HB 1381 2003
1	A bill to be entitled
2	An act relating to anesthesiologist assistants; amending
3	s. 456.048, F.S.; requiring anesthesiologist assistants to
4	maintain medical malpractice insurance or provide proof of
5	financial responsibility as a condition of licensure or
6	licensure renewal; amending ss. 458.331 and 459.015, F.S.;
7	revising grounds for which a physician may be disciplined
8	for failing to provide adequate supervision; providing
9	penalties; creating ss. 458.3475 and 459.023, F.S.;
10	providing definitions; providing performance standards for
11	anesthesiologist assistants and supervising
12	anesthesiologists; providing for the approval of training
13	programs and for services authorized to be performed by
14	trainees; providing licensing procedures; providing for
15	fees; providing for a task force to study the continued
16	need for licensure and requiring a report; providing for
17	additional membership, powers, and duties of the Board of
18	Medicine and the Board of Osteopathic Medicine; providing
19	penalties; providing for disciplinary actions; providing
20	for the adoption of rules; prescribing liability;
21	providing for the allocation of fees; providing an
22	effective date.
23
24	Be It Enacted by the Legislature of the State of Florida:
25
26	Section 1. Section 456.048, Florida Statutes, is amended
27	to read:
28	456.048 Financial responsibility requirements for certain
29	health care practitioners.--
30	(1) As a prerequisite for licensure or license renewal,
31	the Board of Acupuncture, the Board of Chiropractic Medicine,
32	the Board of Podiatric Medicine, and the Board of Dentistry
33	shall, by rule, require that all health care practitioners
34	licensed under the respective board, and the Board of Medicine
35	and the Board of Osteopathic Medicine shall, by rule, require
36	that all anesthesiologist assistants licensed pursuant to s.
37	458.3475 or s. 459.023,and the Board of Nursing shall, by rule,
38	require that advanced registered nurse practitioners certified
39	under s. 464.012, and the department shall, by rule, require
40	that midwives maintain medical malpractice insurance or provide
41	proof of financial responsibility in an amount and in a manner
42	determined by the board or department to be sufficient to cover
43	claims arising out of the rendering of or failure to render
44	professional care and services in this state.
45	(2) The board or department may grant exemptions upon
46	application by practitioners meeting any of the following
47	criteria:
48	(a) Any person licensed under chapter 457, s. 458.3475, s.
49	459.023,chapter 460, chapter 461, s. 464.012, chapter 466, or
50	chapter 467 who practices exclusively as an officer, employee,
51	or agent of the Federal Government or of the state or its
52	agencies or its subdivisions. For the purposes of this
53	subsection, an agent of the state, its agencies, or its
54	subdivisions is a person who is eligible for coverage under any
55	self-insurance or insurance program authorized by the provisions
56	of s. 768.28(15) or who is a volunteer under s. 110.501(1).
57	(b) Any person whose license or certification has become
58	inactive under chapter 457, s. 458.3475, s. 459.023,chapter
59	460, chapter 461, part I of chapter 464, chapter 466, or chapter
60	467 and who is not practicing in this state. Any person applying
61	for reactivation of a license must show either that such
62	licensee maintained tail insurance coverage which provided
63	liability coverage for incidents that occurred on or after
64	October 1, 1993, or the initial date of licensure in this state,
65	whichever is later, and incidents that occurred before the date
66	on which the license became inactive; or such licensee must
67	submit an affidavit stating that such licensee has no
68	unsatisfied medical malpractice judgments or settlements at the
69	time of application for reactivation.
70	(c) Any person holding a limited license pursuant to s.
71	456.015, and practicing under the scope of such limited license.
72	(d) Any person licensed or certified under chapter 457, s.
73	458.3475, s. 459.023,chapter 460, chapter 461, s. 464.012,
74	chapter 466, or chapter 467 who practices only in conjunction
75	with his or her teaching duties at an accredited school or in
76	its main teaching hospitals. Such person may engage in the
77	practice of medicine to the extent that such practice is
78	incidental to and a necessary part of duties in connection with
79	the teaching position in the school.
80	(e) Any person holding an active license or certification
81	under chapter 457, s. 458.3475, s. 459.023,chapter 460, chapter
82	461, s. 464.012, chapter 466, or chapter 467 who is not
83	practicing in this state. If such person initiates or resumes
84	practice in this state, he or she must notify the department of
85	such activity.
86	(f) Any person who can demonstrate to the board or
87	department that he or she has no malpractice exposure in the
88	state.
89	(3) Notwithstanding the provisions of this section, the
90	financial responsibility requirements of ss. 458.320 and
91	459.0085 shall continue to apply to practitioners licensed under
92	those chapters, except for anesthesiologist assistants licensed
93	pursuant to s. 458.3475 or s. 459.023 who must meet the
94	requirements of this section.
