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

                                  4867

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                            February 8, 2011
                               ___________

Introduced  by  M.  of  A.  MORELLE,  HOYT, SCHIMMINGER, ORTIZ, GUNTHER,
  TOWNS, COOK, JACOBS, MARKEY, BRENNAN, LENTOL -- Multi-Sponsored by  --
  M.  of  A.  BING,  BOYLAND,  CYMBROWITZ, DESTITO, DINOWITZ, GABRYSZAK,
  HEASTIE, MAGEE, MAGNARELLI, McENENY, MILLMAN, MOLINARO, PRETLOW, REIL-
  LY, J. RIVERA, P. RIVERA, SCARBOROUGH, WEISENBERG, WRIGHT -- read once
  and referred to the Committee on Higher Education

AN ACT to amend the education law, in relation to  the  registration  of
  nurse anesthetists

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

  Section 1. Section 6902 of the education law is amended  by  adding  a
new subdivision 4 to read as follows:
  4.  (A)  THE  ADMINISTRATION  OF  ANESTHESIA  TO  A  PATIENT  SHALL BE
PERFORMED ONLY BY A QUALIFIED ANESTHESIA PRACTITIONER AS LEGALLY AUTHOR-
IZED UNDER THIS TITLE.
  (B) THE PRACTICE OF PROFESSIONAL NURSING BY A REGISTERED NURSE ANESTH-
ETIST, CERTIFIED UNDER SECTION SIXTY-NINE HUNDRED ELEVEN OF  THIS  ARTI-
CLE, SHALL (I) INCLUDE THE ADMINISTRATION OF ANESTHESIA TO A PATIENT BUT
ONLY  UNDER  THE  SUPERVISION  OF AN ANESTHESIOLOGIST WHO IS IMMEDIATELY
AVAILABLE; OR UNDER THE SUPERVISION OF THE OPERATING  PHYSICIAN  WHO  IS
PHYSICALLY  PRESENT; OR UNDER THE SUPERVISION OF A DENTIST, ORAL SURGEON
OR PODIATRIST WHO IS PHYSICALLY PRESENT AND WHO IS AUTHORIZED BY LAW  TO
ADMINISTER  ANESTHESIA,  TO  THE EXTENT SUCH PERSON IS QUALIFIED BY LAW,
REGULATION OR HOSPITAL APPOINTMENT TO PERFORM AND SUPERVISE THE ADMINIS-
TRATION OF ANESTHESIA; AND
  (II) INCLUDE THE EXECUTION  OF  MEDICAL  REGIMENS  PRESCRIBED  BY  THE
SUPERVISORY  PHYSICIAN,  DENTIST,  ORAL  SURGEON  OR  PODIATRIST  WHO IS
AUTHORIZED BY LAW TO PRESCRIBE; AND
  (III) BE CONSISTENT WITH  POLICIES  AND  PROCEDURES  APPROVED  BY  THE
MEDICAL  STAFF  AND  GOVERNING BODY OF THE HEALTH CARE FACILITY, OR FREE
STANDING AMBULATORY SURGICAL CENTER DEFINED UNDER  ARTICLE  TWENTY-EIGHT

