Bill Text: NY A07268 | 2021-2022 | General Assembly | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Defines the practice of certified registered nurse anesthetist; requires collaboration with a licensed physician qualified to determine the need for anesthesia services; requires licensing; defines qualifications.
Spectrum: Partisan Bill (Democrat 11-0)
Status: (Introduced - Dead) 2022-05-06 - print number 7268a [A07268 Detail]
Download: New_York-2021-A07268-Introduced.html
Bill Title: Defines the practice of certified registered nurse anesthetist; requires collaboration with a licensed physician qualified to determine the need for anesthesia services; requires licensing; defines qualifications.
Spectrum: Partisan Bill (Democrat 11-0)
Status: (Introduced - Dead) 2022-05-06 - print number 7268a [A07268 Detail]
Download: New_York-2021-A07268-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7268 2021-2022 Regular Sessions IN ASSEMBLY April 29, 2021 ___________ Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Higher Education AN ACT to amend the education law, in relation to creating the profes- sion of nurse anesthetist The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The education law is amended by adding a new article 139-A 2 to read as follows: 3 ARTICLE 139-A 4 CERTIFIED REGISTERED NURSE ANESTHETIST 5 Section 6912. Introduction. 6 6913. Definitions. 7 6914. Definition of practice of certified registered nurse 8 anesthetist. 9 6915. Practice of certified registered nurse anesthetist and use 10 of the title "certified registered nurse anesthetist" or 11 "nurse anesthetist." 12 6916. State board for nursing. 13 6917. Requirements for a license as a certified registered nurse 14 anesthetist. 15 6918. Limited permits. 16 6919. Exempt persons. 17 6920. Special provisions. 18 § 6912. Introduction. This article applies to the profession of certi- 19 fied registered nurse anesthetist. The general provisions for all 20 professions contained in article one hundred thirty of this title apply 21 to this article. 22 § 6913. Definitions. As used in this article: 1. "Administration of 23 anesthesia services." (a) In the hospital or ambulatory surgical center, 24 "administration of anesthesia services" means anesthesia services shall 25 be directed by a physician who has responsibility for the clinical EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD08447-01-1A. 7268 2 1 aspects of organization and delivery of all anesthesia services provided 2 by the hospital or ambulatory surgical center. That physician or another 3 individual qualified by education and experience shall direct the admin- 4 istrative aspects of the service, and shall be responsible, in conjunc- 5 tion with the medical staff, for recommending to the governing body 6 privileges to those persons qualified to administer anesthetics, includ- 7 ing the procedures each person is qualified to perform and the levels of 8 required supervision as appropriate. 9 (b) In office based surgery venues, "administration of anesthesia 10 services" means the anesthesia component of the medical or dental proce- 11 dure shall be supervised by an anesthesiologist, physician, dentist or 12 podiatrist qualified to supervise the administration of anesthesia and 13 who is available to immediately diagnose and treat the patient for anes- 14 thesia complications or emergencies, and certified registered nurse 15 anesthetists may be permitted to administer monitored anesthesia care, 16 and/or general anesthesia, regional anesthesia, and/or monitor the 17 patient. 18 2. "General anesthesia" means the administration of a medication by 19 the parenteral or inhalation routes which results in a controlled state 20 of unconsciousness accompanied by a complete loss of protective reflexes 21 including loss of the ability to independently and continuously maintain 22 patient airway and a regular breathing pattern. There is also an inabil- 23 ity to respond purposefully to verbal commands and/or tactile stimu- 24 lation. 25 3. "Local anesthesia" means the introduction of a local anesthetic 26 agent into a localized part of the body by topical application or local 27 infiltration in close proximity to a nerve, which produces a transient 28 and reversible loss of sensation. All local anesthetics possess both 29 excitatory (seizure) and depressant (loss of consciousness) central 30 nervous system effects in sufficient blood levels and may have profound 31 cardiovascular depressant effects. There may also be interactive effects 32 between local anesthetic agents and sedative medications. 