95	Section 2. Paragraph (dd) of subsection (1) of section
96	458.331, Florida Statutes, is amended to read:
97	458.331 Grounds for disciplinary action; action by the
98	board and department.--
99	(1) The following acts constitute grounds for denial of a
100	license or disciplinary action, as specified in s. 456.072(2):
101	(dd) Failing to supervise adequately the activities of
102	those physician assistants, paramedics, emergency medical
103	technicians, or advanced registered nurse practitioners, or
104	anesthesiologist assistantsacting under the supervision of the
105	physician.
106	Section 3. Section 458.3475, Florida Statutes, is created
107	to read:
108	458.3475 Anesthesiologist assistants.--
109	(1) DEFINITIONS.--As used in this section, the term:
110	(a) "Anesthesiologist" means an allopathic physician who
111	holds an active, unrestricted license, who has successfully
112	completed an anesthesiology training program approved by the
113	Accreditation Council for Graduate Medical Education, or its
114	equivalent, and who is certified by the American Board of
115	Anesthesiology or is eligible to take that board's examination
116	or is certified by the Board of Certification in Anesthesiology
117	affiliated with the American Association of Physician
118	Specialists, Inc.
119	(b) "Anesthesiologist assistant" means a graduate of an
120	approved program who is licensed to perform medical services
121	delegated and directly supervised by a supervising
122	anesthesiologist.
123	(c) "Anesthesiology" means the practice of medicine that
124	specializes in the relief of pain during and after surgical
125	procedures and childbirth, during certain chronic disease
126	processes, and during resuscitation and critical care of
127	patients in the operating room and intensive care environments.
128	(d) "Approved program" means a program for the education
129	and training of anesthesiologist assistants that has been
130	approved by the boards as provided in subsection (5).
131	(e) "Boards" means the Board of Medicine and the Board of
132	Osteopathic Medicine.
133	(f) "Continuing medical education" means courses
134	recognized and approved by the boards, the American Academy of
135	Physician Assistants, the American Medical Association, the
136	American Osteopathic Association, the American Academy of
137	Anesthesiologist Assistants, the American Society of
138	Anesthesiologists, or the Accreditation Council for Continuing
139	Medical Education.
140	(g) "Direct supervision" means supervision by an
141	anesthesiologist who is present in the office or the surgical or
142	obstetrical suite the anesthesiologist assistant is in and is
143	immediately available to provide assistance and direction while
144	anesthesia services are being performed.
145	(h) "Proficiency examination" means an entry-level
146	examination approved by the boards, including examinations
147	administered by the National Commission for Certification of
148	Anesthesiologist Assistants.
149	(i) "Trainee" means a person who is currently enrolled in
150	an approved program.
151	(2) PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--
152	(a) An anesthesiologist who directly supervises an
153	anesthesiologist assistant must be qualified in the medical
154	areas in which the anesthesiologist assistant performs and is
155	liable for the performance of the anesthesiologist assistant. An
156	anesthesiologist may only supervise two anesthesiologist
157	assistants at the same time. The board may, by rule, allow an
158	anesthesiologist to supervise up to four anesthesiologist
159	assistants, after July 1, 2006.
160	(b) An anesthesiologist or group of anesthesiologists
161	must, upon establishing a supervisory relationship with an
162	anesthesiologist assistant, file with the board a written
163	protocol that includes, at a minimum:
164	1. The name, address, and license number of the
165	anesthesiologist assistant.
166	2. The name, address, license number, and federal Drug
167	Enforcement Administration number of each physician who will be
168	supervising the anesthesiologist assistant.
169	3. The address of the anesthesiologist assistant's primary
170	practice location and the address of any other locations where
171	the anesthesiologist assistant may practice.
172	4. The date the protocol was developed and the dates of
173	all revisions.
174	5. The signatures of the anesthesiologist assistant and
175	all supervising physicians.
176	6. The duties and functions of the anesthesiologist
177	assistant.
178	7. The conditions or procedures that require the personal
179	provision of care by an anesthesiologist.
180	8. The procedures to be followed in the event of an
181	anesthetic emergency.
182
183	The protocol must be on file with the board before the
184	anesthesiologist assistant may practice with the
185	anesthesiologist or group. An anesthesiologist assistant may not
186	practice unless a written protocol has been filed for that
187	anesthesiologist assistant in accordance with this paragraph,
188	and the anesthesiologist assistant may only practice under the
189	direct supervision of an anesthesiologist who has signed the
190	protocol. The protocol must be updated biennially.
