S T A T E   O F   N E W   Y O R K
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                                  5446

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            February 23, 2015
                               ___________

Introduced  by  M.  of  A. SCHIMMINGER -- Multi-Sponsored by -- M. of A.
  BRENNAN, FAHY -- read once and referred to  the  Committee  on  Higher
  Education

AN  ACT  to  amend  the  education law, in relation to providing for the
  licensing of anesthesiologist assistants and regulating  the  practice
  of such professionals

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

  Section 1.   The education law is amended  by  adding  a  new  section
6529-a to read as follows:
  S   6529-A.  ANESTHESIOLOGIST  ASSISTANTS.  1.  DEFINITIONS.  FOR  THE
PURPOSES OF THIS SECTION, THE FOLLOWING TERMS SHALL HAVE  THE  FOLLOWING
MEANINGS:
  (A)  "ANESTHESIOLOGIST ASSISTANT" MEANS A PERSON WHO IS LICENSED AS AN
ANESTHESIOLOGIST ASSISTANT PURSUANT TO THIS SECTION.
  (B)  "ANESTHESIOLOGIST"  MEANS  A  PHYSICIAN  WHO   HAS   SUCCESSFULLY
COMPLETED  A  RESIDENCY IN ANESTHESIOLOGY APPROVED BY THE AMERICAN BOARD
OF MEDICINE OF ANESTHESIOLOGY  OR  THE  AMERICAN  OSTEOPATHIC  BOARD  OF
ANESTHESIOLOGY  AND WHO IS ACTIVELY AND DIRECTLY ENGAGED IN THE CLINICAL
PRACTICE OF MEDICINE AS AN ANESTHESIOLOGIST.
  (C) "ADMINISTRATION OF ANESTHESIA IN THE HOSPITAL OR AMBULATORY SURGI-
CAL CENTER" MEANS ANESTHESIA SERVICES SHALL BE DIRECTED BY  AN  ANESTHE-
SIOLOGIST  WHO  HAS RESPONSIBILITY FOR THE CLINICAL ASPECTS OR ORGANIZA-
TION AND DELIVERY OF ALL ANESTHESIA SERVICES PROVIDED BY THE HOSPITAL OR
AMBULATORY SURGICAL  CENTER.  THAT  ANESTHESIOLOGIST  SHALL  DIRECT  THE
ADMINISTRATION  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 SUPERVISION AS APPROPRIATE. FOR THE PURPOSES OF THIS
SECTION, "ADMINISTRATION OF ANESTHESIA IN OFFICE-BASED  SURGERY  VENUES"

