HB 1381 2003
1	CHAMBER ACTION
2
3
4
5
6	The Committee on Health Care recommends the following:
7
8	Committee Substitute
9	Remove the entire bill and insert:
10	A bill to be entitled
11	An act relating to anesthesiologist assistants; amending
12	s. 456.048, F.S.; requiring the Board of Medicine and the
13	Board of Osteopathic Medicine to require medical
14	malpractice insurance or proof of financial responsibility
15	as a condition of licensure or licensure renewal for
16	licensed anesthesiology assistants; amending ss. 458.331
17	and 459.015, F.S.; revising grounds for which a physician
18	may be disciplined for failing to provide adequate
19	supervision; providing penalties; creating ss. 458.3475
20	and 459.023, F.S.; providing definitions; providing
21	performance standards for anesthesiologist assistants and
22	supervising anesthesiologists; providing for the approval
23	of training programs and for services authorized to be
24	performed by trainees; providing licensing procedures;
25	providing for fees; providing for a task force to study
26	the continued need for licensure and requiring a report;
27	providing for additional powers and duties of the Board of
28	Medicine and the Board of Osteopathic Medicine; providing
29	penalties; providing for disciplinary actions; providing
30	for the adoption of rules; prescribing liability;
31	providing for the allocation of fees; providing an
32	effective date.
33
34	Be It Enacted by the Legislature of the State of Florida:
35
36	Section 1. Section 456.048, Florida Statutes, is amended
37	to read:
38	456.048 Financial responsibility requirements for certain
39	health care practitioners.--
40	(1) As a prerequisite for licensure or license renewal,
41	the Board of Acupuncture, the Board of Chiropractic Medicine,
42	the Board of Podiatric Medicine, and the Board of Dentistry
43	shall, by rule, require that all health care practitioners
44	licensed under the respective board, and the Board of Medicine
45	and the Board of Osteopathic Medicine shall, by rule, require
46	that all anesthesiologist assistants licensed pursuant to s.
47	458.3475 or s. 459.023,and the Board of Nursing shall, by rule,
48	require that advanced registered nurse practitioners certified
49	under s. 464.012, and the department shall, by rule, require
50	that midwives maintain medical malpractice insurance or provide
51	proof of financial responsibility in an amount and in a manner
52	determined by the board or department to be sufficient to cover
53	claims arising out of the rendering of or failure to render
54	professional care and services in this state.
55	(2) The board or department may grant exemptions upon
56	application by practitioners meeting any of the following
57	criteria:
58	(a) Any person licensed under chapter 457, s. 458.3475, s.
59	459.023,chapter 460, chapter 461, s. 464.012, chapter 466, or
60	chapter 467 who practices exclusively as an officer, employee,
61	or agent of the Federal Government or of the state or its
62	agencies or its subdivisions. For the purposes of this
63	subsection, an agent of the state, its agencies, or its
64	subdivisions is a person who is eligible for coverage under any
65	self-insurance or insurance program authorized by the provisions
66	of s. 768.28(15) or who is a volunteer under s. 110.501(1).
67	(b) Any person whose license or certification has become
68	inactive under chapter 457, s. 458.3475, s. 459.023,chapter
69	460, chapter 461, part I of chapter 464, chapter 466, or chapter
70	467 and who is not practicing in this state. Any person applying
71	for reactivation of a license must show either that such
72	licensee maintained tail insurance coverage which provided
73	liability coverage for incidents that occurred on or after
74	October 1, 1993, or the initial date of licensure in this state,
75	whichever is later, and incidents that occurred before the date
76	on which the license became inactive; or such licensee must
77	submit an affidavit stating that such licensee has no
78	unsatisfied medical malpractice judgments or settlements at the
79	time of application for reactivation.
80	(c) Any person holding a limited license pursuant to s.
81	456.015, and practicing under the scope of such limited license.
82	(d) Any person licensed or certified under chapter 457, s.
83	458.3475, s. 459.023,chapter 460, chapter 461, s. 464.012,
84	chapter 466, or chapter 467 who practices only in conjunction
85	with his or her teaching duties at an accredited school or in
86	its main teaching hospitals. Such person may engage in the
87	practice of medicine to the extent that such practice is
88	incidental to and a necessary part of duties in connection with
89	the teaching position in the school.
90	(e) Any person holding an active license or certification
91	under chapter 457, s. 458.3475, s. 459.023,chapter 460, chapter
92	461, s. 464.012, chapter 466, or chapter 467 who is not
93	practicing in this state. If such person initiates or resumes
94	practice in this state, he or she must notify the department of
95	such activity.
96	(f) Any person who can demonstrate to the board or
97	department that he or she has no malpractice exposure in the
98	state.
