Senate Bill sb2332
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Florida Senate - 2003 SB 2332
By Senator Wasserman Schultz
34-227C-03 See HB 1381
1 A bill to be entitled
2 An act relating to anesthesiologist assistants;
3 amending s. 456.048, F.S.; requiring
4 anesthesiologist assistants to maintain medical
5 malpractice insurance or provide proof of
6 financial responsibility as a condition of
7 licensure or licensure renewal; amending ss.
8 458.331 and 459.015, F.S.; revising grounds for
9 which a physician may be disciplined for
10 failing to provide adequate supervision;
11 providing penalties; creating ss. 458.3475 and
12 459.023, F.S.; providing definitions; providing
13 performance standards for anesthesiologist
14 assistants and supervising anesthesiologists;
15 providing for the approval of training programs
16 and for services authorized to be performed by
17 trainees; providing licensing procedures;
18 providing for fees; providing for a task force
19 to study the continued need for licensure and
20 requiring a report; providing for additional
21 membership, powers, and duties of the Board of
22 Medicine and the Board of Osteopathic Medicine;
23 providing penalties; providing for disciplinary
24 actions; providing for the adoption of rules;
25 prescribing liability; providing for the
26 allocation of fees; providing an effective
27 date.
28
29 Be It Enacted by the Legislature of the State of Florida:
30
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Florida Senate - 2003 SB 2332
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1 Section 1. Section 456.048, Florida Statutes, is
2 amended to read:
3 456.048 Financial responsibility requirements for
4 certain health care practitioners.--
5 (1) As a prerequisite for licensure or license
6 renewal, the Board of Acupuncture, the Board of Chiropractic
7 Medicine, the Board of Podiatric Medicine, and the Board of
8 Dentistry shall, by rule, require that all health care
9 practitioners licensed under the respective board, and the
10 Board of Medicine and the Board of Osteopathic Medicine shall,
11 by rule, require that all anesthesiologist assistants licensed
12 pursuant to s. 458.3475 or s. 459.023, and the Board of
13 Nursing shall, by rule, require that advanced registered nurse
14 practitioners certified under s. 464.012, and the department
15 shall, by rule, require that midwives maintain medical
16 malpractice insurance or provide proof of financial
17 responsibility in an amount and in a manner determined by the
18 board or department to be sufficient to cover claims arising
19 out of the rendering of or failure to render professional care
20 and services in this state.
21 (2) The board or department may grant exemptions upon
22 application by practitioners meeting any of the following
23 criteria:
24 (a) Any person licensed under chapter 457, s.
25 458.3475, s. 459.023, chapter 460, chapter 461, s. 464.012,
26 chapter 466, or chapter 467 who practices exclusively as an
27 officer, employee, or agent of the Federal Government or of
28 the state or its agencies or its subdivisions. For the
29 purposes of this subsection, an agent of the state, its
30 agencies, or its subdivisions is a person who is eligible for
31 coverage under any self-insurance or insurance program
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Florida Senate - 2003 SB 2332
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1 authorized by the provisions of s. 768.28(15) or who is a
2 volunteer under s. 110.501(1).
3 (b) Any person whose license or certification has
4 become inactive under chapter 457, s. 458.3475, s. 459.023,
5 chapter 460, chapter 461, part I of chapter 464, chapter 466,
6 or chapter 467 and who is not practicing in this state. Any
7 person applying for reactivation of a license must show either
8 that such licensee maintained tail insurance coverage which
9 provided liability coverage for incidents that occurred on or
10 after October 1, 1993, or the initial date of licensure in
11 this state, whichever is later, and incidents that occurred
12 before the date on which the license became inactive; or such
13 licensee must submit an affidavit stating that such licensee
14 has no unsatisfied medical malpractice judgments or
15 settlements at the time of application for reactivation.
16 (c) Any person holding a limited license pursuant to
17 s. 456.015, and practicing under the scope of such limited
18 license.
19 (d) Any person licensed or certified under chapter
20 457, s. 458.3475, s. 459.023, chapter 460, chapter 461, s.