191	(3) PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--
192	(a) An anesthesiologist assistant may assist an
193	anesthesiologist in developing and implementing an anesthesia
194	care plan for a patient. In providing assistance to an
195	anesthesiologist, an anesthesiologist assistant may perform
196	duties established by rule by the board in any of the following
197	functions that are included in the anesthesiologist assistant's
198	protocol while under the direct supervision of an
199	anesthesiologist:
200	1. Obtain a comprehensive patient history and present the
201	history to the supervising anesthesiologist.
202	2. Pretest and calibrate anesthesia delivery systems and
203	monitor, obtain, and interpret information from the systems and
204	monitors.
205	3. Assist the supervising anesthesiologist with the
206	implementation of medically accepted monitoring techniques.
207	4. Establish basic and advanced airway interventions,
208	including intubation of the trachea and performing ventilatory
209	support.
210	5. Administer intermittent vasoactive drugs and start and
211	adjust vasoactive infusions.
212	6. Administer anesthetic drugs, adjuvant drugs, and
213	accessory drugs.
214	7. Assist the supervising anesthesiologist with the
215	performance of epidural anesthetic procedures and spinal
216	anesthetic procedures.
217	8. Administer blood, blood products, and supportive
218	fluids.
219	9. Support life functions during anesthesia health care,
220	including induction and intubation procedures, the use of
221	appropriate mechanical supportive devices, and the management of
222	fluid, electrolyte, and blood component balances.
223	10. Recognize and take appropriate corrective action for
224	abnormal patient responses to anesthesia, adjunctive medication,
225	or other forms of therapy.
226	11. Participate in management of the patient while in the
227	postanesthesia recovery area, including the administration of
228	any supporting fluids or drugs.
229	12. Place special peripheral and central venous and
230	arterial lines for blood sampling and monitoring as appropriate.
231	(b) Nothing in this section or chapter prevents third-
232	party payors from reimbursing employers of anesthesiologist
233	assistants for covered services rendered by such
234	anesthesiologist assistants.
235	(c) An anesthesiologist assistant must clearly convey to
236	the patient that he or she is an anesthesiologist assistant.
237	(d) An anesthesiologist assistant may perform anesthesia
238	tasks and services within the framework of a written practice
239	protocol developed between the supervising anesthesiologist and
240	the anesthesiologist assistant.
241	(e) An anesthesiologist assistant may not prescribe,
242	order, or compound any controlled substance, legend drug, or
243	medical device, nor may an anesthesiologist assistant dispense
244	sample drugs to patients. Nothing in this paragraph prohibits an
245	anesthesiologist assistant from administering legend drugs or
246	controlled substances, intravenous drugs, fluids, or blood
247	products, or inhalation or other anesthetic agents to patients
248	that are ordered by the supervising anesthesiologist, and
249	administered while under the direct supervision of the
250	supervising anesthesiologist.
251	(4) PERFORMANCE BY TRAINEES.--The practice of a trainee is
252	exempt from the requirements of this chapter while the trainee
253	is performing assigned tasks as a trainee in conjunction with an
254	approved program. Before providing anesthesia services,
255	including the administration of anesthesia in conjunction with
256	the requirements of an approved program, the trainee must
257	clearly convey to the patient that he or she is a trainee.
258	(5) PROGRAM APPROVAL.--The boards shall approve programs
259	for the education and training of anesthesiologist assistants
260	which meet standards established by the boards by rule. The
261	boards may recommend only those anesthesiologist assistant
262	training programs that hold full accreditation or provisional
263	accreditation from the Commission on Accreditation of Allied
264	Health Education Programs.
265	(6) ANESTHESIOLOGIST ASSISTANT LICENSURE.--
266	(a) Any person desiring to be licensed as an
267	anesthesiologist assistant must apply to the department. The
268	department shall issue a license to any person certified by the
269	board to:
270	1. Be at least 18 years of age.
271	2. Have satisfactorily passed a proficiency examination
272	with a score established by the National Commission for
273	Certification of Anesthesiologist Assistants.
274	3. Have:
275	a. Practiced as an anesthesiologist assistant in another
276	state for at least 12 months without a finding of an adverse
277	incident;
278	b. A degree or prior licensure in an allied health care
279	field, including, but not limited to, respiratory therapy,
280	occupational therapy, nursing, dental hygiene, physician
281	assistant, paramedic, emergency medical technician, or
282	midwifery;
283	c. A baccalaureate or higher degree from a program at an
284	institution of higher education accredited by an organization
285	recognized by the Board of Medicine in one of the following
286	areas of study:
287	(I) General biology;
288	(II) General chemistry;
289	(III) Organic chemistry;
290	(IV) Physics; or
291	(V) Another field of study which includes sufficient
292	courses in chemistry, biology, and life sciences to meet the
293	criteria for admission to a medical school accredited by an
294	organization recognized by the Board of Medicine; or
295	d. Unless meeting the requirements of sub-subparagraph a.,
296	successfully completed a graduate-level training program
297	approved by the Board of Medicine and accredited by the
298	Commission on Accreditation of Allied Health Education Programs
299	or any of the commission's successor organizations which is
300	conducted for the purpose of preparing individuals to practice
301	as anesthesiologist assistants and which included at minimum all
302	of the following components:
303	(I) Basic sciences of anesthesia: physiology,
304	pathophysiology, anatomy, and biochemistry, presented as a
305	continuum of didactic courses designed to teach students the
306	foundations of human biological existence on which clinical
307	correlations to anesthesia practice are based.
