HB 0579 2004
1	A bill to be entitled
2	An act relating to anesthesiologist assistants; amending
3	s. 456.048, F.S.; requiring the Board of Medicine and the
4	Board of Osteopathic Medicine to require medical
5	malpractice insurance or proof of financial responsibility
6	as a condition of licensure or licensure renewal for
7	licensed anesthesiologist assistants; correcting a cross
8	reference; amending ss. 458.331 and 459.015, F.S.;
9	revising grounds for which a physician may be disciplined
10	for failing to provide adequate supervision; providing
11	penalties; creating ss. 458.3475 and 459.023, F.S.;
12	providing definitions; providing performance standards for
13	anesthesiologist assistants and supervising
14	anesthesiologists; providing for the approval of training
15	programs and for services authorized to be performed by
16	trainees; providing licensing procedures; providing for
17	fees; providing for additional powers and duties of the
18	Board of Medicine and the Board of Osteopathic Medicine
19	and appointment of certain advisers to the boards;
20	providing penalties; providing for disciplinary actions;
21	providing for the adoption of rules; prescribing
22	liability; providing for the allocation of fees; providing
23	an effective date.
24
25	Be It Enacted by the Legislature of the State of Florida:
26
27	Section 1. Section 456.048, Florida Statutes, is amended
28	to read:
29	456.048 Financial responsibility requirements for certain
30	health care practitioners.--
31	(1) As a prerequisite for licensure or license renewal,
32	the Board of Acupuncture, the Board of Chiropractic Medicine,
33	the Board of Podiatric Medicine, and the Board of Dentistry
34	shall, by rule, require that all health care practitioners
35	licensed under the respective board, and the Board of Medicine
36	and the Board of Osteopathic Medicine shall, by rule, require
37	that all anesthesiologist assistants licensed pursuant to s.
38	458.3475 or s. 459.023,and the Board of Nursing shall, by rule,
39	require that advanced registered nurse practitioners certified
40	under s. 464.012, and the department shall, by rule, require
41	that midwives maintain medical malpractice insurance or provide
42	proof of financial responsibility in an amount and in a manner
43	determined by the board or department to be sufficient to cover
44	claims arising out of the rendering of or failure to render
45	professional care and services in this state.
46	(2) The board or department may grant exemptions upon
47	application by practitioners meeting any of the following
48	criteria:
49	(a) Any person licensed under chapter 457, s. 458.3475, s.
50	459.023,chapter 460, chapter 461, s. 464.012, chapter 466, or
51	chapter 467 who practices exclusively as an officer, employee,
52	or agent of the Federal Government or of the state or its
53	agencies or its subdivisions. For the purposes of this
54	subsection, an agent of the state, its agencies, or its
55	subdivisions is a person who is eligible for coverage under any
56	self-insurance or insurance program authorized by the provisions
57	of s. 768.28(16)(15)or who is a volunteer under s. 110.501(1).
58	(b) Any person whose license or certification has become
59	inactive under chapter 457, s. 458.3475, s. 459.023,chapter
60	460, chapter 461, part I of chapter 464, chapter 466, or chapter
61	467 and who is not practicing in this state. Any person applying
62	for reactivation of a license must show either that such
63	licensee maintained tail insurance coverage which provided
64	liability coverage for incidents that occurred on or after
65	October 1, 1993, or the initial date of licensure in this state,
66	whichever is later, and incidents that occurred before the date
67	on which the license became inactive; or such licensee must
68	submit an affidavit stating that such licensee has no
69	unsatisfied medical malpractice judgments or settlements at the
70	time of application for reactivation.
71	(c) Any person holding a limited license pursuant to s.
72	456.015, and practicing under the scope of such limited license.
73	(d) Any person licensed or certified under chapter 457, s.
