Summary of 2005 State Activities

Lisa Percy, J.D., Manager
State Legislative and Regulatory Affairs


Opt-Outs
South Dakota and Wisconsin opted out of the federal requirement that a nurse anesthetist administer anesthesia under the supervision of the operating practitioner or anesthesiologist who is immediately available if needed. 14 states have opted out, including: Alaska, Idaho, Iowa, Kansas, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oregon and Washington.

Nurse Anesthetists’ Scope of Practice
Arkansas — H.B. 2613 would have removed the existing physician supervision requirement. Nurse anesthetists would have been allowed to administer anesthesia upon the request of a physician. The sponsor withdrew the bill and recommended a study concerning the administration of anesthesia.

California — The California Society of Anesthesiologists (CSA) challenged a Statement issued by the Nursing Board that allows nurse anesthetists to practice independently and provides that “acute and chronic pain management services and emergency procedures both inside and outside the operating room suite” are within nurse anesthetists’ scope of practice. CSA contends that the Statement constitutes a regulation that was not promulgated in accordance with the Administrative Procedure Act.

Illinois — H.B. 876 would have added Schedule II controlled substances to the list of controlled substances that a nurse anesthetist could prescribe pursuant to delegatory authority. An amendment deleted this provision from the bill.

Missouri — S.B. 90 would have allowed APRNs who practice under a collaborative agreement to prescribe Schedule II-V controlled substances pursuant to delegatory authority.

Nebraska — L.B. 256 creates a new APRN Licensure Act and Certification Acts that define the scope of practice of each specialty (including nurse anesthetists). Signed by Governor.

New York — A.B. 4015 would define the scope of practice of a nurse anesthetist as the administration of anesthesia, perianesthetic and clinical support functions and pain management, at the order of and in conjunction with a procedure performed by a physician, dentist, podiatrist or other authorized health care professional. Nurse anesthetists would have the authority to select, order, possess and administer, but not prescribe drugs. In hospitals, the administration of anesthesia by a nurse anesthetist would also be subject to the Department of Health’s regulations, consistent with this law. In all other settings, nurse anesthetists would be under the direct supervision of an authorized health care professional. S.B. 1784 would provide for the same scope of practice as A.B. 4015, but would not distinguish scope according to setting.

A.B. 3702/ S.B. 1874 would allow nurse anesthetists to administer anesthesia under the supervision of an anesthesiologist who is immediately available, under the supervision of the physically present operating physician or under the supervision of a dentist, oral surgeon or podiatrist who is physically present. This would apply to hospital, ambulatory surgical center and office settings.

North Carolina — H.B. 503/S.B. 394 would solidify physician supervision requirements found in other sources of law. Nurse anesthetists would administer anesthesia under the supervision of a licensed physician. Carried over.

Pennsylvania — H.B. 1066/S.B. 452 would allow a nurse anesthetist to administer anesthesia in cooperation with a physician, dentist or podiatrist. “Cooperation” would be defined as each professional working together contributing expertise at his or her individual and respective levels of education and training. Nurse anesthetists would be under the overall direction of the chief or director of anesthesia services, provided that in situations or facilities where anesthesia services are not mandatory, the nurse anesthetist would be under the overall direction of the physician responsible for the patient’s care. If the anesthesia team consists entirely of nonphysicians, the nurse anesthetist would have available, by physical presence or electronic communication, an anesthesiologist or consulting physician of the nurse anesthetist’s choice.

Office-Based Anesthesia
Florida — The Board of Medicine deleted the requirement that an M.D. or D.O. anesthesiologist supervise the administration of anesthesia in Level III office surgeries.

Illinois — The Illinois Department of Professional Regulation appealed a lower court’s ruling that invalidated rules found in the nursing statutes that permitted nurse anesthetists to provide anesthesia only if the surgeon had training and experience in anesthesia as set forth in the Medical Practice Act (MPA) and to document such training in the written practice agreement. The MPA continues to require surgeons who supervise nurse anesthetists in the office to hold privileges to administer anesthesia in a licensed hospital or ambulatory surgical center or to obtain CMEs in the delivery of anesthesia.

Indiana — The governor signed S.B. 225 that requires the Medical Board to adopt rules that would refer to the American Medical Association’s (AMA’s) Office-Based Surgery Core Principles.