308	(II) Pharmacology for the anesthetic sciences, including
309	instruction in the anesthetic principles of pharmacology,
310	pharmacodynamics, pharmacokinetics, uptake and distribution,
311	intravenous anesthetics and narcotics, and volatile anesthetics.
312	(III) Physics in anesthesia.
313	(IV) Fundamentals of anesthetic sciences, presented as a
314	continuum of courses covering a series of topics in basic
315	medical sciences with special emphasis on the effects of
316	anesthetics on normal physiology and pathophysiology.
317	(V) Patient instrumentation and monitoring, presented as a
318	continuum of courses focusing on the design, proper preparation,
319	and proper methods of resolving problems that arise with
320	anesthesia equipment, and providing a balance between the
321	engineering concepts used in anesthesia instruments and the
322	clinical application of anesthesia instruments.
323	(VI) Clinically based conferences in which techniques of
324	anesthetic management, quality assurance issues, and current
325	professional literature are reviewed from the perspective of
326	practice improvement.
327	(VII) Clinical experience consisting of at least 2,500
328	hours of direct patient contact, presented as a continuum of
329	courses throughout the entirety of the program, beginning with a
330	gradual introduction of the techniques for the anesthetic
331	management of patients and culminating in the assimilation of
332	the graduate of the program into the work force.
333	(IX) Unless meeting the requirements of sub-subparagraph
334	b., successful completion of at least a 3-month postgraduate
335	clinical one-on-one training program with an anesthesiologist in
336	a manner approved by the Board of Medicine.
337	4. Be certified in advanced cardiac life support.
338	5. Have completed the application form and remitted an
339	application fee, not to exceed $1,000, as set by the boards. An
340	application must include:
341	a. A certificate of completion of approved training as
342	provided in subparagraph 3.
343	b. A sworn statement of any prior felony convictions.
344	c. A sworn statement of any prior discipline or denial of
345	licensure or certification in any state.
346	d. Two letters of recommendation from anesthesiologists.
347	(b) A license must be renewed biennially. Each renewal
348	must include:
349	1. A renewal fee, not to exceed $1,000, as set by the
350	boards.
351	2. A sworn statement of no felony convictions in the
352	immediately preceding 2 years.
353	(c) Each licensed anesthesiologist assistant must
354	biennially complete 40 hours of continuing medical education or
355	hold a current certificate issued by the National Commission for
356	Certification of Anesthesiologist Assistants or its successor.
357	(d) An anesthesiologist assistant must notify the
358	department in writing within 30 days after obtaining employment
359	that requires a license under this chapter and after any
360	subsequent change in his or her supervising anesthesiologist.
361	The notification must include the full name, license number,
362	specialty, and address of the supervising anesthesiologist.
363	Submission of the required protocol satisfies this requirement.
364	(e) The Board of Medicine may impose upon an
365	anesthesiologist assistant any penalty specified in s. 456.072
366	or s. 458.331(2) if the anesthesiologist assistant or the
367	supervising anesthesiologist is found guilty of or is
368	investigated for an act that constitutes a violation of this
369	chapter or chapter 456.
370	(f) The Board of Medicine and the Board of Osteopathic
371	Medicine shall appoint a task force of at least five members,
372	with one member each from the Board of Medicine, the Board of
373	Osteopathic Medicine, the Department of Health, Nova
374	Southeastern University, and one of the medical schools in this
375	state. The task force shall study the requirements of this
376	section and issue a report to the Secretary of Health by March
377	1, 2005, concerning the continued need for the requirements of
378	this subsection.
379	(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
380	ADVISE THE BOARD.--
381	(a) The chair of the board may appoint an anesthesiologist
382	and an anesthesiologist assistant to advise the board as to the
383	promulgation of rules for the licensure of anesthesiologist
384	assistants. The board may utilize a committee structure that is
385	most practicable in order to receive any recommendations to the
386	board regarding rules and all matters relating to
387	anesthesiologist assistants, including, but not limited to,
388	recommendations to improve safety in the clinical practices of
389	licensed anesthesiologist assistants.
390	(b) In addition to its other duties and responsibilities
391	as prescribed by law, the board shall:
392	1. Recommend to the department the licensure of
393	anesthesiologist assistants.