74	458.3475, s. 459.023,chapter 460, chapter 461, s. 464.012,
75	chapter 466, or chapter 467 who practices only in conjunction
76	with his or her teaching duties at an accredited school or in
77	its main teaching hospitals. Such person may engage in the
78	practice of medicine to the extent that such practice is
79	incidental to and a necessary part of duties in connection with
80	the teaching position in the school.
81	(e) Any person holding an active license or certification
82	under chapter 457, s. 458.3475, s. 459.023,chapter 460, chapter
83	461, s. 464.012, chapter 466, or chapter 467 who is not
84	practicing in this state. If such person initiates or resumes
85	practice in this state, he or she must notify the department of
86	such activity.
87	(f) Any person who can demonstrate to the board or
88	department that he or she has no malpractice exposure in the
89	state.
90	(3) Notwithstanding the provisions of this section, the
91	financial responsibility requirements of ss. 458.320 and
92	459.0085 shall continue to apply to practitioners licensed under
93	those chapters, except for anesthesiologist assistants licensed
94	pursuant to s. 458.3475 or s. 459.023 who must meet the
95	requirements of this section.
96	Section 2. Paragraph (dd) of subsection (1) of section
97	458.331, Florida Statutes, is amended to read:
98	458.331 Grounds for disciplinary action; action by the
99	board and department.--
100	(1) The following acts constitute grounds for denial of a
101	license or disciplinary action, as specified in s. 456.072(2):
102	(dd) Failing to supervise adequately the activities of
103	those physician assistants, paramedics, emergency medical
104	technicians, or advanced registered nurse practitioners, or
105	anesthesiologist assistantsacting under the supervision of the
106	physician.
107	Section 3. Section 458.3475, Florida Statutes, is created
108	to read:
109	458.3475 Anesthesiologist assistants.--
110	(1) DEFINITIONS.--As used in this section, the term:
111	(a) "Anesthesiologist" means an allopathic physician who
112	holds an active, unrestricted license; who has successfully
113	completed an anesthesiology training program approved by the
114	Accreditation Council for Graduate Medical Education or its
115	equivalent; and who is certified by the American Board of
116	Anesthesiology, is eligible to take that board's examination, or
117	is certified by the Board of Certification in Anesthesiology
118	affiliated with the American Association of Physician
119	Specialists, Inc.
120	(b) "Anesthesiologist assistant" means a graduate of an
121	approved program who is licensed to perform medical services
122	delegated and directly supervised by a supervising
123	anesthesiologist.
124	(c) "Anesthesiology" means the practice of medicine that
125	specializes in the relief of pain during and after surgical
126	procedures and childbirth, during certain chronic disease
127	processes, and during resuscitation and critical care of
128	patients in the operating room and intensive care environments.
129	(d) "Approved program" means a program for the education
130	and training of anesthesiologist assistants which has been
131	approved by the boards as provided in subsection (5).
132	(e) "Boards" means the Board of Medicine and the Board of
133	Osteopathic Medicine.
134	(f) "Continuing medical education" means courses
135	recognized and approved by the boards, the American Academy of
136	Physician Assistants, the American Medical Association, the
137	American Osteopathic Association, the American Academy of
138	Anesthesiologist Assistants, the American Society of
139	Anesthesiologists, or the Accreditation Council for Continuing
140	Medical Education.
141	(g) "Direct supervision" means supervision by an
142	anesthesiologist who is present in the office or the surgical or
143	obstetrical suite that the anesthesiologist assistant is in and
144	who is immediately available to provide assistance and direction
145	while anesthesia services are being performed.
146	(h) "Proficiency examination" means an entry-level
147	examination approved by the boards, including the examination
148	administered by the National Commission for Certification of
149	Anesthesiologist Assistants.
150	(i) "Trainee" means a person who is currently enrolled in
151	an approved program.
152	(2) PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--
153	(a) An anesthesiologist who directly supervises an
154	anesthesiologist assistant must be qualified in the medical
155	areas in which the anesthesiologist assistant performs and is
156	liable for the performance of the anesthesiologist assistant. An
157	anesthesiologist may only supervise two anesthesiologist
158	assistants at the same time. The board may, by rule, allow an
159	anesthesiologist to supervise up to four anesthesiologist
160	assistants, after July 1, 2008.
