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.
STATE OF NEW YORK
________________________________________________________________________
4509--A
2009-2010 Regular Sessions
IN ASSEMBLY
February 4, 2009
___________
Introduced by M. of A. MORELLE, HOYT, SCHIMMINGER, ORTIZ, GUNTHER,
TOWNS, COOK, JACOBS, MARKEY, BRENNAN, LENTOL, POWELL, CARROZZA, SEMIN-
ERIO -- Multi-Sponsored by -- M. of A. BOYLAND, BRADLEY, CYMBROWITZ,
DelMONTE, DESTITO, DINOWITZ, EDDINGTON, ESPAILLAT, GIANARIS, GORDON,
HEASTIE, KOON, MAGEE, MAGNARELLI, McENENY, MILLMAN, PRETLOW, REILLY,
J. RIVERA, P. RIVERA, SCARBOROUGH, WEISENBERG, WEPRIN, WRIGHT -- read
once and referred to the Committee on Higher Education -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
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 eleven 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 admin-
15 istration 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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02130-04-9
A. 4509--A 2
1 (iii) be consistent with policies and procedures approved by the
2 medical staff and governing body of the health care facility, or free
3 standing ambulatory surgical center defined under article twenty-eight
4 of the public health law, where applicable, and as legally authorized
5 under this title and in accordance with applicable regulations of the
6 commissioner of health.
7 (c) The following terms shall have the following meanings:
8 (i) "Administration of anesthesia" in the hospital or ambulatory
9 surgical center means anesthesia services shall be directed by a physi-
10 cian who has responsibility for the clinical aspects of organization and
11 delivery of all anesthesia services provided by the hospital or ambula-
12 tory surgical center. That physician or another individual qualified by
13 education and experience shall direct the administrative aspects of the
14 service, and shall be responsible, in conjunction with the medical
15 staff, for recommending to the governing body privileges to those
16 persons qualified to administer anesthetics, including the procedures
17 each person is qualified to perform and the levels of required super-
18 vision as appropriate. Administration of anesthesia in office based
19 surgery venues means the anesthesia component of the medical or dental
20 procedure shall be supervised by an anesthesiologist, physician, dentist
21 or podiatrist qualified to supervise the administration of anesthesia
22 who is physically present and available to immediately diagnose and
23 treat the patient for anesthesia complications or emergencies, and nurse
24 anesthetists with the appropriate training and experience may be permit-
25 ted to administer unconscious or deep sedation, and/or general anes-
26 thesia, regional anesthesia, and/or monitor the patient.
27 (ii) "Conscious sedation" or "sedation analgesia" means a minimally
28 depressed level of consciousness that retains the patient's ability to
29 maintain adequate cardiorespiratory function and the ability to inde-
30 pendently and continuously maintain an open airway, a regular breathing
31 pattern, protective reflexes, and respond purposefully and rationally to
32 tactile stimulation and verbal command. This does not include unsupple-
33 mented oral pre-operative medications or nitrous oxide analgesia.
34 (iii) "General anesthesia" means the administration of a medication by
35 the parenteral or inhalation routes which results in a controlled state
36 of unconsciousness accompanied by a complete loss of protective reflexes
37 including loss of the ability to independently and continuously maintain
38 patient airway and a regular breathing pattern. There is also an
39 inability to respond purposefully to verbal commands and/or tactile
40 stimulation.
41 (iv) "Immediately available" means remaining physically available for
42 the immediate treatment of emergencies and providing indicated post-op-
43 erative care.
44 (v) "Local anesthesia" means the introduction of a local anesthetic
45 agent into a localized part of the body by topical application or local
46 infiltration in close proximity to a nerve, which produces a transient
47 and reversible loss of sensation. All local anesthetics possess both
48 excitatory (seizure) and depressant (loss of consciousness) central
49 nervous system effects in sufficient blood levels and may have profound
50 cardiovascular depressant effects. There may also be interactive effects
51 between local anesthetic agents and sedative medications.
52 (vi) "Monitoring" means the continual clinical observation of a
53 patient and the use of instruments to measure, display, and record the
54 values of certain physiologic variables such as pulse, oxygen satu-
55 ration, level of consciousness, blood pressure, and respiration.
A. 4509--A 3
1 (vii) "Office-based surgery" means any surgical or other invasive
2 procedure requiring anesthesia, analgesia or sedation including cryosur-
3 gery, laser surgery, and high-volume liposuction which is performed by a
4 practitioner in a location other than a hospital (as defined in article
5 twenty-eight of the public health law) or a diagnostic and treatment
6 center including freestanding ambulatory surgery centers and which
7 results in a patient stay of less than twenty-four consecutive hours.
8 (viii) "Patient" means an individual who is under the care of a physi-
9 cian in a licensed facility or, in an office, under the care of a physi-
10 cian, dentist, oral surgeon or podiatrist.
11 (ix) "Peri-operative period" means the period of time commencing upon
12 the medical evaluation of the patient before surgery and ending upon the
13 patient's medical discharge from the recovery room.
14 (x) "Physically present" by a physician means the ability to react and
15 respond in an immediate and appropriate manner so as to make possible
16 the continuous exercise of medical judgment throughout the adminis-
17 tration of the anesthesia. "Physically present" by a dentist, oral
18 surgeon or podiatrist means the ability of such person who is performing
19 the procedure requiring the administration of anesthesia to react and
20 respond in an immediate and appropriate manner so as to make possible
21 the continuous exercise of professional judgment throughout the adminis-
22 tration of the anesthesia.
