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



                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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  4  ______________________________________________________________

  5                                           ORIGINAL STAMP BELOW

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10  ______________________________________________________________

11  Representative(s) Fasano offered the following:

12

13         Substitute Amendment for Amendment (973265) (with title

14  amendment) 

15  Remove everything after the enacting clause

16

17  and insert:

18         Section 1.  Section 456.048, Florida Statutes, is

19  amended to read:

20         456.048  Financial responsibility requirements for

21  certain health care practitioners.--

22         (1)  As a prerequisite for licensure or license

23  renewal, the Board of Acupuncture, the Board of Chiropractic

24  Medicine, the Board of Podiatric Medicine, and the Board of

25  Dentistry shall, by rule, require that all health care

26  practitioners licensed under the respective board, and the

27  Board of Medicine and the Board of Osteopathic Medicine shall,

28  by rule, require that all anesthesiologist assistants licensed

29  pursuant to s. 458.3475 or s. 459.023, and the Board of

30  Nursing shall, by rule, require that advanced registered nurse

31  practitioners certified under s. 464.012, and the department

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1  shall, by rule, require that midwives maintain medical

  2  malpractice insurance or provide proof of financial

  3  responsibility in an amount and in a manner determined by the

  4  board or department to be sufficient to cover claims arising

  5  out of the rendering of or failure to render professional care

  6  and services in this state.

  7         (2)  The board or department may grant exemptions upon

  8  application by practitioners meeting any of the following

  9  criteria:

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

11  458.3475, s. 459.023, chapter 460, chapter 461, s. 464.012,

12  chapter 466, or chapter 467 who practices exclusively as an

13  officer, employee, or agent of the Federal Government or of

14  the state or its agencies or its subdivisions.  For the

15  purposes of this subsection, an agent of the state, its

16  agencies, or its subdivisions is a person who is eligible for

17  coverage under any self-insurance or insurance program

18  authorized by the provisions of s. 768.28(15) or who is a

19  volunteer under s. 110.501(1).

20         (b)  Any person whose license or certification has

21  become inactive under chapter 457, s. 458.3475, s. 459.023,

22  chapter 460, chapter 461, part I of chapter 464, chapter 466,

23  or chapter 467 and who is not practicing in this state.  Any

24  person applying for reactivation of a license must show either

25  that such licensee maintained tail insurance coverage which

26  provided liability coverage for incidents that occurred on or

27  after October 1, 1993, or the initial date of licensure in

28  this state, whichever is later, and incidents that occurred

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

30  licensee must submit an affidavit stating that such licensee

31  has no unsatisfied medical malpractice judgments or

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1  settlements at the time of application for reactivation.

  2         (c)  Any person holding a limited license pursuant to

  3  s. 456.015, and practicing under the scope of such limited

  4  license.

  5         (d)  Any person licensed or certified under chapter

  6  457, s. 458.3475, s. 459.023, chapter 460, chapter 461, s.

  7  464.012, chapter 466, or chapter 467 who practices only in

  8  conjunction with his or her teaching duties at an accredited

  9  school or in its main teaching hospitals. Such person may

10  engage in the practice of medicine to the extent that such

11  practice is incidental to and a necessary part of duties in

12  connection with the teaching position in the school.

13         (e)  Any person holding an active license or

14  certification under chapter 457, s. 458.3475, s. 459.023,

15  chapter 460, chapter 461, s. 464.012, chapter 466, or chapter

16  467 who is not practicing in this state.  If such person

17  initiates or resumes practice in this state, he or she must

18  notify the department of such activity.

19         (f)  Any person who can demonstrate to the board or

20  department that he or she has no malpractice exposure in the

21  state.

22         (3)  Notwithstanding the provisions of this section,

23  the financial responsibility requirements of ss. 458.320 and

24  459.0085 shall continue to apply to practitioners licensed

25  under those chapters, except for anesthesiologist assistants

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

27  the requirements of this section.

