HB 0579

CS

CHAMBER ACTION

1	The Committee on Finance & Tax recommends the following:
2
3	Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to anesthesiologist assistants; amending
7	s. 456.048, F.S.; requiring the Board of Medicine and the
8	Board of Osteopathic Medicine to require medical
9	malpractice insurance or proof of financial responsibility
10	as a condition of licensure or licensure renewal for
11	licensed anesthesiologist assistants; correcting a cross
12	reference; amending ss. 458.331 and 459.015, F.S.;
13	revising grounds for which a physician may be disciplined
14	for failing to provide adequate supervision; providing
15	penalties; creating ss. 458.3475 and 459.023, F.S.;
16	providing definitions; providing performance standards for
17	anesthesiologist assistants and supervising
18	anesthesiologists; providing for the approval of training
19	programs and for services authorized to be performed by
20	trainees; providing licensing procedures; providing for
21	fees; providing for additional powers and duties of the
22	Board of Medicine and the Board of Osteopathic Medicine
23	and appointment of certain advisers to the boards;
24	providing penalties; providing for disciplinary actions;
25	providing for the adoption of rules; prescribing
26	liability; providing for the allocation of fees; providing
27	an effective date.
28
29	Be It Enacted by the Legislature of the State of Florida:
30
31	Section 1.  Section 456.048, Florida Statutes, is amended
32	to read:
33	456.048  Financial responsibility requirements for certain
34	health care practitioners.--
35	(1)  As a prerequisite for licensure or license renewal,
36	the Board of Acupuncture, the Board of Chiropractic Medicine,
37	the Board of Podiatric Medicine, and the Board of Dentistry
38	shall, by rule, require that all health care practitioners
39	licensed under the respective board, and the Board of Medicine
40	and the Board of Osteopathic Medicine shall, by rule, require
41	that all anesthesiologist assistants licensed pursuant to s.
42	458.3475 or s. 459.023, and the Board of Nursing shall, by rule,
43	require that advanced registered nurse practitioners certified
44	under s. 464.012, and the department shall, by rule, require
45	that midwives maintain medical malpractice insurance or provide
46	proof of financial responsibility in an amount and in a manner
47	determined by the board or department to be sufficient to cover
48	claims arising out of the rendering of or failure to render
49	professional care and services in this state.
50	(2)  The board or department may grant exemptions upon
51	application by practitioners meeting any of the following
52	criteria:
53	(a)  Any person licensed under chapter 457, s. 458.3475, s.
54	459.023, chapter 460, chapter 461, s. 464.012, chapter 466, or
55	chapter 467 who practices exclusively as an officer, employee,
56	or agent of the Federal Government or of the state or its
57	agencies or its subdivisions. For the purposes of this
58	subsection, an agent of the state, its agencies, or its
59	subdivisions is a person who is eligible for coverage under any
60	self-insurance or insurance program authorized by the provisions
61	of s. 768.28(16)(15) or who is a volunteer under s. 110.501(1).
62	(b)  Any person whose license or certification has become
63	inactive under chapter 457, s. 458.3475, s. 459.023, chapter
64	460, chapter 461, part I of chapter 464, chapter 466, or chapter
65	467 and who is not practicing in this state. Any person applying
66	for reactivation of a license must show either that such
67	licensee maintained tail insurance coverage which provided
68	liability coverage for incidents that occurred on or after
69	October 1, 1993, or the initial date of licensure in this state,
70	whichever is later, and incidents that occurred before the date
71	on which the license became inactive; or such licensee must
72	submit an affidavit stating that such licensee has no
73	unsatisfied medical malpractice judgments or settlements at the
74	time of application for reactivation.
75	(c)  Any person holding a limited license pursuant to s.
76	456.015, and practicing under the scope of such limited license.
77	(d)  Any person licensed or certified under chapter 457, s.