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08341-01-5
              

A. 5446                             2

MEANS  THE ANESTHESIA COMPONENT OF THE MEDICAL OR DENTAL PROCEDURE SHALL
BE SUPERVISED BY AN  ANESTHESIOLOGIST  WHO  IS  PHYSICALLY  PRESENT  AND
AVAILABLE  TO  IMMEDIATELY DIAGNOSE AND TREAT THE PATIENT FOR ANESTHESIA
COMPLICATIONS OR EMERGENCIES.
  (D)  "DEEP  SEDATION"  MEANS  THE  ADMINISTRATION OF MEDICATION BY THE
ORAL, PARENTERAL OR INHALATION ROUTES  WHICH  RESULTS  IN  A  CONTROLLED
STATE  OF DEPRESSED CONSCIOUSNESS ACCOMPANIED BY PARTIAL LOSS OF PROTEC-
TIVE REFLEXES. THERE MAY BE AN INABILITY TO  INDEPENDENTLY  AND  CONTIN-
UOUSLY  MAINTAIN  AN  OPEN  AIRWAY AND/OR REGULAR BREATHING PATTERN WITH
DEEP SEDATION, AND THE ABILITY TO APPROPRIATELY AND  RATIONALLY  RESPOND
TO PHYSICAL STIMULI AND VERBAL COMMANDS IS LOST.
  (E)  "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.
  (F)  "HOSPITAL"  MEANS  AN  INSTITUTION OR FACILITY POSSESSING A VALID
OPERATING CERTIFICATE ISSUED PURSUANT TO  ARTICLE  TWENTY-EIGHT  OF  THE
PUBLIC HEALTH LAW.
  (G)  "AMBULATORY  SURGICAL  CENTER"  MEANS  AN INSTITUTION OR FACILITY
POSSESSING A VALID OPERATING  CERTIFICATE  ISSUED  PURSUANT  TO  ARTICLE
TWENTY-EIGHT OF THE PUBLIC HEALTH LAW.
  (H)  "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.
  (I) "MODERATE SEDATION" MEANS A DRUG-INDUCED DEPRESSION OF  CONSCIOUS-
NESS  DURING  WHICH  (I)  THE  PATIENT  RESPONDS  PURPOSEFULLY TO VERBAL
COMMANDS, EITHER ALONE OR ACCOMPANIED BY LIGHT TACTILE STIMULATION; (II)
NO INTERVENTIONS ARE REQUIRED TO MAINTAIN A PATIENT AIRWAY; (III)  SPON-
TANEOUS  VENTILATION  IS  ADEQUATE; AND (IV) THE PATENT'S CARDIOVASCULAR
FUNCTION IS USUALLY MAINTAINED WITHOUT ASSISTANCE.
  (J) "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 SATURATION, LEVEL OF
CONSCIOUSNESS, BLOOD PRESSURE AND RESPIRATION.
  (K) "OFFICE-BASED SURGERY" MEANS ANY SURGICAL OR OTHER INVASIVE PROCE-
DURE, 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,  EXCLUDING  MINOR PROCEDURES AND PROCEDURES REQUIRING
MINIMAL SEDATION.
  (L) "PATIENT" MEANS AN INDIVIDUAL WHO IS UNDER THE CARE OF A PHYSICIAN
IN A LICENSED FACILITY OR IN AN OFFICE, UNDER THE CARE OF  A  PHYSICIAN,
DENTIST, ORAL SURGEON OR PODIATRIST.
  (M)  "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.
  (N) "PHYSICALLY PRESENT" BY AN ANESTHESIOLOGIST 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
ADMINISTRATION OF THE ANESTHESIA.
  (O)  "SUPERVISION"  MEANS  THAT  AN  ANESTHESIOLOGIST SHALL DIRECT THE
ANESTHESIA SERVICES THAT THE ANESTHESIOLOGIST  ASSISTANT  IS  PERFORMING

