This is probably more than you want to know... but it does shed some light on the subject and what's currently going on. Plus, many CRNAs and SRNAs (like myself) have decided to absolutely BOYCOTT any and all groups utilizing AAs in their practice. I would like to encourage YOU to adopt the same stance. It isn't merely "dealing with competition" - what about the safety of the patient and YOUR license to practice?
from the article:
AAs AAs AAs AAS
Anesthesiologist Assistants (AAs)
District of Columbia-The medical board has adopted guidelines to permit AAs
to practice under the delegatory authority of anesthesiologists. The
guidelines, as finalized by the board, have yet to be published.
Florida-Florida H.B. 599, providing for the licensure of AAs, passed the
House but failed to be considered by the full Senate prior to the end of the
session. The House-passed bill would have allowed an anesthesiologist to
supervise two AAs, although the Board of Medicine would have been permitted by
rule to allow an anesthesiologist to supervise up to four AAs after July 1,
2006. "Direct supervision" was defined as supervision by an anesthesiologist
who is present in the same room as the AA or in an immediately adjacent room or
hallway, such that the supervising anesthesiologist is able to monitor the
ongoing anesthetic and be immediately available to provide assistance and
direction while anesthesia services are being performed. The supervising
anesthesiologist would have been required to personally begin the patient's
Indiana-S.B. 370 would have prevented a physician assistant (PA) from
prescribing, administering or monitoring general anesthesia, regional block
anesthesia or deep sedation unless 1) a physician is physically present in the
area and is immediately available to assist in the management of the patient,
and 2) the PA is qualified to rescue patients from deep sedation and is
competent to manage a compromised airway and provide adequate oxygenation and
ventilation. The bill failed to pass.
Kentucky-H.B. 617 was signed into law to provide for the continued practice
of PAs who have been practicing as AAs. The law requires the individual to have
completed a four-year PA program followed by a two-year program that consists
of academic and clinical training in anesthesiology. Under the law, a PA
practicing as an AA may administer or monitor general or regional anesthesia if
the supervising anesthesiologist is physically present in the room during
induction and emergence, is not concurrently performing any other anesthesia
procedure and is available to be immediately present in the room.
Louisiana-The governor has extended the time frame for the AA commission to
develop legislation to license AAs until March 1, 2003.
Maryland-The governor signed H.B. 533 to establish a commission to propose
regulations or legislation regarding the approval of delegation agreements for
the administration of anesthesia by PAs. The commission was to report to the
legislature by December 1, 2002.
New Jersey-A.B. 655 was introduced to license AAs. The bill states that an AA
shall be under the direct supervision and medical direction of an
anesthesiologist at all times. An AA may assist an anesthesiologist in
developing and implementing an anesthesia care plan for a patient pursuant to a
written practice protocol developed by the supervising anesthesiologist. The
written protocol is to delineate all the services that the AA is authorized to
provide and the manner in which the anesthesiologist will supervise and
medically direct the AA. A supervising anesthesiologist shall not have more
than two AAs under his or her supervision and medical direction or employment
at any one time.
Ohio-The Anesthesiologist Assistant Advisory Committee (AAAC), a group formed
by the Board of Medicine to draft regulations for AAs, has issued its final
report to the board. The board has finalized the proposed regulations and has
begun the formal rules process. The proposed regulations require supervising
anesthesiologists to establish a written practice protocol with AAs and to
provide direct supervision in the immediate presence of the AA. During the
first four years of an AA's practice, the supervising anesthesiologist shall
provide "enhanced supervision." "Enhanced supervision" requires regular,
documented quality assurance interactions between the supervising
anesthesiologist and the AA. An AA shall be required, during the first two
years of practice, to file monthly a separate record of cases of anesthetic
management in which he or she participated. The record will be reviewed by a
supervising anesthesiologist, who will then file a report of each quality
AAs are permitted to practice only in hospitals and ambulatory surgical
facilities and are prohibited from performing epidural and spinal anesthetic
procedures and invasive monitoring techniques such as pulmonary artery
catheterization, central venous catheterization and all forms of arterial
catheterization with the exception of brachial, radial and dorsalis pedis
Oklahoma-The Board of Medical Licensure and Supervision adopted regulations
to allow PAs to perform preanesthetic and postanesthetic assessment of patients
and administer topical, local or regional anesthesia. PAs are prohibited from
administering general anesthetics without the express approval of the Board.
Pennsylvania-The Board of Medicine proposed regulations to codify criteria
under which a physician may delegate the performance of medical services. While
this regulation would apply to all physicians, anesthesiologists would be able
to delegate authority to AAs.
Texas-The Board of Medical Examiners amended the AA guidelines to allow an
anesthesiologist to supervise up to four AAs at one time. Previously the
guidelines allowed for a ratio of 1:2.
This year-end summary will continue in January summarizing other activities in
the states related to office-based anesthesia and tort reform.