S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1745
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 16, 2019
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED,  DINOWITZ, GUNTHER, ORTIZ, VANEL,
   JAFFEE, BARRON, PEOPLES-STOKES, SANTABARBARA, ZEBROWSKI -- Multi-Spon-
   sored by -- M. of A. CROUCH, ENGLEBRIGHT,  LENTOL  --  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 (Part A); and to amend the education law, in relation
   to practice agreements with nurse anesthetists; and to repeal  certain
   provisions of such law relating thereto (Part B)
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. This act enacts into law major  components  of  legislation
 relating  to  the practice of nurse anesthesia. Each component is wholly
 contained within a Part identified as Parts A through B.  The  effective
 date  for  each  particular  provision contained within such Part is set
 forth in the last section of such Part. Any  provision  in  any  section
 contained within a Part, including the effective date of the Part, which
 makes reference to a section "of this act", when used in connection with
 that  particular  component,  shall  be  deemed to mean and refer to the
 corresponding section of the Part in which it is found.   Section  three
 of this act sets forth the general effective date of this act.
 
                                  PART A
 
   Section  1.   Section 6902 of the education law is amended by adding a
 new subdivision 4 to read as follows:
   4. (A) (I) THE PRACTICE OF REGISTERED PROFESSIONAL NURSING BY A CERTI-
 FIED REGISTERED NURSE ANESTHETIST, CERTIFIED  UNDER  SECTION  SIXTY-NINE
 HUNDRED  TWELVE  OF THIS ARTICLE MAY INCLUDE THE PRACTICE OF NURSE ANES-
 THESIA. NURSE ANESTHESIA INCLUDES: THE ADMINISTRATION OF ANESTHESIA  AND
 ANESTHESIA RELATED CARE TO PATIENTS; PREANESTHETICS EVALUATION AND PREP-
 ARATION;  ANESTHETIC  INDUCTION,  MAINTENANCE  AND EMERGENCE; POST ANES-