99	(3) Notwithstanding the provisions of this section, the
100	financial responsibility requirements of ss. 458.320 and
101	459.0085 shall continue to apply to practitioners licensed under
102	those chapters, except for anesthesiologist assistants licensed
103	pursuant to s. 458.3475 or s. 459.023 who must meet the
104	requirements of this section.
105	Section 2. Paragraph (dd) of subsection (1) of section
106	458.331, Florida Statutes, is amended to read:
107	458.331 Grounds for disciplinary action; action by the
108	board and department.--
109	(1) The following acts constitute grounds for denial of a
110	license or disciplinary action, as specified in s. 456.072(2):
111	(dd) Failing to supervise adequately the activities of
112	those physician assistants, paramedics, emergency medical
113	technicians, or advanced registered nurse practitioners, or
114	anesthesiologist assistantsacting under the supervision of the
115	physician.
116	Section 3. Section 458.3475, Florida Statutes, is created
117	to read:
118	458.3475 Anesthesiologist assistants.--
119	(1) DEFINITIONS.--As used in this section, the term:
120	(a) "Anesthesiologist" means an allopathic physician who
121	holds an active, unrestricted license, who has successfully
122	completed an anesthesiology training program approved by the
123	Accreditation Council for Graduate Medical Education, or its
124	equivalent, and who is certified by the American Board of
125	Anesthesiology or is eligible to take that board's examination
126	or is certified by the Board of Certification in Anesthesiology
127	affiliated with the American Association of Physician
128	Specialists, Inc.
129	(b) "Anesthesiologist assistant" means a graduate of an
130	approved program who is licensed to perform medical services
131	delegated and directly supervised by a supervising
132	anesthesiologist.
133	(c) "Anesthesiology" means the practice of medicine that
134	specializes in the relief of pain during and after surgical
135	procedures and childbirth, during certain chronic disease
136	processes, and during resuscitation and critical care of
137	patients in the operating room and intensive care environments.
138	(d) "Approved program" means a program for the education
139	and training of anesthesiologist assistants that has been
140	approved by the boards as provided in subsection (5).
141	(e) "Boards" means the Board of Medicine and the Board of
142	Osteopathic Medicine.
143	(f) "Continuing medical education" means courses
144	recognized and approved by the boards, the American Academy of
145	Physician Assistants, the American Medical Association, the
146	American Osteopathic Association, the American Academy of
147	Anesthesiologist Assistants, the American Society of
148	Anesthesiologists, or the Accreditation Council for Continuing
149	Medical Education.
150	(g) "Direct supervision" means supervision by an
151	anesthesiologist who is present in the office or the surgical or
152	obstetrical suite with the anesthesiologist assistant and is
153	immediately available to provide assistance and direction while
154	anesthesia services are being performed.
155	(h) "Proficiency examination" means an entry-level
156	examination approved by the boards, including examinations
157	administered by the National Commission for Certification of
158	Anesthesiologist Assistants.
159	(i) "Trainee" means a person who is currently enrolled in
160	an approved program.
161	(2) PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--
162	(a) An anesthesiologist who directly supervises an
163	anesthesiologist assistant must be qualified in the medical
164	areas in which the anesthesiologist assistant performs and is
165	liable for the performance of the anesthesiologist assistant. An
166	anesthesiologist may only supervise two anesthesiologist
167	assistants at the same time. The board may, by rule, allow an
168	anesthesiologist to supervise up to four anesthesiologist
169	assistants, after July 1, 2006.
170	(b) An anesthesiologist or group of anesthesiologists
171	must, upon establishing a supervisory relationship with an
172	anesthesiologist assistant, file with the board a written
173	protocol that includes, at a minimum:
174	1. The name, address, and license number of the
175	anesthesiologist assistant.
176	2. The name, address, license number, and federal Drug
177	Enforcement Administration number of each physician who will be
178	supervising the anesthesiologist assistant.
179	3. The address of the anesthesiologist assistant's primary
180	practice location and the address of any other locations where
181	the anesthesiologist assistant may practice.
182	4. The date the protocol was developed and the dates of
183	all revisions.
184	5. The signatures of the anesthesiologist assistant and
185	all supervising physicians.
186	6. The duties and functions of the anesthesiologist
187	assistant.
188	7. The conditions or procedures that require the personal
189	provision of care by an anesthesiologist.
190	8. The procedures to be followed in the event of an
191	anesthetic emergency.
192
193	The protocol must be on file with the board before the
194	anesthesiologist assistant may practice with the
195	anesthesiologist or group. An anesthesiologist assistant may not
196	practice unless a written protocol has been filed for that
197	anesthesiologist assistant in accordance with this paragraph,
198	and the anesthesiologist assistant may only practice under the
199	direct supervision of an anesthesiologist who has signed the
200	protocol. The protocol must be updated biennially.