28         Section 2.  Paragraph (dd) of subsection (1) of section

29  458.331, Florida Statutes, is amended to read:

30         458.331  Grounds for disciplinary action; action by the

31  board and department.--

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1         (1)  The following acts constitute grounds for denial

  2  of a license or disciplinary action, as specified in s.

  3  456.072(2):

  4         (dd)  Failing to supervise adequately the activities of

  5  those physician assistants, paramedics, emergency medical

  6  technicians, or advanced registered nurse practitioners, or

  7  anesthesiologist assistants acting under the supervision of

  8  the physician.

  9         Section 3.  Section 458.3475, Florida Statutes, is

10  created to read:

11         458.3475  Anesthesiologist assistants.--

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

13         (a)  "Anesthesiologist" means an allopathic physician

14  who holds an active, unrestricted license, who has

15  successfully completed an anesthesiology training program

16  approved by the Accreditation Council on Graduate Medical

17  Education, or its equivalent, and who is certified by the

18  American Board of Anesthesiology or is eligible to take that

19  board's examination or is certified by the Board of

20  Certification in Anesthesiology affiliated with the American

21  Association of Physician Specialists.

22         (b)  "Anesthesiologist assistant" means a graduate of

23  an approved program who is licensed to perform medical

24  services delegated and directly supervised by a supervising

25  anesthesiologist.

26         (c)  "Anesthesiology" means the practice of medicine

27  that specializes in the relief of pain during and after

28  surgical procedures and childbirth, during certain chronic

29  disease processes, and during resuscitation and critical care

30  of patients in the operating room and intensive care

31  environments.

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1         (d)  "Approved program" means a program for the

  2  education and training of anesthesiologist assistants that has

  3  been approved by the boards as provided in subsection (5).

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

  5  of Osteopathic Medicine.

  6         (f)  "Continuing medical education" means courses

  7  recognized and approved by the boards, the American Academy of

  8  Physician Assistants, the American Medical Association, the

  9  American Osteopathic Association, the American Academy of

10  Anesthesiologist Assistants, the American Society of

11  Anesthesiologists, or the Accreditation Council on Continuing

12  Medical Education.

13         (g)  "Direct supervision" means supervision by an

14  anesthesiologist who is present in the same room as the

15  anesthesiologist assistant, or in an immediately adjacent room

16  or hallway, such that the supervising anesthesiologist is able

17  to monitor the ongoing anesthetic and be immediately available

18  to provide assistance and direction while anesthesia services

19  are being performed. Direct supervision requires the

20  supervising anesthesiologist to personally begin the patient's

21  preanesthetic assessment.

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

23  examination approved by the boards, including examination

24  administered by the National Commission on Certification of

25  Anesthesiologist Assistants.

26         (i)  "Trainee" means a person who is currently enrolled

27  in an approved program.

28         (2)  PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--

29         (a)  An anesthesiologist who directly supervises an

30  anesthesiologist assistant must be qualified in the medical

31  areas in which the anesthesiologist assistant performs and is

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1  liable for the performance of the anesthesiologist assistant.

  2  An anesthesiologist may only supervise two anesthesiologist

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

  4  anesthesiologist to supervise up to four anesthesiologist

  5  assistants, after July 1, 2006.

  6         (b)  An anesthesiologist or group of anesthesiologists

  7  must, upon establishing a supervisory relationship with an

  8  anesthesiologist assistant, file with the board a written

  9  protocol that includes, at a minimum:

10         1.  The name, address, and license number of the

11  anesthesiologist assistant.

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

13  Enforcement Administration number of each physician who will

14  be supervising the anesthesiologist assistant.

15         3.  The address of the anesthesiologist assistant's

16  primary practice location, and the address of any other

17  locations where the anesthesiologist assistant may practice.

18         4.  The date the protocol was developed and the dates

19  of all revisions.

20         5.  The signatures of the anesthesiologist assistant

21  and all supervising physicians.

22         6.  The duties and functions of the anesthesiologist

23  assistant.

24         7.  The conditions or procedures that require the

25  personal provision of care by an anesthesiologist.

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

27  anesthetic emergency.

