S T A T E   O F   N E W   Y O R K
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                                  1727

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                             January 9, 2009
                               ___________

Introduced  by  M.  of  A.  GOTTFRIED, JACOBS, GALEF, CLARK, CANESTRARI,
  PERRY, ORTIZ -- Multi-Sponsored by -- M. of A. AUBRY,  CAHILL,  CHRIS-
  TENSEN,  COOK,  DelMONTE, DINOWITZ, GLICK, HOOPER, MAYERSOHN, McENENY,
  O'DONNELL, PAULIN, POWELL, PRETLOW, REILLY, WEISENBERG  --  read  once
  and referred to the Committee on Higher Education

AN  ACT  to  amend  the  education law, in relation to the profession of
  nurse anesthesia

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Legislative  intent.  The  legislature  hereby finds that
certified registered nurse anesthetists are highly educated and  trained
advanced practice nurses who hold a national professional certification,
and whose competency in the professional practice of nurse anesthesia in
hospitals,  free-standing  ambulatory  surgery centers, clinics, profes-
sional offices and other facilities is well  known.  Nurse  anesthetists
are  integral to the continued professional delivery of services in such
health care facilities throughout the state.
  The legislature further finds  that  statutory  recognition  of  nurse
anesthetists  will  further  enhance  patient  safety by codifying their
professional scope of practice that is currently governed in this  state
by regulations promulgated pursuant to the public health law in the case
of hospitals and ambulatory surgery centers.
  The  legislature also finds that while nurse anesthetists are advanced
practice nurses, licensed as registered professional nurses under  arti-
cle  139  of  the  education  law,  no provision of this act is meant to
limit, diminish or in any way impinge upon the practice of  the  profes-
sion of nursing as a registered professional nurse under such article.
  Therefore,  the legislature hereby declares that, due to the intrinsic
nature of the administration of anesthesia services, the  integral  part
that  certified  registered nurse anesthetists play in the safe delivery
of such services and the need to protect and enhance patient  safety  in