161	(b) An anesthesiologist or group of anesthesiologists
162	must, upon establishing a supervisory relationship with an
163	anesthesiologist assistant, file with the board a written
164	protocol that includes, at a minimum:
165	1. The name, address, and license number of the
166	anesthesiologist assistant.
167	2. The name, address, license number, and federal Drug
168	Enforcement Administration number of each physician who will be
169	supervising the anesthesiologist assistant.
170	3. The address of the anesthesiologist assistant's primary
171	practice location and the address of any other locations where
172	the anesthesiologist assistant may practice.
173	4. The date the protocol was developed and the dates of
174	all revisions.
175	5. The signatures of the anesthesiologist assistant and
176	all supervising physicians.
177	6. The duties and functions of the anesthesiologist
178	assistant.
179	7. The conditions or procedures that require the personal
180	provision of care by an anesthesiologist.
181	8. The procedures to be followed in the event of an
182	anesthetic emergency.
183
184	The protocol must be on file with the board before the
185	anesthesiologist assistant may practice with the
186	anesthesiologist or group. An anesthesiologist assistant may not
187	practice unless a written protocol has been filed for that
188	anesthesiologist assistant in accordance with this paragraph,
189	and the anesthesiologist assistant may only practice under the
190	direct supervision of an anesthesiologist who has signed the
191	protocol. The protocol must be updated biennially.
192	(3) PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--
193	(a) An anesthesiologist assistant may assist an
194	anesthesiologist in developing and implementing an anesthesia
195	care plan for a patient. In providing assistance to an
196	anesthesiologist, an anesthesiologist assistant may perform
197	duties established by rule by the board in any of the following
198	functions that are included in the anesthesiologist assistant's
199	protocol while under the direct supervision of an
200	anesthesiologist:
201	1. Obtain a comprehensive patient history and present the
202	history to the supervising anesthesiologist.
203	2. Pretest and calibrate anesthesia delivery systems and
204	monitor, obtain, and interpret information from the systems and
205	monitors.
206	3. Assist the supervising anesthesiologist with the
207	implementation of medically accepted monitoring techniques.
208	4. Establish basic and advanced airway interventions,
209	including intubation of the trachea and performing ventilatory
210	support.
211	5. Administer intermittent vasoactive drugs and start and
212	adjust vasoactive infusions.
213	6. Administer anesthetic drugs, adjuvant drugs, and
214	accessory drugs.
215	7. Assist the supervising anesthesiologist with the
216	performance of epidural anesthetic procedures and spinal
217	anesthetic procedures.
218	8. Administer blood, blood products, and supportive
219	fluids.
220	9. Support life functions during anesthesia health care,
221	including induction and intubation procedures, the use of
222	appropriate mechanical supportive devices, and the management of
223	fluid, electrolyte, and blood component balances.
224	10. Recognize and take appropriate corrective action for
225	abnormal patient responses to anesthesia, adjunctive medication,
226	or other forms of therapy.
227	11. Participate in management of the patient while in the
228	postanesthesia recovery area, including the administration of
229	any supporting fluids or drugs.
230	12. Place special peripheral and central venous and
231	arterial lines for blood sampling and monitoring as appropriate.
232	(b) Nothing in this section or chapter prevents third-
233	party payors from reimbursing employers of anesthesiologist
234	assistants for covered services rendered by such
235	anesthesiologist assistants.
236	(c) An anesthesiologist assistant must clearly convey to
237	the patient that he or she is an anesthesiologist assistant.
238	(d) An anesthesiologist assistant may perform anesthesia
239	tasks and services within the framework of a written practice
240	protocol developed between the supervising anesthesiologist and
241	the anesthesiologist assistant.