28

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

30  anesthesiologist assistant may practice with the

31  anesthesiologist or group. An anesthesiologist assistant may

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1  not practice unless a written protocol has been filed for that

  2  anesthesiologist assistant in accordance with this paragraph,

  3  and the anesthesiologist assistant may only practice under the

  4  direct supervision of an anesthesiologist who has signed the

  5  protocol. The protocol must be updated biennially.

  6         (3)  PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--

  7         (a)  An anesthesiologist assistant may assist an

  8  anesthesiologist in developing and implementing an anesthesia

  9  care plan for a patient. In providing assistance to an

10  anesthesiologist, an anesthesiologist assistant may perform

11  duties established by rule by the board in any of the

12  following functions that are included in the anesthesiologist

13  assistant's protocol while under the direct supervision of an

14  anesthesiologist:

15         1.  Obtain a comprehensive patient history and present

16  the history to the supervising anesthesiologist.

17         2.  Pretest and calibrate anesthesia delivery systems

18  and monitor, obtain, and interpret information from the

19  systems and monitors.

20         3.  Assist the supervising anesthesiologist with the

21  implementation of medically accepted monitoring techniques.

22         4.  Establish basic and advanced airway interventions,

23  including intubation of the trachea and performing ventilatory

24  support.

25         5.  Administer intermittent vasoactive drugs and start

26  and adjust vasoactive infusions.

27         6.  Administer anesthetic drugs, adjuvant drugs, and

28  accessory drugs.

29         7.  Assist the supervising anesthesiologist with the

30  performance of epidural anesthetic procedures and spinal

31  anesthetic procedures.

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

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  1         8.  Administer blood, blood products, and supportive

  2  fluids.

  3         9.  Support life functions during anesthesia health

  4  care, including induction and intubation procedures, the use

  5  of appropriate mechanical supportive devices, and the

  6  management of fluid, electrolyte, and blood component

  7  balances.

  8         10.  Recognize and take appropriate corrective action

  9  for abnormal patient responses to anesthesia, adjunctive

10  medication, or other forms of therapy.

11         11.  Participate in management of the patient while in

12  the postanesthesia recovery area, including the administration

13  of any supporting fluids or drugs.

14         12.  Place special peripheral and central venous and

15  arterial lines for blood sampling and monitoring as

16  appropriate.

17         (b)  Nothing in this section or chapter prevents

18  third-party payors from reimbursing employers of

19  anesthesiologist assistants for covered services rendered by

20  such anesthesiologist assistants.

21         (c)  An anesthesiologist assistant must clearly convey

22  to the patient that he or she is an anesthesiologist

23  assistant.

24         (d)  An anesthesiologist assistant may perform

25  anesthesia tasks and services within the framework of a

26  written practice protocol developed between the supervising

27  anesthesiologist and the anesthesiologist assistant.

28         (e)  An anesthesiologist assistant may not prescribe,

29  order or compound any controlled substance, legend drug or

30  medical device, nor may an anesthesiologist assistant dispense

31  sample drugs to patients.  Nothing in this paragraph prohibits

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1  an anesthesiologist assistant from administering legend drugs

  2  or controlled substances, intravenous drugs, fluids, or blood

  3  products, or inhalation or other anesthetic agents to patients

  4  that are ordered by the supervising anesthesiologist, and

  5  administered while under the direct supervision of the

  6  supervising anesthesiologist. 

  7         (4)  PERFORMANCE BY TRAINEES.--The practice of a

  8  trainee is exempt from the requirements of this chapter while

  9  the trainee is performing assigned tasks as a trainee in

10  conjunction with an approved program. Before providing

11  anesthesia services including the administration of anesthesia

12  in conjunction with the requirements of an approved program,

13  the trainee must clearly convey to the patient that he or she

14  is a trainee.

15         (5)  PROGRAM APPROVAL.--The boards shall approve

16  programs for the education and training of anesthesiologist

17  assistants which meet standards established by board rules.