21 464.012, chapter 466, or chapter 467 who practices only in
22 conjunction with his or her teaching duties at an accredited
23 school or in its main teaching hospitals. Such person may
24 engage in the practice of medicine to the extent that such
25 practice is incidental to and a necessary part of duties in
26 connection with the teaching position in the school.
27 (e) Any person holding an active license or
28 certification under chapter 457, s. 458.3475, s. 459.023,
29 chapter 460, chapter 461, s. 464.012, chapter 466, or chapter
30 467 who is not practicing in this state. If such person
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Florida Senate - 2003 SB 2332
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1 initiates or resumes practice in this state, he or she must
2 notify the department of such activity.
3 (f) Any person who can demonstrate to the board or
4 department that he or she has no malpractice exposure in the
5 state.
6 (3) Notwithstanding the provisions of this section,
7 the financial responsibility requirements of ss. 458.320 and
8 459.0085 shall continue to apply to practitioners licensed
9 under those chapters, except for anesthesiologist assistants
10 licensed pursuant to s. 458.3475 or s. 459.023 who must meet
11 the requirements of this section.
12 Section 2. Paragraph (dd) of subsection (1) of section
13 458.331, Florida Statutes, is amended to read:
14 458.331 Grounds for disciplinary action; action by the
15 board and department.--
16 (1) The following acts constitute grounds for denial
17 of a license or disciplinary action, as specified in s.
18 456.072(2):
19 (dd) Failing to supervise adequately the activities of
20 those physician assistants, paramedics, emergency medical
21 technicians, or advanced registered nurse practitioners, or
22 anesthesiologist assistants acting under the supervision of
23 the physician.
24 Section 3. Section 458.3475, Florida Statutes, is
25 created to read:
26 458.3475 Anesthesiologist assistants.--
27 (1) DEFINITIONS.--As used in this section, the term:
28 (a) "Anesthesiologist" means an allopathic physician
29 who holds an active, unrestricted license, who has
30 successfully completed an anesthesiology training program
31 approved by the Accreditation Council for Graduate Medical
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1 Education, or its equivalent, and who is certified by the
2 American Board of Anesthesiology or is eligible to take that
3 board's examination or is certified by the Board of
4 Certification in Anesthesiology affiliated with the American
5 Association of Physician Specialists, Inc.
6 (b) "Anesthesiologist assistant" means a graduate of
7 an approved program who is licensed to perform medical
8 services delegated and directly supervised by a supervising
9 anesthesiologist.
10 (c) "Anesthesiology" means the practice of medicine
11 that specializes in the relief of pain during and after
12 surgical procedures and childbirth, during certain chronic
13 disease processes, and during resuscitation and critical care
14 of patients in the operating room and intensive care
15 environments.
16 (d) "Approved program" means a program for the
17 education and training of anesthesiologist assistants which
18 has been approved by the boards as provided in subsection (5).
19 (e) "Boards" means the Board of Medicine and the Board
20 of Osteopathic Medicine.
21 (f) "Continuing medical education" means courses
22 recognized and approved by the boards, the American Academy of
23 Physician Assistants, the American Medical Association, the
24 American Osteopathic Association, the American Academy of
25 Anesthesiologist Assistants, the American Society of
26 Anesthesiologists, or the Accreditation Council for Continuing
27 Medical Education.
28 (g) "Direct supervision" means supervision by an
29 anesthesiologist who is present in the office or the surgical
30 or obstetrical suite the anesthesiologist assistant is in and
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Florida Senate - 2003 SB 2332
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1 is immediately available to provide assistance and direction
2 while anesthesia services are being performed.
3 (h) "Proficiency examination" means an entry-level
4 examination approved by the boards, including examinations
5 administered by the National Commission for 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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Florida Senate - 2003 SB 2332
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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.
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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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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
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Florida Senate - 2003 SB 2332
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1 anesthesiologist assistants for covered services rendered by
2 such anesthesiologist assistants.
3 (c) An anesthesiologist assistant must clearly convey
4 to the patient that he or she is an anesthesiologist
5 assistant.
6 (d) An anesthesiologist assistant may perform
7 anesthesia tasks and services within the framework of a
8 written practice protocol developed between the supervising
9 anesthesiologist and the anesthesiologist assistant.