201	(3) PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--
202	(a) An anesthesiologist assistant may assist an
203	anesthesiologist in developing and implementing an anesthesia
204	care plan for a patient. In providing assistance to an
205	anesthesiologist, an anesthesiologist assistant may perform
206	duties established by rule by the board in any of the following
207	functions that are included in the anesthesiologist assistant's
208	protocol while under the direct supervision of an
209	anesthesiologist:
210	1. Obtain a comprehensive patient history and present the
211	history to the supervising anesthesiologist.
212	2. Pretest and calibrate anesthesia delivery systems and
213	monitor, obtain, and interpret information from the systems and
214	monitors.
215	3. Assist the supervising anesthesiologist with the
216	implementation of medically accepted monitoring techniques.
217	4. Establish basic and advanced airway interventions,
218	including intubation of the trachea and performing ventilatory
219	support.
220	5. Administer intermittent vasoactive drugs and start and
221	adjust vasoactive infusions.
222	6. Administer anesthetic drugs, adjuvant drugs, and
223	accessory drugs.
224	7. Assist the supervising anesthesiologist with the
225	performance of epidural anesthetic procedures and spinal
226	anesthetic procedures.
227	8. Administer blood, blood products, and supportive
228	fluids.
229	9. Support life functions during anesthesia health care,
230	including induction and intubation procedures, the use of
231	appropriate mechanical supportive devices, and the management of
232	fluid, electrolyte, and blood component balances.
233	10. Recognize and take appropriate corrective action for
234	abnormal patient responses to anesthesia, adjunctive medication,
235	or other forms of therapy.
236	11. Participate in management of the patient while in the
237	postanesthesia recovery area, including the administration of
238	any supporting fluids or drugs.
239	12. Place special peripheral and central venous and
240	arterial lines for blood sampling and monitoring as appropriate.
241	(b) Nothing in this section or chapter prevents third-
242	party payors from reimbursing employers of anesthesiologist
243	assistants for covered services rendered by such
244	anesthesiologist assistants.
245	(c) An anesthesiologist assistant must clearly convey to
246	the patient that he or she is an anesthesiologist assistant.
247	(d) An anesthesiologist assistant may perform anesthesia
248	tasks and services within the framework of a written practice
249	protocol developed between the supervising anesthesiologist and
250	the anesthesiologist assistant.
251	(e) An anesthesiologist assistant may not prescribe,
252	order, or compound any controlled substance, legend drug, or
253	medical device, nor may an anesthesiologist assistant dispense
254	sample drugs to patients. Nothing in this paragraph prohibits an
255	anesthesiologist assistant from administering legend drugs or
256	controlled substances, intravenous drugs, fluids, or blood
257	products, or inhalation or other anesthetic agents to patients
258	that are ordered by the supervising anesthesiologist and
259	administered while under the direct supervision of the
260	supervising anesthesiologist.
261	(4) PERFORMANCE BY TRAINEES.--The practice of a trainee is
262	exempt from the requirements of this chapter while the trainee
263	is performing assigned tasks as a trainee in conjunction with an
264	approved program. Before providing anesthesia services,
265	including the administration of anesthesia in conjunction with
266	the requirements of an approved program, the trainee must
267	clearly convey to the patient that he or she is a trainee.
268	(5) PROGRAM APPROVAL.--The boards shall approve programs
269	for the education and training of anesthesiologist assistants
270	which meet standards established by the boards by rule. The
271	boards may recommend only those anesthesiologist assistant
272	training programs that hold full accreditation or provisional
273	accreditation from the Commission on Accreditation of Allied
274	Health Education Programs.
275	(6) ANESTHESIOLOGIST ASSISTANT LICENSURE.--
276	(a) Any person desiring to be licensed as an
277	anesthesiologist assistant must apply to the department. The
278	department shall issue a license to any person certified by the
279	board to:
280	1. Be at least 18 years of age.
281	2. Have satisfactorily passed a proficiency examination
282	with a score established by the National Commission for
283	Certification of Anesthesiologist Assistants.
284	3.a. Have:
285	(I) Practiced as an anesthesiologist assistant in another
286	state for at least 12 months without a finding of an adverse
287	incident;
288	(II) A degree or prior licensure in an allied health care
289	field, including, but not limited to, respiratory therapy,
290	occupational therapy, nursing, dental hygiene, physician
291	assistant, paramedic, emergency medical technician, or
292	midwifery; or
293	(III) A baccalaureate or higher degree from a program at
294	an institution of higher education accredited by an organization
295	recognized by the board in one of the following areas of study:
296	general biology; general chemistry; organic chemistry; physics;
297	or another field of study which includes sufficient courses in
298	chemistry, biology, and life sciences to meet the criteria for
299	admission to a medical school accredited by an organization
300	recognized by the board.