18  The boards may recommend only those anesthesiologist assistant

19  training programs that hold full accreditation or provisional

20  accreditation from the Commission on Accreditation of Allied

21  Health Education Programs.

22         (6)  ANESTHESIOLOGIST ASSISTANT LICENSURE.--

23         (a)  Any person desiring to be licensed as an

24  anesthesiologist assistant must apply to the department. The

25  department shall issue a license to any person certified by

26  the board to:

27         1.  Be at least 18 years of age.

28         2.  Have satisfactorily passed a proficiency

29  examination with a score established by the National

30  Commission on Certification of Anesthesiologist Assistants.

31         3.  Be certified in advanced cardiac life support.

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  1         4.  Have completed the application form and remitted an

  2  application fee, not to exceed $1,000, as set by the boards.

  3  An application must include:

  4         a.  A certificate of completion of an approved graduate

  5  level program.

  6         b.  A sworn statement of any prior felony convictions.

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

  8  of licensure or certification in any state.

  9         d.  Two letters of recommendation from

10  anesthesiologists.

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

12  must include:

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

14  boards.

15         2.  A sworn statement of no felony convictions in the

16  immediately preceding 2 years.

17         (c)  Each licensed anesthesiologist assistant must

18  biennially complete 40 hours of continuing medical education

19  or hold a current certificate issued by the National

20  Commission on Certification of Anesthesiologist Assistants or

21  its successor.

22         (d)  An anesthesiologist assistant must notify the

23  department in writing within 30 days after obtaining

24  employment that requires a license under this chapter and

25  after any subsequent change in his or her supervising

26  anesthesiologist. The notification must include the full name,

27  license number, specialty, and address of the supervising

28  anesthesiologist. Submission of the required protocol

29  satisfies this requirement.

30         (e)  The Board of Medicine may impose upon an

31  anesthesiologist assistant any penalty specified in s. 456.072

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

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  1  or s. 458.331(2) if the anesthesiologist assistant or the

  2  supervising anesthesiologist is found guilty of or is

  3  investigated for an act that constitutes a violation of this

  4  chapter or chapter 456.

  5         (7)  ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO

  6  ADVISE THE BOARD.--

  7         (a)  The chairman of the board may appoint an

  8  anesthesiologist and an anesthesiologist assistant to advise

  9  the board as to the promulgation of rules for the licensure of

10  anesthesiologist assistants. The board may utilize a committee

11  structure that is most practicable in order to receive any

12  recommendations to the board regarding rules and all matters

13  relating anesthesiologist assistants, including but not

14  limited to recommendations to improve safety in the clinical

15  practices of licensed anesthesiologist assistants.

16         (b)  In addition to its other duties and

17  responsibilities as prescribed by law, the board shall:

18         1.  Recommend to the department the licensure of

19  anesthesiologist assistants.

20         2.  Develop all rules regulating the use of

21  anesthesiologist assistants by qualified anesthesiologists

22  under this chapter and chapter 459, except for rules relating

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

24  shall also develop rules to ensure that the continuity of

25  supervision is maintained in each practice setting. The boards

26  shall consider adopting a proposed rule at the regularly

27  scheduled meeting immediately following the submission of the

28  proposed rule. A proposed rule may not be adopted by either

29  board unless both boards have accepted and approved the

30  identical language contained in the proposed rule. The

31  language of all proposed rules must be approved by both boards

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    dhs-21                                         Bill No. HB 599

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  1  pursuant to each respective board's guidelines and standards

  2  regarding the adoption of proposed rules.

  3         3.  Address concerns and problems of practicing

  4  anesthesiologist assistants to improve safety in the clinical

  5  practices of licensed anesthesiologist assistants.

  6         (c)  When the board finds that an applicant for

  7  licensure has failed to meet, to the board's satisfaction,

  8  each of the requirements for licensure set forth in this

  9  section, the board may enter an order to:

10         1.  Refuse to certify the applicant for licensure;

11         2.  Approve the applicant for licensure with

12  restrictions on the scope of practice or license; or

13         3.  Approve the applicant for conditional licensure.