242	(e) An anesthesiologist assistant may not prescribe,
243	order, or compound any controlled substance, legend drug, or
244	medical device, nor may an anesthesiologist assistant dispense
245	sample drugs to patients. Nothing in this paragraph prohibits an
246	anesthesiologist assistant from administering legend drugs or
247	controlled substances; intravenous drugs, fluids, or blood
248	products; or inhalation or other anesthetic agents to patients
249	which are ordered by the supervising anesthesiologist and
250	administered while under the direct supervision of the
251	supervising anesthesiologist.
252	(4) PERFORMANCE BY TRAINEES.--The practice of a trainee is
253	exempt from the requirements of this chapter while the trainee
254	is performing assigned tasks as a trainee in conjunction with an
255	approved program. Before providing anesthesia services,
256	including the administration of anesthesia in conjunction with
257	the requirements of an approved program, the trainee must
258	clearly convey to the patient that he or she is a trainee.
259	(5) PROGRAM APPROVAL.--The boards shall approve programs
260	for the education and training of anesthesiologist assistants
261	which meet standards established by board rules. The boards may
262	recommend only those anesthesiologist assistant training
263	programs that hold full accreditation or provisional
264	accreditation from the Commission on Accreditation of Allied
265	Health Education Programs.
266	(6) ANESTHESIOLOGIST ASSISTANT LICENSURE.--
267	(a) Any person desiring to be licensed as an
268	anesthesiologist assistant must apply to the department. The
269	department shall issue a license to any person certified by the
270	board to:
271	1. Be at least 18 years of age.
272	2. Have satisfactorily passed a proficiency examination
273	with a score established by the National Commission for
274	Certification of Anesthesiologist Assistants.
275	3. Be certified in advanced cardiac life support.
276	4. Have completed the application form and remitted an
277	application fee, not to exceed $1,000, as set by the boards. An
278	application must include:
279	a. A certificate of completion of an approved graduate-
280	level program.
281	b. A sworn statement of any prior felony convictions.
282	c. A sworn statement of any prior discipline or denial of
283	licensure or certification in any state.
284	d. Two letters of recommendation from anesthesiologists.
285	(b) A license must be renewed biennially. Each renewal
286	must include:
287	1. A renewal fee, not to exceed $1,000, as set by the
288	boards.
289	2. A sworn statement of no felony convictions in the
290	immediately preceding 2 years.
291	(c) Each licensed anesthesiologist assistant must
292	biennially complete 40 hours of continuing medical education or
293	hold a current certificate issued by the National Commission for
294	Certification of Anesthesiologist Assistants or its successor.
295	(d) An anesthesiologist assistant must notify the
296	department in writing within 30 days after obtaining employment
297	that requires a license under this chapter and after any
298	subsequent change in his or her supervising anesthesiologist.
299	The notification must include the full name, license number,
300	specialty, and address of the supervising anesthesiologist.
301	Submission of the required protocol satisfies this requirement.
302	(e) The Board of Medicine may impose upon an
303	anesthesiologist assistant any penalty specified in s. 456.072
304	or s. 458.331(2) if the anesthesiologist assistant or the
305	supervising anesthesiologist is found guilty of or is
306	investigated for an act that constitutes a violation of this
307	chapter or chapter 456.
308	(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
309	ADVISE THE BOARD.--
310	(a) The chair of the board may appoint an anesthesiologist
311	and an anesthesiologist assistant to advise the board as to the
312	adoption of rules for the licensure of anesthesiologist
313	assistants. The board may use a committee structure that is most
314	practicable in order to receive any recommendations to the board
315	regarding rules and all matters relating to anesthesiologist
316	assistants, including, but not limited to, recommendations to
317	improve safety in the clinical practices of licensed
318	anesthesiologist assistants.
319	(b) In addition to its other duties and responsibilities
320	as prescribed by law, the board shall:
321	1. Recommend to the department the licensure of
322	anesthesiologist assistants.