78	458.3475, s. 459.023, chapter 460, chapter 461, s. 464.012,
79	chapter 466, or chapter 467 who practices only in conjunction
80	with his or her teaching duties at an accredited school or in
81	its main teaching hospitals. Such person may engage in the
82	practice of medicine to the extent that such practice is
83	incidental to and a necessary part of duties in connection with
84	the teaching position in the school.
85	(e)  Any person holding an active license or certification
86	under chapter 457, s. 458.3475, s. 459.023, chapter 460, chapter
87	461, s. 464.012, chapter 466, or chapter 467 who is not
88	practicing in this state. If such person initiates or resumes
89	practice in this state, he or she must notify the department of
90	such activity.
91	(f)  Any person who can demonstrate to the board or
92	department that he or she has no malpractice exposure in the
93	state.
94	(3)  Notwithstanding the provisions of this section, the
95	financial responsibility requirements of ss. 458.320 and
96	459.0085 shall continue to apply to practitioners licensed under
97	those chapters, except for anesthesiologist assistants licensed
98	pursuant to s. 458.3475 or s. 459.023 who must meet the
99	requirements of this section.
100	Section 2.  Paragraph (dd) of subsection (1) of section
101	458.331, Florida Statutes, is amended to read:
102	458.331  Grounds for disciplinary action; action by the
103	board and department.--
104	(1)  The following acts constitute grounds for denial of a
105	license or disciplinary action, as specified in s. 456.072(2):
106	(dd)  Failing to supervise adequately the activities of
107	those physician assistants, paramedics, emergency medical
108	technicians, or advanced registered nurse practitioners, or
109	anesthesiologist assistants acting under the supervision of the
110	physician.
111	Section 3.  Section 458.3475, Florida Statutes, is created
112	to read:
113	458.3475  Anesthesiologist assistants.--
114	(1)  DEFINITIONS.--As used in this section, the term:
115	(a)  "Anesthesiologist" means an allopathic physician who
116	holds an active, unrestricted license; who has successfully
117	completed an anesthesiology training program approved by the
118	Accreditation Council for Graduate Medical Education or its
119	equivalent; and who is certified by the American Board of
120	Anesthesiology, is eligible to take that board's examination, or
121	is certified by the Board of Certification in Anesthesiology
122	affiliated with the American Association of Physician
123	Specialists, Inc.
124	(b)  "Anesthesiologist assistant" means a graduate of an
125	approved program who is licensed to perform medical services
126	delegated and directly supervised by a supervising
127	anesthesiologist.
128	(c)  "Anesthesiology" means the practice of medicine that
129	specializes in the relief of pain during and after surgical
130	procedures and childbirth, during certain chronic disease
131	processes, and during resuscitation and critical care of
132	patients in the operating room and intensive care environments.
133	(d)  "Approved program" means a program for the education
134	and training of anesthesiologist assistants which has been
135	approved by the boards as provided in subsection (5).
136	(e)  "Boards" means the Board of Medicine and the Board of
137	Osteopathic Medicine.
138	(f)  "Continuing medical education" means courses
139	recognized and approved by the boards, the American Academy of
140	Physician Assistants, the American Medical Association, the
141	American Osteopathic Association, the American Academy of
142	Anesthesiologist Assistants, the American Society of
143	Anesthesiologists, or the Accreditation Council for Continuing
144	Medical Education.
145	(g)  "Direct supervision" means the on-site, personal
146	supervision by an anesthesiologist who is present in the office
147	when the procedure is being performed in that office, or is
148	present in the surgical or obstetrical suite when the procedure
149	is being performed in that surgical or obstetrical suite, and
150	who is in all instances immediately available to provide
151	assistance and direction to the anesthesiologist assistant while
152	anesthesia services are being performed.
153	(h)  "Proficiency examination" means an entry-level
154	examination approved by the boards, including the examination
155	administered by the National Commission for Certification of
156	Anesthesiologist Assistants.
157	(i)  "Trainee" means a person who is currently enrolled in
158	an approved program.