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04838-02-1
              

A. 4867                             2

OF  THE  PUBLIC  HEALTH LAW, WHERE APPLICABLE, AND AS LEGALLY AUTHORIZED
UNDER THIS TITLE AND IN ACCORDANCE WITH APPLICABLE  REGULATIONS  OF  THE
COMMISSIONER OF HEALTH.
  (C) THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
  (I)  "ADMINISTRATION  OF  ANESTHESIA"  IN  THE  HOSPITAL OR AMBULATORY
SURGICAL CENTER MEANS ANESTHESIA SERVICES SHALL BE DIRECTED BY A  PHYSI-
CIAN WHO HAS RESPONSIBILITY FOR THE CLINICAL ASPECTS OF ORGANIZATION AND
DELIVERY  OF ALL ANESTHESIA SERVICES PROVIDED BY THE HOSPITAL OR AMBULA-
TORY SURGICAL CENTER. THAT PHYSICIAN OR ANOTHER INDIVIDUAL QUALIFIED  BY
EDUCATION  AND EXPERIENCE SHALL DIRECT THE ADMINISTRATIVE ASPECTS OF THE
SERVICE, AND SHALL BE  RESPONSIBLE,  IN  CONJUNCTION  WITH  THE  MEDICAL
STAFF,  FOR  RECOMMENDING  TO  THE  GOVERNING  BODY  PRIVILEGES TO THOSE
PERSONS QUALIFIED TO ADMINISTER ANESTHETICS,  INCLUDING  THE  PROCEDURES
EACH  PERSON  IS  QUALIFIED TO PERFORM AND THE LEVELS OF REQUIRED SUPER-
VISION AS APPROPRIATE. ADMINISTRATION  OF  ANESTHESIA  IN  OFFICE  BASED
SURGERY  VENUES  MEANS THE ANESTHESIA COMPONENT OF THE MEDICAL OR DENTAL
PROCEDURE SHALL BE SUPERVISED BY AN ANESTHESIOLOGIST, PHYSICIAN, DENTIST
OR PODIATRIST QUALIFIED TO SUPERVISE THE  ADMINISTRATION  OF  ANESTHESIA
WHO  IS  PHYSICALLY  PRESENT  AND  AVAILABLE TO IMMEDIATELY DIAGNOSE AND
TREAT THE PATIENT FOR ANESTHESIA COMPLICATIONS OR EMERGENCIES, AND NURSE
ANESTHETISTS WITH THE APPROPRIATE TRAINING AND EXPERIENCE MAY BE PERMIT-
TED TO ADMINISTER UNCONSCIOUS OR DEEP  SEDATION,  AND/OR  GENERAL  ANES-
THESIA, REGIONAL ANESTHESIA, AND/OR MONITOR THE PATIENT.
  (II)  "CONSCIOUS  SEDATION"  OR "SEDATION ANALGESIA" MEANS A MINIMALLY
DEPRESSED LEVEL OF CONSCIOUSNESS THAT RETAINS THE PATIENT'S  ABILITY  TO
MAINTAIN  ADEQUATE  CARDIORESPIRATORY  FUNCTION AND THE ABILITY TO INDE-
PENDENTLY AND CONTINUOUSLY MAINTAIN AN OPEN AIRWAY, A REGULAR  BREATHING
