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