394	2. Develop all rules regulating the use of
395	anesthesiologist assistants by qualified anesthesiologists under
396	this chapter and chapter 459, except for rules relating to the
397	formulary developed under s. 458.347(4)(f). The board shall also
398	develop rules to ensure that the continuity of supervision is
399	maintained in each practice setting. The boards shall consider
400	adopting a proposed rule at the regularly scheduled meeting
401	immediately following the submission of the proposed rule. A
402	proposed rule may not be adopted by either board unless both
403	boards have accepted and approved the identical language
404	contained in the proposed rule. The language of all proposed
405	rules must be approved by both boards pursuant to each
406	respective board's guidelines and standards regarding the
407	adoption of proposed rules.
408	3. Address concerns and problems of practicing
409	anesthesiologist assistants to improve safety in the clinical
410	practices of licensed anesthesiologist assistants.
411	(c) When the board finds that an applicant for licensure
412	has failed to meet, to the board's satisfaction, each of the
413	requirements for licensure set forth in this section, the board
414	may enter an order to:
415	1. Refuse to certify the applicant for licensure;
416	2. Approve the applicant for licensure with restrictions
417	on the scope of practice or license; or
418	3. Approve the applicant for conditional licensure. Such
419	conditions may include placement of the licensee on probation
420	for a period of time and subject to such conditions as the board
421	may specify, including, but not limited to, requiring the
422	licensee to undergo treatment, to attend continuing education
423	courses, or to take corrective action.
424	(8) PENALTY.--A person who falsely holds himself or
425	herself out as an anesthesiologist assistant commits a felony of
426	the third degree, punishable as provided in s. 775.082, s.
427	775.083, or s. 775.084.
428	(9) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
429	board may deny, suspend, or revoke the license of an
430	anesthesiologist assistant who the board determines has violated
431	any provision of this section or chapter or any rule adopted
432	pursuant thereto.
433	(10) RULES.--The boards shall adopt rules to implement
434	this section.
435	(11) LIABILITY.--A supervising anesthesiologist is liable
436	for any act or omission of an anesthesiologist assistant acting
437	under the anesthesiologist's supervision and control and shall
438	comply with the financial responsibility requirements of this
439	chapter and chapter 456, as applicable.
440	(12) FEES.--The department shall allocate the fees
441	collected under this section to the board.
442	Section 4. Paragraph (hh) of subsection (1) of section
443	459.015, Florida Statutes, is amended to read:
444	459.015 Grounds for disciplinary action; action by the
445	board and department.--
446	(1) The following acts constitute grounds for denial of a
447	license or disciplinary action, as specified in s. 456.072(2):
448	(hh) Failing to supervise adequately the activities of
449	those physician assistants, paramedics, emergency medical
450	technicians, advanced registered nurse practitioners,
451	anesthesiologist assistants,or other persons acting under the
452	supervision of the osteopathic physician.
453	Section 5. Section 459.023, Florida Statutes, is created
454	to read:
455	459.023 Anesthesiologist assistants.--
456	(1) DEFINITIONS.--As used in this section, the term:
457	(a) "Anesthesiologist" means an osteopathic physician who
458	holds an active, unrestricted license, who has successfully
459	completed an anesthesiology training program approved by the
460	Accreditation Council for Graduate Medical Education, or its
461	equivalent, or the American Osteopathic Association, and who is
462	certified by the American Osteopathic Board of Anesthesiology or
463	is eligible to take that board's examination, is certified by
464	the American Board of Anesthesiology or is eligible to take that
465	board's examination, or is certified by the Board of
466	Certification in Anesthesiology affiliated with the American
467	Association of Physician Specialists, Inc.
468	(b) "Anesthesiologist assistant" means a graduate of an
469	approved program who is licensed to perform medical services
470	delegated and directly supervised by a supervising
471	anesthesiologist.
472	(c) "Anesthesiology" means the practice of medicine that
473	specializes in the relief of pain during and after surgical
474	procedures and childbirth, during certain chronic disease
475	processes, and during resuscitation and critical care of
476	patients in the operating room and intensive care environments.
477	(d) "Approved program" means a program for the education
478	and training of anesthesiologist assistants that has been
479	approved by the boards as provided in subsection (5).
480	(e) "Boards" means the Board of Medicine and the Board of
481	Osteopathic Medicine.
482	(f) "Continuing medical education" means courses
483	recognized and approved by the boards, the American Academy of
484	Physician Assistants, the American Medical Association, the
485	American Osteopathic Association, the American Academy of
486	Anesthesiologist Assistants, the American Society of
487	Anesthesiologists, or the Accreditation Council for Continuing
488	Medical Education.
489	(g) "Direct supervision" means supervision by an
490	anesthesiologist who is present in the office or the surgical or
491	obstetrical suite the anesthesiologist assistant is in and is
492	immediately available to provide assistance and direction while
493	anesthesia services are being performed.