Kansas — S.B. 314 would direct the Board of Healing Arts to establish standards that would be followed by each licensee who is authorized to perform office-based surgery or special procedures. Carried over.
Missouri — S.B. 127 would have directed the Board of Registration for the Healing Arts to promulgate guidelines and standards for office-based surgery. Withdrawn.

New Jersey — The New Jersey Supreme Court affirmed the Appellate Division’s decision and held that the office-based surgery regulations were within the Board of Medical Examiners’ (BME) delegated authority. The court agreed with the holding that the “administration of anesthesia is, in fact, the ‘practice of medicine’” and that the regulations fall squarely within the BME’s core jurisdiction, the licensing and qualifications of physicians and how they perform their professional services.

New York — The Governor signed A.B. 4122 that amends the laws concerning the Department of Health Statewide Planning and Research Cooperative System (SPARCS). The regulations governing SPARCS require reporting data that identifies patients transferred, admitted or treated at a hospital subsequent to office-based surgery.

The Committee on Quality Assurance in Office-Based Surgery reconvened to study and recommend improvements in safety and outcomes in the office setting.

North Carolina — The North Carolina Supreme Court denied an appeal of the Nursing Board to review the decision that affirmed physician supervision as the standard of anesthesia care and reaffirmed the Medical Board’s authority to issue guidelines for physicians performing office-based surgery in the interest of public safety.  The Nursing Board sought to remove the requirement that a nurse anesthetist administer anesthesia under the supervision of a physician from the Medical Board’s position statement on office-based surgery.

Tennessee — The Attorney General approved the office-based surgery rules that were adopted by the Medical Board. Accreditation by the Joint Commission on Accreditation of Healthcare Organizations, the American Association for Accreditation of Ambulatory Surgery Facilities or the Accreditation Association for Ambulatory Health Care is required for offices that provide Level III surgeries. The rules limit Level III surgeries to ASA Physical Status 1 or 2 patients and prohibits Level III surgery on children under age 14. An anesthesiologist or nurse anesthetist must administer general or regional anesthesia. Physicians performing Level II or IIA surgery must have staff privileges or a written transfer protocol, while physicians performing Level III surgery must have staff privileges to perform the same procedure in a local hospital. The regulations also specify requirements concerning liposuction and laser surgery.

Proposed office-based surgery regulations are before the state medical boards in Arizona, Kansas and Oregon.

Anesthesiologist Assistants (AAs)
Alabama — The Board of Health adopted rules that allow AAs to administer general, regional or local anesthesia in ambulatory surgical facilities.

Washington, D.C. — Congress approved Bill 15-634 that permits AAs to practice under the supervision and direction of an anesthesiologist and sets forth an AA’s scope of practice.

Florida — The Boards of Medicine and Osteopathic Medicine adopted rules that implement legislation enacted last session.

North Carolina — H.B. 503/S.B. 394 would allow AAs to administer anesthesia and develop and implement an anesthesia care plan under the supervision of an anesthesiologist. The Board of Medicine would develop rules governing the provision of anesthesia services. Student AAs would be prohibited from identifying themselves as “intern,” “resident” or “fellow.” A student in any AA training program would only identify be identified as a “student AA” or an “AA student.” Carried over.

Ohio — The Court of Appeals of Ohio reversed the lower court’s ruling and upheld the Medical Board’s regulation prohibiting AAs from performing epidural and spinal anesthetic procedures and invasive monitoring techniques. The issue before the Court involved the statutory interpretation of the word “assist” as set forth in the language governing the scope of authority of an AA. The decision has been appealed.

South Carolina — S.B. 142 would include technical correction to existing law and would amend the supervision ratio from 1:2 to 1:4. Carried over.

Pain Management
Indiana — H.B. 1412 would have created the Advisory Council on Pain and Symptom Management to recommend policies on acute and chronic pain management treatment practices; laws concerning pain management; and sanctions and use of alternative therapies. Died in Committee.

New Mexico — H.B. 727 creates the Pain Management Advisory Council in order to recommend pain management guidelines for each licensed health care professional with prescriptive authority. Disciplinary action could be taken against such providers whose conduct violates their respective boards’ practice acts. Each licensing board would be required to adopt rules that establish standards and procedures for the application of the Pain Relief Act. Signed by governor.

Tennessee — The Nursing Board adopted rules setting forth the circumstances under which APNs with prescriptive authority and who possess a current DEA Certificate to Prescribe Controlled Substances may prescribe, order, administer or dispense controlled substances for the treatment and relief of pain, including intractable pain.