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

                                                            LBD03584-01-9

 A. 1745                             2
 
 THESIA CARE; PERIANESTHETICS AND CLINICAL SUPPORT  FUNCTIONS;  AND  PAIN
 MANAGEMENT,  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 WRIT-
 TEN PRACTICE PROTOCOLS EXCEPT AS PERMITTED  BY  PARAGRAPH  (B)  OF  THIS
 SUBDIVISION.  THE  WRITTEN  PRACTICE  AGREEMENT  SHALL  INCLUDE EXPLICIT
 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 PRAC-
 TICE OF BOTH. TO THE EXTENT THE PRACTICE AGREEMENT DOES NOT SO  PROVIDE,
 THEN THE COLLABORATING PHYSICIAN'S TREATMENT SHALL PREVAIL.
   (II)  PRESCRIPTIONS  FOR  DRUGS,  DEVICES AND ANESTHETIC AGENTS MAY BE
 ISSUED BY A CERTIFIED REGISTERED NURSE ANESTHETIST, UNDER THIS PARAGRAPH
 AND SECTION SIXTY-NINE HUNDRED TWELVE OF  THIS  ARTICLE,  IN  ACCORDANCE
 WITH  THE  PRACTICE AGREEMENT AND PRACTICE PROTOCOLS, EXCEPT AS PROVIDED
 BY PARAGRAPH (B) OF THIS SUBDIVISION.  THE  CERTIFIED  REGISTERED  NURSE
 ANESTHETIST SHALL OBTAIN A CERTIFICATE FROM THE DEPARTMENT UPON SUCCESS-
 FULLY  COMPLETING A PROGRAM INCLUDING AN APPROPRIATE PHARMACOLOGY COMPO-
 NENT, OR ITS EQUIVALENT, AS  ESTABLISHED  BY  THE  COMMISSIONER'S  REGU-
 LATIONS,  PRIOR  TO  PRESCRIBING  UNDER  THIS PARAGRAPH. THE CERTIFICATE
 ISSUED UNDER SECTION SIXTY-NINE HUNDRED TWELVE  OF  THIS  ARTICLE  SHALL
 STATE WHETHER THE CERTIFIED REGISTERED NURSE ANESTHETIST HAS SUCCESSFUL-
 LY COMPLETED SUCH A PROGRAM OR EQUIVALENT AND IS AUTHORIZED TO PRESCRIBE
 UNDER THIS SUBDIVISION.
   (III) 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.
   (IV) 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.
   (V) 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.
   (B) NOTWITHSTANDING SUBPARAGRAPH (I) OF PARAGRAPH (A) OF THIS SUBDIVI-
 SION, A CERTIFIED REGISTERED NURSE ANESTHETIST, CERTIFIED UNDER  SECTION
 SIXTY-NINE  HUNDRED  TWELVE OF THIS ARTICLE AND PRACTICING FOR MORE THAN
 THREE THOUSAND SIX HUNDRED HOURS MAY COMPLY WITH THIS PARAGRAPH IN  LIEU
 OF  COMPLYING WITH THE REQUIREMENTS OF PARAGRAPH (A) OF THIS SUBDIVISION
 RELATING TO COLLABORATION WITH A PHYSICIAN, A WRITTEN PRACTICE AGREEMENT
 AND WRITTEN PRACTICE PROTOCOLS. A CERTIFIED REGISTERED NURSE ANESTHETIST
 COMPLYING WITH THIS PARAGRAPH  SHALL  HAVE  COLLABORATIVE  RELATIONSHIPS
 WITH  ONE  OR MORE LICENSED PHYSICIANS QUALIFIED BY LAW TO DETERMINE THE
 NEED FOR ANESTHESIA SERVICES OR A HOSPITAL, LICENSED UNDER ARTICLE TWEN-
 TY-EIGHT OF THE  PUBLIC  HEALTH  LAW,  THAT  PROVIDES  SERVICES  THROUGH
 LICENSED  PHYSICIANS  QUALIFIED  BY  LAW TO DETERMINE THE NEED FOR ANES-
 THESIA SERVICES AND HAVING PRIVILEGES AT SUCH INSTITUTION.  AS  EVIDENCE
 THAT  THE CERTIFIED REGISTERED NURSE ANESTHETIST MAINTAINS COLLABORATIVE
 RELATIONSHIPS, THE CERTIFIED REGISTERED NURSE ANESTHETIST SHALL COMPLETE
 AND MAINTAIN A FORM, CREATED BY THE DEPARTMENT, TO WHICH  THE  CERTIFIED
 REGISTERED  NURSE ANESTHETIST SHALL ATTEST, THAT DESCRIBES SUCH COLLABO-