301	b. Each person qualifying under sub-sub-subparagraph
302	a.(II) or sub-sub-subparagraph a.(III) must have successfully
303	completed a graduate-level training program approved by the
304	board and accredited by the Commission on Accreditation of
305	Allied Health Education Programs or any of the commission's
306	successor organizations which is conducted for the purpose of
307	preparing individuals to practice as anesthesiologist assistants
308	and which included at minimum all of the following components:
309	(I) Basic sciences of anesthesia: physiology,
310	pathophysiology, anatomy, and biochemistry, presented as a
311	continuum of didactic courses designed to teach students the
312	foundations of human biological existence on which clinical
313	correlations to anesthesia practice are based.
314	(II) Pharmacology for the anesthetic sciences, including
315	instruction in the anesthetic principles of pharmacology,
316	pharmacodynamics, pharmacokinetics, uptake and distribution,
317	intravenous anesthetics and narcotics, and volatile anesthetics.
318	(III) Physics in anesthesia.
319	(IV) Fundamentals of anesthetic sciences, presented as a
320	continuum of courses covering a series of topics in basic
321	medical sciences with special emphasis on the effects of
322	anesthetics on normal physiology and pathophysiology.
323	(V) Patient instrumentation and monitoring, presented as a
324	continuum of courses focusing on the design of, proper
325	preparation of, and proper methods of resolving problems that
326	arise with anesthesia equipment, and providing a balance between
327	the engineering concepts used in anesthesia instruments and the
328	clinical application of anesthesia instruments.
329	(VI) Clinically based conferences in which techniques of
330	anesthetic management, quality assurance issues, and current
331	professional literature are reviewed from the perspective of
332	practice improvement.
333	(VII) Clinical experience consisting of at least 2,500
334	hours of direct patient contact, presented as a continuum of
335	courses throughout the entirety of the program, beginning with a
336	gradual introduction of the techniques for the anesthetic
337	management of patients and culminating in the assimilation of
338	the graduate of the program into the work force.
339	(IX) Unless meeting the requirements of sub-sub-
340	subparagraph a.(II), successful completion of at least a 3-month
341	postgraduate clinical one-on-one training program with an
342	anesthesiologist in a manner approved by the board.
343	4. Be certified in advanced cardiac life support.
344	5. Have completed the application form and remitted an
345	application fee, not to exceed $1,000, as set by the boards. An
346	application must include:
347	a. A certificate of completion of approved training as
348	provided in subparagraph 3.
349	b. A sworn statement of any prior felony convictions.
350	c. A sworn statement of any prior discipline or denial of
351	licensure or certification in any state.
352	d. Two letters of recommendation from anesthesiologists.
353	(b) A license must be renewed biennially. Each renewal
354	must include:
355	1. A renewal fee, not to exceed $1,000, as set by the
356	boards.
357	2. A sworn statement of no felony convictions in the
358	immediately preceding 2 years.
359	(c) Each licensed anesthesiologist assistant must
360	biennially complete 40 hours of continuing medical education or
361	hold a current certificate issued by the National Commission for
362	Certification of Anesthesiologist Assistants or its successor.
363	(d) An anesthesiologist assistant must notify the
364	department in writing within 30 days after obtaining employment
365	that requires a license under this chapter and after any
366	subsequent change in his or her supervising anesthesiologist.
367	The notification must include the full name, license number,
368	specialty, and address of the supervising anesthesiologist.
369	Submission of the required protocol satisfies this requirement.
370	(e) The board may impose upon an anesthesiologist
371	assistant any penalty specified in s. 456.072 or s. 458.331(2)
372	if the anesthesiologist assistant or the supervising
373	anesthesiologist is found guilty of or is investigated for an
374	act that constitutes a violation of this chapter or chapter 456.
375	(f) The boards shall appoint a task force of at least five
376	members, with one member each from the Board of Medicine, the
377	Board of Osteopathic Medicine, the Department of Health, Nova
378	Southeastern University, and one of the medical schools in this
379	state. The task force shall study the requirements of this
380	section and issue a report to the Secretary of Health by March
381	1, 2005, concerning the continued need for the requirements of
382	this subsection.
383	(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
384	ADVISE THE BOARD.--
385	(a) The chair of the board may appoint an anesthesiologist
386	and an anesthesiologist assistant to advise the board as to the
387	promulgation of rules for the licensure of anesthesiologist
388	assistants. The board may utilize a committee structure that is
389	most practicable in order to receive any recommendations to the
390	board regarding rules and all matters relating to
391	anesthesiologist assistants, including, but not limited to,
392	recommendations to improve safety in the clinical practices of
393	licensed anesthesiologist assistants.
394	(b) In addition to its other duties and responsibilities
395	as prescribed by law, the board shall:
396	1. Recommend to the department the licensure of
397	anesthesiologist assistants.