323	2. Develop all rules regulating the use of
324	anesthesiologist assistants by qualified anesthesiologists under
325	this chapter and chapter 459, except for rules relating to the
326	formulary developed under s. 458.347(4)(f). The board shall also
327	develop rules to ensure that the continuity of supervision is
328	maintained in each practice setting. The boards shall consider
329	adopting a proposed rule at the regularly scheduled meeting
330	immediately following the submission of the proposed rule. A
331	proposed rule may not be adopted by either board unless both
332	boards have accepted and approved the identical language
333	contained in the proposed rule. The language of all proposed
334	rules must be approved by both boards pursuant to each
335	respective board's guidelines and standards regarding the
336	adoption of proposed rules.
337	3. Address concerns and problems of practicing
338	anesthesiologist assistants to improve safety in the clinical
339	practices of licensed anesthesiologist assistants.
340	(c) When the board finds that an applicant for licensure
341	has failed to meet, to the board's satisfaction, each of the
342	requirements for licensure set forth in this section, the board
343	may enter an order to:
344	1. Refuse to certify the applicant for licensure;
345	2. Approve the applicant for licensure with restrictions
346	on the scope of practice or license; or
347	3. Approve the applicant for conditional licensure. Such
348	conditions may include placement of the licensee on probation
349	for a period of time and subject to such conditions as the board
350	specifies, including, but not limited to, requiring the licensee
351	to undergo treatment, to attend continuing education courses, or
352	to take corrective action.
353	(8) PENALTY.--A person who falsely holds himself or
354	herself out as an anesthesiologist assistant commits a felony of
355	the third degree, punishable as provided in s. 775.082, s.
356	775.083, or s. 775.084.
357	(9) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
358	boards may deny, suspend, or revoke the license of an
359	anesthesiologist assistant who the board determines has violated
360	any provision of this section or chapter or any rule adopted
361	pursuant thereto.
362	(10) RULES.--The boards shall adopt rules to administer
363	this section.
364	(11) LIABILITY.--A supervising anesthesiologist is liable
365	for any act or omission of an anesthesiologist assistant acting
366	under the anesthesiologist's supervision and control and shall
367	comply with the financial responsibility requirements of this
368	chapter and chapter 456, as applicable.
369	(12) FEES.--The department shall allocate the fees
370	collected under this section to the board.
371	Section 4. Paragraph (hh) of subsection (1) of section
372	459.015, Florida Statutes, is amended to read:
373	459.015 Grounds for disciplinary action; action by the
374	board and department.--
375	(1) The following acts constitute grounds for denial of a
376	license or disciplinary action, as specified in s. 456.072(2):
377	(hh) Failing to supervise adequately the activities of
378	those physician assistants, paramedics, emergency medical
379	technicians, advanced registered nurse practitioners,
380	anesthesiologist assistants,or other persons acting under the
381	supervision of the osteopathic physician.
382	Section 5. Section 459.023, Florida Statutes, is created
383	to read:
384	459.023 Anesthesiologist assistants.--
385	(1) DEFINITIONS.--As used in this section, the term:
386	(a) "Anesthesiologist" means an osteopathic physician who
387	holds an active, unrestricted license; who has successfully
388	completed an anesthesiology training program approved by the
389	Accreditation Council for Graduate Medical Education, or its
390	equivalent, or the American Osteopathic Association; and who is
391	certified by the American Osteopathic Board of Anesthesiology or
392	is eligible to take that board's examination, is certified by
393	the American Board of Anesthesiology or is eligible to take that
394	board's examination, or is certified by the Board of
395	Certification in Anesthesiology affiliated with the American
396	Association of Physician Specialists, Inc.
397	(b) "Anesthesiologist assistant" means a graduate of an
398	approved program who is licensed to perform medical services
399	delegated and directly supervised by a supervising
400	anesthesiologist.
401	(c) "Anesthesiology" means the practice of medicine that
402	specializes in the relief of pain during and after surgical
403	procedures and childbirth, during certain chronic disease
404	processes, and during resuscitation and critical care of
405	patients in the operating room and intensive care environments.