 A. 1745                             3
 
 RATIVE RELATIONSHIPS. FOR PURPOSES  OF  THIS  PARAGRAPH,  "COLLABORATIVE
 RELATIONSHIPS"  SHALL  MEAN THAT THE CERTIFIED REGISTERED NURSE ANESTHE-
 TIST SHALL COMMUNICATE, WHETHER IN PERSON, BY TELEPHONE OR THROUGH WRIT-
 TEN (INCLUDING ELECTRONIC) MEANS, WITH A LICENSED PHYSICIAN QUALIFIED BY
 LAW  TO  DETERMINE THE NEED FOR ANESTHESIA SERVICES OR, IN THE CASE OF A
 HOSPITAL, COMMUNICATE WITH A LICENSED  PHYSICIAN  QUALIFIED  BY  LAW  TO
 DETERMINE THE NEED FOR ANESTHESIA SERVICES AND HAVING PRIVILEGES AT SUCH
 HOSPITAL,  FOR  THE  PURPOSES  OF  EXCHANGING INFORMATION, AS NEEDED, IN
 ORDER TO PROVIDE COMPREHENSIVE PATIENT CARE AND  TO  MAKE  REFERRALS  AS
 NECESSARY.  SUCH  FORM SHALL ALSO REFLECT THE CERTIFIED REGISTERED NURSE
 ANESTHETIST'S ACKNOWLEDGEMENT THAT IF REASONABLE EFFORTS TO RESOLVE  ANY
 DISPUTE  THAT MAY ARISE WITH THE COLLABORATING PHYSICIAN OR, IN THE CASE
 OF A COLLABORATION WITH A HOSPITAL, WITH A LICENSED PHYSICIAN  QUALIFIED
 BY  LAW  TO DETERMINE THE NEED FOR ANESTHESIA SERVICES AND HAVING PRIVI-
 LEGES AT SUCH HOSPITAL, ABOUT A PATIENT'S CARE ARE NOT  SUCCESSFUL,  THE
 RECOMMENDATION  OF  THE  PHYSICIAN  SHALL  PREVAIL.  SUCH  FORM SHALL BE
 UPDATED AS NEEDED AND MAY BE SUBJECT TO REVIEW BY  THE  DEPARTMENT.  THE
 CERTIFIED REGISTERED NURSE ANESTHETIST SHALL MAINTAIN DOCUMENTATION THAT
 SUPPORTS  SUCH  COLLABORATIVE  RELATIONSHIPS. FAILURE TO COMPLY WITH THE
 REQUIREMENTS OF THIS PARAGRAPH BY A CERTIFIED REGISTERED NURSE  ANESTHE-
 TIST, WHO IS NOT COMPLYING WITH SUCH PROVISIONS OF PARAGRAPH (A) OF THIS
 SUBDIVISION, SHALL SUBJECT THE CERTIFIED REGISTERED NURSE ANESTHETIST TO
 THE  PROFESSIONAL MISCONDUCT PROVISIONS SET FORTH IN ARTICLE ONE HUNDRED
 THIRTY OF THIS TITLE.
   (C) 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.
   (D) 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.
   § 2. The education law is amended by adding a new section 6912 to read
 as follows:
   § 6912. 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.

 A. 1745                             4

   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.
   §  3. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law.  Effective  immediate-
 ly,  the  addition,  amendment  and/or  repeal of any rule or regulation
 necessary for the implementation of this act on its effective  date  are
 authorized  and  directed  to  be  made  and completed on or before such
 effective date.
 
                                  PART B
 
   Section 1. Paragraph (b) of subdivision  4  of  section  6902  of  the
 education law is REPEALED.
   §  2.  Subparagraphs (i) and (ii) of paragraph (a) of subdivision 4 of
 section 6902 of the education law, as added by section 1 of  part  A  of
 this act, are amended to read as follows:
   (i)  The  practice  of  registered professional nursing by a certified
 registered nurse anesthetist, certified under section sixty-nine hundred
 twelve 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 [except as permitted by paragraph (b) of this  subdi-
 vision].   The   written   practice  agreement  shall  include  explicit

 A. 1745                             5
 
 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 prac-
 tice  of both. To the extent the practice agreement does not so provide,
 then the collaborating physician's treatment shall prevail.
   (ii) Prescriptions for drugs, devices and  anesthetic  agents  may  be
 issued by a certified registered nurse anesthetist, under this paragraph
 and  section  sixty-nine  hundred  twelve of this article, in accordance
 with the practice agreement and practice protocols[, except as  provided
 by  paragraph  (b)  of this subdivision]. The certified registered nurse
 anesthetist shall obtain a certificate from the department upon success-
 fully completing a program including an appropriate pharmacology  compo-
 nent,  or  its  equivalent,  as  established by the commissioner's regu-
 lations, prior to prescribing  under  this  paragraph.  The  certificate
 issued  under  section  sixty-nine  hundred twelve of this article shall
 state whether the certified registered nurse anesthetist has successful-
 ly completed such a program or equivalent and is authorized to prescribe
 under this subdivision.
   § 3. This act shall take effect June 30 of the  sixth  year  after  it
 shall have become a law.
   §  2. Severability clause. If any provision of this act, or any appli-
 cation of any provision of this act, is held to be invalid,  that  shall
 not  affect the validity or effectiveness of any other provision of this
 act, or of any other application of any provision of this act, which can
 be given effect without that provision or application; and to that  end,
 the provisions and applications of this act are severable.
   §  3.  This act shall take effect immediately; provided, however, that
 the applicable effective dates of Parts A through B of this act shall be
 as specifically set forth in the last section of such Parts.