23 (xi) "Qualified anesthesia practitioner" means a physician, dentist,
24 podiatrist or certified registered nurse anesthetist whose professional
25 practice is subject to the department of health for professional medical
26 or professional conduct or the state education department office of
27 professional discipline.
28 (xii) "Regional anesthesia" means the administration of local anes-
29 thesia agents to interrupt nerve impulses in a major region of the body.
30 Included in this category, for example, are spinal, epidural, caudal,
31 upper or lower extremity plexus block anesthesia, and intravenous
32 regional anesthesia.
33 (xiii) "Supervision" means that a physician, dentist, oral surgeon or
34 podiatrist shall perform a pre-anesthetic examination and evaluation,
35 prescribe the anesthesia, including post-operative medications as needed
36 for pain and discomfort, including nausea and vomiting, remain phys-
37 ically present during the entire peri-operative period and immediately
38 available for diagnosis, treatment, and management of anesthesia-related
39 complications or emergencies, and assure the provision of indicated
40 post-anesthesia care.
41 (xiv) "Supplemented local anesthesia" means the use of local anes-
42 thesia supplemented with conscious sedation.
43 (xv) "Unconscious or deep sedation" means the administration of medi-
44 cation by the oral, parenteral, or inhalation routes which results in a
45 controlled state of depressed consciousness accompanied by partial loss
46 of protective reflexes. There may be an inability to independently and
47 continuously maintain an open airway and/or regular breathing pattern
48 with unconscious or deep sedation, and the ability to appropriately and
49 rationally respond to physical stimuli and verbal commands is lost.
50 (xvi) "Unsupplemented local anesthesia" means the use of local anes-
51 thesia without supplementing with conscious sedation.
52 (d) The provisions of this chapter shall not operate to modify the
53 scope of practice of certified registered nurse anesthetists pursuant to
54 statute or the rules and regulations of the commissioner of health in a
55 hospital or in a free-standing ambulatory surgery center as defined in
56 article twenty-eight of the public health law.
A. 4509--A 4
1 § 2. The education law is amended by adding a new section 6911 to read
2 as follows:
3 § 6911. Certification of nurse anesthetists. 1. For issuance of a
4 certificate to practice as a certified registered nurse anesthetist
5 under subdivision four of section sixty-nine hundred two of this arti-
6 cle, the applicant shall fulfill the following requirements:
7 (a) Application: file an application with the department. Such appli-
8 cation shall be in such form as provided by the commissioner;
9 (b) License: be licensed as a registered professional nurse in this
10 state;
11 (c) Education: (i) have satisfactorily completed a prescribed course
12 of study in a school of nurse anesthesia accredited by the council on
13 accreditation of nurse anesthesia education programs or schools or other
14 accrediting body which the commissioner finds to be substantially equiv-
15 alent; and
16 (ii) have passed the national certifying examination given by the
17 council on certification of nurse anesthetists or other certifying exam-
18 ination which the commissioner finds to be substantially equivalent; and
19 (iii) is currently certified by the council on certification of nurse
20 anesthetists or by the council on recertification of nurse anesthetists
21 or other accrediting body which the commissioner finds to be substan-
22 tially equivalent. A registered professional nurse licensed and current-
23 ly registered with the department who does not meet the requirements as
24 set forth in this paragraph, shall be permitted to continue the practice
25 of nurse anesthesia only under the supervision of a qualified anesthe-
26 siologist until one year after the effective date of this section.
27 Notwithstanding anything to the contrary herein, a graduate nurse
28 anesthetist awaiting certification shall be permitted to administer
29 anesthesia only in the hospital or ambulatory surgical center setting as
30 provided herein;
31 (d) Fees: pay to the department a fee of fifty dollars for initial
32 certification and a triennial registration fee of thirty dollars. After
33 a certified registered nurse anesthetist's initial registration, regis-
34 tration under this section shall be coterminous with the certified
35 registered nurse anesthetist's registration as a professional nurse.
36 2. Only a person certified under this section shall use the title
37 "nurse anesthetist" or "certified registered nurse anesthetist".
38 3. A registered professional nurse duly enrolled in a program of
39 educational preparation under subdivision one of this section may admin-
40 ister anesthesia as a student nurse anesthetist under the direct
41 personal supervision of a certified registered nurse anesthetist who is
42 supervised by an anesthesiologist or an anesthesiologist. The certified
43 registered nurse anesthetist or anesthesiologist shall be continuously
44 present.
45 4. The commissioner may promulgate regulations to implement this
46 section.
47 § 3. Notwithstanding any other provision of law to the contrary, a
48 registered professional nurse certified as a certified registered nurse
49 anesthetist on, before, or within one year after the date on which
50 sections one and two of this act take effect may administer anesthesia
51 as a certified registered nurse anesthetist, and shall be deemed to be
52 certified as a certified registered nurse anesthetist under section 6911
53 of the education law as added by section two of this act, until one year
54 after sections one and two of this act shall take effect; provided that
55 certification under such section shall be by a national certifying body
A. 4509--A 5
1 that has been certifying registered nurse anesthetists for at least five
2 years prior to such section becoming a law.
3 § 4. This act shall take effect on the thirtieth day after it shall
4 have become a law, except that sections one and two of this act shall
5 take effect on the first of April next succeeding the date on which it
6 shall have become a law.
