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A07100 Summary:

COSPNSRAbinanti, Braunstein, Montesano
Amd §§6902 & 6522, add §6912, Ed L
Relates to the certification of registered nurse anesthetists; provides that for such certification an applicant shall file an application, be licensed as a registered professional nurse, have satisfactorily completed educational preparation for the administration of anesthesia by an accredited entity and pay a fee.
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A07100 Text:

                STATE OF NEW YORK
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                      April 8, 2019
        Introduced by M. of A. BICHOTTE -- read once and referred to the Commit-
          tee on Higher Education
        AN  ACT  to  amend the education law, in relation to the registration of
          nurse anesthetists
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Section  6902 of the education law is amended by adding a
     2  new subdivision 4 to read as follows:
     3    4. (a)  The  administration  of  anesthesia  to  a  patient  shall  be
     4  performed only by a qualified anesthesia practitioner as legally author-
     5  ized under this title.
     6    (b) The practice of professional nursing by a registered nurse anesth-
     7  etist,  certified  under section sixty-nine hundred twelve of this arti-
     8  cle, shall (i) include the administration of anesthesia to a patient but
     9  only under the supervision of an  anesthesiologist  who  is  immediately
    10  available;  or  under  the supervision of the operating physician who is
    11  physically present; or under the supervision of a dentist, oral  surgeon
    12  or  podiatrist who is physically present and who is authorized by law to
    13  administer anesthesia, to the extent such person is  qualified  by  law,
    14  regulation or hospital appointment to perform and supervise the adminis-
    15  tration of anesthesia; and
    16    (ii)  include  the  execution  of  medical  regimens prescribed by the
    17  supervisory physician,  dentist,  oral  surgeon  or  podiatrist  who  is
    18  authorized by law to prescribe; and
    19    (iii)  be  consistent  with  policies  and  procedures approved by the
    20  medical staff and governing body of the health care  facility,  or  free
    21  standing  ambulatory  surgical center defined under article twenty-eight
    22  of the public health law, where applicable, and  as  legally  authorized
    23  under  this  title  and in accordance with applicable regulations of the
    24  commissioner of health.
    25    (c) The following terms shall have the following meanings:
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 7100                             2
     1    (i) "Administration of  anesthesia"  in  the  hospital  or  ambulatory
     2  surgical  center means anesthesia services shall be directed by a physi-
     3  cian who has responsibility for the clinical aspects of organization and
     4  delivery of all anesthesia services provided by the hospital or  ambula-
     5  tory  surgical center. That physician or another individual qualified by
     6  education and experience shall direct the administrative aspects of  the
     7  service,  and  shall  be  responsible,  in  conjunction with the medical
     8  staff, for recommending  to  the  governing  body  privileges  to  those
     9  persons  qualified  to  administer anesthetics, including the procedures
    10  each person is qualified to perform and the levels  of  required  super-
    11  vision  as  appropriate.  Administration  of  anesthesia in office based
    12  surgery venues means the anesthesia component of the medical  or  dental
    13  procedure shall be supervised by an anesthesiologist, physician, dentist
    14  or  podiatrist  qualified  to supervise the administration of anesthesia
    15  who is physically present and  available  to  immediately  diagnose  and
    16  treat the patient for anesthesia complications or emergencies, and nurse
    17  anesthetists with the appropriate training and experience may be permit-
    18  ted  to  administer  unconscious  or deep sedation, and/or general anes-
    19  thesia, regional anesthesia, and/or monitor the patient.
    20    (ii) "Conscious sedation" or "sedation analgesia"  means  a  minimally
    21  depressed  level  of consciousness that retains the patient's ability to
    22  maintain adequate cardiorespiratory function and the  ability  to  inde-
    23  pendently  and continuously maintain an open airway, a regular breathing
    24  pattern, protective reflexes, and respond purposefully and rationally to
    25  tactile stimulation and verbal command. This does not include  unsupple-
    26  mented oral pre-operative medications or nitrous oxide analgesia.
    27    (iii) "General anesthesia" means the administration of a medication by
    28  the  parenteral or inhalation routes which results in a controlled state
    29  of unconsciousness accompanied by a complete loss of protective reflexes
    30  including loss of the ability to independently and continuously maintain
    31  patient airway and a regular  breathing  pattern.    There  is  also  an
    32  inability  to  respond  purposefully  to  verbal commands and/or tactile
    33  stimulation.
    34    (iv) "Immediately available" means remaining in physical proximity  so
    35  as  to  allow  the  anesthesiologist  to  return  to re-establish direct
    36  contact with the patient in order to meet the  patient's  medical  needs
    37  and address any urgent or emergent clinical problems.
    38    (v)  "Local  anesthesia"  means the introduction of a local anesthetic
    39  agent into a localized part of the body by topical application or  local
    40  infiltration  in  close proximity to a nerve, which produces a transient
    41  and reversible loss of sensation. All  local  anesthetics  possess  both
    42  excitatory  (seizure)  and  depressant  (loss  of consciousness) central
    43  nervous system effects in sufficient blood levels and may have  profound
    44  cardiovascular depressant effects. There may also be interactive effects
    45  between local anesthetic agents and sedative medications.
    46    (vi)  "Monitoring"  means  the  continual  clinical  observation  of a
    47  patient and the use of instruments to measure, display, and  record  the
    48  values  of  certain  physiologic  variables  such as pulse, oxygen satu-
    49  ration, level of consciousness, blood pressure, and respiration.
    50    (vii) "Office-based surgery" means  any  surgical  or  other  invasive
    51  procedure,  requiring  general  anesthesia,  moderate  sedation, or deep
    52  sedation, and any liposuction procedure, where such  surgical  or  other
    53  invasive  procedure  or  liposuction  is  performed  by  a licensee in a
    54  location other than a hospital, as such term is defined in article twen-
    55  ty-eight of the public health law, excluding minor procedures and proce-
    56  dures requiring minimal sedation.

