I work in KY. Don't know that the MD has to be around all over KY but at my hospital the MD has to be there except for epidural/spinals. LIke I said the CRNA can do the section as long as the MD is in house. He can be in the bathroom, in the lounge or in the OR just inhouse someplace. I have a problem when the MD is in house doing something and I need an epidural. If the MD is walking out the door and I tell him he'll say call the CRNA who might be at home 30 minutes away instead of doing it himself. We don't have in house anesthesia 24/7 they work in general 7-5 M-F with rotating call after hours and weekends always a MD and CRNA both oncall. You call who you need.