406	(d) "Approved program" means a program for the education
407	and training of anesthesiologist assistants which has been
408	approved by the boards as provided in subsection (5).
409	(e) "Boards" means the Board of Medicine and the Board of
410	Osteopathic Medicine.
411	(f) "Continuing medical education" means courses
412	recognized and approved by the boards, the American Academy of
413	Physician Assistants, the American Medical Association, the
414	American Osteopathic Association, the American Academy of
415	Anesthesiologist Assistants, the American Society of
416	Anesthesiologists, or the Accreditation Council for Continuing
417	Medical Education.
418	(g) "Direct supervision" means supervision by an
419	anesthesiologist who is present in the office or the surgical or
420	obstetrical suite that the anesthesiologist assistant is in and
421	who is immediately available to provide assistance and direction
422	while anesthesia services are being performed.
423	(h) "Proficiency examination" means an entry-level
424	examination approved by the boards, including examinations
425	administered by the National Commission for Certification of
426	Anesthesiologist Assistants.
427	(i) "Trainee" means a person who is currently enrolled in
428	an approved program.
429	(2) PERFORMANCE OF SUPERVISING ANESTHESIOLOGIST.--
430	(a) An anesthesiologist who directly supervises an
431	anesthesiologist assistant must be qualified in the medical
432	areas in which the anesthesiologist assistant performs and is
433	liable for the performance of the anesthesiologist assistant. An
434	anesthesiologist may only supervise two anesthesiologist
435	assistants at the same time. The board may, by rule, allow an
436	anesthesiologist to supervise up to four anesthesiologist
437	assistants, after July 1, 2008.
438	(b) An anesthesiologist or group of anesthesiologists
439	must, upon establishing a supervisory relationship with an
440	anesthesiologist assistant, file with the board a written
441	protocol that includes, at a minimum:
442	1. The name, address, and license number of the
443	anesthesiologist assistant.
444	2. The name, address, license number, and federal Drug
445	Enforcement Administration number of each physician who will be
446	supervising the anesthesiologist assistant.
447	3. The address of the anesthesiologist assistant's primary
448	practice location and the address of any other locations where
449	the anesthesiologist assistant may practice.
450	4. The date the protocol was developed and the dates of
451	all revisions.
452	5. The signatures of the anesthesiologist assistant and
453	all supervising physicians.
454	6. The duties and functions of the anesthesiologist
455	assistant.
456	7. The conditions or procedures that require the personal
457	provision of care by an anesthesiologist.
458	8. The procedures to be followed in the event of an
459	anesthetic emergency.
460
461	The protocol must be on file with the board before the
462	anesthesiologist assistant may practice with the
463	anesthesiologist or group. An anesthesiologist assistant may not
464	practice unless a written protocol has been filed for that
465	anesthesiologist assistant in accordance with this paragraph,
466	and the anesthesiologist assistant may only practice under the
467	direct supervision of an anesthesiologist who has signed the
468	protocol. The protocol must be updated biennially.
469	(3) PERFORMANCE OF ANESTHESIOLOGIST ASSISTANTS.--
470	(a) An anesthesiologist assistant may assist an
471	anesthesiologist in developing and implementing an anesthesia
472	care plan for a patient. In providing assistance to an
473	anesthesiologist, an anesthesiologist assistant may perform
474	duties established by rule by the board in any of the following
475	functions that are included in the anesthesiologist assistant's
476	protocol while under the direct supervision of an
477	anesthesiologist:
478	1. Obtain a comprehensive patient history and present the
479	history to the supervising anesthesiologist.
480	2. Pretest and calibrate anesthesia delivery systems and
481	monitor, obtain, and interpret information from the systems and
482	monitors.
483	3. Assist the supervising anesthesiologist with the
484	implementation of medically accepted monitoring techniques.