494	(h) "Proficiency examination" means an entry-level
495	examination approved by the boards, including examinations
496	administered by the National Commission for Certification of
497	Anesthesiologist Assistants.
498	(i) "Trainee" means a person who is currently enrolled in
499	an approved program.
500	(2) PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--
501	(a) An anesthesiologist who directly supervises an
502	anesthesiologist assistant must be qualified in the medical
503	areas in which the anesthesiologist assistant performs, and is
504	liable for the performance of the anesthesiologist assistant. An
505	anesthesiologist may only supervise two anesthesiologist
506	assistants at the same time. The board may, by rule, allow an
507	anesthesiologist to supervise up to four anesthesiologist
508	assistants, after July 1, 2006.
509	(b) An anesthesiologist or group of anesthesiologists
510	must, upon establishing a supervisory relationship with an
511	anesthesiologist assistant, file with the board a written
512	protocol that includes, at a minimum:
513	1. The name, address, and license number of the
514	anesthesiologist assistant.
515	2. The name, address, license number, and federal Drug
516	Enforcement Administration number of each physician who will be
517	supervising the anesthesiologist assistant.
518	3. The address of the anesthesiologist assistant's primary
519	practice location and the address of any other locations where
520	the anesthesiologist assistant may practice.
521	4. The date the protocol was developed and the dates of
522	all revisions.
523	5. The signatures of the anesthesiologist assistant and
524	all supervising physicians.
525	6. The duties and functions of the anesthesiologist
526	assistant.
527	7. The conditions or procedures that require the personal
528	provision of care by an anesthesiologist.
529	8. The procedures to be followed in the event of an
530	anesthetic emergency.
531
532	The protocol must be on file with the board before the
533	anesthesiologist assistant may practice with the
534	anesthesiologist or group. An anesthesiologist assistant may not
535	practice unless a written protocol has been filed for that
536	anesthesiologist assistant in accordance with this paragraph,
537	and the anesthesiologist assistant may only practice under the
538	direct supervision of an anesthesiologist who has signed the
539	protocol. The protocol must be updated biennially.
540	(3) PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--
541	(a) An anesthesiologist assistant may assist an
542	anesthesiologist in developing and implementing an anesthesia
543	care plan for a patient. In providing assistance to an
544	anesthesiologist, an anesthesiologist assistant may perform
545	duties established by rule by the board in any of the following
546	functions that are included in the anesthesiologist assistant's
547	protocol while under the direct supervision of an
548	anesthesiologist:
549	1. Obtain a comprehensive patient history and present the
550	history to the supervising anesthesiologist.
551	2. Pretest and calibrate anesthesia delivery systems and
552	monitor, obtain, and interpret information from the systems and
553	monitors.
554	3. Assist the supervising anesthesiologist with the
555	implementation of medically accepted monitoring techniques.
556	4. Establish basic and advanced airway interventions,
557	including intubation of the trachea and performing ventilatory
558	support.
559	5. Administer intermittent vasoactive drugs and start and
560	adjust vasoactive infusions.
561	6. Administer anesthetic drugs, adjuvant drugs, and
562	accessory drugs.
563	7. Assist the supervising anesthesiologist with the
564	performance of epidural anesthetic procedures and spinal
565	anesthetic procedures.
566	8. Administer blood, blood products, and supportive
567	fluids.
568	9. Support life functions during anesthesia health care,
569	including induction and intubation procedures, the use of
570	appropriate mechanical supportive devices, and the management of
571	fluid, electrolyte, and blood component balances.
572	10. Recognize and take appropriate corrective action for
573	abnormal patient responses to anesthesia, adjunctive medication,
574	or other forms of therapy.
575	11. Participate in management of the patient while in the
576	postanesthesia recovery area, including the administration of
577	any supporting fluids or drugs.
578	12. Place special peripheral and central venous and
579	arterial lines for blood sampling and monitoring as appropriate.
580	(b) Nothing in this section or chapter prevents third-
581	party payors from reimbursing employers of anesthesiologist
582	assistants for covered services rendered by such
583	anesthesiologist assistants.
584	(c) An anesthesiologist assistant must clearly convey to
585	the patient that she or he is an anesthesiologist assistant.
586	(d) An anesthesiologist assistant may perform anesthesia
587	tasks and services within the framework of a written practice
588	protocol developed between the supervising anesthesiologist and
589	the anesthesiologist assistant.
590	(e) An anesthesiologist assistant may not prescribe,
591	order, or compound any controlled substance, legend drug, or
592	medical devices, nor may an anesthesiologist assistant dispense
593	sample drugs to patients. Nothing in this paragraph prohibits an
594	anesthesiologist assistant from administering legend drugs or
595	controlled substances, intravenous drugs, fluids, or blood
596	products, or inhalation or other anesthetic agents to patients
597	while under the direct supervision of an anesthesiologist.