14  Such conditions may include placement of the licensee on

15  probation for a period of time and subject to such conditions

16  as the board may specify, including, but not limited to,

17  requiring the licensee to undergo treatment, to attend

18  continuing education courses, or to take corrective action.

19         (8)  PENALTY.--A person who falsely holds himself or

20  herself out as an anesthesiologist assistant commits a felony

21  of the third degree, punishable as provided in s. 775.082, s.

22  775.083, or s. 775.084.

23         (9)  DENIAL, SUSPENSION, OR REVOCATION OF

24  LICENSURE.--The boards may deny, suspend, or revoke the

25  license of an anesthesiologist assistant who the board

26  determines has violated any provision of this section or

27  chapter or any rule adopted pursuant thereto.

28         (10)  RULES.--The boards shall adopt rules to implement

29  this section.

30         (11)  LIABILITY.--A supervising anesthesiologist is

31  liable for any act or omission of an anesthesiologist

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    dhs-21                                         Bill No. HB 599

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  1  assistant acting under the anesthesiologist's supervision and

  2  control and shall comply with the financial responsibility

  3  requirements of this chapter and chapter 456, as applicable. 

  4         (12)  FEES.--The department shall allocate the fees

  5  collected under this section to the board.

  6         Section 4.  Paragraph (hh) of subsection (1) of section

  7  459.015, Florida Statutes, is amended to read:

  8         459.015  Grounds for disciplinary action; action by the

  9  board and department.--

10         (1)  The following acts constitute grounds for denial

11  of a license or disciplinary action, as specified in s.

12  456.072(2):

13         (hh)  Failing to supervise adequately the activities of

14  those physician assistants, paramedics, emergency medical

15  technicians, advanced registered nurse practitioners,

16  anesthesiologist assistants, or other persons acting under the

17  supervision of the osteopathic physician.

18         Section 5.  Section 459.023, Florida Statutes, is

19  created to read:

20         459.023  Anesthesiologist assistants.--

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

22         (a)  "Anesthesiologist" means an osteopathic physician

23  who holds an active, unrestricted license, who has

24  successfully completed an anesthesiology training program

25  approved by the Accreditation Council on Graduate Medical

26  Education, or its equivalent, or the American Osteopathic

27  Association, and who is certified by the American Osteopathic

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

29  examination, is certified by the American Board of

30  Anesthesiology or is eligible to take that board's

31  examination, or is certified by the Board of Certification in

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  1  Anesthesiology affiliated with the American Association of

  2  Physician Specialists.

  3         (b)  "Anesthesiologist assistant" means a graduate of

  4  an approved program who is licensed to perform medical

  5  services delegated and directly supervised by a supervising

  6  anesthesiologist.

  7         (c)  "Anesthesiology" means the practice of medicine

  8  that specializes in the relief of pain during and after

  9  surgical procedures and childbirth, during certain chronic

10  disease processes, and during resuscitation and critical care

11  of patients in the operating room and intensive care

12  environments.

13         (d)  "Approved program" means a program for the

14  education and training of anesthesiologist assistants that has

15  been approved by the boards as provided in subsection (5).

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

17  of Osteopathic Medicine.

18         (f)  "Continuing medical education" means courses

19  recognized and approved by the boards, the American Academy of

20  Physician Assistants, the American Medical Association, the

21  American Osteopathic Association, the American Academy of

22  Anesthesiologist Assistants, the American Society of

23  Anesthesiologists, or the Accreditation Council on Continuing

24  Medical Education.

25         (g)  "Direct supervision" means supervision by an

26  anesthesiologist who is present in the same room as the

27  anesthesiologist assistant, or in an immediately adjacent room

28  or hallway, such that the supervising anesthesiologist is able

29  to monitor the ongoing anesthetic and be immediately available

30  to provide assistance and direction while anesthesia services

31  are being performed. Direct supervision requires the

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1  supervising anesthesiologist to personally begin the patient's

  2  preanesthetic assessment.