485	4. Establish basic and advanced airway interventions,
486	including intubation of the trachea and performing ventilatory
487	support.
488	5. Administer intermittent vasoactive drugs and start and
489	adjust vasoactive infusions.
490	6. Administer anesthetic drugs, adjuvant drugs, and
491	accessory drugs.
492	7. Assist the supervising anesthesiologist with the
493	performance of epidural anesthetic procedures and spinal
494	anesthetic procedures.
495	8. Administer blood, blood products, and supportive
496	fluids.
497	9. Support life functions during anesthesia health care,
498	including induction and intubation procedures, the use of
499	appropriate mechanical supportive devices, and the management of
500	fluid, electrolyte, and blood component balances.
501	10. Recognize and take appropriate corrective action for
502	abnormal patient responses to anesthesia, adjunctive medication,
503	or other forms of therapy.
504	11. Participate in management of the patient while in the
505	postanesthesia recovery area, including the administration of
506	any supporting fluids or drugs.
507	12. Place special peripheral and central venous and
508	arterial lines for blood sampling and monitoring as appropriate.
509	(b) Nothing in this section or chapter prevents third-
510	party payors from reimbursing employers of anesthesiologist
511	assistants for covered services rendered by such
512	anesthesiologist assistants.
513	(c) An anesthesiologist assistant must clearly convey to
514	the patient that she or he is an anesthesiologist assistant.
515	(d) An anesthesiologist assistant may perform anesthesia
516	tasks and services within the framework of a written practice
517	protocol developed between the supervising anesthesiologist and
518	the anesthesiologist assistant.
519	(e) An anesthesiologist assistant may not prescribe,
520	order, or compound any controlled substance, legend drug, or
521	medical device, nor may an anesthesiologist assistant dispense
522	sample drugs to patients. Nothing in this paragraph prohibits an
523	anesthesiologist assistant from administering legend drugs or
524	controlled substances; intravenous drugs, fluids, or blood
525	products; or inhalation or other anesthetic agents to patients
526	which are ordered by the supervising anesthesiologist and
527	administered while under the direct supervision of the
528	supervising anesthesiologist.
529	(4) PERFORMANCE BY TRAINEES.--The practice of a trainee is
530	exempt from the requirements of this chapter while the trainee
531	is performing assigned tasks as a trainee in conjunction with an
532	approved program. Before providing anesthesia services,
533	including the administration of anesthesia in conjunction with
534	the requirements of an approved program, the trainee must
535	clearly convey to the patient that she or he is a trainee.
536	(5) PROGRAM APPROVAL.--The boards shall approve programs
537	for the education and training of anesthesiologist assistants
538	which meet standards established by board rules. The boards may
539	recommend only those anesthesiologist assistant training
540	programs that hold full accreditation or provisional
541	accreditation from the Commission on Accreditation of Allied
542	Health Education Programs.
543	(6) ANESTHESIOLOGIST ASSISTANT LICENSURE.--
544	(a) Any person desiring to be licensed as an
545	anesthesiologist assistant must apply to the department. The
546	department shall issue a license to any person certified by the
547	board to:
548	1. Be at least 18 years of age.
549	2. Have satisfactorily passed a proficiency examination
550	with a score established by the National Commission for
551	Certification of Anesthesiologist Assistants.
552	3. Be certified in advanced cardiac life support.
553	4. Have completed the application form and remitted an
554	application fee, not to exceed $1,000, as set by the boards. An
555	application must include:
556	a. A certificate of completion of an approved graduate-
557	level program.
558	b. A sworn statement of any prior felony convictions.
559	c. A sworn statement of any prior discipline or denial of
560	licensure or certification in any state.
561	d. Two letters of recommendation from anesthesiologists.
562	(b) A license must be renewed biennially. Each renewal
563	must include:
564	1. A renewal fee, not to exceed $1,000, as set by the
565	boards.
566	2. A sworn statement of no felony convictions in the
567	immediately preceding 2 years.
