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LEGISLATION

ANESTHESIOLOGIST ASSISTANTS

CHAPTER 2004-303

Committee Substitute for Senate Bill No. 626

An act relating to anesthesiologist assistants; amending s. 456.048,

F.S.; requiring the Board of Medicine and the Board of Osteopathic

Medicine to require medical malpractice insurance or proof of financial

responsibility as a condition of licensure or licensure renewal for

licensed anesthesiologist assistants; amending ss. 458.331, 459.015,

F.S.; revising grounds for which a physician may be disciplined for

failing to provide adequate supervision; creating ss. 458.3475,

459.023, F.S.; providing definitions; providing performance standards

for anesthesiologist assistants and supervising anesthesiologists;

providing for the approval of training programs and for services

authorized to be performed by trainees; providing licensing

procedures; providing for fees; providing for additional membership,

powers, and duties of the Board of Medicine and the Board of Osteopathic

Medicine; providing penalties; providing for disciplinary actions;

providing for the adoption of rules; prescribing liability; providing

for the allocation of fees; providing an effective date.

Be It Enacted by the Legislature of the State of Florida:

Section 1. Section 456.048, Florida Statutes, is amended to read:

456.048 Financial responsibility requirements for certain health care

practitioners.-

CODING: Words stricken are deletions; words underlined are additions.

(1) As a prerequisite for licensure or license renewal, the Board of Acupuncture,

the Board of Chiropractic Medicine, the Board of Podiatric Medicine,

and the Board of Dentistry shall, by rule, require that all health care

practitioners licensed under the respective board, and the Board of Medicine

and the Board of Osteopathic Medicine shall, by rule, require that all anesthesiologist

assistants licensed pursuant to s. 458.3475 or s. 459.023, and

the Board of Nursing shall, by rule, require that advanced registered nurse

practitioners certified under s. 464.012, and the department shall, by rule,

require that midwives maintain medical malpractice insurance or provide

proof of financial responsibility in an amount and in a manner determined

by the board or department to be sufficient to cover claims arising out of the

rendering of or failure to render professional care and services in this state.

(2) The board or department may grant exemptions upon application by

practitioners meeting any of the following criteria:

(a) Any person licensed under chapter 457, s. 458.3475, s. 459.023, chapter

460, chapter 461, s. 464.012, chapter 466, or chapter 467 who practices

exclusively as an officer, employee, or agent of the Federal Government or

of the state or its agencies or its subdivisions. For the purposes of this

subsection, an agent of the state, its agencies, or its subdivisions is a person

who is eligible for coverage under any self-insurance or insurance program

authorized by the provisions of s. 768.28(15) or who is a volunteer under- s.

110.501(1).

(b) Any person whose license or certification has become inactive under

chapter 457, s. 458.3475, s. 459.023, chapter 460, chapter 461, part I of

chapter 464, chapter 466, or chapter 467 and who is not practicing in this

state. Any person applying for reactivation of a license must show either

that such licensee maintained tail insurance coverage which provided liability

coverage for incidents that occurred on or after October 1, 1993, or the

initial date of licensure in this state, whichever is later, and incidents that

occurred before the date on which the license became inactive; or such

licensee must submit an affidavit stating that such licensee has no unsatisfied

medical malpractice judgments or settlements at the time of application

for reactivation.

(c) Any person holding a limited license pursuant to s. 456.015, and

practicing under the scope of such limited license.

(d) Any person licensed or certified under chapter 457, s. 458.3475, s.

459.023, chapter 460, chapter 461, s. 464.012, chapter 466, or chapter 467

who practices only in conjunction with his or her teaching duties at an

accredited school or in its main teaching hospitals. Such person may engage

in the practice of medicine to the extent that such practice is incidental to

and a necessary part of duties in connection with the teaching position in

the school.

(e) Any person holding an active license or certification under chapter

457, s. 458.3475, s. 459.023, chapter 460, chapter 461, s. 464.012, chapter

466, or chapter 467 who is not practicing in this state. If such person initiates

or resumes practice in this state, he or she must notify the department

of such activity.

(f) Any person who can demonstrate to the board or department that he

or she has no malpractice exposure in the state.

