S T A T E   O F   N E W   Y O R K
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                                  4572

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                             April 11, 2013
                               ___________

Introduced  by  Sen.  DeFRANCISCO -- read twice and ordered printed, and
  when printed to be committed 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
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:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06605-02-3
              

S. 4572                             2

  (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 IN PHYSICAL PROXIMITY  SO
AS  TO  ALLOW  THE  ANESTHESIOLOGIST  TO  RETURN  TO RE-ESTABLISH DIRECT
CONTACT WITH THE PATIENT IN ORDER TO MEET THE  PATIENT'S  MEDICAL  NEEDS
AND ADDRESS ANY URGENT OR EMERGENT CLINICAL PROBLEMS.
  (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
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.

S. 4572                             3

  (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
UNDER  SUBDIVISION  FOUR OF SECTION SIXTY-NINE HUNDRED TWO OF THIS ARTI-
CLE, THE APPLICANT SHALL FULFILL THE FOLLOWING REQUIREMENTS:

S. 4572                             4

  (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.