33 4. "Monitored anesthesia care" means: (a) a minimally depressed level 34 of consciousness that retains the patient's ability to maintain adequate 35 cardiorespiratory function and the ability to independently and contin- 36 uously maintain an open airway, a regular breathing pattern, protective 37 reflexes, and respond purposefully and rationally to tactile stimulation 38 and verbal command. This does not include unsupplemented oral pre-opera- 39 tive medications or nitrous oxide analgesia; or 40 (b) the administration of medication by the oral, parenteral, or inha- 41 lation routes which results in a controlled state of depressed 42 consciousness accompanied by partial loss of protective reflexes. There 43 may be an inability to independently and continuously maintain an open 44 airway and/or regular breathing pattern with unconscious or deep 45 sedation, and the ability to appropriately and rationally respond to 46 physical stimuli and verbal commands is lost. 47 5. "Monitoring" means the continual clinical observation of a patient 48 and the use of instruments to measure, display, and record the values of 49 certain physiologic variables such as pulse, oxygen saturation, level of 50 consciousness, blood pressure, and respiration. 51 6. "Office-based surgery" means any surgical or other invasive proce- 52 dure, requiring general anesthesia, monitored anesthesia care, and any 53 liposuction procedure, where such surgical or other invasive procedure 54 or liposuction is performed by a licensee in a location other than a 55 hospital, as such term is defined in article twenty-eight of the publicA. 7268 3 1 health law, excluding minor procedures and procedures requiring minimal 2 sedation. 3 7. "Patient" means an individual who is under the care of a physician, 4 dentist, oral surgeon or podiatrist in a licensed facility or in an 5 office. 6 8. "Peri-anesthetic period" means the period of time commencing upon 7 the pre-operative evaluation of the patient before surgery and ending 8 upon the patient's post-operative discharge from the recovery room. 9 9. "Regional anesthesia" means the administration of local anesthesia 10 agents to interrupt nerve impulses in a major region of the body. 11 Including but not limited to in this category are spinal, epidural, 12 caudal, upper or lower extremity plexus block anesthesia, and intrave- 13 nous regional anesthesia. 14 10. "Supplemented local anesthesia" means the use of local anesthesia 15 supplemented with monitored anesthesia care. 16 11. "Unsupplemented local anesthesia" means the use of local anes- 17 thesia without supplementing with monitored anesthesia care. 18 § 6914. Definition of practice of certified registered nurse anesthe- 19 tist. 1. In addition to the provisions of practice for registered 20 professional nursing outlined in section sixty-nine hundred two of this 21 title, the practice of a certified registered nurse anesthetist further 22 includes, but is not limited to, administration of anesthesia, which 23 includes general anesthesia, monitored anesthesia care, local anes- 24 thesia, regional anesthesia, spinal, epidural, caudal anesthesia, 25 supplemented local anesthesia, and unsupplemented local anesthesia to a 26 patient during the peri-anesthetic period; performing and documenting a 27 preanesthetic assessment and evaluation of the patient, including 28 requesting consultations and diagnostic studies; selecting, obtaining, 29 ordering, and administering preanesthetic medications and fluids; and 30 obtaining informed consent for anesthesia, developing and implementing 31 an anesthetic plan; initiating the anesthetic technique; monitoring the 32 patient including selecting, applying, and inserting appropriate nonin- 33 vasive and invasive monitoring modalities for continuous evaluation of 34 the patient's physical status; selecting, obtaining, and administering 35 the anesthetics, adjuvant and accessory drugs, and fluids necessary to 36 manage the anesthetic; managing a patient's airway and pulmonary status 37 using current practice modalities; facilitating emergence and recovery 38 from anesthesia by selecting, obtaining, ordering and administering 39 medications, fluids, and ventilatory support; discharging the patient 40 from a postanesthesia care area and providing postanesthesia follow-up 41 evaluation and care; implementing acute and chronic pain management 42 modalities; and responding to emergency situations by providing airway 43 management, administration of emergency fluids and drugs, and using 44 basic or advanced cardiac life support techniques. 45 2. Nurse anesthesia must be provided in collaboration with a licensed 46 physician qualified to determine the need for anesthesia services, 47 provided such services are performed in accordance with a written prac- 48 tice agreement and written practice protocols as set forth in subdivi- 49 sion four of this section or pursuant to collaborative relationships as 50 set forth in subdivision five of this section, whichever is applicable. 51 3. Prescriptions for drugs, devices, and anesthetic agents, anesthesia 52 related agents, and pain management agents may be issued by a certified 53 registered nurse anesthetist during the peri-anesthetic period, in 54 accordance with the written practice agreement and written practice 55 protocols described in subdivision four of this section if applicable. 56 The certified registered nurse anesthetist shall obtain a certificateA. 