159	(2)  PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--
160	(a)  An anesthesiologist who directly supervises an
161	anesthesiologist assistant must be qualified in the medical
162	areas in which the anesthesiologist assistant performs and is
163	liable for the performance of the anesthesiologist assistant. An
164	anesthesiologist may only supervise two anesthesiologist
165	assistants at the same time. The board may, by rule, allow an
166	anesthesiologist to supervise up to four anesthesiologist
167	assistants, after July 1, 2008.
168	(b)  An anesthesiologist or group of anesthesiologists
169	must, upon establishing a supervisory relationship with an
170	anesthesiologist assistant, file with the board a written
171	protocol that includes, at a minimum:
172	1.  The name, address, and license number of the
173	anesthesiologist assistant.
174	2.  The name, address, license number, and federal Drug
175	Enforcement Administration number of each physician who will be
176	supervising the anesthesiologist assistant.
177	3.  The address of the anesthesiologist assistant's primary
178	practice location and the address of any other locations where
179	the anesthesiologist assistant may practice.
180	4.  The date the protocol was developed and the dates of
181	all revisions.
182	5.  The signatures of the anesthesiologist assistant and
183	all supervising physicians.
184	6.  The duties and functions of the anesthesiologist
185	assistant.
186	7.  The conditions or procedures that require the personal
187	provision of care by an anesthesiologist.
188	8.  The procedures to be followed in the event of an
189	anesthetic emergency.
190
191	The protocol must be on file with the board before the
192	anesthesiologist assistant may practice with the
193	anesthesiologist or group. An anesthesiologist assistant may not
194	practice unless a written protocol has been filed for that
195	anesthesiologist assistant in accordance with this paragraph,
196	and the anesthesiologist assistant may only practice under the
197	direct supervision of an anesthesiologist who has signed the
198	protocol. The protocol must be updated biennially.
199	(3)  PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--
200	(a)  An anesthesiologist assistant may assist an
201	anesthesiologist in developing and implementing an anesthesia
202	care plan for a patient. In providing assistance to an
203	anesthesiologist, an anesthesiologist assistant may perform
204	duties established by rule by the board in any of the following
205	functions that are included in the anesthesiologist assistant's
206	protocol while under the direct supervision of an
207	anesthesiologist:
208	1.  Obtain a comprehensive patient history and present the
209	history to the supervising anesthesiologist.
210	2.  Pretest and calibrate anesthesia delivery systems and
211	monitor, obtain, and interpret information from the systems and
212	monitors.
213	3.  Assist the supervising anesthesiologist with the
214	implementation of medically accepted monitoring techniques.
215	4.  Establish basic and advanced airway interventions,
216	including intubation of the trachea and performing ventilatory
217	support.
218	5.  Administer intermittent vasoactive drugs and start and
219	adjust vasoactive infusions.
220	6.  Administer anesthetic drugs, adjuvant drugs, and
221	accessory drugs.
222	7.  Assist the supervising anesthesiologist with the
223	performance of epidural anesthetic procedures and spinal
224	anesthetic procedures.
225	8.  Administer blood, blood products, and supportive
226	fluids.
227	9.  Support life functions during anesthesia health care,
228	including induction and intubation procedures, the use of
229	appropriate mechanical supportive devices, and the management of
230	fluid, electrolyte, and blood component balances.
231	10.  Recognize and take appropriate corrective action for
232	abnormal patient responses to anesthesia, adjunctive medication,
233	or other forms of therapy.
234	11.  Participate in management of the patient while in the
235	postanesthesia recovery area, including the administration of
236	any supporting fluids or drugs.
237	12.  Place special peripheral and central venous and
238	arterial lines for blood sampling and monitoring as appropriate.
239	(b)  Nothing in this section or chapter prevents third-
240	party payors from reimbursing employers of anesthesiologist
241	assistants for covered services rendered by such
242	anesthesiologist assistants.
243	(c)  An anesthesiologist assistant must clearly convey to
244	the patient that he or she is an anesthesiologist assistant.
245	(d)  An anesthesiologist assistant may perform anesthesia
246	tasks and services within the framework of a written practice
247	protocol developed between the supervising anesthesiologist and
248	the anesthesiologist assistant.
