In the late-1990s, Collier Anesthesia, a private medical group based in Naples, was struggling to find enough nurse anesthetists to serve a growing number of patients.

Hiring temporary agency staff proved too expensive. So Thomas Cook, the group’s president, decided to solve the labor shortage by getting into the education business, partnering with Edward Morton, then CEO of Naples Community Hospital, and a nurse anesthetist named Norman Wolford.

The trio launched a master’s-level training program for those who wanted to become certified registered nurse anesthetists (CRNAs). Naming their program after Wolford, they affiliated with Florida Gulf Coast University, which had yet to create its own program.

The school graduated its first class — 16 students — in 2002. By 2004, however, the program was bringing in more tuition dollars for FGCU than the university was spending on the program, says Lynda Waterhouse, then-executive director of Collier Anesthesia. One factor: Many of the students came to enroll in the program from outside Florida and paid higher, out-of-state tuition.

Waterhouse said the program decided to part ways with the university, believing it “could give the students more value at a lesser cost by becoming independent.”

Since then, Wolford has operated as a for-profit institution, owned by the same people who own Collier Anesthesia. Today, Wolford is the only single-purpose nurse anesthesia college in Florida and one of only two nationwide. (The other is in Tennessee.) Each year, Wolford graduates about 60 students who typically go on to pass a national certification exam to become CRNAs.

The school has operated handin- glove with Collier Anesthesia throughout its history. Initially, because it was only provisionally accredited, students couldn’t get federal financial aid. Wolford worked with local banks to provide student loans backed by Collier Anesthesia. It also offered student stipends with a two-year post-graduate commitment to work for Collier as repayment.

(Since 2007, the school has been accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA), a federally recognized accrediting agency for nurse anesthesia programs nationwide.)

More recently, Wolford’s ties with Collier Anesthesia have become an issue for the school. To get a master’s degree, students must complete 12 months of classroom study followed by 16 months of clinical training at partner sites in southwest Florida, Orlando and Miami — including NCH Healthcare, where Collier provides anesthesia services to surgical and obstetric patients.

In 2012, 25 former students filed a federal class-action lawsuit against Wolford and Collier, seeking unpaid wages and overtime pay for duties performed during clinical training supervised by the anesthesia group.

The students say they’re entitled to be paid as employees because the work they did was for the financial benefit of Collier and not educational and because they displaced licensed nurse anesthetists. While it’s common for medical students to get paid for their training as residents, nurse anesthesia students typically are not paid for clinical hours.

Wolford and Collier say the students knew ahead of time that the clinical training was required and unpaid. They also argue that the students’ participation in medical procedures didn’t amount to free labor because the supervision required creates added stress for professionals and slows things down. “It’s not like they can just walk in there and do the job,” Waterhouse says.

Three years ago, a federal court ruled in favor of Wolford, but the 11th Circuit Court revived the suit on appeal, and a trial court ruled against Wolford in early May. The college says it will appeal. Waterhouse says the educational community is watching the case closely. “If we were to lose,” she says, “it would change the face of any kind of clinical experience anywhere.”

John McDonough, president of the Florida Association of Nurse Anesthetists, and director of the nurse anesthesia program at the University of North Florida, downplays any wider implications, however. “The circumstances are very, very different,” he says, pointing to Wolford’s unique for-profit status.

Most of the school’s founders are still involved. Cook is now chancellor emeritus. Morton chairs the board of trustees. Waterhouse is now president. Norman Wolford died three years ago.

These days, Waterhouse says she’s focused on getting Wolford regionally accredited by the Southern Association of Colleges & Schools Commission on Colleges, which would enable students to transfer credits or pursue admission to another graduate program in the U.S. In 2015, the profession’s accrediting agency, COA, began requiring degreegranting nurse anesthesia programs such as Wolford to obtain regional accreditation.

Meanwhile, demand for nurse anesthetists remains high. Last year, more than 2,400 students graduated from nearly 120 nurse anesthesia programs nationwide, up from about 950 graduates and 83 programs in 1999.

Between 2014 and 2024, the number of jobs for nurse anesthetists is projected to grow 19%.

Cheryl Nimmo, president of the American Association of Nurse Anesthetists, attributes the trend to an aging population and more people insured under the Affordable Care Act. During the next decade, millions of Baby Boomers will become 65 or older, aging into a group that accounts for at least a third of all surgical procedures.

The workforce itself also is aging, she says. “Nurse anesthetists are retiring, and we’re trying to fill those slots.”

Wolford points to the success of its graduates as proof that it does right by students — more than 90% report landing a job in the field within six months. Nurse anesthetists, on average, make $163,370 a year in Florida, according to the U.S. Bureau of Labor Statistics. With overtime, some make upward of $300,000, Waterhouse says.

“I don’t know if any CRNAs ever graduate and don’t have a six-figure job,” she says. “It doesn’t matter if they’re at the top of their class or at the bottom. They can still go out and get high-paying jobs. That speaks to the demand.”

Wolford College

Location: Naples

Enrollment: 150

Focus: The school offers only master’s and Ph.D. training programs for nurse anesthetists — specialists who administer anesthesia to patients undergoing medical, dental and obstetrical procedures. To become licensed, certified registered nurse anesthetists (CRNAs) must get a master’s degree and pass a national certification exam. By 2025, they’ll need a doctorate to enter the field.

Cost: For a 28-month master’s degree program, $63,740. For a 24-month online doctoral program, $30,000.

Finances: The for-profit school has about $4 million in annual revenue.

Context: Wolford is one of nine programs in Florida that offer training for nurse anesthetists. It is one of only two independent, single-purpose nurse anesthetist schools in the U.S. The other is in Tennessee.

STUDENT PROFILE

David Budenbender

Home State: Texas

Family: Wife, Alecia, three children

Career: Received an online bachelor’s degree in nursing from Notre Dame College of Ohio. Most recently worked as a registered nurse in the intensive care unit of Weatherford Regional Medical Center in Texas. Moved to Naples two years ago to attend Wolford; finishes his master’s degree this month. Has used loans to support himself and his family.

Challenge: Learning to inject a local anesthetic through a needle into a patient’s back, shoulder or leg “with a high degree of precision. You have to hit the right spot to anesthetize those nerves.”

Goal: Wants to return to a hospital trauma center; has begun interviewing for jobs throughout the U.S.

Quote: “I think I’ll end up in a Level I or Level II trauma center. There’s everything there, and it’s amazing. Talk about being pushed,” he says. “If you think you’ve learned it all, you haven’t.”