7268 4 1 from the department upon successfully completing a program including an 2 appropriate pharmacology component, or its equivalent, as established by 3 the commissioner's regulations, prior to prescribing under this subdivi- 4 sion. The license issued under this article shall state whether the 5 certified registered nurse anesthetist has successfully completed such a 6 program or equivalent and is authorized to prescribe under this subdivi- 7 sion. 8 4. A certified registered nurse anesthetist licensed under this arti- 9 cle and practicing for thirty-six hundred hours or less shall do so in 10 accordance with a written practice agreement and written practice proto- 11 cols agreed upon by a licensed physician qualified by education and 12 experience to determine the need for anesthesia. 13 (a) The written practice agreement shall include explicit provisions 14 for the resolution of any disagreement between the collaborating physi- 15 cian and the certified registered nurse anesthetist regarding a matter 16 of anesthesia or pain management treatment that is within the scope of 17 practice of both. To the extent the practice agreement does not so 18 provide, then the collaborating physician's treatment shall prevail. 19 (b) Each practice agreement shall provide for patient records review 20 by the collaborating physician in a timely fashion but in no event less 21 often than every three months. The names of the certified registered 22 nurse anesthetist and the collaborating physician shall be clearly post- 23 ed in the practice setting of the certified registered nurse anesthe- 24 tist. 25 (c) The practice protocol shall reflect current accepted medical and 26 nursing practice. The protocols shall be filed with the department with- 27 in ninety days of the commencement of the practice and may be updated 28 periodically. The commissioner shall make regulations establishing the 29 procedure for the review of protocols and the disposition of any issues 30 arising from such review. 31 5. A certified registered nurse anesthetist licensed under this arti- 32 cle and practicing for more than thirty-six hundred hours shall have 33 collaborative relationships with one or more licensed physicians quali- 34 fied to determine the need for anesthesia services or a hospital, 35 licensed under article twenty-eight of the public health law, that 36 provides services through licensed physicians qualified to determine the 37 need for anesthesia services and having privileges at such institution. 38 (a) For purposes of this subdivision, "collaborative relationships" 39 shall mean that the certified registered nurse anesthetist shall commu- 40 nicate, whether in person, by telephone or through written (including 41 electronic) means, with a licensed physician qualified to determine the 42 need for anesthesia services or, in the case of a hospital, communicate 43 with a licensed physician qualified to determine the need for anesthesia 44 services and having privileges at such hospital, for the purposes of 45 exchanging information, as needed, in order to provide comprehensive 46 patient care and to make referrals as necessary. 47 (b) As evidence that the certified registered nurse anesthetist main- 48 tains collaborative relationships, the certified registered nurse 49 anesthetist shall complete and maintain a form, created by the depart- 50 ment, to which the certified registered nurse anesthetist shall attest, 51 that describes such collaborative relationships. Such form shall also 52 reflect the certified registered nurse anesthetist's acknowledgement 53 that if reasonable efforts to resolve any dispute that may arise with 54 the collaborating physician or, in the case of a collaboration with a 55 hospital, with a licensed physician qualified to determine the need for 56 anesthesia services and having privileges at such hospital, about aA. 7268 5 1 patient's care are not successful, the recommendation of the physician 2 shall prevail. Such form shall be updated as needed and may be subject 3 to review by the department. The certified registered nurse anesthetist 4 shall maintain documentation that supports such collaborative relation- 5 ships. 6 6. Nothing in this section shall be deemed to limit or diminish the 7 practice of the profession of nursing as a registered professional nurse 8 under article one hundred thirty-nine of this title or any other law, 9 rule, regulation or certification, nor to deny any registered profes- 10 sional nurse the right to do any act or engage in any practice author- 11 ized by article one hundred thirty-nine of this title or any other law, 12 rule, regulation or certification. 13 § 6915. Practice of certified registered nurse anesthetist and use of 14 the title "certified registered nurse anesthetist" or "nurse anesthe- 15 tist." Only a person licensed or otherwise authorized under this article 16 shall practice certified registered nurse anesthetist or nurse anesthe- 17 tist. 18 § 6916. State board for nursing. The state board for nursing as estab- 19 lished in section sixty-nine hundred four of this title shall be the 20 governing state board for certified registered nurse anesthetists. 