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

  4  examination approved by the boards, including examinations

  5  administered by the National Commission on Certification of

  6  Anesthesiologist Assistants.

  7         (i)  "Trainee" means a person who is currently enrolled

  8  in an approved program.

  9         (2)  PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--

10         (a)  An anesthesiologist who directly supervises an

11  anesthesiologist assistant must be qualified in the medical

12  areas in which the anesthesiologist assistant performs, and is

13  liable for the performance of the anesthesiologist assistant.

14  An anesthesiologist may only supervise two anesthesiologist

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

16  anesthesiologist to supervise up to four anesthesiologist

17  assistants, after July 1, 2006.

18         (b)  An anesthesiologist or group of anesthesiologists

19  must, upon establishing a supervisory relationship with an

20  anesthesiologist assistant, file with the board a written

21  protocol that includes, at a minimum:

22         1.  The name, address, and license number of the

23  anesthesiologist assistant.

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

25  Enforcement Administration number of each physician who will

26  be supervising the anesthesiologist assistant.

27         3.  The address of the anesthesiologist assistant's

28  primary practice location, and the address of any other

29  locations where the anesthesiologist assistant may practice.

30         4.  The date the protocol was developed and the dates

31  of all revisions.

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1         5.  The signatures of the anesthesiologist assistant

  2  and all supervising physicians.

  3         6.  The duties and functions of the anesthesiologist

  4  assistant.

  5         7.  The conditions or procedures that require the

  6  personal provision of care by an anesthesiologist.

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

  8  anesthetic emergency.

  9

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

11  anesthesiologist assistant may practice with the

12  anesthesiologist or group. An anesthesiologist assistant may

13  not practice unless a written protocol has been filed for that

14  anesthesiologist assistant in accordance with this paragraph,

15  and the anesthesiologist assistant may only practice under the

16  direct supervision of an anesthesiologist who has signed the

17  protocol. The protocol must be updated biennially.

18         (3)  PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--

19         (a)  An anesthesiologist assistant may assist an

20  anesthesiologist in developing and implementing an anesthesia

21  care plan for a patient. In providing assistance to an

22  anesthesiologist, an anesthesiologist assistant may perform

23  duties established by rule by the board in any of the

24  following functions that are included in the anesthesiologist

25  assistant's protocol while under the direct supervision of an

26  anesthesiologist:

27         1.  Obtain a comprehensive patient history and present

28  the history to the supervising anesthesiologist.

29         2.  Pretest and calibrate anesthesia delivery systems

30  and monitor, obtain, and interpret information from the

31  systems and monitors.

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1         3.  Assist the supervising anesthesiologist with the

  2  implementation of medically accepted monitoring techniques.

  3         4.  Establish basic and advanced airway interventions,

  4  including intubation of the trachea and performing ventilatory

  5  support.

  6         5.  Administer intermittent vasoactive drugs and start

  7  and adjust vasoactive infusions.

  8         6.  Administer anesthetic drugs, adjuvant drugs, and

  9  accessory drugs.

10         7.  Assist the supervising anesthesiologist with the

11  performance of epidural anesthetic procedures and spinal

12  anesthetic procedures.

13         8.  Administer blood, blood products, and supportive

14  fluids.

15         9.  Support life functions during anesthesia health

16  care, including induction and intubation procedures, the use

17  of appropriate mechanical supportive devices, and the

18  management of fluid, electrolyte, and blood component

19  balances.

20         10.  Recognize and take appropriate corrective action

21  for abnormal patient responses to anesthesia, adjunctive

22  medication, or other forms of therapy.

23         11.  Participate in management of the patient while in

24  the postanesthesia recovery area, including the administration

25  of any supporting fluids or drugs.

26         12.  Place special peripheral and central venous and

27  arterial lines for blood sampling and monitoring as

28  appropriate.

29         (b)  Nothing in this section or chapter prevents

30  third-party payors from reimbursing employers of

31  anesthesiologist assistants for covered services rendered by

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1  such anesthesiologist assistants.

  2         (c)  An anesthesiologist assistant must clearly convey

  3  to the patient that she or he is an anesthesiologist

  4  assistant.