10 (e) An anesthesiologist assistant may not prescribe,
11 order, or compound any controlled substance, legend drug, or
12 medical device, nor may an anesthesiologist assistant dispense
13 sample drugs to patients. Nothing in this paragraph prohibits
14 an anesthesiologist assistant from administering legend drugs
15 or controlled substances, intravenous drugs, fluids, or blood
16 products, or inhalation or other anesthetic agents to patients
17 that are ordered by the supervising anesthesiologist, and
18 administered while under the direct supervision of the
19 supervising anesthesiologist.
20 (4) PERFORMANCE BY TRAINEES.--The practice of a
21 trainee is exempt from the requirements of this chapter while
22 the trainee is performing assigned tasks as a trainee in
23 conjunction with an approved program. Before providing
24 anesthesia services, including the administration of
25 anesthesia in conjunction with the requirements of an approved
26 program, the trainee must clearly convey to the patient that
27 he or she is a trainee.
28 (5) PROGRAM APPROVAL.--The boards shall approve
29 programs for the education and training of anesthesiologist
30 assistants which meet standards established by the boards by
31 rule. The boards may recommend only those anesthesiologist
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1 assistant training programs that hold full accreditation or
2 provisional accreditation from the Commission on Accreditation
3 of Allied Health Education Programs.
4 (6) ANESTHESIOLOGIST ASSISTANT LICENSURE.--
5 (a) Any person desiring to be licensed as an
6 anesthesiologist assistant must apply to the department. The
7 department shall issue a license to any person certified by
8 the board to:
9 1. Be at least 18 years of age.
10 2. Have satisfactorily passed a proficiency
11 examination with a score established by the National
12 Commission for Certification of Anesthesiologist Assistants.
13 3. Have:
14 a. Practiced as an anesthesiologist assistant in
15 another state for at least 12 months without a finding of an
16 adverse incident; or
17 b. A degree or prior licensure in an allied health
18 care field, including, but not limited to, respiratory
19 therapy, occupational therapy, nursing, dental hygiene,
20 physician assistant, paramedic, emergency medical technician,
21 or midwifery; or
22 c. A baccalaureate or higher degree from a program at
23 an institution of higher education accredited by an
24 organization recognized by the Board of Medicine in one of the
25 following areas of study:
26 (I) General biology;
27 (II) General chemistry;
28 (III) Organic chemistry;
29 (IV) Physics; or
30 (V) Another field of study which includes sufficient
31 courses in chemistry, biology, and life sciences to meet the
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Florida Senate - 2003 SB 2332
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1 criteria for admission to a medical school accredited by an
2 organization recognized by the Board of Medicine; or
3 d. Unless meeting the requirements of sub-subparagraph
4 a., successfully completed a graduate-level training program
5 approved by the Board of Medicine and accredited by the
6 Commission on Accreditation of Allied Health Education
7 Programs or any of the commission's successor organizations
8 which is conducted for the purpose of preparing individuals to
9 practice as anesthesiologist assistants and which included at
10 minimum all of the following components:
11 (I) Basic sciences of anesthesia: physiology,
12 pathophysiology, anatomy, and biochemistry, presented as a
13 continuum of didactic courses designed to teach students the
14 foundations of human biological existence on which clinical
15 correlations to anesthesia practice are based.
16 (II) Pharmacology for the anesthetic sciences,
17 including instruction in the anesthetic principles of
18 pharmacology, pharmacodynamics, pharmacokinetics, uptake and
19 distribution, intravenous anesthetics and narcotics, and
20 volatile anesthetics.
21 (III) Physics in anesthesia.
22 (IV) Fundamentals of anesthetic sciences, presented as
23 a continuum of courses covering a series of topics in basic
24 medical sciences with special emphasis on the effects of
25 anesthetics on normal physiology and pathophysiology.
26 (V) Patient instrumentation and monitoring, presented
27 as a continuum of courses focusing on the design, proper
28 preparation, and proper methods of resolving problems that
29 arise with anesthesia equipment, and providing a balance
30 between the engineering concepts used in anesthesia
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1 instruments and the clinical application of anesthesia
2 instruments.
3 (VI) Clinically based conferences in which techniques
4 of anesthetic management, quality assurance issues, and
5 current professional literature are reviewed from the
6 perspective of practice improvement.