PATTERN, PROTECTIVE REFLEXES, AND RESPOND PURPOSEFULLY AND RATIONALLY TO
TACTILE  STIMULATION AND VERBAL COMMAND. THIS DOES NOT INCLUDE UNSUPPLE-
MENTED ORAL PRE-OPERATIVE MEDICATIONS OR NITROUS OXIDE ANALGESIA.
  (III) "GENERAL ANESTHESIA" MEANS THE ADMINISTRATION OF A MEDICATION BY
THE PARENTERAL OR INHALATION ROUTES WHICH RESULTS IN A CONTROLLED  STATE
OF UNCONSCIOUSNESS ACCOMPANIED BY A COMPLETE LOSS OF PROTECTIVE REFLEXES
INCLUDING LOSS OF THE ABILITY TO INDEPENDENTLY AND CONTINUOUSLY MAINTAIN
PATIENT  AIRWAY  AND  A  REGULAR  BREATHING  PATTERN.   THERE IS ALSO AN
INABILITY TO RESPOND PURPOSEFULLY  TO  VERBAL  COMMANDS  AND/OR  TACTILE
STIMULATION.
  (IV)  "IMMEDIATELY AVAILABLE" MEANS REMAINING PHYSICALLY AVAILABLE FOR
THE IMMEDIATE TREATMENT OF EMERGENCIES AND PROVIDING INDICATED  POST-OP-
ERATIVE CARE.
  (V)  "LOCAL  ANESTHESIA"  MEANS THE INTRODUCTION OF A LOCAL ANESTHETIC
AGENT INTO A LOCALIZED PART OF THE BODY BY TOPICAL APPLICATION OR  LOCAL
INFILTRATION  IN  CLOSE PROXIMITY TO A NERVE, WHICH PRODUCES A TRANSIENT
AND REVERSIBLE LOSS OF SENSATION. ALL  LOCAL  ANESTHETICS  POSSESS  BOTH
EXCITATORY  (SEIZURE)  AND  DEPRESSANT  (LOSS  OF CONSCIOUSNESS) CENTRAL
NERVOUS SYSTEM EFFECTS IN SUFFICIENT BLOOD LEVELS AND MAY HAVE  PROFOUND
CARDIOVASCULAR DEPRESSANT EFFECTS. THERE MAY ALSO BE INTERACTIVE EFFECTS
BETWEEN LOCAL ANESTHETIC AGENTS AND SEDATIVE MEDICATIONS.
  (VI)  "MONITORING"  MEANS  THE  CONTINUAL  CLINICAL  OBSERVATION  OF A
PATIENT AND THE USE OF INSTRUMENTS TO MEASURE, DISPLAY, AND  RECORD  THE
VALUES  OF  CERTAIN  PHYSIOLOGIC  VARIABLES  SUCH AS PULSE, OXYGEN SATU-
RATION, LEVEL OF CONSCIOUSNESS, BLOOD PRESSURE, AND RESPIRATION.
  (VII) "OFFICE-BASED SURGERY" MEANS  ANY  SURGICAL  OR  OTHER  INVASIVE
PROCEDURE,  REQUIRING  GENERAL  ANESTHESIA,  MODERATE  SEDATION, OR DEEP
SEDATION, AND ANY LIPOSUCTION PROCEDURE, WHERE SUCH  SURGICAL  OR  OTHER
INVASIVE  PROCEDURE  OR  LIPOSUCTION  IS  PERFORMED  BY  A LICENSEE IN A