598	(4) PERFORMANCE BY TRAINEES.--The practice of a trainee is
599	exempt from the requirements of this chapter while the trainee
600	is performing assigned tasks as a trainee in conjunction with an
601	approved program. Before providing anesthesia services,
602	including the administration of anesthesia in conjunction with
603	the requirements of an approved program, the trainee must
604	clearly convey to the patient that she or he is a trainee.
605	(5) PROGRAM APPROVAL.--The boards shall approve programs
606	for the education and training of anesthesiologist assistants
607	which meet standards established by the boards by rule. The
608	boards may recommend only those anesthesiologist assistant
609	training programs that hold full accreditation or provisional
610	accreditation from the Commission on Accreditation of Allied
611	Health Education Programs.
612	(6) ANESTHESIOLOGIST ASSISTANT LICENSURE.--
613	(a) Any person desiring to be licensed as an
614	anesthesiologist assistant must apply to the department. The
615	department shall issue a license to any person certified by the
616	board to:
617	1. Be at least 18 years of age.
618	2. Have satisfactorily passed a proficiency examination
619	with a score established by the National Commission for
620	Certification of Anesthesiologist Assistants.
621	3. Have:
622	a. Practiced as an anesthesiologist assistant in another
623	state for at least 12 months without a finding of an adverse
624	incident;
625	b. A degree or prior licensure in an allied health care
626	field, including, but not limited to, respiratory therapy,
627	occupational therapy, nursing, dental hygiene, physician
628	assistant, paramedic, emergency medical technician, or
629	midwifery;
630	c. A baccalaureate or higher degree from a program at an
631	institution of higher education accredited by an organization
632	recognized by the Board of Osteopathic Medicine in one of the
633	following areas of study:
634	(I) General biology;
635	(II) General chemistry;
636	(III) Organic chemistry;
637	(IV) Physics; or
638	(V) Another field of study which includes sufficient
639	courses in chemistry, biology, and life sciences to meet the
640	criteria for admission to a medical school accredited by an
641	organization recognized by the Board of Osteopathic Medicine; or
642	d. Unless meeting the requirements of sub-subparagraph a.,
643	successfully completed a graduate-level training program
644	approved by the Board of Osteopathic Medicine and accredited by
645	the Commission on Accreditation of Allied Health Education
646	Programs or any of the commission's successor organizations
647	which is conducted for the purpose of preparing individuals to
648	practice as anesthesiologist assistants and which included at
649	minimum all of the following components:
650	(I) Basic sciences of anesthesia: physiology,
651	pathophysiology, anatomy, and biochemistry, presented as a
652	continuum of didactic courses designed to teach students the
653	foundations of human biological existence on which clinical
654	correlations to anesthesia practice are based.
655	(II) Pharmacology for the anesthetic sciences, including
656	instruction in the anesthetic principles of pharmacology,
657	pharmacodynamics, pharmacokinetics, uptake and distribution,
658	intravenous anesthetics and narcotics, and volatile anesthetics.
659	(III) Physics in anesthesia.
660	(IV) Fundamentals of anesthetic sciences, presented as a
661	continuum of courses covering a series of topics in basic
662	medical sciences with special emphasis on the effects of
663	anesthetics on normal physiology and pathophysiology.
664	(V) Patient instrumentation and monitoring, presented as a
665	continuum of courses focusing on the design, proper preparation,
666	and proper methods of resolving problems that arise with
667	anesthesia equipment, and providing a balance between the
668	engineering concepts used in anesthesia instruments and the
669	clinical application of anesthesia instruments.
670	(VI) Clinically based conferences in which techniques of
671	anesthetic management, quality assurance issues, and current
672	professional literature are reviewed from the perspective of
673	practice improvement.
674	(VII) Clinical experience consisting of at least 2,500
675	hours of direct patient contact, presented as a continuum of
676	courses throughout the entirety of the program, beginning with a
677	gradual introduction of the techniques for the anesthetic
678	management of patients and culminating in the assimilation of
679	the graduate of the program into the work force.
680	(IX) Unless meeting the requirements of sub-subparagraph
681	b., successful completion of at least a 3-month postgraduate
682	clinical one-on-one training program with an anesthesiologist in
683	a manner approved by the Board of Osteopathic Medicine.
684	4. Be certified in advanced cardiac life support.
685	5. Have completed the application form and remitted an
686	application fee, not to exceed $1,000, as set by the boards. An
687	application must include:
688	a. A certificate of completion of approved training as
689	provided in subparagraph 3.
690	b. A sworn statement of any prior felony convictions.