7 (VII) Clinical experience consisting of at least 2,500
8 hours of direct patient contact, presented as a continuum of
9 courses throughout the entirety of the program, beginning with
10 a gradual introduction of the techniques for the anesthetic
11 management of patients and culminating in the assimilation of
12 the graduate of the program into the work force.
13 (VIII) Unless meeting the requirements of
14 sub-subparagraph b., successful completion of at least a
15 3-month postgraduate clinical one-on-one training program with
16 an anesthesiologist in a manner approved by the Board of
17 Medicine.
18 4. Be certified in advanced cardiac life support.
19 5. Have completed the application form and remitted an
20 application fee, not to exceed $1,000, as set by the boards.
21 An application must include:
22 a. A certificate of completion of approved training as
23 provided in subparagraph 3.
24 b. A sworn statement of any prior felony convictions.
25 c. A sworn statement of any prior discipline or denial
26 of licensure or certification in any state.
27 d. Two letters of recommendation from
28 anesthesiologists.
29 (b) A license must be renewed biennially. Each renewal
30 must include:
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Florida Senate - 2003 SB 2332
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1 1. A renewal fee, not to exceed $1,000, as set by the
2 boards.
3 2. A sworn statement of no felony convictions in the
4 immediately preceding 2 years.
5 (c) Each licensed anesthesiologist assistant must
6 biennially complete 40 hours of continuing medical education
7 or hold a current certificate issued by the National
8 Commission for Certification of Anesthesiologist Assistants or
9 its successor.
10 (d) An anesthesiologist assistant must notify the
11 department in writing within 30 days after obtaining
12 employment that requires a license under this chapter and
13 after any subsequent change in his or her supervising
14 anesthesiologist. The notification must include the full name,
15 license number, specialty, and address of the supervising
16 anesthesiologist. Submission of the required protocol
17 satisfies this requirement.
18 (e) The Board of Medicine may impose upon an
19 anesthesiologist assistant any penalty specified in s. 456.072
20 or s. 458.331(2) if the anesthesiologist assistant or the
21 supervising anesthesiologist is found guilty of or is
22 investigated for an act that constitutes a violation of this
23 chapter or chapter 456.
24 (f) The Board of Medicine and the Board of Osteopathic
25 Medicine shall appoint a task force of at least five members,
26 with one member each from the Board of Medicine, the Board of
27 Osteopathic Medicine, the Department of Health, Nova
28 Southeastern University, and one of the medical schools in
29 this state. The task force shall study the requirements of
30 this section and issue a report to the Secretary of Health by
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1 March 1, 2005, concerning the continued need for the
2 requirements of this subsection.
3 (7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
4 ADVISE THE BOARD.--
5 (a) The chair of the board may appoint an
6 anesthesiologist and an anesthesiologist assistant to advise
7 the board as to the promulgation of rules for the licensure of
8 anesthesiologist assistants. The board may utilize a committee
9 structure that is most practicable in order to receive any
10 recommendations to the board regarding rules and all matters
11 relating to anesthesiologist assistants, including, but not
12 limited to, recommendations to improve safety in the clinical
13 practices of licensed anesthesiologist assistants.
14 (b) In addition to its other duties and
15 responsibilities as prescribed by law, the board shall:
16 1. Recommend to the department the licensure of
17 anesthesiologist assistants.
18 2. Develop all rules regulating the use of
19 anesthesiologist assistants by qualified anesthesiologists
20 under this chapter and chapter 459, except for rules relating
21 to the formulary developed under s. 458.347(4)(f). The board
22 shall also develop rules to ensure that the continuity of
23 supervision is maintained in each practice setting. The boards
24 shall consider adopting a proposed rule at the regularly
25 scheduled meeting immediately following the submission of the
26 proposed rule. A proposed rule may not be adopted by either
27 board unless both boards have accepted and approved the
28 identical language contained in the proposed rule. The
29 language of all proposed rules must be approved by both boards
30 pursuant to each respective board's guidelines and standards
31 regarding the adoption of proposed rules.
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1 3. Address concerns and problems of practicing
2 anesthesiologist assistants to improve safety in the clinical
3 practices of licensed anesthesiologist assistants.