249	(e)  An anesthesiologist assistant may not prescribe,
250	order, or compound any controlled substance, legend drug, or
251	medical device, nor may an anesthesiologist assistant dispense
252	sample drugs to patients. Nothing in this paragraph prohibits an
253	anesthesiologist assistant from administering legend drugs or
254	controlled substances; intravenous drugs, fluids, or blood
255	products; or inhalation or other anesthetic agents to patients
256	which are ordered by the supervising anesthesiologist and
257	administered while under the direct supervision of the
258	supervising anesthesiologist.
259	(4)  PERFORMANCE BY TRAINEES.--The practice of a trainee is
260	exempt from the requirements of this chapter while the trainee
261	is performing assigned tasks as a trainee in conjunction with an
262	approved program. Before providing anesthesia services,
263	including the administration of anesthesia in conjunction with
264	the requirements of an approved program, the trainee must
265	clearly convey to the patient that he or she is a trainee.
266	(5)  PROGRAM APPROVAL.--The boards shall approve programs
267	for the education and training of anesthesiologist assistants
268	which meet standards established by board rules. The boards may
269	recommend only those anesthesiologist assistant training
270	programs that hold full accreditation or provisional
271	accreditation from the Commission on Accreditation of Allied
272	Health Education Programs.
273	(6)  ANESTHESIOLOGIST ASSISTANT LICENSURE.--
274	(a)  Any person desiring to be licensed as an
275	anesthesiologist assistant must apply to the department. The
276	department shall issue a license to any person certified by the
277	board to:
278	1.  Be at least 18 years of age.
279	2.  Have satisfactorily passed a proficiency examination
280	with a score established by the National Commission for
281	Certification of Anesthesiologist Assistants.
282	3.  Be certified in advanced cardiac life support.
283	4.  Have completed the application form and remitted an
284	application fee, not to exceed $1,000, as set by the boards. An
285	application must include:
286	a.  A certificate of completion of an approved graduate-
287	level program.
288	b.  A sworn statement of any prior felony convictions.
289	c.  A sworn statement of any prior discipline or denial of
290	licensure or certification in any state.
291	d.  Two letters of recommendation from anesthesiologists.
292	(b)  A license must be renewed biennially. Each renewal
293	must include:
294	1.  A renewal fee, not to exceed $1,000, as set by the
295	boards.
296	2.  A sworn statement of no felony convictions in the
297	immediately preceding 2 years.
298	(c)  Each licensed anesthesiologist assistant must
299	biennially complete 40 hours of continuing medical education or
300	hold a current certificate issued by the National Commission for
301	Certification of Anesthesiologist Assistants or its successor.
302	(d)  An anesthesiologist assistant must notify the
303	department in writing within 30 days after obtaining employment
304	that requires a license under this chapter and after any
305	subsequent change in his or her supervising anesthesiologist.
306	The notification must include the full name, license number,
307	specialty, and address of the supervising anesthesiologist.
308	Submission of the required protocol satisfies this requirement.
309	(e)  The Board of Medicine may impose upon an
310	anesthesiologist assistant any penalty specified in s. 456.072
311	or s. 458.331(2) if the anesthesiologist assistant or the
312	supervising anesthesiologist is found guilty of or is
313	investigated for an act that constitutes a violation of this
314	chapter or chapter 456.
315	(7)  ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
316	ADVISE THE BOARD.--
317	(a)  The chair of the board may appoint an anesthesiologist
318	and an anesthesiologist assistant to advise the board as to the
319	adoption of rules for the licensure of anesthesiologist
320	assistants. The board may use a committee structure that is most
321	practicable in order to receive any recommendations to the board
322	regarding rules and all matters relating to anesthesiologist
323	assistants, including, but not limited to, recommendations to
324	improve safety in the clinical practices of licensed
325	anesthesiologist assistants.
326	(b)  In addition to its other duties and responsibilities
327	as prescribed by law, the board shall:
328	1.  Recommend to the department the licensure of
329	anesthesiologist assistants.