  5         (d)  An anesthesiologist assistant may perform

  6  anesthesia tasks and services within the framework of a

  7  written practice protocol developed between the supervising

  8  anesthesiologist and the anesthesiologist assistant.

  9         (e)  An anesthesiologist assistant may not prescribe

10  legend drugs or medical devices, compound medicines for

11  patients, or dispense sample drugs to patients. Nothing in

12  this paragraph prohibits an anesthesiologist assistant from

13  administering legend drugs, narcotics or scheduled drugs,

14  intravenous drugs, fluids, or blood products, or inhalation or

15  other anesthetic agents to patients while under the direct

16  supervision of an anesthesiologist.

17         (4)  PERFORMANCE BY TRAINEES.--The practice of a

18  trainee is exempt from the requirements of this chapter while

19  the trainee is performing assigned tasks as a trainee in

20  conjunction with an approved program. Before providing

21  anesthesia services including the administration of anesthesia

22  in conjunction with the requirements of an approved program,

23  the trainee must clearly convey to the patient that he or she

24  is a trainee.

25         (5)  PROGRAM APPROVAL.--The boards shall approve

26  programs for the education and training of anesthesiologist

27  assistants which meet standards established by board rules.

28  The board may recommend only those anesthesiologist assistant

29  training programs that hold full accreditation or provisional

30  accreditation from the Commission on Accreditation of Allied

31  Health Education Programs.

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1         (6)  ANESTHESIOLOGIST ASSISTANT LICENSURE.--

  2         (a)  Any person desiring to be licensed as an

  3  anesthesiologist assistant must apply to the department. The

  4  department shall issue a license to any person certified by

  5  the board to:

  6         1.  Be at least 18 years of age.

  7         2.  Have satisfactorily passed a proficiency

  8  examination with a score established by the National

  9  Commission on Certification of Anesthesiologist Assistants.

10         3.  Be certified in advanced cardiac life support.

11         4.  Have completed the application form and remitted an

12  application fee, not to exceed $1,000, as set by the boards.

13  An application must include:

14         a.  A certificate of completion of an approved graduate

15  level program.

16         b.  A sworn statement of any prior felony convictions.

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

18  of licensure or certification in any state.

19         d.  Two letters of recommendation from

20  anesthesiologists.

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

22  must include:

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

24  boards.

25         2.  A sworn statement of no felony convictions in the

26  immediately preceding 2 years.

27         (c)  Each licensed anesthesiologist assistant must

28  biennially complete 40 hours of continuing medical education

29  or hold a current certificate issued by the National

30  Commission on Certification of Anesthesiologist Assistants or

31  its successor.

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1         (d)  An anesthesiologist assistant must notify the

  2  department in writing within 30 days after obtaining

  3  employment that requires a license under this chapter and

  4  after any subsequent change in her or his supervising

  5  anesthesiologist. The notification must include the full name,

  6  license number, specialty, and address of the supervising

  7  anesthesiologist. Submission of the required protocol

  8  satisfies this requirement.

  9         (e)  The Board of Osteopathic Medicine may impose upon

10  an anesthesiologist assistant any penalty specified in s.

11  456.072 or s. 459.015(2) if the anesthesiologist assistant or

12  the supervising anesthesiologist is found guilty of or is

13  investigated for an act that constitutes a violation of this

14  chapter or chapter 456.

15         (7)  ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO

16  ADVISE THE BOARD.--

17         (a)  The chairman of the board may appoint an

18  anesthesiologist and an anesthesiologist assistant to advise

19  the board as to the promulgation of rules for the licensure of

20  anesthesiologist assistants. The board may utilize a committee

21  structure that is most practicable in order to receive any

22  recommendations to the board regarding rules and all matters

23  relating anesthesiologist assistants, including but not

24  limited to recommendations to improve safety in the clinical

25  practices of licensed anesthesiologist assistants.

26         (b)  In addition to its other duties and

27  responsibilities as prescribed by law, the board shall:

28         1.  Recommend to the department the licensure of

29  anesthesiologist assistants.

