egislation has been introduced into the Texas Legislature that would require a person to obtain a license in order to practice as an anesthesiologist assistant (AA). Although AAs in Texas currently practice pursuant to the delegatory authority of anesthesiologists as set forth in the medical board’s guidelines, licensure more clearly defines and anchors the practice of AAs in a state than delegatory authority. AAs are currently licensed in 10 states* and practice pursuant to a physician’s delegatory authority in six.†

Under H.B. 3313, an AA would be authorized to assist the supervising anesthesiologist in developing and implementing an anesthesia care plan for a patient. AAs would practice only under the direct supervision of a board-certified anesthesiologist who is physically present or immediately available. The supervising anesthesiologist may supervise no more than four AAs; an AA may have more than one supervising anesthesiologist.

In providing assistance, an AA’s scope of practice could include:

• obtaining a comprehensive patient history, performing relevant elements of the physical examination and presenting the information to the anesthesiologist;

• pretesting and calibrating anesthesia delivery systems and interpreting such information from the monitors in consultation with the anesthesiologist;

• initiating multiparameter monitoring before anesthesia or in other acute care settings under anesthesiologist supervision;

• establishing basic and advanced airway interventions, including intubation and the performance of ventilatory support;

• administering intermittent vasoactive drugs and starting and adjusting vasoactive infusions;

• administering anesthetic, adjuvant and accessory drugs;

• assisting and initiating with the supervising anesthesiologist the performance of epidural anesthetic procedures, spinal anesthetic procedures and other regional anesthetic techniques;

• providing initial CPR in response to a life-threatening situation as directed by a physician or protocol until the supervising anesthesiologist arrives;

• participating in research and clinical teaching activities as authorized by the supervising anesthesiologist; or

• performing other tasks delegated by an anesthesiologist and that the AA has been trained and proficient to perform.

Conversely AAs would be prohibited from prescribing medication or controlled substances. AAs would practice only under the supervision of an anesthesiologist or in any location where the supervising anesthesiologist is immediately available for consultation, assistance and intervention.

H.B. 3313 creates the Texas Anesthesiologist Assistant Board, which would be an advisory board to the medical board. The AA board would consist of six members, including a physician, AA, two anesthesiologists and two members from the public who are not licensed or trained in a health care profession. The board also would adopt rules that establish continuing education requirements for AAs, licensure fees, procedures for disciplinary actions and procedures to review licensure applications. The medical board would adopt rules to regulate AAs and the supervising anesthesiologists.

Lastly H.B. 3313 protects patients from misrepresentation. AAs would be prohibited from referring to a license as “board-certified” or any other terminology that implies that the AA is a physician. Student AAs would not be permitted to use the terms “intern,” “resident” or “fellow.”

Office-Based Surgery
In February 2007, the Washington Medical Quality Assurance Commission (MQAC) announced that it was considering proposed office-based surgery rules and that it planned to hold four public workshops titled “Safe and Effective Analgesia and Anesthesia Administration in Office-Based Surgical Settings.” The first three meetings were held in February and March.

This subject has been a topic of discussion for the past four years. In fact MQAC has previously held public workshops, issued obstetric anesthesia (OBA) guidelines and drafted rules. The Washington State Society of Anesthesiologists (WSSA) has been an active participant throughout this process. WSSA has attended the public workshops and communicated its position to MQAC, Department of Health, the Washington State Medical Association and state legislators.

One of the primary hurdles in developing OBA regulations is to establish that MQAC is authorized to regulate the office setting. Legislation has been introduced that would be a significant step toward the development of these rules. H.B. 1414 would provide MQAC, the Board of Osteopathic Medicine and Surgery and the Podiatric Medical Board with the authority to adopt office-based surgery regulations. Washington would join the 22 states that regulate the office setting via statute, regulation or guidelines.

Scope of Practice
The Louisiana Supreme Court denied the Louisiana State Board of Nursing’s petition to review the lower court’s decision. The lower court ruled that the board’s statement was a rule, subject to the Louisiana Administrative Procedures Act, and issued a preliminary injunction against the nursing board and nurse anesthetist who sought the statement. The “statement” authorized nurse anesthetists to perform interventional pain management procedures (for background, see www.ASAhq.org/Newsletters/2007/02-07/stateBeat02_07.html). The Louisiana Society of Anesthesiologists (LSA) and ASA continue to monitor this lawsuit as there are several unresolved issues at the trial court level. Congratulations to LSA for its hard work!

Lisa Percy, J.D., manages state affairs for ASA’s Office of Governmental and Legal Affairs in Washington, D.C.