330	2.  Develop all rules regulating the use of
331	anesthesiologist assistants by qualified anesthesiologists under
332	this chapter and chapter 459, except for rules relating to the
333	formulary developed under s. 458.347(4)(f). The board shall also
334	develop rules to ensure that the continuity of supervision is
335	maintained in each practice setting. The boards shall consider
336	adopting a proposed rule at the regularly scheduled meeting
337	immediately following the submission of the proposed rule. A
338	proposed rule may not be adopted by either board unless both
339	boards have accepted and approved the identical language
340	contained in the proposed rule. The language of all proposed
341	rules must be approved by both boards pursuant to each
342	respective board's guidelines and standards regarding the
343	adoption of proposed rules.
344	3.  Address concerns and problems of practicing
345	anesthesiologist assistants to improve safety in the clinical
346	practices of licensed anesthesiologist assistants.
347	(c)  When the board finds that an applicant for licensure
348	has failed to meet, to the board's satisfaction, each of the
349	requirements for licensure set forth in this section, the board
350	may enter an order to:
351	1.  Refuse to certify the applicant for licensure;
352	2.  Approve the applicant for licensure with restrictions
353	on the scope of practice or license; or
354	3.  Approve the applicant for conditional licensure. Such
355	conditions may include placement of the licensee on probation
356	for a period of time and subject to such conditions as the board
357	specifies, including, but not limited to, requiring the licensee
358	to undergo treatment, to attend continuing education courses, or
359	to take corrective action.
360	(8)  PENALTY.--A person who falsely holds himself or
361	herself out as an anesthesiologist assistant commits a felony of
362	the third degree, punishable as provided in s. 775.082, s.
363	775.083, or s. 775.084.
364	(9)  DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
365	boards may deny, suspend, or revoke the license of an
366	anesthesiologist assistant who the board determines has violated
367	any provision of this section or chapter or any rule adopted
368	pursuant thereto.
369	(10)  RULES.--The boards shall adopt rules to administer
370	this section.
371	(11)  LIABILITY.--A supervising anesthesiologist is liable
372	for any act or omission of an anesthesiologist assistant acting
373	under the anesthesiologist's supervision and control and shall
374	comply with the financial responsibility requirements of this
375	chapter and chapter 456, as applicable.
376	(12)  FEES.--The department shall allocate the fees
377	collected under this section to the board.
378	Section 4.  Paragraph (hh) of subsection (1) of section
379	459.015, Florida Statutes, is amended to read:
380	459.015  Grounds for disciplinary action; action by the
381	board and department.--
382	(1)  The following acts constitute grounds for denial of a
383	license or disciplinary action, as specified in s. 456.072(2):
384	(hh)  Failing to supervise adequately the activities of
385	those physician assistants, paramedics, emergency medical
386	technicians, advanced registered nurse practitioners,
387	anesthesiologist assistants, or other persons acting under the
388	supervision of the osteopathic physician.
389	Section 5.  Section 459.023, Florida Statutes, is created
390	to read:
391	459.023  Anesthesiologist assistants.--
392	(1)  DEFINITIONS.--As used in this section, the term:
393	(a)  "Anesthesiologist" means an osteopathic physician who
394	holds an active, unrestricted license; who has successfully
395	completed an anesthesiology training program approved by the
396	Accreditation Council for Graduate Medical Education, or its
397	equivalent, or the American Osteopathic Association; and who is
398	certified by the American Osteopathic Board of Anesthesiology or
399	is eligible to take that board's examination, is certified by
400	the American Board of Anesthesiology or is eligible to take that
401	board's examination, or is certified by the Board of
402	Certification in Anesthesiology affiliated with the American
403	Association of Physician Specialists, Inc.
404	(b)  "Anesthesiologist assistant" means a graduate of an
405	approved program who is licensed to perform medical services
406	delegated and directly supervised by a supervising
407	anesthesiologist.