4 (c) When the board finds that an applicant for
5 licensure has failed to meet, to the board's satisfaction,
6 each of the requirements for licensure set forth in this
7 section, the board may enter an order to:
8 1. Refuse to certify the applicant for licensure;
9 2. Approve the applicant for licensure with
10 restrictions on the scope of practice or license; or
11 3. Approve the applicant for conditional licensure.
12 Such conditions may include placement of the licensee on
13 probation for a period of time and subject to such conditions
14 as the board may specify, including, but not limited to,
15 requiring the licensee to undergo treatment, to attend
16 continuing education courses, or to take corrective action.
17 (8) PENALTY.--A person who falsely holds himself or
18 herself out as an anesthesiologist assistant commits a felony
19 of the third degree, punishable as provided in s. 775.082, s.
20 775.083, or s. 775.084.
21 (9) DENIAL, SUSPENSION, OR REVOCATION OF
22 LICENSURE.--The board may deny, suspend, or revoke the license
23 of an anesthesiologist assistant who the board determines has
24 violated any provision of this section or chapter or any rule
25 adopted pursuant thereto.
26 (10) RULES.--The boards shall adopt rules to implement
27 this section.
28 (11) LIABILITY.--A supervising anesthesiologist is
29 liable for any act or omission of an anesthesiologist
30 assistant acting under the anesthesiologist's supervision and
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1 control and shall comply with the financial responsibility
2 requirements of this chapter and chapter 456, as applicable.
3 (12) FEES.--The department shall allocate the fees
4 collected under this section to the board.
5 Section 4. Paragraph (hh) of subsection (1) of section
6 459.015, Florida Statutes, is amended to read:
7 459.015 Grounds for disciplinary action; action by the
8 board and department.--
9 (1) The following acts constitute grounds for denial
10 of a license or disciplinary action, as specified in s.
11 456.072(2):
12 (hh) Failing to supervise adequately the activities of
13 those physician assistants, paramedics, emergency medical
14 technicians, advanced registered nurse practitioners,
15 anesthesiologist assistants, or other persons acting under the
16 supervision of the osteopathic physician.
17 Section 5. Section 459.023, Florida Statutes, is
18 created to read:
19 459.023 Anesthesiologist assistants.--
20 (1) DEFINITIONS.--As used in this section, the term:
21 (a) "Anesthesiologist" means an osteopathic physician
22 who holds an active, unrestricted license, who has
23 successfully completed an anesthesiology training program
24 approved by the Accreditation Council for Graduate Medical
25 Education, or its equivalent, or the American Osteopathic
26 Association, and who is certified by the American Osteopathic
27 Board of Anesthesiology or is eligible to take that board's
28 examination, is certified by the American Board of
29 Anesthesiology or is eligible to take that board's
30 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, Inc.
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 for Continuing
24 Medical Education.
25 (g) "Direct supervision" means supervision by an
26 anesthesiologist who is present in the office or the surgical
27 or obstetrical suite the anesthesiologist assistant is in and
28 is immediately available to provide assistance and direction
29 while anesthesia services are being performed.
30 (h) "Proficiency examination" means an entry-level
31 examination approved by the boards, including examinations
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1 administered by the National Commission for Certification of
2 Anesthesiologist Assistants.
3 (i) "Trainee" means a person who is currently enrolled
4 in an approved program.
5 (2) PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--
6 (a) An anesthesiologist who directly supervises an
7 anesthesiologist assistant must be qualified in the medical
8 areas in which the anesthesiologist assistant performs, and is
9 liable for the performance of the anesthesiologist assistant.
10 An anesthesiologist may only supervise two anesthesiologist
11 assistants at the same time. The board may, by rule, allow an
12 anesthesiologist to supervise up to four anesthesiologist
13 assistants, after July 1, 2006.
14 (b) An anesthesiologist or group of anesthesiologists
15 must, upon establishing a supervisory relationship with an
16 anesthesiologist assistant, file with the board a written
17 protocol that includes, at a minimum:
18 1. The name, address, and license number of the
19 anesthesiologist assistant.
20 2. The name, address, license number, and federal Drug
21 Enforcement Administration number of each physician who will
22 be supervising the anesthesiologist assistant.