(3) Notwithstanding the provisions of this section, the financial responsibility

requirements of ss. 458.320 and 459.0085 shall continue to apply to

practitioners licensed under those chapters, except for anesthesiologist assistants

licensed pursuant to s. 458.3475 or s. 459.023 who must meet the

requirements of this section.

Section 2. Paragraph (dd) of subsection (1) of section 458.331, Florida

Statutes, is amended to read:

458.331 Grounds for disciplinary action; action by the board and department.-

(1) The following acts constitute grounds for denial of a license or disciplinary

action, as specified in s. 456.072(2):

(dd) Failing to supervise adequately the activities of those physician

assistants, paramedics, emergency medical technicians, or advanced registered

nurse practitioners, or anesthesiologist assistants acting under the

supervision of the physician.

Section 3. Section 458.3475, Florida Statutes, is created to read:

CODING: Words stricken are deletions; words underlined are additions.

458.3475 Anesthesiologist assistants.-

(1) DEFINITIONS.-As used in this section, the term:

(a) "Anesthesiologist" means an allopathic physician who holds an active,

unrestricted license; who has successfully completed an anesthesiology

training program approved by the Accreditation Council on Graduate Medical

Education or its equivalent; and who is certified by the American Board

of Anesthesiology, is eligible to take that board's examination, or is certified

by the Board of Certification in Anesthesiology affiliated with the American

Association of Physician Specialists.

(b) "Anesthesiologist assistant" means a graduate of an approved program

who is licensed to perform medical services delegated and directly

supervised by a supervising anesthesiologist.

(c) "Anesthesiology" means the practice of medicine that specializes in

the relief of pain during and after surgical procedures and childbirth, during

certain chronic disease processes, and during resuscitation and critical care

of patients in the operating room and intensive care environments.

(d) "Approved program" means a program for the education and training

of anesthesiologist assistants which has been approved by the boards as

provided in subsection (5).

(e) "Boards" means the Board of Medicine and the Board of Osteopathic

Medicine.

(f) "Continuing medical education" means courses recognized and approved

by the boards, the American Academy of Physician Assistants, the

American Medical Association, the American Osteopathic Association, the

American Academy of Anesthesiologist Assistants, the American Society of

Anesthesiologists, or the Accreditation Council on Continuing Medical Education.

(g) "Direct supervision" means 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.

(h) "Proficiency examination" means an entry-level examination approved

by the boards, including examinations administered by the National

Commission on Certification of Anesthesiologist Assistants.

(i) "Trainee" means a person who is currently enrolled in an approved

program.

(2) PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.---

(a) An anesthesiologist who directly supervises an anesthesiologist assistant

must be qualified in the medical areas in which the anesthesiologist

assistant performs and is liable for the performance of the anesthesiologist

assistant. An anesthesiologist may only supervise two anesthesiologist assistants

at the same time. The board may, by rule, allow an anesthesiologist

to supervise up to four anesthesiologist assistants, after July 1, 2008.

(b) An anesthesiologist or group of anesthesiologists must, upon establishing

a supervisory relationship with an anesthesiologist assistant, file

with the board a written protocol that includes, at a minimum:

1. The name, address, and license number of the anesthesiologist assistant.

2. The name, address, license number, and federal Drug Enforcement

Administration number of each physician who will be supervising the anesthesiologist

assistant.

3. The address of the anesthesiologist assistant's primary practice location

and the address of any other locations where the anesthesiologist assistant

may practice.

4. The date the protocol was developed and the dates of all revisions.

5. The signatures of the anesthesiologist assistant and all supervising

physicians.

6. The duties and functions of the anesthesiologist assistant.

7. The conditions or procedures that require the personal provision of

care by an anesthesiologist.

8. The procedures to be followed in the event of an anesthetic emergency.

The protocol must be on file with the board before the anesthesiologist

assistant may practice with the anesthesiologist or group. An anesthesiologist

assistant may not practice unless a written protocol has been filed for

that anesthesiologist assistant in accordance with this paragraph, and the

anesthesiologist assistant may only practice under the direct supervision of

an anesthesiologist who has signed the protocol. The protocol must be updated

biennially.

(3) PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.-

(a) An anesthesiologist assistant may assist an anesthesiologist in developing

and implementing an anesthesia care plan for a patient. In providing

assistance to an anesthesiologist, an anesthesiologist assistant may perform

duties established by rule by the board in any of the following functions that

are included in the anesthesiologist assistant's protocol while under the

direct supervision of an anesthesiologist:

1. Obtain a comprehensive patient history and present the history to the

supervising anesthesiologist.

