or ASC may delegate anesthesia to a CRNA. Your order does not need to specify a drug, dose, or technique. The CRNA selects and administers what is needed to carry out the order and keep the patient physiologically stable. For office-based cases, Texas Board of Nursing Rule 221.16 says the same: the order need not be drug-, dose-, or technique-specific.
Signing the order is not, by itself, a basis for liability. Section 157.060 says a physician is not liable for an APRN's act solely because the physician signed the order or protocol, unless the physician had reason to doubt the APRN's competency.
In fairness, §157.060 is not blanket immunity. A 2021 Texas Attorney General opinion (KP-0353) declined to read it as limiting a delegating physician's liability to the competency question alone. Liability still turns on the facts of what you did. The same opinion confirmed that chapter 157 does not, by itself, require you to supervise a CRNA's performance of the anesthetic.
The same rules apply to anesthesiologists. Surgeons have been held liable for an anesthesiologist's negligence when they took control of the anesthetic. Working with a physician anesthesiologist is not a liability shield, and working with a CRNA is not a liability trap.
Medicare's hospital rule requires CRNA supervision by “the operating practitioner or an anesthesiologist,” but meeting that requirement does not make you liable for the anesthetic. The rule is 42 CFR §482.52(a)(4). Texas has not opted out of it, so in many facilities you may be the supervising practitioner of record. Federal ASC rules and some state controlled-substance and facility rules also call for physician presence or supervision.
Supervision in this sense is a payment and participation condition. Courts look past the label to what actually happened: did you make the anesthesia decisions? AANA legal counsel reports finding no published case that held a surgeon liable for a CRNA solely because the surgeon provided the supervision Medicare requires.
I am licensed, insured, and accountable for every anesthetic I deliver. When I take a case, the anesthesia decisions are mine, and so is the professional responsibility for them.
The surest way to limit anesthesia liability is to let your anesthesia provider run the anesthetic. That holds whether the provider is a CRNA or an anesthesiologist.
A 2010 Health Affairs analysis of 481,440 Medicare hospitalizations found no increase in deaths or complications where CRNAs practiced without physician supervision. Outcomes were similar whether the anesthetic was delivered by a CRNA alone, an anesthesiologist alone, or a team. The study was funded by the AANA, and the American Society of Anesthesiologists has disputed its methods.
In Texas, noneconomic damages in a health care liability claim are capped at $250,000 per claimant against all individual providers combined (Tex. Civ. Prac. & Rem. Code §74.301). That cap applies no matter which anesthesia model you use.
No. Texas rejected automatic “captain of the ship” liability in Sparger v. Worley Hospital (1977). Liability depends on whether you controlled the anesthetic or were personally negligent.
Possibly, with any anesthesia provider. Plaintiffs commonly name everyone in the room. Being named is not the same as being held liable, and the legal test is identical for CRNAs and anesthesiologists.
Supervision required by 42 CFR §482.52 is a payment and participation condition. Courts look at actual control of the anesthetic, not the supervision label.
Not as a matter of law. Surgeons have been held liable for anesthesiologists' negligence when they controlled the anesthetic. The safeguard is the same either way: let the anesthesia provider manage the anesthesia.
I do. I carry my own professional liability coverage, and I provide a certificate of insurance on request.
This section summarizes general legal principles for educational purposes. It is not legal advice. Liability in any specific case depends on its facts and applicable law; consult your own counsel.
More questions surgeons ask
Not under Texas law. In hospitals and ASCs, Texas Occupations Code §157.058 lets a physician delegate anesthesia to a CRNA; in office settings, Texas Board of Nursing Rule 221.16 applies. Medicare's conditions of participation require CRNA supervision by the operating practitioner or an anesthesiologist, and some state drug and facility rules call for a physician's presence — typically satisfied by the operating physician. The liability section above explains what that supervision does and doesn't mean for you.
It depends on the arrangement. Some practices pay Chiron directly for coverage; in others, Chiron bills for the anesthesia services. We'll choose the model that fits your practice and payer mix.
Common fits include plastics and aesthetics, GI, ENT, pain management, ophthalmic, and OB/GYN procedures — generally shorter cases in patients whose health history supports an office setting.
National board certification through the NBCRNA, an advanced practice license from the Texas Board of Nursing, current BLS, ACLS, and PALS, and professional liability insurance in my own name with limits that meet or exceed facility credentialing requirements. Certificates of insurance and credentialing documents go directly to your medical staff office once we agree on services.
Tell me your specialty, case types, and the setting you have in mind. I respond within 24 hours.
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