Nurse Anesthetists

Hawaii — S.B. 792 and H.B. 613 provide that a physician or surgeon would have no duty to supervise or direct any advanced practice registered nurse (APRN) with whom the physician or surgeon has collaborated or entered into a collegial agreement. The bills also would prohibit any medical malpractice insurer from imposing a surcharge or otherwise discriminating against any physician or surgeon for collaborating or entering into a collegial agreement with an APRN. Nurse anesthetists are considered a special category of APRNs.

Legislation addressing the scope of practice of nurse anesthetists is expected to be introduced in Missouri, Montana, New York, North Dakota and Pennsylvania.



Office-Based Anesthesia

In New York, the appellate court upheld the lower court’s decision that the Department of Health did not have the legal authority to promulgate guidelines for the office surgical setting. The lower court had found that the guidelines were intended to be standards to be applied in physician disciplinary proceedings and would be evidence of local community medical standards in medical malpractice actions. In brief, the lower court held that the guidelines were essentially regulations and such regulations were beyond the scope of the department’s authority, and the appellate court concurred. The initial lawsuit was brought by the New York State Association of Nurse Anesthetists.

Legislation may be introduced this session to give the department the statutory authority to promulgate regulations for the office-based surgical setting.

In January, the North Carolina Medical Board adopted a position statement on office-based surgical procedures. Physicians who perform surgical or special procedures in an office requiring the administration of anesthesia should be credentialed to perform that procedure by a hospital, ambulatory surgical facility or substantially comply with criteria established by the Board. The guidelines provide that a licensed physician with appropriate qualifications takes responsibility for the supervision of all aspects of the perioperative surgical, procedural and anesthesia care delivered in the office setting. Physicians should perform a preprocedure examination and evaluation. The physician performing the procedure should: ensure that an appropriate preanesthetic examination and evaluation is performed; prescribe the anesthetic unless the anesthesia is administered by an anesthesiologist; ensure that qualified health care professionals participate; remain physically present during the intraoperative period and be immediately available for diagnosis, treatment and management of anesthesia-related complications or emergencies; and ensure the provision of postanesthesia care. The guidelines suggest that physicians who perform Level II or Level III procedures should be able to demonstrate substantial compliance with the guidelines or should obtain accreditation by an approved accrediting agency or organization within one year of adoption.

The Alabama Board of Medical Examiners has proposed guidelines for office-based surgery and anesthesia. The guidelines in the current form provide for a preanesthetic examination and evaluation to be conducted by the physician who will be administering or supervising the administration of anesthesia. If a nurse anesthetist is to administer the anesthesia, the physician must collaborate in the examination and evaluation. Under the guidelines, anesthesia should be administered only by licensed, qualified and competent practitioners. Practitioners must have documented competence and training to administer anesthesia and to assist in any support or resuscitation measures as required. Supervision of the “sedation/analgesia component of the medical procedure” should be provided by a physician who is physically present (immediately and readily available), who is qualified to supervise and who has accepted responsibility for supervision. Reporting to the Board of Medical Examiners is required within three business days for all surgical-related deaths and all events that resulted in an emergency transfer of the patient to the hospital, anesthetic or surgical mishaps requiring cardiopulmonary resuscitation, unscheduled hospitalization related to surgery and surgical-site wound infection.