398	2. Develop all rules regulating the use of
399	anesthesiologist assistants by qualified anesthesiologists under
400	this chapter and chapter 459, except for rules relating to the
401	formulary developed under s. 458.347(4)(f). The board shall also
402	develop rules to ensure that the continuity of supervision is
403	maintained in each practice setting. The boards shall consider
404	adopting a proposed rule at the regularly scheduled meeting
405	immediately following the submission of the proposed rule. A
406	proposed rule may not be adopted by either board unless both
407	boards have accepted and approved the identical language
408	contained in the proposed rule. The language of all proposed
409	rules must be approved by both boards pursuant to each
410	respective board's guidelines and standards regarding the
411	adoption of proposed rules.
412	3. Address concerns and problems of practicing
413	anesthesiologist assistants to improve safety in the clinical
414	practices of licensed anesthesiologist assistants.
415	(c) When the board finds that an applicant for licensure
416	has failed to meet, to the board's satisfaction, each of the
417	requirements for licensure set forth in this section, the board
418	may enter an order to:
419	1. Refuse to certify the applicant for licensure;
420	2. Approve the applicant for licensure with restrictions
421	on the scope of practice or license; or
422	3. Approve the applicant for conditional licensure. Such
423	conditions may include placement of the licensee on probation
424	for a period of time and subject to such conditions as the board
425	may specify, including, but not limited to, requiring the
426	licensee to undergo treatment, to attend continuing education
427	courses, or to take corrective action.
428	(8) PENALTY.--A person who falsely holds himself or
429	herself out as an anesthesiologist assistant commits a felony of
430	the third degree, punishable as provided in s. 775.082, s.
431	775.083, or s. 775.084.
432	(9) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
433	board may deny, suspend, or revoke the license of an
434	anesthesiologist assistant who the board determines has violated
435	any provision of this section, this chapter, or chapter 456 or
436	any rule adopted pursuant thereto.
437	(10) RULES.--The boards shall adopt rules to implement
438	this section.
439	(11) LIABILITY.--A supervising anesthesiologist is liable
440	for any act or omission of an anesthesiologist assistant acting
441	under the anesthesiologist's supervision and control and shall
442	comply with the financial responsibility requirements of this
443	chapter and chapter 456, as applicable.
444	(12) FEES.--The department shall allocate the fees
445	collected under this section to the board.
446	Section 4. Paragraph (hh) of subsection (1) of section
447	459.015, Florida Statutes, is amended to read:
448	459.015 Grounds for disciplinary action; action by the
449	board and department.--
450	(1) The following acts constitute grounds for denial of a
451	license or disciplinary action, as specified in s. 456.072(2):
452	(hh) Failing to supervise adequately the activities of
453	those physician assistants, paramedics, emergency medical
454	technicians, advanced registered nurse practitioners,
455	anesthesiologist assistants,or other persons acting under the
456	supervision of the osteopathic physician.
457	Section 5. Section 459.023, Florida Statutes, is created
458	to read:
459	459.023 Anesthesiologist assistants.--
460	(1) DEFINITIONS.--As used in this section, the term:
461	(a) "Anesthesiologist" means an osteopathic physician who
462	holds an active, unrestricted license, who has successfully
463	completed an anesthesiology training program approved by the
464	Accreditation Council for Graduate Medical Education, or its
465	equivalent, or the American Osteopathic Association, and who is
466	certified by the American Osteopathic Board of Anesthesiology or
467	is eligible to take that board's examination, is certified by
468	the American Board of Anesthesiology or is eligible to take that
469	board's examination, or is certified by the Board of
470	Certification in Anesthesiology affiliated with the American
471	Association of Physician Specialists, Inc.
472	(b) "Anesthesiologist assistant" means a graduate of an
473	approved program who is licensed to perform medical services
474	delegated and directly supervised by a supervising
475	anesthesiologist.
476	(c) "Anesthesiology" means the practice of medicine that
477	specializes in the relief of pain during and after surgical
478	procedures and childbirth, during certain chronic disease
479	processes, and during resuscitation and critical care of
480	patients in the operating room and intensive care environments.
481	(d) "Approved program" means a program for the education
482	and training of anesthesiologist assistants that has been
483	approved by the boards as provided in subsection (5).
484	(e) "Boards" means the Board of Medicine and the Board of
485	Osteopathic Medicine.
486	(f) "Continuing medical education" means courses
487	recognized and approved by the boards, the American Academy of
488	Physician Assistants, the American Medical Association, the
489	American Osteopathic Association, the American Academy of
490	Anesthesiologist Assistants, the American Society of
491	Anesthesiologists, or the Accreditation Council for Continuing
492	Medical Education.
493	(g) "Direct supervision" means supervision by an
494	anesthesiologist who is present in the office or the surgical or
495	obstetrical suite with the anesthesiologist assistant and is
496	immediately available to provide assistance and direction while
497	anesthesia services are being performed.