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00777-01-9
              

A. 1727                             2

all  health care facilities, it is in the interest of the people of this
state to recognize the national professional certification of registered
nurse anesthetists and that the existing  scope  of  practice  of  nurse
anesthesia,  as  currently practiced in this state, be codified in stat-
ute.
  S 2.  Section 6902 of the education law is amended  by  adding  a  new
subdivision 4 to read as follows:
  4.  (A) THE PRACTICE OF REGISTERED PROFESSIONAL NURSING BY A CERTIFIED
REGISTERED NURSE ANESTHETIST, CERTIFIED UNDER SECTION SIXTY-NINE HUNDRED
ELEVEN OF THIS ARTICLE MAY INCLUDE THE  PRACTICE  OF  NURSE  ANESTHESIA.
NURSE  ANESTHESIA  INCLUDES:  THE ADMINISTRATION OF ANESTHESIA AND ANES-
THESIA RELATED CARE TO PATIENTS; PREANESTHETICS EVALUATION AND  PREPARA-
TION;  ANESTHETIC  INDUCTION, MAINTENANCE AND EMERGENCE; POST ANESTHESIA
CARE; PERIANESTHETICS AND CLINICAL SUPPORT FUNCTIONS; AND  PAIN  MANAGE-
MENT,  IN  COLLABORATION  WITH  A LICENSED PHYSICIAN QUALIFIED BY LAW TO
DETERMINE THE NEED FOR ANESTHESIA SERVICES, PROVIDED SUCH  SERVICES  ARE
PERFORMED  IN  ACCORDANCE  WITH A WRITTEN PRACTICE AGREEMENT AND WRITTEN
PRACTICE PROTOCOLS. THE WRITTEN PRACTICE AGREEMENT SHALL INCLUDE EXPLIC-
IT PROVISIONS FOR THE RESOLUTION OF ANY DISAGREEMENT BETWEEN THE COLLAB-
ORATING PHYSICIAN AND THE CERTIFIED REGISTERED NURSE ANESTHETIST REGARD-
ING A MATTER OF  ANESTHESIA  TREATMENT  THAT  IS  WITHIN  THE  SCOPE  OF
PRACTICE  OF  BOTH.  TO  THE  EXTENT  THE PRACTICE AGREEMENT DOES NOT SO
PROVIDE, THEN THE COLLABORATING PHYSICIAN'S TREATMENT SHALL PREVAIL.
  (B) PRESCRIPTIONS FOR DRUGS, DEVICES  AND  ANESTHETIC  AGENTS  MAY  BE
ISSUED  BY A CERTIFIED REGISTERED NURSE ANESTHETIST, UNDER THIS SUBDIVI-
SION AND SECTION SIXTY-NINE HUNDRED ELEVEN OF THIS ARTICLE,  IN  ACCORD-
ANCE  WITH  THE PRACTICE AGREEMENT AND PRACTICE PROTOCOLS. THE CERTIFIED
REGISTERED NURSE ANESTHETIST SHALL OBTAIN A CERTIFICATE FROM THE DEPART-
MENT UPON SUCCESSFULLY COMPLETING A  PROGRAM  INCLUDING  AN  APPROPRIATE
PHARMACOLOGY COMPONENT, OR ITS EQUIVALENT, AS ESTABLISHED BY THE COMMIS-
SIONER'S  REGULATIONS,  PRIOR TO PRESCRIBING UNDER THIS SUBDIVISION. THE
CERTIFICATE ISSUED UNDER SECTION SIXTY-NINE HUNDRED ELEVEN OF THIS ARTI-
CLE SHALL STATE WHETHER THE CERTIFIED REGISTERED NURSE  ANESTHETIST  HAS
SUCCESSFULLY COMPLETED SUCH A PROGRAM OR EQUIVALENT AND IS AUTHORIZED TO
PRESCRIBE UNDER THIS SUBDIVISION.
  (C)  EACH  PRACTICE AGREEMENT SHALL PROVIDE FOR PATIENT RECORDS REVIEW
BY THE COLLABORATING PHYSICIAN IN A TIMELY FASHION BUT IN NO EVENT  LESS
OFTEN  THAN  EVERY  THREE  MONTHS. THE NAMES OF THE CERTIFIED REGISTERED
NURSE ANESTHETIST AND THE COLLABORATING PHYSICIAN SHALL BE CLEARLY POST-
ED IN THE PRACTICE SETTING OF THE CERTIFIED  REGISTERED  NURSE  ANESTHE-
TIST.
  (D)  THE  PRACTICE PROTOCOL SHALL REFLECT CURRENT ACCEPTED MEDICAL AND
NURSING PRACTICE. THE PROTOCOLS SHALL BE FILED WITH THE DEPARTMENT WITH-
IN NINETY DAYS OF THE COMMENCEMENT OF THE PRACTICE AND  MAY  BE  UPDATED
PERIODICALLY.  THE  COMMISSIONER SHALL MAKE REGULATIONS ESTABLISHING THE
PROCEDURE FOR THE REVIEW OF PROTOCOLS AND THE DISPOSITION OF ANY  ISSUES
ARISING FROM SUCH REVIEW.
  (E)  NO  PHYSICIAN SHALL ENTER INTO PRACTICE AGREEMENTS WITH MORE THAN
FOUR CERTIFIED REGISTERED NURSE ANESTHETISTS WHO ARE NOT LOCATED ON  THE
SAME PHYSICAL PREMISES AS THE COLLABORATING PHYSICIAN.
  (F)  NOTHING  IN THIS SUBDIVISION SHALL BE DEEMED TO LIMIT OR DIMINISH
THE PRACTICE OF THE PROFESSION OF NURSING AS A  REGISTERED  PROFESSIONAL
NURSE  UNDER  THIS ARTICLE OR ANY OTHER LAW, RULE, REGULATION OR CERTIF-
ICATION, NOR TO DENY ANY REGISTERED PROFESSIONAL NURSE THE RIGHT  TO  DO
ANY  ACT  OR  ENGAGE  IN  ANY PRACTICE AUTHORIZED BY THIS ARTICLE OR ANY
OTHER LAW, RULE, REGULATION OR CERTIFICATION.

