The group walked away, then sued the CRNAs who stayed

The Anesthesia Brief  ·  Issue #8

If you're thinking it, we're talking about it.

By Marc Smith, DNP, CRNA & Shantall Ruiz Cummins, DNP, CRNA

Six things worth knowing today. Let's get into it.

The group walked away, then sued the CRNAs who stayed

Four CRNAs in Texas are barred from working where they were already working, and the reason matters more than the state does.

Here is the sequence. In March 2025 an anesthesia group gave written notice that it was terminating its own contract with CHRISTUS, effective August 1. The group chose to leave. On the day that contract ended, four CRNAs began working at those same CHRISTUS facilities for a competitor, which is to say they stayed with the patients while their employer walked.

Their former employer sued them that same day and had a restraining order in hand within hours. The fight has run through two temporary injunctions and an appeal since. On April 16, 2026 the Texas Ninth Court of Appeals affirmed the injunction, accepting that the group still had protectable goodwill at those hospitals even though it had given up the contract there.

Two things are worth being precise about. The trial court found a three-year restriction inside a twenty-mile radius reasonable. And this is still a temporary injunction, with the merits set for later, so the CRNAs have been off those sites for months without a final ruling on whether any of it holds.

It does not always go that way. In Tennessee, a group that demanded a large subsidy increase and then gave notice it would stop providing services tried the same move, and the Court of Appeals refused to enforce the covenants. These cases turn hard on their facts.

What is settled is that no one is coming to fix this federally. The FTC spent 2024 trying to ban non-competes nationwide, lost in court, dropped its appeal, and removed the rule from the federal regulations in February. What is left is your state's law and whatever you signed.

Our take is at the bottom of this issue ↓

The comment window closes tomorrow

The Council on Accreditation is taking comments on how it defines eligibility for accreditation, and the window closes August 5. That is tomorrow.

Those definitions decide which institutions are allowed to run a nurse anesthesia program at all. COA's own page says feedback from the community of interest is very important in considering the revisions, and that responses are aggregated and reviewed before it decides. Which means the ratio of program administrators to working CRNAs in that pile is doing real work.

If you precept, if you have an RRNA in your room, or if you came through a program that is still running, you have the most direct experience and the least representation in that pile. It takes a few minutes and the window does not reopen.

Ohio and Rhode Island are law, the federal bill is still sitting

Ohio's HB52 is law now, last action June 9. It replaces blanket physician supervision with a collaborative model, and the physician on the record no longer has to be an anesthesiologist. That widens who can collaborate with you, which matters most in the facilities that do not have an anesthesiologist in the building.

Rhode Island's S3184 and H7740 also passed, last action June 18. They stop RNs and non-CRNA nurse practitioners from administering general anesthesia and deep sedation for elective cases. Read that one as scope protection rather than scope expansion. It draws a line under who is qualified to do what we do.

If you practice in either state the law has already changed. The open question is how long your facility's policy takes to catch up, and policy moves slower than statute.

Still moving, and we covered it when it started. HB9642 cleared House Ways and Means on July 15 and has not moved since. In plain terms: Medicare pays small rural hospitals extra to keep anesthesia available, and today that money can only go to a CRNA or a CAA. This bill would let it go to an anesthesiologist too, without adding a dollar to it. Same pot, more hands.

→ Full scope tracker + your state

Glycopyrrolate is being discontinued, not backordered

Glycopyrrolate is the one to ask about this week, and it is worth being exact because it is not a shortage. Four injection listings were flagged to be discontinued on July 30. That is a manufacturer choosing to stop making a presentation, which is a different problem with a different fix.

Ask pharmacy whether your glyco is single sourced and what the substitute plan is. Five minutes now, or a surprise at the head of the bed later.

Lidocaine also moved this week and remains the largest active shortage on our board.

→ Full shortage list

The cases moved out of the OR, and the jobs followed

The cases are moving out of the main OR and the staffing has not followed. Anesthesiology News reported this month that non-operating-room anesthesia keeps expanding while the workforce to cover it does not.

For once that math runs in your direction. GI, IR, cath lab and MRI are where new coverage is being added, and those rooms tend to be staffed by whoever is willing to go to them. If you have been waiting for a reason to reopen a rate conversation, a facility that just opened two procedure rooms it cannot staff is a much better place to have that conversation than a main OR whose schedule has not changed in a decade.

Ask what you are actually walking into before you say yes. Who is your second set of hands when something goes wrong at the scanner? Where is the closest working suction? Does the remote site carry the same airway cart as the main OR, or a smaller one nobody has inventoried since spring?

Those answers tell you what the job really is, and they are worth having in writing before the rate is agreed rather than after.

Two non-opioid drugs, and only one is real yet

We covered Journavx here two weeks ago when its first real-world safety data landed. A second drug in the same family is now in the headlines, the two are getting mixed up, so here is the difference.

Both block Nav1.8, a sodium channel that carries pain signals from the site of injury toward the spinal cord. Blocking it is the first genuinely new mechanism for acute pain in decades, and the promise is opioid-level relief without the opioid.

Suzetrigine, sold as Journavx, is the approved one. FDA cleared it in January 2025 for moderate to severe acute pain including after surgery. Oral tablet, 100 mg to start and then 50 mg every 12 hours, contraindicated with strong CYP3A inhibitors.

LTG-001 is the one making headlines and it is investigational. Not approved and not orderable. Its phase 2 trial published in the New England Journal of Medicine on July 30 enrolled 343 abdominoplasty patients, 99% of them women, opioid naive, with chronic pain excluded, and it was given on its own rather than alongside anything else. The authors said plainly that those limits matter.

The effect was real and it was modest. Patients on LTG-001 reported roughly 1 to 2 points less pain on a 0 to 10 scale than patients on placebo. Headlines are quoting a much larger figure that is a 48 hour running total rather than a pain score, so if a number sounds dramatic, that is why.

Neither of these changes what you reach for this week. But suzetrigine is approved and it is the first new mechanism for acute pain in a long time, which means it is the kind of thing that turns up in a multimodal order set a year from now without much announcement. Worth having on the radar before it shows up on a preference card.

→ Tech watch

They stayed. That is what they are being punished for.

The part that should bother you is not the legal reasoning. It is the shape of it.

The group decided to walk away from that hospital. Nobody fired it, nobody outbid it, it gave notice and left. Four CRNAs made the opposite choice and stayed where the patients were. And the ones facing an injunction, months off the schedule, and a legal bill are the four who stayed.

That is the gap worth naming. A non-compete is written to stop you walking out with a book of business. It was never written for the situation where your employer walks out and you are the one who stayed put. The language does not make that distinction, and this court declined to make it either.

Which is exactly why the language deserves attention before you sign it. Find the restrictive covenant and ask one specific question of someone who is not the recruiter: what happens to me if this group leaves, or loses, this contract? Get the answer in writing. Those four did nothing but keep showing up, and that is the whole point.

- Marc & Shantall

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Legislative data, LegiScan & OpenStates (CC BY 4.0). Drug shortage data, ASHP / openFDA. Federal regulatory data, FederalRegister.gov (public domain). Compensation, Marit Health, BLS, AANA.

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