A. 4867                             3

LOCATION OTHER THAN A HOSPITAL, AS SUCH TERM IS DEFINED IN ARTICLE TWEN-
TY-EIGHT OF THE PUBLIC HEALTH LAW, EXCLUDING MINOR PROCEDURES AND PROCE-
DURES REQUIRING MINIMAL SEDATION.
  (VIII) "PATIENT" MEANS AN INDIVIDUAL WHO IS UNDER THE CARE OF A PHYSI-
CIAN IN A LICENSED FACILITY OR, IN AN OFFICE, UNDER THE CARE OF A PHYSI-
CIAN, DENTIST, ORAL SURGEON OR PODIATRIST.
  (IX)  "PERI-OPERATIVE PERIOD" MEANS THE PERIOD OF TIME COMMENCING UPON
THE MEDICAL EVALUATION OF THE PATIENT BEFORE SURGERY AND ENDING UPON THE
PATIENT'S MEDICAL DISCHARGE FROM THE RECOVERY ROOM.
  (X) "PHYSICALLY PRESENT" BY A PHYSICIAN MEANS THE ABILITY TO REACT AND
RESPOND IN AN IMMEDIATE AND APPROPRIATE MANNER SO AS  TO  MAKE  POSSIBLE
THE  CONTINUOUS  EXERCISE  OF  MEDICAL  JUDGMENT THROUGHOUT THE ADMINIS-
TRATION OF THE ANESTHESIA.  "PHYSICALLY  PRESENT"  BY  A  DENTIST,  ORAL
SURGEON OR PODIATRIST MEANS THE ABILITY OF SUCH PERSON WHO IS PERFORMING
THE  PROCEDURE  REQUIRING  THE ADMINISTRATION OF ANESTHESIA TO REACT AND
RESPOND IN AN IMMEDIATE AND APPROPRIATE MANNER SO AS  TO  MAKE  POSSIBLE
THE CONTINUOUS EXERCISE OF PROFESSIONAL JUDGMENT THROUGHOUT THE ADMINIS-
TRATION OF THE ANESTHESIA.
  (XI)  "QUALIFIED  ANESTHESIA PRACTITIONER" MEANS A PHYSICIAN, DENTIST,
PODIATRIST OR CERTIFIED REGISTERED NURSE ANESTHETIST WHOSE  PROFESSIONAL
PRACTICE IS SUBJECT TO THE DEPARTMENT OF HEALTH FOR PROFESSIONAL MEDICAL
OR  PROFESSIONAL  CONDUCT  OR  THE  STATE EDUCATION DEPARTMENT OFFICE OF
PROFESSIONAL DISCIPLINE.
  (XII) "REGIONAL ANESTHESIA" MEANS THE ADMINISTRATION  OF  LOCAL  ANES-
THESIA AGENTS TO INTERRUPT NERVE IMPULSES IN A MAJOR REGION OF THE BODY.
INCLUDED  IN  THIS  CATEGORY, FOR EXAMPLE, ARE SPINAL, EPIDURAL, CAUDAL,
UPPER OR  LOWER  EXTREMITY  PLEXUS  BLOCK  ANESTHESIA,  AND  INTRAVENOUS
REGIONAL ANESTHESIA.
  (XIII)  "SUPERVISION" MEANS THAT A PHYSICIAN, DENTIST, ORAL SURGEON OR
PODIATRIST SHALL PERFORM A PRE-ANESTHETIC  EXAMINATION  AND  EVALUATION,
PRESCRIBE THE ANESTHESIA, INCLUDING POST-OPERATIVE MEDICATIONS AS NEEDED
FOR  PAIN  AND  DISCOMFORT,  INCLUDING NAUSEA AND VOMITING, REMAIN PHYS-
ICALLY PRESENT DURING THE ENTIRE PERI-OPERATIVE PERIOD  AND  IMMEDIATELY
AVAILABLE FOR DIAGNOSIS, TREATMENT, AND MANAGEMENT OF ANESTHESIA-RELATED
COMPLICATIONS  OR  EMERGENCIES,  AND  ASSURE  THE PROVISION OF INDICATED
POST-ANESTHESIA CARE.
  (XIV) "SUPPLEMENTED LOCAL ANESTHESIA" MEANS THE  USE  OF  LOCAL  ANES-
THESIA SUPPLEMENTED WITH CONSCIOUS SEDATION.
  (XV)  "UNCONSCIOUS OR DEEP SEDATION" MEANS THE ADMINISTRATION OF MEDI-
CATION BY THE ORAL, PARENTERAL, OR INHALATION ROUTES WHICH RESULTS IN  A
CONTROLLED  STATE OF DEPRESSED CONSCIOUSNESS ACCOMPANIED BY PARTIAL LOSS
OF PROTECTIVE REFLEXES. THERE MAY BE AN INABILITY TO  INDEPENDENTLY  AND
CONTINUOUSLY  MAINTAIN  AN  OPEN AIRWAY AND/OR REGULAR BREATHING PATTERN
WITH UNCONSCIOUS OR DEEP SEDATION, AND THE ABILITY TO APPROPRIATELY  AND
RATIONALLY RESPOND TO PHYSICAL STIMULI AND VERBAL COMMANDS IS LOST.
  (XVI)  "UNSUPPLEMENTED  LOCAL ANESTHESIA" MEANS THE USE OF LOCAL ANES-
THESIA WITHOUT SUPPLEMENTING WITH CONSCIOUS SEDATION.
  (D) THE PROVISIONS OF THIS SECTION SHALL NOT  OPERATE  TO  MODIFY  THE
SCOPE OF PRACTICE OF CERTIFIED REGISTERED NURSE ANESTHETISTS PURSUANT TO
STATUTE  OR THE RULES AND REGULATIONS OF THE COMMISSIONER OF HEALTH IN A
HOSPITAL OR IN A FREE-STANDING AMBULATORY SURGERY CENTER AS  DEFINED  IN
ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW.
  S 2. The education law is amended by adding a new section 6911 to read
as follows:
  S  6911.  CERTIFICATION  OF  NURSE  ANESTHETISTS. 1. FOR ISSUANCE OF A
CERTIFICATE TO PRACTICE AS  A  CERTIFIED  REGISTERED  NURSE  ANESTHETIST