498	(h) "Proficiency examination" means an entry-level
499	examination approved by the boards, including examinations
500	administered by the National Commission for Certification of
501	Anesthesiologist Assistants.
502	(i) "Trainee" means a person who is currently enrolled in
503	an approved program.
504	(2) PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--
505	(a) An anesthesiologist who directly supervises an
506	anesthesiologist assistant must be qualified in the medical
507	areas in which the anesthesiologist assistant performs, and is
508	liable for the performance of the anesthesiologist assistant. An
509	anesthesiologist may only supervise two anesthesiologist
510	assistants at the same time. The board may, by rule, allow an
511	anesthesiologist to supervise up to four anesthesiologist
512	assistants, after July 1, 2006.
513	(b) An anesthesiologist or group of anesthesiologists
514	must, upon establishing a supervisory relationship with an
515	anesthesiologist assistant, file with the board a written
516	protocol that includes, at a minimum:
517	1. The name, address, and license number of the
518	anesthesiologist assistant.
519	2. The name, address, license number, and federal Drug
520	Enforcement Administration number of each physician who will be
521	supervising the anesthesiologist assistant.
522	3. The address of the anesthesiologist assistant's primary
523	practice location and the address of any other locations where
524	the anesthesiologist assistant may practice.
525	4. The date the protocol was developed and the dates of
526	all revisions.
527	5. The signatures of the anesthesiologist assistant and
528	all supervising physicians.
529	6. The duties and functions of the anesthesiologist
530	assistant.
531	7. The conditions or procedures that require the personal
532	provision of care by an anesthesiologist.
533	8. The procedures to be followed in the event of an
534	anesthetic emergency.
535
536	The protocol must be on file with the board before the
537	anesthesiologist assistant may practice with the
538	anesthesiologist or group. An anesthesiologist assistant may not
539	practice unless a written protocol has been filed for that
540	anesthesiologist assistant in accordance with this paragraph,
541	and the anesthesiologist assistant may only practice under the
542	direct supervision of an anesthesiologist who has signed the
543	protocol. The protocol must be updated biennially.
544	(3) PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--
545	(a) An anesthesiologist assistant may assist an
546	anesthesiologist in developing and implementing an anesthesia
547	care plan for a patient. In providing assistance to an
548	anesthesiologist, an anesthesiologist assistant may perform
549	duties established by rule by the board in any of the following
550	functions that are included in the anesthesiologist assistant's
551	protocol while under the direct supervision of an
552	anesthesiologist:
553	1. Obtain a comprehensive patient history and present the
554	history to the supervising anesthesiologist.
555	2. Pretest and calibrate anesthesia delivery systems and
556	monitor, obtain, and interpret information from the systems and
557	monitors.
558	3. Assist the supervising anesthesiologist with the
559	implementation of medically accepted monitoring techniques.
560	4. Establish basic and advanced airway interventions,
561	including intubation of the trachea and performing ventilatory
562	support.
563	5. Administer intermittent vasoactive drugs and start and
564	adjust vasoactive infusions.
565	6. Administer anesthetic drugs, adjuvant drugs, and
566	accessory drugs.
567	7. Assist the supervising anesthesiologist with the
568	performance of epidural anesthetic procedures and spinal
569	anesthetic procedures.
570	8. Administer blood, blood products, and supportive
571	fluids.
572	9. Support life functions during anesthesia health care,
573	including induction and intubation procedures, the use of
574	appropriate mechanical supportive devices, and the management of
575	fluid, electrolyte, and blood component balances.
576	10. Recognize and take appropriate corrective action for
577	abnormal patient responses to anesthesia, adjunctive medication,
578	or other forms of therapy.
579	11. Participate in management of the patient while in the
580	postanesthesia recovery area, including the administration of
581	any supporting fluids or drugs.
582	12. Place special peripheral and central venous and
583	arterial lines for blood sampling and monitoring as appropriate.
584	(b) Nothing in this section or chapter prevents third-
585	party payors from reimbursing employers of anesthesiologist
586	assistants for covered services rendered by such
587	anesthesiologist assistants.
588	(c) An anesthesiologist assistant must clearly convey to
589	the patient that she or he is an anesthesiologist assistant.
590	(d) An anesthesiologist assistant may perform anesthesia
591	tasks and services within the framework of a written practice
592	protocol developed between the supervising anesthesiologist and
593	the anesthesiologist assistant.
