Florida Licenses AAs; Louisiana Bans AAs

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


fter a three-year legislative battle, Florida Governor Jeb Bush signed legislation into law to license anesthesiologist assistants (AAs) to practice in the state. The bill passed the Senate by a vote of 280-12 and the House by a vote of 74-39. As previously reported, the Florida Association of Nurse Anesthetists vigorously opposed the legislation, keeping it from passage in two previous legislative sessions. This legislation would not have succeeded had it not been for the tireless efforts by the Florida Society of Anesthesiologists.

The legislation licenses AAs to practice under the “direct supervision” of an anesthesiologist. “Direct supervision” is defined as “the on-site, personal supervision by an anesthesiologist who is present in the office when the procedure is being performed in that office, or is present in the surgical or obstetrical suite when the procedure is being performed in that surgical or obstetrical suite and who is in all instances immediately available to provide assistance and direction to the anesthesiologist assistant while anesthesia services are being performed.” An anesthesiologist may supervise two AAs at the same time, although the Board of Medicine may, by rule, allow an anesthesiologist to supervise up to four AAs after July 1, 2008.

The new law defines the scope of practice of AAs, which is similar to the scope of practice in other states where AAs are licensed. The Board of Medicine has begun its rulemaking procedures. Florida becomes the eighth state (joining Alabama, Georgia, Kentucky, Missouri, Ohio, South Carolina and Vermont) where AAs are specifically licensed to practice. AAs practice in other states pursuant to Board of Medicine guidelines or the delegatory authority of an anesthesiologist.

A three-year effort to license AAs in Louisiana ended not only in defeat of AA licensure but with a new law effectively banning AAs from practicing in the state. The first of its kind in the nation, this new law also includes what can only be described as a press release from the American Association of Nurse Anesthetists.

The text of the new law reads as follows:

(1)The Louisiana Legislature hereby finds that:
Certified registered nurse anesthetists (CRNAs) have been selecting and administering anesthesia in Louisiana and the United States for over one hundred years.

The specialty of nurse anesthesia was established in the late 1800s as the first clinical nursing specialty.

Nursing took the lead in formalizing anesthesia practice as a specialty and in providing for specialty education and credentialing in anesthesia practice. During World War I, nurse anesthetists trained both physicians and nurses to provide anesthesia services both at home and abroad.

Nurse anesthetists alone provided the overwhelming majority of anesthetics up until World War II.

Nurse anesthetists receive rigorous clinical and academic training, requiring a bachelor’s degree from an accredited school of nursing and one year of professional nursing experience in an acute care setting prior to being considered for entrance to an accredited twenty-four to thirty-six month nurse anesthesia educational program.

CRNAs administer the majority of anesthetics in Louisiana, and all of the anesthetics in many parts of the state.

Multiple studies have demonstrated that CRNAs are safe, accessible, and cost-effective providers of anesthetics.

CRNAs are critical providers of quality anesthesia services in the health care delivery system in this state.

An adequate supply of CRNAs in Louisiana is vital to continued access to safe, cost-effective health care for the citizens of Louisiana.

Anesthesiologist Assistants (AAs) are not presently authorized to train or practice in Louisiana and are only recognized in eight states.

Less than six hundred AAs exist in the United States while over 30,000 CRNAs are licensed and authorized to practice in every state in the United States.

CRNAS receive a much higher level of education and training than do AAs.

After thirty years of existence, only two AA schools exist in the United States while there are ninety-nine CRNA schools.

CRNAs are trained and legally authorized to administer all types of anesthetics in all settings while AAs are limited by the type of anesthetics they can administer and the settings in which they are authorized to perform their services.

(2) It is hereby declared that CRNAs are an essential provider of safe, accessible, and cost-effective anesthesia care to the citizens of Louisiana. It is further declared that a sufficient supply of CRNAs in Louisiana is affected with the public interest. It is hereby declared to be the legislative intent to encourage a sufficient ongoing supply of CRNAs in this state and to discourage the creation and authorization of providers of anesthesia not otherwise presently trained and licensed to provide anesthesia. Specifically, it is the intent of the Legislature to prevent the introduction of AAs into Louisiana until such time that they are deemed to be viable providers of anesthesia services. The purpose of this subsection is to carry out that policy in the public interest, providing for the repeal of any provision that provides otherwise.

(3) No health care provider or other person, other than a Certified Registered Nurse Anesthetist, Physician, Dentist, Perfusionist, or other explicitly authorized provider shall select or administer any form of anesthetic to any person either directly or by delegation, unless explicitly authorized by this title.

Blatant factual errors notwithstanding, this bill passed the House by a vote of 81-11 and the Senate by a vote of 37-2. Governor Kathleen Blanco wasted no time in signing the bill into law. Despite the efforts of the Louisiana Society of Anesthesiologists, ASA and the American Academy of Anesthesiologist Assistants, the nurse anesthetists prevailed and have prevented (for now) AAs from practicing in the state of Louisiana.

This effort to ban AAs and to single out anesthesiologists as the only physicians who are prohibited from delegating authority to a nonphysician provider will spread to other states.