A. 1727                             3

  (G) THE PROVISIONS OF THIS SUBDIVISION SHALL NOT APPLY TO ANY ACTIVITY
AUTHORIZED, PURSUANT TO STATUTE, RULE OR REGULATION, TO BE PERFORMED  BY
A  REGISTERED  PROFESSIONAL  NURSE  IN  A HOSPITAL AS DEFINED IN ARTICLE
TWENTY-EIGHT OF THE PUBLIC HEALTH LAW.
  S 3. The education law is amended by adding a new section 6911 to read
as follows:
  S 6911. CERTIFICATES FOR NURSE ANESTHESIA PRACTICE. 1. FOR ISSUANCE OF
A  CERTIFICATE  TO  PRACTICE AS A CERTIFIED REGISTERED NURSE ANESTHETIST
UNDER SUBDIVISION FOUR OF SECTION SIXTY-NINE HUNDRED TWO OF  THIS  ARTI-
CLE, THE APPLICANT SHALL FULFILL THE FOLLOWING REQUIREMENTS:
  (A) APPLICATION: FILE AN APPLICATION WITH THE DEPARTMENT;
  (B)  LICENSE:  BE  LICENSED  AS A REGISTERED PROFESSIONAL NURSE IN THE
STATE;
  (C) EDUCATION: (I) HAVE SATISFACTORILY COMPLETED EDUCATIONAL  PREPARA-
TION  FOR  PROVISION  OF  THESE  SERVICES IN A PROGRAM REGISTERED BY THE
DEPARTMENT OR IN A PROGRAM ACCREDITED BY A NATIONAL BODY  RECOGNIZED  BY
THE DEPARTMENT OR DETERMINED BY THE DEPARTMENT TO BE THE EQUIVALENT; AND
(II)  SUBMIT  EVIDENCE  OF CURRENT CERTIFICATION OR RECERTIFICATION BY A
NATIONAL CERTIFYING BODY, RECOGNIZED BY THE DEPARTMENT;
  (D) FEES: PAY A FEE TO THE DEPARTMENT OF FIFTY DOLLARS FOR AN  INITIAL
CERTIFICATE AUTHORIZING NURSE ANESTHESIA PRACTICE AND A TRIENNIAL REGIS-
TRATION FEE OF THIRTY DOLLARS.
  AFTER A CERTIFIED REGISTERED NURSE ANESTHETIST'S INITIAL REGISTRATION,
REGISTRATION  UNDER THIS SECTION SHALL BE COTERMINOUS WITH THE CERTIFIED
REGISTERED NURSE ANESTHETIST'S REGISTRATION AS A PROFESSIONAL NURSE.
  2. ONLY A PERSON CERTIFIED UNDER THIS  SECTION  SHALL  USE  THE  TITLE
"CERTIFIED REGISTERED NURSE ANESTHETIST".
  3.  THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO ANY ACT OR PRAC-
TICE AUTHORIZED BY ANY OTHER LAW, RULE, REGULATION OR CERTIFICATION.
  4. THE PROVISIONS OF THIS SECTION SHALL  NOT  APPLY  TO  ANY  ACTIVITY
AUTHORIZED,  PURSUANT TO STATUTE, RULE OR REGULATION, TO BE PERFORMED BY
A REGISTERED PROFESSIONAL NURSE IN A  HOSPITAL  AS  DEFINED  IN  ARTICLE
TWENTY-EIGHT OF THE PUBLIC HEALTH LAW.
  5.  AN  INDIVIDUAL WHO IS AUTHORIZED TO PRACTICE AS A CERTIFIED REGIS-
TERED NURSE ANESTHETIST IN A HOSPITAL UNDER REGULATIONS OF  THE  DEPART-
MENT  OF  HEALTH  MAY USE THE TITLE "CERTIFIED REGISTERED NURSE ANESTHE-
TIST" IN CONNECTION WITH THAT PRACTICE.  IF SUCH AN  INDIVIDUAL  APPLIES
FOR  A  CERTIFICATE UNDER THIS SECTION, HE OR SHE MAY SATISFY THE EDUCA-
TION REQUIREMENT OF SUBDIVISION ONE OF THIS SECTION BY PRESENTING SATIS-
FACTORY EVIDENCE OF SUCH AUTHORITY.
  6.  (A)  A  REGISTERED  PROFESSIONAL  NURSE  LICENSED  UNDER   SECTION
SIXTY-NINE HUNDRED FIVE OF THIS ARTICLE WHO HAS SATISFACTORILY COMPLETED
A  PROGRAM  OF EDUCATIONAL PREPARATION AS PROVIDED IN SUBDIVISION ONE OF
THIS SECTION MAY, FOR A PERIOD NOT TO EXCEED  TWENTY-FOUR  MONTHS  IMME-
DIATELY  FOLLOWING  THE COMPLETION OF SUCH EDUCATIONAL PROGRAM, PRACTICE
NURSE ANESTHESIA UNDER SUBDIVISION FOUR OF  SECTION  SIXTY-NINE  HUNDRED
TWO  OF  THIS ARTICLE AS A GRADUATE NURSE ANESTHETIST IN THE SAME MANNER
AS A CERTIFIED REGISTERED NURSE ANESTHETIST UNDER THAT SUBDIVISION.
  (B) A REGISTERED PROFESSIONAL NURSE LICENSED UNDER SECTION  SIXTY-NINE
HUNDRED FIVE OF THIS ARTICLE WHO IS DULY ENROLLED IN A PROGRAM OF EDUCA-
TIONAL  PREPARATION,  MAY  PRACTICE  NURSE ANESTHESIA AS A STUDENT NURSE
ANESTHETIST UNDER THE SUPERVISION OF AN ANESTHESIOLOGIST OR A  CERTIFIED
REGISTERED NURSE ANESTHETIST, WHO IS IMMEDIATELY AVAILABLE AS NEEDED.
  7.  THE COMMISSIONER IS AUTHORIZED TO PROMULGATE REGULATIONS TO IMPLE-
MENT THE PROVISIONS OF THIS SECTION.
  S 4. This act shall take effect immediately.