594	(e) An anesthesiologist assistant may not prescribe,
595	order, or compound any controlled substance, legend drug, or
596	medical device, nor may an anesthesiologist assistant dispense
597	sample drugs to patients. Nothing in this paragraph prohibits an
598	anesthesiologist assistant from administering legend drugs or
599	controlled substances, intravenous drugs, fluids, or blood
600	products, or inhalation or other anesthetic agents to patients
601	that are ordered by the supervising anesthesiologist and
602	administered while under the direct supervision of the
603	supervising anesthesiologist.
604	(4) PERFORMANCE BY TRAINEES.--The practice of a trainee is
605	exempt from the requirements of this chapter while the trainee
606	is performing assigned tasks as a trainee in conjunction with an
607	approved program. Before providing anesthesia services,
608	including the administration of anesthesia in conjunction with
609	the requirements of an approved program, the trainee must
610	clearly convey to the patient that she or he is a trainee.
611	(5) PROGRAM APPROVAL.--The boards shall approve programs
612	for the education and training of anesthesiologist assistants
613	which meet standards established by the boards by rule. The
614	boards may recommend only those anesthesiologist assistant
615	training programs that hold full accreditation or provisional
616	accreditation from the Commission on Accreditation of Allied
617	Health Education Programs.
618	(6) ANESTHESIOLOGIST ASSISTANT LICENSURE.--
619	(a) Any person desiring to be licensed as an
620	anesthesiologist assistant must apply to the department. The
621	department shall issue a license to any person certified by the
622	board to:
623	1. Be at least 18 years of age.
624	2. Have satisfactorily passed a proficiency examination
625	with a score established by the National Commission for
626	Certification of Anesthesiologist Assistants.
627	3.a. Have:
628	(I) Practiced as an anesthesiologist assistant in another
629	state for at least 12 months without a finding of an adverse
630	incident;
631	(II) A degree or prior licensure in an allied health care
632	field, including, but not limited to, respiratory therapy,
633	occupational therapy, nursing, dental hygiene, physician
634	assistant, paramedic, emergency medical technician, or
635	midwifery; or
636	(III) A baccalaureate or higher degree from a program at
637	an institution of higher education accredited by an organization
638	recognized by the board in one of the following areas of study:
639	general biology; general chemistry; organic chemistry; physics;
640	or another field of study which includes sufficient courses in
641	chemistry, biology, and life sciences to meet the criteria for
642	admission to a medical school accredited by an organization
643	recognized by the board; or
644	b. Each person qualifying under sub-sub-subparagraph
645	a.(II) or sub-sub-subparagraph a.(III) must have successfully
646	completed a graduate-level training program approved by the
647	board and accredited by the Commission on Accreditation of
648	Allied Health Education Programs or any of the commission's
649	successor organizations which is conducted for the purpose of
650	preparing individuals to practice as anesthesiologist assistants
651	and which included at minimum all of the following components:
652	(I) Basic sciences of anesthesia: physiology,
653	pathophysiology, anatomy, and biochemistry, presented as a
654	continuum of didactic courses designed to teach students the
655	foundations of human biological existence on which clinical
656	correlations to anesthesia practice are based.
657	(II) Pharmacology for the anesthetic sciences, including
658	instruction in the anesthetic principles of pharmacology,
659	pharmacodynamics, pharmacokinetics, uptake and distribution,
660	intravenous anesthetics and narcotics, and volatile anesthetics.
661	(III) Physics in anesthesia.
662	(IV) Fundamentals of anesthetic sciences, presented as a
663	continuum of courses covering a series of topics in basic
664	medical sciences with special emphasis on the effects of
665	anesthetics on normal physiology and pathophysiology.
666	(V) Patient instrumentation and monitoring, presented as a
667	continuum of courses focusing on the design of, proper
668	preparation of, and proper methods of resolving problems that
669	arise with anesthesia equipment, and providing a balance between
670	the engineering concepts used in anesthesia instruments and the
671	clinical application of anesthesia instruments.
672	(VI) Clinically based conferences in which techniques of
673	anesthetic management, quality assurance issues, and current
674	professional literature are reviewed from the perspective of
675	practice improvement.
676	(VII) Clinical experience consisting of at least 2,500
677	hours of direct patient contact, presented as a continuum of
678	courses throughout the entirety of the program, beginning with a
679	gradual introduction of the techniques for the anesthetic
680	management of patients and culminating in the assimilation of
681	the graduate of the program into the work force.
682	(IX) Unless meeting the requirements of sub-sub-
683	subparagraph a.(II), successful completion of at least a 3-month
684	postgraduate clinical one-on-one training program with an
685	anesthesiologist in a manner approved by the board.
686	4. Be certified in advanced cardiac life support.
687	5. Have completed the application form and remitted an
688	application fee, not to exceed $1,000, as set by the boards. An
689	application must include:
690	a. A certificate of completion of approved training as
691	provided in subparagraph 3.