2. Pretest and calibrate anesthesia delivery systems and monitor, obtain,

and interpret information from the systems and monitors.

3. Assist the supervising anesthesiologist with the implementation of

medically accepted monitoring techniques.

4. Establish basic and advanced airway interventions, including intubation

of the trachea and performing ventilatory support.

5. Administer intermittent vasoactive drugs and start and adjust vasoactive

infusions.

6. Administer anesthetic drugs, adjuvant drugs, and accessory drugs.

7. Assist the supervising anesthesiologist with the performance of epidural

anesthetic procedures and spinal anesthetic procedures.

8. Administer blood, blood products, and supportive fluids.

9. Support life functions during anesthesia health care, including induction

and intubation procedures, the use of appropriate mechanical supportive

devices, and the management of fluid, electrolyte, and blood component

balances.

10. Recognize and take appropriate corrective action for abnormal patient

responses to anesthesia, adjunctive medication, or other forms of therapy.

11. Participate in management of the patient while in the postanesthesia

recovery area, including the administration of any supporting fluids or

drugs.

12. Place special peripheral and central venous and arterial lines for

blood sampling and monitoring as appropriate.

(b) Nothing in this section or chapter prevents third-party payors from

reimbursing employers of anesthesiologist assistants for covered services

rendered by such anesthesiologist assistants.

(c) An anesthesiologist assistant must clearly convey to the patient that

he or she is an anesthesiologist assistant.

(d) An anesthesiologist assistant may perform anesthesia tasks and services

within the framework of a written practice protocol developed between

the supervising anesthesiologist and the anesthesiologist assistant.

(e) An anesthesiologist assistant may not prescribe, order, or compound

any controlled substance, legend drug, or medical device, nor may an anesthesiologist

assistant dispense sample drugs to patients. Nothing in this

paragraph prohibits an anesthesiologist assistant from administering legend drugs or

controllrd substances; intravenous drugs, fluids, or blood products; or inhalation or

other anesthetic agents to patients which are ordered by the supervising anesthesiologist

and administered while under the direct supervising anesthesiologist.

(4)PERFORMANCE BY TRAINEES.---

The practice of a trainee is exempt from the requirements of this chapter while the trainee is

performing assigned tasks as a trainee in conjunction with an approved program. Before

providing anesthesia services, including the administration of anesthesia in

conjunction with the requirements of an approved program, the trainee

must clearly convey to the patient that he or she is a trainee.

(5) PROGRAM APPROVAL.---

The boards shall approve programs for the education and training of anesthesiologist assistants

which meet standards established by board rules. The boards may recommend only those

anesthesiologist assistant training programs that hold full accreditation or provisional

accreditation from the Commission on Accreditation of Allied Health

Education Programs.

(6) ANESTHESIOLOGIST ASSISTANT LICENSURE.---

(a) ((Any person desiring to be licensed as an anesthesiologist assistant

must apply to the department. The department shall issue a license to any

person certified by the board to:

1. Be at least 18 years of age.

2. Have satisfactorily passed a proficiency examination with a score established

by the National Commission on Certification of Anesthesiologist

Assistants.

3. Be certified in advanced cardiac life support.

4. Have completed the application form and remitted an application fee,

not to exceed $1,000, as set by the boards. An application must include:

a. A certificate of completion of an approved graduate level program.

b. A sworn statement of any prior felony convictions.

c. A sworn statement of any prior discipline or denial of licensure or

certification in any state.

d. Two letters of recommendation from anesthesiologists.

(b) A license must be renewed biennially. Each renewal must include:

1. A renewal fee, not to exceed $1,000, as set by the boards.

2. A sworn statement of no felony convictions in the immediately preceding

2 years.

(c) Each licensed anesthesiologist assistant must biennially complete 40

hours of continuing medical education or hold a current certificate issued by

the National Commission on Certification of Anesthesiologist Assistants or

its successor.

(d) An anesthesiologist assistant must notify the department in writing

within 30 days after obtaining employment that requires a license under

this chapter and after any subsequent change in his or her supervising

anesthesiologist. The notification must include the full name, license number,

specialty, and address of the supervising anesthesiologist. Submission

of a copy of the required protocol by the anesthesiologist assistant satisfies

this requirement.