408	(c)  "Anesthesiology" means the practice of medicine that
409	specializes in the relief of pain during and after surgical
410	procedures and childbirth, during certain chronic disease
411	processes, and during resuscitation and critical care of
412	patients in the operating room and intensive care environments.
413	(d)  "Approved program" means a program for the education
414	and training of anesthesiologist assistants which has been
415	approved by the boards as provided in subsection (5).
416	(e)  "Boards" means the Board of Medicine and the Board of
417	Osteopathic Medicine.
418	(f)  "Continuing medical education" means courses
419	recognized and approved by the boards, the American Academy of
420	Physician Assistants, the American Medical Association, the
421	American Osteopathic Association, the American Academy of
422	Anesthesiologist Assistants, the American Society of
423	Anesthesiologists, or the Accreditation Council for Continuing
424	Medical Education.
425	(g)  "Direct supervision" means the on-site, personal
426	supervision by an anesthesiologist who is present in the office
427	when the procedure is being performed in that office, or is
428	present in the surgical or obstetrical suite when the procedure
429	is being performed in that surgical or obstetrical suite, and
430	who is in all instances immediately available to provide
431	assistance and direction to the anesthesiologist assistant while
432	anesthesia services are being performed.
433	(h)  "Proficiency examination" means an entry-level
434	examination approved by the boards, including examinations
435	administered by the National Commission for Certification of
436	Anesthesiologist Assistants.
437	(i)  "Trainee" means a person who is currently enrolled in
438	an approved program.
439	(2)  PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--
440	(a)  An anesthesiologist who directly supervises an
441	anesthesiologist assistant must be qualified in the medical
442	areas in which the anesthesiologist assistant performs and is
443	liable for the performance of the anesthesiologist assistant. An
444	anesthesiologist may only supervise two anesthesiologist
445	assistants at the same time. The board may, by rule, allow an
446	anesthesiologist to supervise up to four anesthesiologist
447	assistants, after July 1, 2008.
448	(b)  An anesthesiologist or group of anesthesiologists
449	must, upon establishing a supervisory relationship with an
450	anesthesiologist assistant, file with the board a written
451	protocol that includes, at a minimum:
452	1.  The name, address, and license number of the
453	anesthesiologist assistant.
454	2.  The name, address, license number, and federal Drug
455	Enforcement Administration number of each physician who will be
456	supervising the anesthesiologist assistant.
457	3.  The address of the anesthesiologist assistant's primary
458	practice location and the address of any other locations where
459	the anesthesiologist assistant may practice.
460	4.  The date the protocol was developed and the dates of
461	all revisions.
462	5.  The signatures of the anesthesiologist assistant and
463	all supervising physicians.
464	6.  The duties and functions of the anesthesiologist
465	assistant.
466	7.  The conditions or procedures that require the personal
467	provision of care by an anesthesiologist.
468	8.  The procedures to be followed in the event of an
469	anesthetic emergency.
470
471	The protocol must be on file with the board before the
472	anesthesiologist assistant may practice with the
473	anesthesiologist or group. An anesthesiologist assistant may not
474	practice unless a written protocol has been filed for that
475	anesthesiologist assistant in accordance with this paragraph,
476	and the anesthesiologist assistant may only practice under the
477	direct supervision of an anesthesiologist who has signed the
478	protocol. The protocol must be updated biennially.
479	(3)  PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--
480	(a)  An anesthesiologist assistant may assist an
481	anesthesiologist in developing and implementing an anesthesia
482	care plan for a patient. In providing assistance to an
483	anesthesiologist, an anesthesiologist assistant may perform
484	duties established by rule by the board in any of the following
485	functions that are included in the anesthesiologist assistant's
486	protocol while under the direct supervision of an
487	anesthesiologist:
488	1.  Obtain a comprehensive patient history and present the
489	history to the supervising anesthesiologist.
490	2.  Pretest and calibrate anesthesia delivery systems and
491	monitor, obtain, and interpret information from the systems and
492	monitors.
493	3.  Assist the supervising anesthesiologist with the
494	implementation of medically accepted monitoring techniques.