        A. 7100                             3
     1    (viii) "Patient" means an individual who is under the care of a physi-
     2  cian in a licensed facility or, in an office, under the care of a physi-
     3  cian, dentist, oral surgeon or podiatrist.
     4    (ix)  "Peri-operative period" means the period of time commencing upon
     5  the medical evaluation of the patient before surgery and ending upon the
     6  patient's medical discharge from the recovery room.
     7    (x) "Physically present" by a physician means the ability to react and
     8  respond in an immediate and appropriate manner so as  to  make  possible
     9  the  continuous  exercise  of  medical  judgment throughout the adminis-
    10  tration of the anesthesia.  "Physically  present"  by  a  dentist,  oral
    11  surgeon or podiatrist means the ability of such person who is performing
    12  the  procedure  requiring  the administration of anesthesia to react and
    13  respond in an immediate and appropriate manner so as  to  make  possible
    14  the continuous exercise of professional judgment throughout the adminis-
    15  tration of the anesthesia.
    16    (xi)  "Qualified  anesthesia practitioner" means a physician, dentist,
    17  podiatrist or certified registered nurse anesthetist whose  professional
    18  practice is subject to the department of health for professional medical
    19  or  professional  conduct  or  the  state education department office of
    20  professional discipline.
    21    (xii) "Regional anesthesia" means the administration  of  local  anes-
    22  thesia agents to interrupt nerve impulses in a major region of the body.
    23  Included  in  this  category, for example, are spinal, epidural, caudal,
    24  upper or  lower  extremity  plexus  block  anesthesia,  and  intravenous
    25  regional anesthesia.
    26    (xiii)  "Supervision" means that a physician, dentist, oral surgeon or
    27  podiatrist shall perform a pre-anesthetic  examination  and  evaluation,
    28  prescribe the anesthesia, including post-operative medications as needed
    29  for  pain  and  discomfort,  including nausea and vomiting, remain phys-
    30  ically present during the entire peri-operative period  and  immediately
    31  available for diagnosis, treatment, and management of anesthesia-related
    32  complications  or  emergencies,  and  assure  the provision of indicated
    33  post-anesthesia care.
    34    (xiv) "Supplemented local anesthesia" means the  use  of  local  anes-
    35  thesia supplemented with conscious sedation.
    36    (xv)  "Unconscious or deep sedation" means the administration of medi-
    37  cation by the oral, parenteral, or inhalation routes which results in  a
    38  controlled  state of depressed consciousness accompanied by partial loss
    39  of protective reflexes. There may be an inability to  independently  and
    40  continuously  maintain  an  open airway and/or regular breathing pattern
    41  with unconscious or deep sedation, and the ability to appropriately  and
    42  rationally respond to physical stimuli and verbal commands is lost.
    43    (xvi)  "Unsupplemented  local anesthesia" means the use of local anes-
    44  thesia without supplementing with conscious sedation.
    45    (d) The provisions of this section shall not  operate  to  modify  the
    46  scope of practice of certified registered nurse anesthetists pursuant to
    47  statute  or the rules and regulations of the commissioner of health in a
    48  hospital or in a free-standing ambulatory surgery center as  defined  in
    49  article twenty-eight of the public health law.
    50    § 2. The education law is amended by adding a new section 6912 to read
    51  as follows:
    52    §  6912.  Certification  of  nurse  anesthetists. 1. For issuance of a
    53  certificate to practice as  a  certified  registered  nurse  anesthetist
    54  under  subdivision  four of section sixty-nine hundred two of this arti-
    55  cle, the applicant shall fulfill the following requirements:

