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May 2001
Volume 65 |
Number 5
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STATE BEAT
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| State
Legislative Report: AL, GA, IL, LA, MD, MI, NM, NY, PA, WA
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S. Diane Turpin
Assistant Director of Governmental Affairs (State)
Although 19 states have adjourned their regular legislative
sessions for this year (Arizona, Arkansas, Georgia, Idaho, Indiana,
Iowa, Kansas, Kentucky, Maryland, Mississippi, Montana, New Mexico,
North Dakota, South Dakota, Virginia, Washington, West Virginia,
Wisconsin and Wyoming), the remainder of the states are in session.
The following bills are of significant interest to anesthesiologists.
1
Alabama The governor has signed legislation into law that
requires nurse anesthetists to function under the direction of
a physician licensed to practice medicine (or a dentist) who is
immediately available. The Alabama Society of Anesthesiologists
worked tirelessly to ensure passage of this legislation.
Georgia H.B. 632 and H.B. 784 would have required the
Board of Medical Examiners to implement measures to ensure that
physicians who provide surgical services in office-based surgical
settings and physicians who provide, or supervise the provision
of, anesthesia services in office-based surgical settings are
appropriately credentialed to provide such services. Under the
legislation, a physician could apply to any credentialing entity
approved by the board or, alternatively, a physician could be
deemed sufficiently credentialed if the physician had specific
unlimited privileges as a member of the active medical staff in
a hospital located within 50 miles of the physician's primary
office. The bills also required the reporting of an unexpected
occurrence involving death or serious injury, or the risk thereof
within 30 days after the occurrence to an independent peer-review
organization. The legislative session ended before the bills were
passed.
Illinois Regulations were adopted to require that nurse
anesthetists may provide anesthesia services in the office setting
only if the physician has training and experience in the delivery
of anesthesia services to patients. The physician’s training and
experience must be documented in a written practice agreement.
The physician must either have clinical privileges to administer
anesthesia services in a hospital or ambulatory surgical treatment
center or have completed specified continuing medical education
(CME) in the subject area. For conscious sedation only, the physician
shall complete a minimum of eight hours of CME within each three-year
license renewal period in delivery of anesthesia, including the
administration of conscious sedation. For deep sedation, regional
anesthesia and/or general anesthesia, a physician shall complete
a minimum of 34 hours of CME in the delivery of anesthesia services
within each three-year license renewal period.
Louisiana H.B. 1765 would eliminate the current requirement
for nurse anesthetists to practice only under the direction and
supervision of a physician or dentist. S.B. 726 would allow advanced
practice registered nurses (APRNs), including nurse anesthetists,
to write prescriptions. Under current law APRNs may apply for
limited prescriptive authority in accordance with written clinical
practice guidelines and a collaborative practice agreement between
the APRN and a supervising physician.
Maryland The legislative session ended without passage
of H.B. 1356, legislation advanced by the nurse anesthetists.
The bill was amended in committee and, if passed, would have given
the Board of Nursing sole authority to govern anesthesia as a
nursing function in all practice settings where nurse anesthetists
are authorized to practice.
Michigan H.B. 4591 would ensure that physicians who supervise
the administration of general anesthesia or major conductive regional
anesthesia do so while they are physically available in the health
facility at the time of surgery. The legislation is intended to
close a loophole in the current law that may permit supervision
by a physician who is not in the health care facility.
New Mexico H.B. 337, granting prescriptive authority to
nurse anesthetists, was signed into law. S.B. 370, providing for
the licensure of anesthesiologists’ assistants, was signed into
law.
New York A.B. 5548 and S.B. 3457 would require the Commissioner
of Health to promulgate regulations for office-based surgery.
A.B. 5549 and S.B. 3458 would require all health care practitioners
performing office-based surgery to report to the Commissioner
of Health all reportable incidents.
Pennsylvania H.B. 823 would amend the Medical Practice
Act as follows:
Supervision of authorized services – When a certified
registered nurse anesthetist administers anesthetics and provides
related services in a health care facility, the certified registered
nurse anesthetist shall be under the supervision of a physician
who is present in the health care facility when the anesthesia
is administered. The services provided by a certified registered
nurse anesthetist do not include the prescription of medication
or the performance of medical diagnosis or therapeutics.
The bill defines supervision as medical direction provided
by a qualified physician who is responsible for the anesthesia
care provided by the certified registered nurse anesthetist.
The Board shall promulgate regulations which define the medical
direction required by the standards of acceptable medical practice
embraced by the medical doctor community in this Commonwealth.
Washington S.B. 5796 and H.B. 1621 would have expanded
the prescriptive authority of APRNs by allowing them to prescribe
controlled substances in Schedules II-IV. Under current law, APRNs
are permitted to prescribe legend drugs and Schedule V controlled
substances. Furthermore, nurse anesthetists are permitted to select,
order and administer controlled substances as defined in Schedules
II-IV of the Uniform Controlled Substances act, provided such
authority is consistent with their commission-recognized scope
of practice, facility-specific protocols and a physician’s request
for a nurse anesthetist's services. The authority to select, order
or administer Schedule II-IV controlled substances is limited
to those drugs that are to be directly administered to patients
who require anesthesia for diagnostic, operative, obstetrical
or therapeutic procedures in a hospital, clinic, ambulatory surgical
facility or the offices of other designated licensed practitioners.
These bills did not pass.
1 Copies of the bills are available upon request
from the ASA Washington Office at (202) 289-2222 or mail@ASAwash.org.
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