495	4.  Establish basic and advanced airway interventions,
496	including intubation of the trachea and performing ventilatory
497	support.
498	5.  Administer intermittent vasoactive drugs and start and
499	adjust vasoactive infusions.
500	6.  Administer anesthetic drugs, adjuvant drugs, and
501	accessory drugs.
502	7.  Assist the supervising anesthesiologist with the
503	performance of epidural anesthetic procedures and spinal
504	anesthetic procedures.
505	8.  Administer blood, blood products, and supportive
506	fluids.
507	9.  Support life functions during anesthesia health care,
508	including induction and intubation procedures, the use of
509	appropriate mechanical supportive devices, and the management of
510	fluid, electrolyte, and blood component balances.
511	10.  Recognize and take appropriate corrective action for
512	abnormal patient responses to anesthesia, adjunctive medication,
513	or other forms of therapy.
514	11.  Participate in management of the patient while in the
515	postanesthesia recovery area, including the administration of
516	any supporting fluids or drugs.
517	12.  Place special peripheral and central venous and
518	arterial lines for blood sampling and monitoring as appropriate.
519	(b)  Nothing in this section or chapter prevents third-
520	party payors from reimbursing employers of anesthesiologist
521	assistants for covered services rendered by such
522	anesthesiologist assistants.
523	(c)  An anesthesiologist assistant must clearly convey to
524	the patient that she or he is an anesthesiologist assistant.
525	(d)  An anesthesiologist assistant may perform anesthesia
526	tasks and services within the framework of a written practice
527	protocol developed between the supervising anesthesiologist and
528	the anesthesiologist assistant.
529	(e)  An anesthesiologist assistant may not prescribe,
530	order, or compound any controlled substance, legend drug, or
531	medical device, nor may an anesthesiologist assistant dispense
532	sample drugs to patients. Nothing in this paragraph prohibits an
533	anesthesiologist assistant from administering legend drugs or
534	controlled substances; intravenous drugs, fluids, or blood
535	products; or inhalation or other anesthetic agents to patients
536	which are ordered by the supervising anesthesiologist and
537	administered while under the direct supervision of the
538	supervising anesthesiologist.
539	(4)  PERFORMANCE BY TRAINEES.--The practice of a trainee is
540	exempt from the requirements of this chapter while the trainee
541	is performing assigned tasks as a trainee in conjunction with an
542	approved program. Before providing anesthesia services,
543	including the administration of anesthesia in conjunction with
544	the requirements of an approved program, the trainee must
545	clearly convey to the patient that she or he is a trainee.
546	(5)  PROGRAM APPROVAL.--The boards shall approve programs
547	for the education and training of anesthesiologist assistants
548	which meet standards established by board rules. The boards may
549	recommend only those anesthesiologist assistant training
550	programs that hold full accreditation or provisional
551	accreditation from the Commission on Accreditation of Allied
552	Health Education Programs.
553	(6)  ANESTHESIOLOGIST ASSISTANT LICENSURE.--
554	(a)  Any person desiring to be licensed as an
555	anesthesiologist assistant must apply to the department. The
556	department shall issue a license to any person certified by the
557	board to:
558	1.  Be at least 18 years of age.
559	2.  Have satisfactorily passed a proficiency examination
560	with a score established by the National Commission for
561	Certification of Anesthesiologist Assistants.
562	3.  Be certified in advanced cardiac life support.
563	4.  Have completed the application form and remitted an
564	application fee, not to exceed $1,000, as set by the boards. An
565	application must include:
566	a.  A certificate of completion of an approved graduate-
567	level program.
568	b.  A sworn statement of any prior felony convictions.
569	c.  A sworn statement of any prior discipline or denial of
570	licensure or certification in any state.
571	d.  Two letters of recommendation from anesthesiologists.
572	(b)  A license must be renewed biennially. Each renewal
573	must include:
574	1.  A renewal fee, not to exceed $1,000, as set by the
575	boards.
576	2.  A sworn statement of no felony convictions in the
577	immediately preceding 2 years.