23 3. The address of the anesthesiologist assistant's
24 primary practice location and the address of any other
25 locations where the anesthesiologist assistant may practice.
26 4. The date the protocol was developed and the dates
27 of all revisions.
28 5. The signatures of the anesthesiologist assistant
29 and all supervising physicians.
30 6. The duties and functions of the anesthesiologist
31 assistant.
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1 7. The conditions or procedures that require the
2 personal provision of care by an anesthesiologist.
3 8. The procedures to be followed in the event of an
4 anesthetic emergency.
5
6 The protocol must be on file with the board before the
7 anesthesiologist assistant may practice with the
8 anesthesiologist or group. An anesthesiologist assistant may
9 not practice unless a written protocol has been filed for that
10 anesthesiologist assistant in accordance with this paragraph,
11 and the anesthesiologist assistant may only practice under the
12 direct supervision of an anesthesiologist who has signed the
13 protocol. The protocol must be updated biennially.
14 (3) PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--
15 (a) An anesthesiologist assistant may assist an
16 anesthesiologist in developing and implementing an anesthesia
17 care plan for a patient. In providing assistance to an
18 anesthesiologist, an anesthesiologist assistant may perform
19 duties established by rule by the board in any of the
20 following functions that are included in the anesthesiologist
21 assistant's protocol while under the direct supervision of an
22 anesthesiologist:
23 1. Obtain a comprehensive patient history and present
24 the history to the supervising anesthesiologist.
25 2. Pretest and calibrate anesthesia delivery systems
26 and monitor, obtain, and interpret information from the
27 systems and monitors.
28 3. Assist the supervising anesthesiologist with the
29 implementation of medically accepted monitoring techniques.
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1 4. Establish basic and advanced airway interventions,
2 including intubation of the trachea and performing ventilatory
3 support.
4 5. Administer intermittent vasoactive drugs and start
5 and adjust vasoactive infusions.
6 6. Administer anesthetic drugs, adjuvant drugs, and
7 accessory drugs.
8 7. Assist the supervising anesthesiologist with the
9 performance of epidural anesthetic procedures and spinal
10 anesthetic procedures.
11 8. Administer blood, blood products, and supportive
12 fluids.
13 9. Support life functions during anesthesia health
14 care, including induction and intubation procedures, the use
15 of appropriate mechanical supportive devices, and the
16 management of fluid, electrolyte, and blood component
17 balances.
18 10. Recognize and take appropriate corrective action
19 for abnormal patient responses to anesthesia, adjunctive
20 medication, or other forms of therapy.
21 11. Participate in management of the patient while in
22 the postanesthesia recovery area, including the administration
23 of any supporting fluids or drugs.
24 12. Place special peripheral and central venous and
25 arterial lines for blood sampling and monitoring as
26 appropriate.
27 (b) Nothing in this section or chapter prevents
28 third-party payors from reimbursing employers of
29 anesthesiologist assistants for covered services rendered by
30 such anesthesiologist assistants.
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1 (c) An anesthesiologist assistant must clearly convey
2 to the patient that she or he is an anesthesiologist
3 assistant.
4 (d) An anesthesiologist assistant may perform
5 anesthesia tasks and services within the framework of a
6 written practice protocol developed between the supervising
7 anesthesiologist and the anesthesiologist assistant.
8 (e) An anesthesiologist assistant may not prescribe,
9 order, or compound any controlled substance, legend drug, or
10 medical devices, nor may an anesthesiologist assistant
11 dispense sample drugs to patients. Nothing in this paragraph
12 prohibits an anesthesiologist assistant from administering
13 legend drugs or controlled substances, intravenous drugs,
14 fluids, or blood products, or inhalation or other anesthetic
15 agents to patients while under the direct supervision of an
16 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
22 anesthesia in conjunction with the requirements of an approved
23 program, the trainee must clearly convey to the patient that
24 she or he 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 the boards by
28 rule. The boards may recommend only those anesthesiologist
29 assistant training programs that hold full accreditation or
30 provisional accreditation from the Commission on Accreditation
31 of Allied Health Education Programs.
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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 for Certification of Anesthesiologist Assistants.