A. 4867                             4

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. SUCH APPLI-
CATION SHALL BE IN SUCH FORM AS PROVIDED BY THE COMMISSIONER;
  (B) LICENSE: BE LICENSED AS A REGISTERED PROFESSIONAL  NURSE  IN  THIS
STATE;
  (C)  EDUCATION:  (I) HAVE SATISFACTORILY COMPLETED A PRESCRIBED COURSE
OF STUDY IN A SCHOOL OF NURSE ANESTHESIA ACCREDITED BY  THE  COUNCIL  ON
ACCREDITATION OF NURSE ANESTHESIA EDUCATION PROGRAMS OR SCHOOLS OR OTHER
ACCREDITING BODY WHICH THE COMMISSIONER FINDS TO BE SUBSTANTIALLY EQUIV-
ALENT; AND
  (II)  HAVE  PASSED  THE  NATIONAL  CERTIFYING EXAMINATION GIVEN BY THE
COUNCIL ON CERTIFICATION OF NURSE ANESTHETISTS OR OTHER CERTIFYING EXAM-
INATION WHICH THE COMMISSIONER FINDS TO BE SUBSTANTIALLY EQUIVALENT; AND
  (III) IS CURRENTLY CERTIFIED BY THE COUNCIL ON CERTIFICATION OF  NURSE
ANESTHETISTS  OR BY THE COUNCIL ON RECERTIFICATION OF NURSE ANESTHETISTS
OR OTHER ACCREDITING BODY WHICH THE COMMISSIONER FINDS  TO  BE  SUBSTAN-
TIALLY EQUIVALENT. A REGISTERED PROFESSIONAL NURSE LICENSED AND CURRENT-
LY  REGISTERED WITH THE DEPARTMENT WHO DOES NOT MEET THE REQUIREMENTS AS
SET FORTH IN THIS PARAGRAPH, SHALL BE PERMITTED TO CONTINUE THE PRACTICE
OF NURSE ANESTHESIA ONLY UNDER THE SUPERVISION OF A  QUALIFIED  ANESTHE-
SIOLOGIST  UNTIL  ONE  YEAR  AFTER  THE  EFFECTIVE DATE OF THIS SECTION.
NOTWITHSTANDING ANYTHING TO THE CONTRARY IN  THIS  SECTION,  A  GRADUATE
NURSE  ANESTHETIST AWAITING CERTIFICATION SHALL BE PERMITTED TO ADMINIS-
TER ANESTHESIA ONLY  IN  THE  HOSPITAL  OR  AMBULATORY  SURGICAL  CENTER
SETTING AS PROVIDED IN THIS SECTION;
  (D)  FEES:  PAY  TO  THE DEPARTMENT A FEE OF FIFTY DOLLARS FOR INITIAL
CERTIFICATION AND A TRIENNIAL REGISTRATION FEE OF THIRTY DOLLARS.  AFTER
A  CERTIFIED REGISTERED NURSE ANESTHETIST'S INITIAL REGISTRATION, REGIS-
TRATION 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
"NURSE ANESTHETIST" OR "CERTIFIED REGISTERED NURSE ANESTHETIST".
  3. A REGISTERED PROFESSIONAL NURSE  DULY  ENROLLED  IN  A  PROGRAM  OF
EDUCATIONAL PREPARATION UNDER SUBDIVISION ONE OF THIS SECTION MAY ADMIN-
ISTER  ANESTHESIA  AS  A  STUDENT  NURSE  ANESTHETIST  UNDER  THE DIRECT
PERSONAL SUPERVISION OF A CERTIFIED REGISTERED NURSE ANESTHETIST WHO  IS
SUPERVISED  BY AN ANESTHESIOLOGIST OR AN ANESTHESIOLOGIST. THE CERTIFIED
REGISTERED NURSE ANESTHETIST OR ANESTHESIOLOGIST SHALL  BE  CONTINUOUSLY
PRESENT.
  4.  THE  COMMISSIONER  MAY  PROMULGATE  REGULATIONS  TO IMPLEMENT THIS
SECTION.
  S 3. Notwithstanding any other provision of law  to  the  contrary,  a
registered  professional nurse certified as a certified registered nurse
anesthetist on, before or within one year after the  effective  date  of
sections  one  and two of this act may administer anesthesia as a certi-
fied registered nurse anesthetist, and shall be deemed to  be  certified
as  a  certified  registered nurse anesthetist under section 6911 of the
education law as added by section two of this act, until one year  after
the  effective  date  of sections one and two of this act; provided that
certification under such section shall be by a national certifying  body
that has been certifying registered nurse anesthetists for at least five
years prior to such section becoming a law.
  S  4. This act shall take effect immediately, except that sections one
and two of this act shall  take  effect  on  the  first  of  April  next
succeeding the date on which it shall have become a law.