568	(c) Each licensed anesthesiologist assistant must
569	biennially complete 40 hours of continuing medical education or
570	hold a current certificate issued by the National Commission for
571	Certification of Anesthesiologist Assistants or its successor.
572	(d) An anesthesiologist assistant must notify the
573	department in writing within 30 days after obtaining employment
574	that requires a license under this chapter and after any
575	subsequent change in her or his supervising anesthesiologist.
576	The notification must include the full name, license number,
577	specialty, and address of the supervising anesthesiologist.
578	Submission of the required protocol satisfies this requirement.
579	(e) The Board of Osteopathic Medicine may impose upon an
580	anesthesiologist assistant any penalty specified in s. 456.072
581	or s. 459.015(2) if the anesthesiologist assistant or the
582	supervising anesthesiologist is found guilty of or is
583	investigated for an act that constitutes a violation of this
584	chapter or chapter 456.
585	(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
586	ADVISE THE BOARD.--
587	(a) The chair of the board may appoint an anesthesiologist
588	and an anesthesiologist assistant to advise the board as to the
589	adoption of rules for the licensure of anesthesiologist
590	assistants. The board may use a committee structure that is most
591	practicable in order to receive any recommendations to the board
592	regarding rules and all matters relating to anesthesiologist
593	assistants, including, but not limited to, recommendations to
594	improve safety in the clinical practices of licensed
595	anesthesiologist assistants.
596	(b) In addition to its other duties and responsibilities
597	as prescribed by law, the board shall:
598	1. Recommend to the department the licensure of
599	anesthesiologist assistants.
600	2. Develop all rules regulating the use of
601	anesthesiologist assistants by qualified anesthesiologists under
602	this chapter and chapter 458, except for rules relating to the
603	formulary developed under s. 458.347(4)(f). The board shall also
604	develop rules to ensure that the continuity of supervision is
605	maintained in each practice setting. The boards shall consider
606	adopting a proposed rule at the regularly scheduled meeting
607	immediately following the submission of the proposed rule. A
608	proposed rule may not be adopted by either board unless both
609	boards have accepted and approved the identical language
610	contained in the proposed rule. The language of all proposed
611	rules must be approved by both boards pursuant to each
612	respective board's guidelines and standards regarding the
613	adoption of proposed rules.
614	3. Address concerns and problems of practicing
615	anesthesiologist assistants to improve safety in the clinical
616	practices of licensed anesthesiologist assistants.
617	(c) When the board finds that an applicant for licensure
618	has failed to meet, to the board's satisfaction, each of the
619	requirements for licensure set forth in this section, the board
620	may enter an order to:
621	1. Refuse to certify the applicant for licensure;
622	2. Approve the applicant for licensure with restrictions
623	on the scope of practice or license; or
624	3. Approve the applicant for conditional licensure. Such
625	conditions may include placement of the licensee on probation
626	for a period of time and subject to such conditions as the board
627	specifies, including, but not limited to, requiring the licensee
628	to undergo treatment, to attend continuing education courses, or
629	to take corrective action.
630	(8) PENALTY.--A person who falsely holds herself or
631	himself out as an anesthesiologist assistant commits a felony of
632	the third degree, punishable as provided in s. 775.082, s.
633	775.083, or s. 775.084.
634	(9) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
635	boards may deny, suspend, or revoke the license of an
636	anesthesiologist assistant who the board determines has violated
637	any provision of this section or chapter or any rule adopted
638	pursuant thereto.
639	(10) RULES.--The boards shall adopt rules to administer
640	this section.
641	(11) LIABILITY.--A supervising anesthesiologist is liable
642	for any act or omission of an anesthesiologist assistant acting
643	under the anesthesiologist's supervision and control and shall
644	comply with the financial responsibility requirements of this
645	chapter and chapter 456, as applicable.
646	(12) FEES.--The department shall allocate the fees
647	collected under this section to the board.
648	Section 6. This act shall take effect July 1, 2004.