578	(c)  Each licensed anesthesiologist assistant must
579	biennially complete 40 hours of continuing medical education or
580	hold a current certificate issued by the National Commission for
581	Certification of Anesthesiologist Assistants or its successor.
582	(d)  An anesthesiologist assistant must notify the
583	department in writing within 30 days after obtaining employment
584	that requires a license under this chapter and after any
585	subsequent change in her or his supervising anesthesiologist.
586	The notification must include the full name, license number,
587	specialty, and address of the supervising anesthesiologist.
588	Submission of the required protocol satisfies this requirement.
589	(e)  The Board of Osteopathic Medicine may impose upon an
590	anesthesiologist assistant any penalty specified in s. 456.072
591	or s. 459.015(2) if the anesthesiologist assistant or the
592	supervising anesthesiologist is found guilty of or is
593	investigated for an act that constitutes a violation of this
594	chapter or chapter 456.
595	(7)  ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
596	ADVISE THE BOARD.--
597	(a)  The chair of the board may appoint an anesthesiologist
598	and an anesthesiologist assistant to advise the board as to the
599	adoption of rules for the licensure of anesthesiologist
600	assistants. The board may use a committee structure that is most
601	practicable in order to receive any recommendations to the board
602	regarding rules and all matters relating to anesthesiologist
603	assistants, including, but not limited to, recommendations to
604	improve safety in the clinical practices of licensed
605	anesthesiologist assistants.
606	(b)  In addition to its other duties and responsibilities
607	as prescribed by law, the board shall:
608	1.  Recommend to the department the licensure of
609	anesthesiologist assistants.
610	2.  Develop all rules regulating the use of
611	anesthesiologist assistants by qualified anesthesiologists under
612	this chapter and chapter 458, except for rules relating to the
613	formulary developed under s. 458.347(4)(f). The board shall also
614	develop rules to ensure that the continuity of supervision is
615	maintained in each practice setting. The boards shall consider
616	adopting a proposed rule at the regularly scheduled meeting
617	immediately following the submission of the proposed rule. A
618	proposed rule may not be adopted by either board unless both
619	boards have accepted and approved the identical language
620	contained in the proposed rule. The language of all proposed
621	rules must be approved by both boards pursuant to each
622	respective board's guidelines and standards regarding the
623	adoption of proposed rules.
624	3.  Address concerns and problems of practicing
625	anesthesiologist assistants to improve safety in the clinical
626	practices of licensed anesthesiologist assistants.
627	(c)  When the board finds that an applicant for licensure
628	has failed to meet, to the board's satisfaction, each of the
629	requirements for licensure set forth in this section, the board
630	may enter an order to:
631	1.  Refuse to certify the applicant for licensure;
632	2.  Approve the applicant for licensure with restrictions
633	on the scope of practice or license; or
634	3.  Approve the applicant for conditional licensure. Such
635	conditions may include placement of the licensee on probation
636	for a period of time and subject to such conditions as the board
637	specifies, including, but not limited to, requiring the licensee
638	to undergo treatment, to attend continuing education courses, or
639	to take corrective action.
640	(8)  PENALTY.--A person who falsely holds herself or
641	himself out as an anesthesiologist assistant commits a felony of
642	the third degree, punishable as provided in s. 775.082, s.
643	775.083, or s. 775.084.
644	(9)  DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
645	boards may deny, suspend, or revoke the license of an
646	anesthesiologist assistant who the board determines has violated
647	any provision of this section or chapter or any rule adopted
648	pursuant thereto.
649	(10)  RULES.--The boards shall adopt rules to administer
650	this section.
651	(11)  LIABILITY.--A supervising anesthesiologist is liable
652	for any act or omission of an anesthesiologist assistant acting
653	under the anesthesiologist's supervision and control and shall
654	comply with the financial responsibility requirements of this
655	chapter and chapter 456, as applicable.
656	(12)  FEES.--The department shall allocate the fees
657	collected under this section to the board.
658	Section 6.  This act shall take effect July 1, 2004.

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