691	c. A sworn statement of any prior discipline or denial of
692	licensure or certification in any state.
693	d. Two letters of recommendation from anesthesiologists.
694	(b) A license must be renewed biennially. Each renewal
695	must include:
696	1. A renewal fee, not to exceed $1,000, as set by the
697	boards.
698	2. A sworn statement of no felony convictions in the
699	immediately preceding 2 years.
700	(c) Each licensed anesthesiologist assistant must
701	biennially complete 40 hours of continuing medical education or
702	hold a current certificate issued by the National Commission for
703	Certification of Anesthesiologist Assistants or its successor.
704	(d) An anesthesiologist assistant must notify the
705	department in writing within 30 days after obtaining employment
706	that requires a license under this chapter and after any
707	subsequent change in her or his supervising anesthesiologist.
708	The notification must include the full name, license number,
709	specialty, and address of the supervising anesthesiologist.
710	Submission of the required protocol satisfies this requirement.
711	(e) The Board of Osteopathic Medicine may impose upon an
712	anesthesiologist assistant any penalty specified in s. 456.072
713	or s. 459.015(2) if the anesthesiologist assistant or the
714	supervising anesthesiologist is found guilty of or is
715	investigated for an act that constitutes a violation of this
716	chapter or chapter 456.
717	(f) The Board of Medicine and the Board of Osteopathic
718	Medicine shall appoint a task force of at least five members,
719	with one member each from the Board of Medicine, the Board of
720	Osteopathic Medicine, the Department of Health, Nova
721	Southeastern University, and one of the medical schools in this
722	state. The task force shall study the requirements of this
723	section and issue a report to the Secretary of Health by March
724	1, 2005, concerning the continued need for the requirements of
725	this subsection.
726	(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
727	ADVISE THE BOARD.--
728	(a) The chair of the board may appoint an anesthesiologist
729	and an anesthesiologist assistant to advise the board as to the
730	promulgation of rules for the licensure of anesthesiologist
731	assistants. The board may utilize a committee structure that is
732	most practicable in order to receive any recommendations to the
733	board regarding rules and all matters relating to
734	anesthesiologist assistants, including, but not limited to,
735	recommendations to improve safety in the clinical practices of
736	licensed anesthesiologist assistants.
737	(b) In addition to its other duties and responsibilities
738	as prescribed by law, the board shall:
739	1. Recommend to the department the licensure of
740	anesthesiologist assistants.
741	2. Develop all rules regulating the use of
742	anesthesiologist assistants by qualified anesthesiologists under
743	this chapter and chapter 458, except for rules relating to the
744	formulary developed under s. 458.347(4)(f). The board shall also
745	develop rules to ensure that the continuity of supervision is
746	maintained in each practice setting. The boards shall consider
747	adopting a proposed rule at the regularly scheduled meeting
748	immediately following the submission of the proposed rule. A
749	proposed rule may not be adopted by either board unless both
750	boards have accepted and approved the identical language
751	contained in the proposed rule. The language of all proposed
752	rules must be approved by both boards pursuant to each
753	respective board's guidelines and standards regarding the
754	adoption of proposed rules.
755	3. Address concerns and problems of practicing
756	anesthesiologist assistants to improve safety in the clinical
757	practices of licensed anesthesiologist assistants.
758	(c) When the board finds that an applicant for licensure
759	has failed to meet, to the board's satisfaction, each of the
760	requirements for licensure set forth in this section, the board
761	may enter an order to:
762	1. Refuse to certify the applicant for licensure;
763	2. Approve the applicant for licensure with restrictions
764	on the scope of practice or license; or
765	3. Approve the applicant for conditional licensure. Such
766	conditions may include placement of the licensee on probation
767	for a period of time and subject to such conditions as the board
768	may specify, including, but not limited to, requiring the
769	licensee to undergo treatment, to attend continuing education
770	courses, or to take corrective action.
771	(8) PENALTY.--A person who falsely holds herself or
772	himself out as an anesthesiologist assistant commits a felony of
773	the third degree, punishable as provided in s. 775.082, s.
774	775.083, or s. 775.084.
775	(9) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
776	board may deny, suspend, or revoke the license of an
777	anesthesiologist assistant who the board determines has violated
778	any provision of this section or chapter or any rule adopted
779	pursuant thereto.
780	(10) RULES.--The boards shall adopt rules to implement
781	this section.
782	(11) LIABILITY.--A supervising anesthesiologist is liable
783	for any act or omission of an anesthesiologist assistant acting
784	under the anesthesiologist's supervision and control and shall
785	comply with the financial responsibility requirements of this
786	chapter and chapter 456, as applicable.
787	(12) FEES.--The department shall allocate the fees
788	collected under this section to the board.
789	Section 6. This act shall take effect July 1, 2003.