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INCLUDING  BUT  NOT  LIMITED  TO A PRE-ANESTHETIC EXAMINATION AND EVALU-
ATION, PRESCRIBING THE ANESTHESIA, INCLUDING POST-OPERATIVE  MEDICATIONS
AS  NEEDED  FOR  PAIN AND DISCOMFORT, INCLUDING NAUSEA AND VOMITING, AND
SHALL  BE  IMMEDIATELY AVAILABLE DURING THE ENTIRE PERI-OPERATIVE PERIOD
FOR DIAGNOSIS, TREATMENT, AND MANAGEMENT OF  ANESTHESIA-RELATED  COMPLI-
CATIONS  OR  EMERGENCIES, AND ASSURE THE PROVISION OF INDICATED POST-AN-
ESTHESIA CARE.
  2. LICENSURE. FOR ISSUANCE OF A LICENSE  TO  PRACTICE  AS  A  LICENSED
ANESTHESIOLOGIST  ASSISTANT  THE  APPLICANT  SHALL FULFILL THE FOLLOWING
REQUIREMENTS:
  (A) APPLICATION: FILE AN APPLICATION WITH THE DEPARTMENT  WHICH  SHALL
BE IN SUCH FORM AS PROVIDED BY THE COMMISSIONER;
  (B) AGE: BE AT LEAST TWENTY-ONE YEARS OF AGE AND OF GOOD MORAL CHARAC-
TER;
  (C) EDUCATION:
  (I)  HAVE OBTAINED A BACHELOR'S OR HIGHER DEGREE APPROVED BY THE BOARD
OF MEDICINE;
  (II)  HAVE  SATISFACTORILY  COMPLETED  AN  ANESTHESIOLOGIST  ASSISTANT
PROGRAM  THAT IS ACCREDITED BY THE COMMISSION ON ACCREDITATION OF ALLIED
HEALTH EDUCATION PROGRAMS OR BY A PREDECESSOR OR SUCCESSOR ENTITY;
  (III) PASSED THE CERTIFYING EXAMINATION ADMINISTERED BY  AND  OBTAINED
ACTIVE  CERTIFICATION  FROM  THE NATIONAL COMMISSION ON CERTIFICATION OF
ANESTHESIOLOGIST ASSISTANTS OR A SUCCESSOR ENTITY; AND
  (IV) BIENNIALLY COMPLETE FORTY HOURS OF CONTINUING  MEDICAL  EDUCATION
OR  HOLD  A  CURRENT  CERTIFICATE  ISSUED  BY THE NATIONAL COMMISSION ON
CERTIFICATION OF ANESTHESIOLOGIST ASSISTANTS OR ITS SUCCESSOR; AND
  (D) FEES: PAY TO THE DEPARTMENT A  FEE  OF  ONE  HUNDRED  SEVENTY-FIVE
DOLLARS  FOR  INITIAL  LICENSURE AND A TRIENNIAL REGISTRATION FEE OF ONE
HUNDRED FIFTY-FIVE DOLLARS.
  3. USE OF TITLE. ONLY A PERSON LICENSED UNDER THIS SECTION  SHALL  USE
THE  TITLE  "ANESTHESIOLOGIST ASSISTANT" OR USE THE LETTERS "A.A." AFTER
HIS OR HER NAME.
  4. PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS. THE PRACTICE OF ANESTH-
ESIOLOGIST ASSISTANTS LICENSED UNDER THIS SECTION SHALL:
  (A) INCLUDE THE ADMINISTRATION OF ANESTHESIA TO  A  PATIENT  BUT  ONLY
UNDER  THE SUPERVISION OF AN  ANESTHESIOLOGIST WHO IS IMMEDIATELY AVAIL-
ABLE;
  (B) EACH ANESTHESIOLOGIST WHO AGREES TO ACT AS THE SUPERVISING ANESTH-
ESIOLOGIST OF AN ANESTHESIOLOGIST ASSISTANT SHALL ADOPT A WRITTEN  PRAC-
TICE  PROTOCOL  WHICH  DELINEATES THE SERVICES THAT THE ANESTHESIOLOGIST
ASSISTANT IS AUTHORIZED TO PROVIDE AND THE MANNER IN WHICH THE  ANESTHE-
SIOLOGIST  WILL  SUPERVISE  THE ANESTHESIOLOGIST ASSISTANT. THE ANESTHE-
SIOLOGIST SHALL BASE THE PROVISIONS OF THE PROTOCOL ON CONSIDERATION  OF
RELEVANT  QUALITY  ASSURANCE  STANDARDS, INCLUDING REGULAR REVIEW BY THE
ANESTHESIOLOGIST OF THE MEDICAL RECORDS OF THE PATIENTS OF THE  ANESTHE-
SIOLOGIST  ASSISTANT.  THE  SUPERVISING ANESTHESIOLOGIST SHALL SUPERVISE
THE ANESTHESIOLOGIST ASSISTANT IN  ACCORDANCE  WITH  THE  TERMS  OF  THE
PROTOCOL  UNDER  WHICH  THE ASSISTANT PRACTICES AND THE RULES FOR SUPER-
VISION OF ANESTHESIOLOGIST ASSISTANTS; AND
  (C) BE CONSISTENT WITH POLICIES AND PROCEDURE APPROVED BY THE  MEDICAL
STAFF  AND  GOVERNING STAFF OF THE HEALTH CARE FACILITY OR FREE STANDING
AMBULATORY SURGICAL CENTER DEFINED UNDER  ARTICLE  TWENTY-EIGHT  OF  THE
PUBLIC HEALTH LAW WHERE APPLICABLE.
  5.  AN  INDIVIDUAL  WHO  IS  DULY ENROLLED IN A PROGRAM OF EDUCATIONAL
PREPAREDNESS TO BECOME  AN  ANESTHESIOLOGIST  ASSISTANT  MAY  ADMINISTER

A. 5446                             4

ANESTHESIA  TO  A PATIENT BUT ONLY UNDER THE DIRECT PERSONAL SUPERVISION
OF AN ANESTHESIOLOGIST.
  6.  THE  COMMISSIONER  IS  AUTHORIZED AND DIRECTED TO PROMULGATE REGU-
LATIONS TO IMPLEMENT THE PROVISIONS OF THIS SECTION.
  S 2. This act shall take effect on the  first  of  the  twelfth  month
which commences after this act shall have become a law; provided, howev-
er, that effective immediately, the addition, amendment and/or repeal of
any  rule  or regulation necessary for the implementation of this act on
its effective date is authorized and directed to be made  and  completed
on or before such effective date.