        A. 7100                             4
     1    (a) Application: file an application with the department. Such  appli-
     2  cation shall be in such form as provided by the commissioner;
     3    (b)  License:  be  licensed as a registered professional nurse in this
     4  state;
     5    (c) Education: (i) have satisfactorily completed a  prescribed  course
     6  of  study  in  a school of nurse anesthesia accredited by the council on
     7  accreditation of nurse anesthesia education programs or schools or other
     8  accrediting body which the commissioner finds to be substantially equiv-
     9  alent; and
    10    (ii) have passed the national  certifying  examination  given  by  the
    11  council on certification of nurse anesthetists or other certifying exam-
    12  ination which the commissioner finds to be substantially equivalent; and
    13    (iii)  is currently certified by the council on certification of nurse
    14  anesthetists or by the council on recertification of nurse  anesthetists
    15  or  other  accrediting  body which the commissioner finds to be substan-
    16  tially equivalent. A registered professional nurse licensed and current-
    17  ly registered with the department who does not meet the requirements  as
    18  set forth in this paragraph, shall be permitted to continue the practice
    19  of  nurse  anesthesia only under the supervision of a qualified anesthe-
    20  siologist until one year after  the  effective  date  of  this  section.
    21  Notwithstanding  anything  to  the  contrary in this section, a graduate
    22  nurse anesthetist awaiting certification shall be permitted to  adminis-
    23  ter  anesthesia  only  in  the  hospital  or  ambulatory surgical center
    24  setting as provided in this section;
    25    (d) Fees: pay to the department a fee of  fifty  dollars  for  initial
    26  certification  and a triennial registration fee of thirty dollars. After
    27  a certified registered nurse anesthetist's initial registration,  regis-
    28  tration  under  this  section  shall  be  coterminous with the certified
    29  registered nurse anesthetist's registration as a professional nurse.
    30    2. Only a person certified under this  section  shall  use  the  title
    31  "nurse anesthetist" or "certified registered nurse anesthetist".
    32    3.  A  registered  professional  nurse  duly  enrolled in a program of
    33  educational preparation under subdivision one of this section may admin-
    34  ister anesthesia  as  a  student  nurse  anesthetist  under  the  direct
    35  personal  supervision of a certified registered nurse anesthetist who is
    36  supervised by an  anesthetist  or  an  anesthesiologist.  The  certified
    37  registered  nurse  anesthetist or anesthesiologist shall be continuously
    38  present.
    39    4. The commissioner  may  promulgate  regulations  to  implement  this
    40  section.
    41    § 3. Section 6522 of the education law, as added by chapter 987 of the
    42  laws of 1971, is amended to read as follows:
    43    § 6522. Practice  of  medicine  and  use of title "physician".  Only a
    44  person licensed or otherwise authorized under this article  shall  prac-
    45  tice  medicine  or use the title "physician".  No person unless licensed
    46  or otherwise authorized under this article shall use the title "anesthe-
    47  siologist" or any other title or abbreviation  or  in  combination  with
    48  another  title  or  abbreviation that would represent to the public that
    49  the person is authorized to practice medicine under this article.
    50    § 4. Notwithstanding any other provision of law  to  the  contrary,  a
    51  registered  professional nurse certified as a certified registered nurse
    52  anesthetist on, before or within one year after the  effective  date  of
    53  sections  one  and two of this act may administer anesthesia as a certi-
    54  fied registered nurse anesthetist, and shall be deemed to  be  certified
    55  as  a  certified  registered nurse anesthetist under section 6912 of the
    56  education law as added by section two of this act, until one year  after

        A. 7100                             5
     1  the  effective  date  of sections one and two of this act; provided that
     2  certification under such section shall be by a national certifying  body
     3  that has been certifying registered nurse anesthetists for at least five
     4  years prior to such section becoming a law.
     5    §  5. This act shall take effect immediately, except that sections one
     6  and two of this act shall  take  effect  on  the  first  of  April  next
     7  succeeding the date on which it shall have become a law.
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