(e) The Board of Medicine may impose upon an anesthesiologist assistant

any penalty specified in s. 456.072 or s. 458.331(2) if the anesthesiologist

assistant or the supervising anesthesiologist is found guilty of or is investigated

for an act that constitutes a violation of this chapter or chapter 456.

(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT

TO ADVISE THE BOARD.-

(a) The chairman of the board may appoint an anesthesiologist and an

anesthesiologist assistant to advise the board as to the adoption of rules for

the licensure of anesthesiologist assistants. The board may use a committee

structure that is most practicable in order to receive any recommendations

to the board regarding rules and all matters relating to anesthesiologist

assistants, including, but not limited to, recommendations to improve safety

in the clinical practices of licensed anesthesiologist assistants.

(b) In addition to its other duties and responsibilities as prescribed by

law, the board shall:

1. Recommend to the department the licensure of anesthesiologist assistants.

2. Develop all rules regulating the use of anesthesiologist assistants by

qualified anesthesiologists under this chapter and chapter 459, except for

rules relating to the formulary developed under s. 458.347(4)(f). The board

shall also develop rules to ensure that the continuity of supervision is maintained

in each practice setting. The boards shall consider adopting a proposed

rule at the regularly scheduled meeting immediately following the

submission of the proposed rule. A proposed rule may not be adopted by

either board unless both boards have accepted and approved the identical

language contained in the proposed rule. The language of all proposed rules

must be approved by both boards pursuant to each respective board's guidelines

and standards regarding the adoption of proposed rules.

3. Address concerns and problems of practicing anesthesiologist assistants

to improve safety in the clinical practices of licensed anesthesiologist

assistants.

(c) When the board finds that an applicant for licensure has failed to

meet, to the board's satisfaction, each of the requirements for licensure set

forth in this section, the board may enter an order to:

1. Refuse to certify the applicant for licensure;

2. Approve the applicant for licensure with restrictions on the scope of

practice or license; or

3. Approve the applicant for conditional licensure. Such conditions may

include placement of the licensee on probation for a period of time and

subject to such conditions as the board specifies, including, but not limited

to, requiring the licensee to undergo treatment, to attend continuing education

courses, or to take corrective action.

(8) PENALTY.-A person who falsely holds himself or herself out as an

anesthesiologist assistant commits a felony of the third degree, punishable

as provided in s. 775.082, s. 775.083, or s. 775.084.

(9) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.-

The boards may deny, suspend, or revoke the license of an anesthesiologist

assistant who the board determines has violated any provision of this section

or chapter or any rule adopted pursuant thereto.

(10) RULES.-The boards shall adopt rules to administer this section.

(11) LIABILITY.-A supervising anesthesiologist is liable for any act or

omission of an anesthesiologist assistant acting under the anesthesiologist's

supervision and control and shall comply with the financial responsibility

requirements of this chapter and chapter 456, as applicable.

(12) FEES.-The department shall allocate the fees collected under this

section to the board.

Section 4. Paragraph (hh) of subsection (1) of section 459.015, Florida

Statutes, is amended to read:

459.015 Grounds for disciplinary action; action by the board and department.-

(1) The following acts constitute grounds for denial of a license or disciplinary

action, as specified in s. 456.072(2):

(hh) Failing to supervise adequately the activities of those physician

assistants, paramedics, emergency medical technicians, advanced registered

nurse practitioners, anesthesiologist assistants, or other persons acting

under the supervision of the osteopathic physician.

Section 5. Section 459.023, Florida Statutes, is created to read:

459.023 Anesthesiologist assistants.-

(1) DEFINITIONS.-As used in this section, the term:

(a) "Anesthesiologist" means an osteopathic physician who holds an active,

unrestricted license; who has successfully completed an anesthesiology

training program approved by the Accreditation Council on Graduate Medical

Education, or its equivalent, or the American Osteopathic Association;

and who is certified by the American Osteopathic Board of Anesthesiology

or is eligible to take that board's examination, is certified by the American

Board of Anesthesiology or is eligible to take that board's examination, or

is certified by the Board of Certification in Anesthesiology affiliated with the

American Association of Physician Specialists.