30         2.  Develop all rules regulating the use of

31  anesthesiologist assistants by qualified anesthesiologists

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1  under this chapter and chapter 458, except for rules relating

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

  3  shall also develop rules to ensure that the continuity of

  4  supervision is maintained in each practice setting. The boards

  5  shall consider adopting a proposed rule at the regularly

  6  scheduled meeting immediately following the submission of the

  7  proposed rule. A proposed rule may not be adopted by either

  8  board unless both boards have accepted and approved the

  9  identical language contained in the proposed rule. The

10  language of all proposed rules must be approved by both boards

11  pursuant to each respective board's guidelines and standards

12  regarding the adoption of proposed rules.

13         3.  Address concerns and problems of practicing

14  anesthesiologist assistants to improve safety in the clinical

15  practices of licensed anesthesiologist assistants.

16         (c)  When the board finds that an applicant for

17  licensure has failed to meet, to the board's satisfaction,

18  each of the requirements for licensure set forth in this

19  section, the board may enter an order to:

20         1.  Refuse to certify the applicant for licensure;

21         2.  Approve the applicant for licensure with

22  restrictions on the scope of practice or license; or

23         3.  Approve the applicant for conditional licensure.

24  Such conditions may include placement of the licensee on

25  probation for a period of time and subject to such conditions

26  as the board may specify, including, but not limited to,

27  requiring the licensee to undergo treatment, to attend

28  continuing education courses, or to take corrective action.

29         (8)  PENALTY.--A person who falsely holds herself or

30  himself out as an anesthesiologist assistant commits a felony

31  of the third degree, punishable as provided in s. 775.082, s.

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1  775.083, or s. 775.084.

  2         (9)  DENIAL, SUSPENSION, OR REVOCATION OF

  3  LICENSURE.--The boards may deny, suspend, or revoke the

  4  license of an anesthesiologist assistant who the board

  5  determines has violated any provision of this section or

  6  chapter or any rule adopted pursuant thereto.

  7         (10)  RULES.--The boards shall adopt rules to implement

  8  this section.

  9         (11)  LIABILITY.--A supervising anesthesiologist is

10  liable for any act or omission of an anesthesiologist

11  assistant acting under the anesthesiologist's supervision and

12  control and shall comply with the financial responsibility

13  requirements of this chapter and chapter 456, as applicable.

14         (12)  FEES.--The department shall allocate the fees

15  collected under this section to the board.

16         Section 6.  This act shall take effect July 1, 2002.

17

18

19  ================ T I T L E   A M E N D M E N T ===============

20  And the title is amended as follows:

21  remove everything before the enacting clause

22

23  and insert:

24                      A bill to be entitled

25         An act relating to anesthesiologist assistants;

26         amending s. 456.048, F.S.; requiring the Board

27         of Medicine and the Board of Osteopathic

28         Medicine to require medical malpractice

29         insurance or proof of financial responsibility

30         as a condition of licensure or licensure

31         renewal for licensed anesthesiologist

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                                                   HOUSE AMENDMENT

    dhs-21                                         Bill No. HB 599

    Amendment No. ___ (for drafter's use only)





  1         assistants; amending ss. 458.331, 459.015,

  2         F.S.; revising grounds for which a physician

  3         may be disciplined for failing to provide

  4         adequate supervision; creating ss. 458.3475,

  5         459.023, F.S.; providing definitions; providing

  6         performance standards for anesthesiologist

  7         assistants and supervising anesthesiologists;

  8         providing for the approval of training programs

  9         and for services authorized to be performed by

10         trainees; providing licensing procedures;

11         providing for fees; providing for additional

12         membership, powers, and duties of the Board of

13         Medicine and the Board of Osteopathic Medicine;

14         providing penalties; providing for disciplinary

15         actions; providing for the adoption of rules;

16         prescribing liability; providing for the

17         allocation of fees; providing an effective

18         date.

19

20

21

22

23

24

25

26

27

28

29

30

31

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