Office-Based Alternative Privileging Rules Blocked in New Jersey

S. Diane Turpin, J.D.
Associate Director of Governmental Affairs


On December 10, 2003, the New Jersey Board of Medicine suspended implementation for 60 days of regulations requiring physicians who do not have hospital privileges to perform surgery or special procedures or to administer anesthesia services to apply for such privileges to do so in the office setting. Prior to this first suspension, applications were due to the board by December 16, 2003.

As a result of the suspension, physicians who were supervising nurse anesthetists in the office setting without privileges to do so or without applying for privileges to do so were permitted to continue this practice until February 17, 2004. Under the board’s regulations, alternative privileges are required for licensed physicians and podiatrists who do not have hospital privileges to administer or supervise the administration of anesthesia services and to perform surgery or special procedures in the office.

The regulations were suspended again until March 1, 2004, but until April 1, 2004, for those physicians supervising regional and general anesthesia. Even under this scenario, physicians were allowed to seek a temporary exception and were permitted to continue their practice without privileges until June 28, 2004.

On February 26, 2004, the New Jersey Association of Nurse Anesthetists (NJANA) filed a lawsuit and obtained a stay of the anesthesia privileging requirements that were scheduled to become effective on March 1. The litigation continues, and until the court issues a final decision, the enforcement of rules relating to alternative privileging and the personnel requirements applicable to surgical and anesthesia services in a physician’s office will be suspended.

NJANA’s previous lawsuit to overturn the alternative privileging requirements was dismissed as not ripe, in that the lawsuit had been filed prior to the board’s promulgation of final regulations.

Scope-of-Practice Issues
In Nebraska, L.B. 1027 would consolidate the regulation of advanced-practice nurses (including nurse anesthetists) under the Board of Nursing and eliminate oversight currently provided by the Board of Medical Examiners. The legislation sets forth a generic scope of practice for all advanced-practice nurses, eliminating the existing statutory scope of practice specified for each category of advanced practice nurses, including nurse anesthetists. The legislation also would eliminate the advisory committee for nurse anesthetists’ practice, which currently includes both physician and nurse representatives.

In Rhode Island, S.B. 2134 would repeal the Nurse Anesthetist Advisory Committee. The advisory committee is charged with consulting with the nursing board on nurse anesthesia matters and is composed of three nurse anesthetists, a surgeon, an anesthesiologist and one representative of the medical society. The legislation would replace this advisory committee with a nurse practitioner joint practice advisory committee, without physicians, to review complaints and recommend any disciplinary or corrective action.

AA Licensure Bills
Michigan S.B. 924 would license anesthesiologist assistants to practice under the medical direction of an anesthesiologist. Similar legislation is pending in Florida and the District of Columbia.

Office-Based Anesthesia
Legislation has been introduced in Kansas to direct the Secretary of Health and Environment to establish standards for office-based surgery rules and regulations, giving consideration to the guidelines adopted by the Kansas Medical Society in 2002.