692	b. A sworn statement of any prior felony convictions.
693	c. A sworn statement of any prior discipline or denial of
694	licensure or certification in any state.
695	d. Two letters of recommendation from anesthesiologists.
696	(b) A license must be renewed biennially. Each renewal
697	must include:
698	1. A renewal fee, not to exceed $1,000, as set by the
699	boards.
700	2. A sworn statement of no felony convictions in the
701	immediately preceding 2 years.
702	(c) Each licensed anesthesiologist assistant must
703	biennially complete 40 hours of continuing medical education or
704	hold a current certificate issued by the National Commission for
705	Certification of Anesthesiologist Assistants or its successor.
706	(d) An anesthesiologist assistant must notify the
707	department in writing within 30 days after obtaining employment
708	that requires a license under this chapter and after any
709	subsequent change in her or his supervising anesthesiologist.
710	The notification must include the full name, license number,
711	specialty, and address of the supervising anesthesiologist.
712	Submission of the required protocol satisfies this requirement.
713	(e) The board may impose upon an anesthesiologist
714	assistant any penalty specified in s. 456.072 or s. 459.015(2)
715	if the anesthesiologist assistant or the supervising
716	anesthesiologist is found guilty of or is investigated for an
717	act that constitutes a violation of this chapter or chapter 456.
718	(f) The boards shall appoint a task force of at least five
719	members, with one member each from the Board of Medicine, the
720	Board of Osteopathic Medicine, the Department of Health, Nova
721	Southeastern University, and one of the medical schools in this
722	state. The task force shall study the requirements of this
723	section and issue a report to the Secretary of Health by March
724	1, 2005, concerning the continued need for the requirements of
725	this subsection.
726	(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
727	ADVISE THE BOARD.--
728	(a) The chair of the board may appoint an anesthesiologist
729	and an anesthesiologist assistant to advise the board as to the
730	promulgation of rules for the licensure of anesthesiologist
731	assistants. The board may utilize a committee structure that is
732	most practicable in order to receive any recommendations to the
733	board regarding rules and all matters relating to
734	anesthesiologist assistants, including, but not limited to,
735	recommendations to improve safety in the clinical practices of
736	licensed anesthesiologist assistants.
737	(b) In addition to its other duties and responsibilities
738	as prescribed by law, the board shall:
739	1. Recommend to the department the licensure of
740	anesthesiologist assistants.
741	2. Develop all rules regulating the use of
742	anesthesiologist assistants by qualified anesthesiologists under
743	this chapter and chapter 458, except for rules relating to the
744	formulary developed under s. 458.347(4)(f). The board shall also
745	develop rules to ensure that the continuity of supervision is
746	maintained in each practice setting. The boards shall consider
747	adopting a proposed rule at the regularly scheduled meeting
748	immediately following the submission of the proposed rule. A
749	proposed rule may not be adopted by either board unless both
750	boards have accepted and approved the identical language
751	contained in the proposed rule. The language of all proposed
752	rules must be approved by both boards pursuant to each
753	respective board's guidelines and standards regarding the
754	adoption of proposed rules.
755	3. Address concerns and problems of practicing
756	anesthesiologist assistants to improve safety in the clinical
757	practices of licensed anesthesiologist assistants.
758	(c) When the board finds that an applicant for licensure
759	has failed to meet, to the board's satisfaction, each of the
760	requirements for licensure set forth in this section, the board
761	may enter an order to:
762	1. Refuse to certify the applicant for licensure;
763	2. Approve the applicant for licensure with restrictions
764	on the scope of practice or license; or
765	3. Approve the applicant for conditional licensure. Such
766	conditions may include placement of the licensee on probation
767	for a period of time and subject to such conditions as the board
768	may specify, including, but not limited to, requiring the
769	licensee to undergo treatment, to attend continuing education
770	courses, or to take corrective action.
771	(8) PENALTY.--A person who falsely holds herself or
772	himself out as an anesthesiologist assistant commits a felony of
773	the third degree, punishable as provided in s. 775.082, s.
774	775.083, or s. 775.084.
775	(9) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
776	board may deny, suspend, or revoke the license of an
777	anesthesiologist assistant who the board determines has violated
778	any provision of this section, this chapter, or chapter 456 or
779	any rule adopted pursuant thereto.
780	(10) RULES.--The boards shall adopt rules to implement
781	this section.
782	(11) LIABILITY.--A supervising anesthesiologist is liable
783	for any act or omission of an anesthesiologist assistant acting
784	under the anesthesiologist's supervision and control and shall
785	comply with the financial responsibility requirements of this
786	chapter and chapter 456, as applicable.
787	(12) FEES.--The department shall allocate the fees
788	collected under this section to the board.
789	Section 6. This act shall take effect July 1, 2003.