egislation was introduced into the Utah Legislature that would have licensed anesthesiologist assistants (AAs). H.B. 477 would have authorized AAs to administer anesthesia under the supervision of a physician specializing in anesthesia. The supervising anesthesiologist would have been actively engaged in clinical practice and immediately available on site to supervise the AA. The practice of an AA would have also been defined by administrative rule. H.B. 477 would have created an AA licensing board that consists of four people licensed in accordance with the AA Licensing Act and one member of the general public. The division of occupational health could have issued a temporary license to an AA who had not yet passed the certification examination offered by the National Commission for Certification of Anesthesiologist Assistants, but who had met the statutory requirements concerning temporary licenses.

Missouri — There has been a continued effort for the past few years to grant prescriptive authority for controlled substances to advanced practice registered nurses (APRNs). This effort continues in 2008. S.B. 724 would grant a certificate of controlled substance prescriptive authority to an APRN who has completed a board-approved advanced pharmacology course and completed a minimum of 300 hours of preceptorial experience in the prescription of drugs, medicines and therapeutic devices; provides evidence of a minimum of 1,000 hours of practice in an APRN category prior to application for a certificate of prescriptive authority; and has controlled substance prescribing authority delegated in the collaborative practice agreement with a physician who has an unrestricted Drug Enforcement Administration number and who is actively engaged in a practice comparable in scope, specialty or expertise to that of the APRN.

Colorado — Governor Bill Ritter has issued an executive order commissioning the Collaborative Scopes of Care Study and creating the Collaborative Scopes of Care Advisory Committee (Advisory Committee). The executive order states that health workforce studies reveal that there are insufficient numbers of providers, especially physicians and dentists, to meet the current needs of Coloradans. This problem is especially acute in rural and other underserved communities, where many individuals simply have no access to health care regardless of whether they are insured or can otherwise afford care.

The Advisory Committee will look at the approach adopted by other states, which is to examine the potential collaborative roles of other health care providers, including advanced practice nurses, physician assistants and dental hygienists, in order to meet the medical and dental needs in communities. Both physicians and non-physician providers will serve as Advisory Committee members. Dr. Alex Slucky is one of the five physician Advisory Committee members. The study must be completed and sent to the Colorado Legislature by December.

Office-Based Surgery
The Medical Licensing Board of Indiana unanimously adopted office-based surgery regulations, which mirror the regulation that had been adopted by the medical board in 2007. Shortly thereafter, the rules were sent to the attorney general for review; however, the attorney general informed the medical board that he could not approve the regulations due to the failure of the board to provide the public with 21-day notice of a hearing, as required by Indiana law. As a result, the medical board withdrew the regulations it had previously adopted and reissued proposal earlier this year.

During a medical board hearing in February, Johnson & Johnson and Ethicon Endo-Surgery offered an amendment that would have carved out an exception of the propofol safeguards provided in the rule. The safeguards prohibit a health care provider from administering or monitoring an anesthetic agent containing alkylphenols unless such provider is trained in the administration of general anesthesia and is not involved in the conduct of the procedure. The purpose of Johnson & Johnson’s amendment was to accommodate their computer-assisted personalized sedation, or CAPS. The proposed amendment would have excluded the propofol safeguards if a registered nurse uses an FDA-approved delivery device to administer moderate sedation containing alkyphenols under the direct supervision of a physician.

The medical board rejected the amendment. Testimony by the Indiana Society of Anesthesiologists (ISA) reminded the medical board that the FDA has approved drugs that subsequently were found to have posed unexpected problems. ISA requested that the board refrain from adopting Johnson & Johnson’s amendment until further studies are completed concerning the device’s safety in the hospital and surgical center settings before allowing its use in the office-based setting. The regulations have been sent to the attorney general’s office for review.

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