10 3. Have:
11 a. Practiced as an anesthesiologist assistant in
12 another state for at least 12 months without a finding of an
13 adverse incident;
14 b. A degree or prior licensure in an allied health
15 care field, including, but not limited to, respiratory
16 therapy, occupational therapy, nursing, dental hygiene,
17 physician assistant, paramedic, emergency medical technician,
18 or midwifery;
19 c. A baccalaureate or higher degree from a program at
20 an institution of higher education accredited by an
21 organization recognized by the Board of Osteopathic Medicine
22 in one of the following areas of study:
23 (I) General biology;
24 (II) General chemistry;
25 (III) Organic chemistry;
26 (IV) Physics; or
27 (V) Another field of study which includes sufficient
28 courses in chemistry, biology, and life sciences to meet the
29 criteria for admission to a medical school accredited by an
30 organization recognized by the Board of Osteopathic Medicine;
31 or
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1 d. Unless meeting the requirements of sub-subparagraph
2 a., successfully completed a graduate-level training program
3 approved by the Board of Osteopathic Medicine and accredited
4 by the Commission on Accreditation of Allied Health Education
5 Programs or any of the commission's successor organizations
6 which is conducted for the purpose of preparing individuals to
7 practice as anesthesiologist assistants and which included at
8 minimum all of the following components:
9 (I) Basic sciences of anesthesia: physiology,
10 pathophysiology, anatomy, and biochemistry, presented as a
11 continuum of didactic courses designed to teach students the
12 foundations of human biological existence on which clinical
13 correlations to anesthesia practice are based.
14 (II) Pharmacology for the anesthetic sciences,
15 including instruction in the anesthetic principles of
16 pharmacology, pharmacodynamics, pharmacokinetics, uptake and
17 distribution, intravenous anesthetics and narcotics, and
18 volatile anesthetics.
19 (III) Physics in anesthesia.
20 (IV) Fundamentals of anesthetic sciences, presented as
21 a continuum of courses covering a series of topics in basic
22 medical sciences with special emphasis on the effects of
23 anesthetics on normal physiology and pathophysiology.
24 (V) Patient instrumentation and monitoring, presented
25 as a continuum of courses focusing on the design, proper
26 preparation, and proper methods of resolving problems that
27 arise with anesthesia equipment, and providing a balance
28 between the engineering concepts used in anesthesia
29 instruments and the clinical application of anesthesia
30 instruments.
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1 (VI) Clinically based conferences in which techniques
2 of anesthetic management, quality assurance issues, and
3 current professional literature are reviewed from the
4 perspective of practice improvement.
5 (VII) Clinical experience consisting of at least 2,500
6 hours of direct patient contact, presented as a continuum of
7 courses throughout the entirety of the program, beginning with
8 a gradual introduction of the techniques for the anesthetic
9 management of patients and culminating in the assimilation of
10 the graduate of the program into the work force.
11 (VIII) Unless meeting the requirements of
12 sub-subparagraph b., successful completion of at least a
13 3-month postgraduate clinical one-on-one training program with
14 an anesthesiologist in a manner approved by the Board of
15 Osteopathic Medicine.
16 4. Be certified in advanced cardiac life support.
17 5. Have completed the application form and remitted an
18 application fee, not to exceed $1,000, as set by the boards.
19 An application must include:
20 a. A certificate of completion of approved training as
21 provided in subparagraph 3.
22 b. A sworn statement of any prior felony convictions.
23 c. A sworn statement of any prior discipline or denial
24 of licensure or certification in any state.
25 d. Two letters of recommendation from
26 anesthesiologists.
27 (b) A license must be renewed biennially. Each renewal
28 must include:
29 1. A renewal fee, not to exceed $1,000, as set by the
30 boards.
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1 2. A sworn statement of no felony convictions in the
2 immediately preceding 2 years.
3 (c) Each licensed anesthesiologist assistant must
4 biennially complete 40 hours of continuing medical education
5 or hold a current certificate issued by the National
6 Commission for Certification of Anesthesiologist Assistants or
7 its successor.
8 (d) An anesthesiologist assistant must notify the
9 department in writing within 30 days after obtaining
10 employment that requires a license under this chapter and
11 after any subsequent change in her or his supervising
12 anesthesiologist. The notification must include the full name,
13 license number, specialty, and address of the supervising
14 anesthesiologist. Submission of the required protocol
15 satisfies this requirement.
16 (e) The Board of Osteopathic Medicine may impose upon
17 an anesthesiologist assistant any penalty specified in s.
18 456.072 or s. 459.015(2) if the anesthesiologist assistant or
19 the supervising anesthesiologist is found guilty of or is
20 investigated for an act that constitutes a violation of this
21 chapter or chapter 456.
22 (f) The Board of Medicine and the Board of Osteopathic
23 Medicine shall appoint a task force of at least five members,
24 with one member each from the Board of Medicine, the Board of
25 Osteopathic Medicine, the Department of Health, Nova
26 Southeastern University, and one of the medical schools in
27 this state. The task force shall study the requirements of
28 this section and issue a report to the Secretary of Health by
29 March 1, 2005, concerning the continued need for the
30 requirements of this subsection.
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1 (7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
2 ADVISE THE BOARD.--
3 (a) The chair of the board may appoint an
4 anesthesiologist and an anesthesiologist assistant to advise
5 the board as to the promulgation of rules for the licensure of
6 anesthesiologist assistants. The board may utilize a committee
7 structure that is most practicable in order to receive any
8 recommendations to the board regarding rules and all matters
9 relating to anesthesiologist assistants, including, but not
10 limited to, recommendations to improve safety in the clinical
11 practices of licensed anesthesiologist assistants.
12 (b) In addition to its other duties and
13 responsibilities as prescribed by law, the board shall:
14 1. Recommend to the department the licensure of
15 anesthesiologist assistants.
16 2. Develop all rules regulating the use of
17 anesthesiologist assistants by qualified anesthesiologists
18 under this chapter and chapter 458, except for rules relating
19 to the formulary developed under s. 458.347(4)(f). The board
20 shall also develop rules to ensure that the continuity of
21 supervision is maintained in each practice setting. The boards
22 shall consider adopting a proposed rule at the regularly
23 scheduled meeting immediately following the submission of the
24 proposed rule. A proposed rule may not be adopted by either
25 board unless both boards have accepted and approved the
26 identical language contained in the proposed rule. The
27 language of all proposed rules must be approved by both boards
28 pursuant to each respective board's guidelines and standards
29 regarding the adoption of proposed rules.
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1 3. Address concerns and problems of practicing
2 anesthesiologist assistants to improve safety in the clinical
3 practices of licensed anesthesiologist assistants.
4 (c) When the board finds that an applicant for
5 licensure has failed to meet, to the board's satisfaction,
6 each of the requirements for licensure set forth in this
7 section, the board may enter an order to:
8 1. Refuse to certify the applicant for licensure;
9 2. Approve the applicant for licensure with
10 restrictions on the scope of practice or license; or
11 3. Approve the applicant for conditional licensure.
12 Such conditions may include placement of the licensee on
13 probation for a period of time and subject to such conditions
14 as the board may specify, including, but not limited to,
15 requiring the licensee to undergo treatment, to attend
16 continuing education courses, or to take corrective action.
17 (8) PENALTY.--A person who falsely holds herself or
18 himself out as an anesthesiologist assistant commits a felony
19 of the third degree, punishable as provided in s. 775.082, s.
20 775.083, or s. 775.084.
21 (9) DENIAL, SUSPENSION, OR REVOCATION OF
22 LICENSURE.--The board may deny, suspend, or revoke the license
23 of an anesthesiologist assistant who the board determines has
24 violated any provision of this section or chapter or any rule
25 adopted pursuant thereto.
26 (10) RULES.--The boards shall adopt rules to implement
27 this section.
28 (11) LIABILITY.--A supervising anesthesiologist is
29 liable for any act or omission of an anesthesiologist
30 assistant acting under the anesthesiologist's supervision and
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1 control and shall comply with the financial responsibility
2 requirements of this chapter and chapter 456, as applicable.
3 (12) FEES.--The department shall allocate the fees
4 collected under this section to the board.
5 Section 6. This act shall take effect July 1, 2003.
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