21 § 6917. Requirements for a license as a certified registered nurse 22 anesthetist. To qualify for a license as a certified registered nurse 23 anesthetist, an applicant shall fulfill the following requirements: 24 1. Application: file an application with the department; 25 2. Education: have received a master's degree or higher in a program 26 of nurse anesthesia in accordance with the commissioner's regulations; 27 3. Examination: meet the standards to sit for the certifying exam 28 provided by the national board; 29 4. Age: be at least eighteen years of age; 30 5. Character: be of good moral character as determined by the depart- 31 ment; 32 6. Fees: pay a fee of fifty dollars to the department for an initial 33 license and a fee of thirty dollars for each triennial registration 34 period; and 35 7. Information and documentation: in conjunction with and as a condi- 36 tion of each triennial registration, provide to the department, and the 37 department shall collect, such information and documentation required by 38 the department, in consultation with the department of health, as is 39 necessary to enable the department of health to evaluate access to need- 40 ed services in this state, including, but not limited to, the location 41 and type of setting wherein the certified registered nurse anesthetist 42 practices and other information the department, in consultation with the 43 department of health, deems relevant. The department of health, in 44 consultation with the department, shall make such data available in 45 aggregate, de-identified form on a publicly accessible website. Addi- 46 tionally, in conjunction with each triennial registration, the depart- 47 ment, in consultation with the department of health, shall provide 48 information on registering in the donate life registry for organ and 49 tissue donation, including the website address for such registry. 50 § 6918. Limited permits. 1. A permit to practice as a certified regis- 51 tered nurse anesthetist may be issued by the department upon the filing 52 of an application for a license as a certified registered nurse anesthe- 53 tist and submission of such other information as the department may 54 require to (a) graduates of schools of nurse anesthesia registered by 55 the department or (b) graduates of schools of nursing anesthesia 56 approved in another state, province, or country.A. 7268 6 1 2. Such limited permit shall expire one year from the date of issuance 2 or upon notice to the applicant by the department that the application 3 for license has been denied. The limited permit may be renewed, at the 4 discretion of the department, for one additional year. 5 3. A limited permit shall entitle the holder to practice certified 6 registered nurse anesthesia only under the supervision of a certified 7 registered nurse anesthetist currently registered in this state and with 8 the endorsement of the employing agency. 9 4. Fees. The fee for each limited permit shall be thirty-five dollars. 10 5. Graduates of schools of nursing anesthesia registered by the 11 department may be employed to practice nurse anesthesia under super- 12 vision of a certified registered nurse anesthetist currently registered 13 in this state and with the endorsement of the employing agency for nine- 14 ty days immediately following graduation from a program in nurse anes- 15 thesia and pending receipt of a limited permit for which an application 16 has been filed as provided in this section. 17 § 6919. Exempt persons. 1. This article shall not be construed: 18 (a) as modifying the scope of practice of certified registered nurse 19 anesthetists pursuant to statute or the rules and regulations of the 20 commissioner of health in a hospital or in a free-standing ambulatory 21 surgery center as defined in article twenty-eight of the public health 22 law; 23 (b) as applying to any activity authorized, pursuant to statutes, rule 24 or regulation, to be performed by a registered professional nurse in a 25 hospital as defined in article twenty-eight of the public health law; 26 (c) as prohibiting an individual who has been licensed as a nurse 27 practitioner in the acute care specialty area from performing the duties 28 of a certified registered nurse anesthetist; 29 (d) as prohibiting the furnishing of nursing anesthesia assistance in 30 case of an emergency; 31 (e) as prohibiting such performance of nursing anesthesia service by 32 students enrolled in registered schools or programs as may be incidental 33 to their course of study; 34 (f) as prohibiting or preventing the practice of nursing anesthesia in 35 this state by any legally qualified nurse or practical nurse of another 36 state, province, or country whose engagement requires him or her to 37 accompany and care for a patient temporarily residing in this state 38 during the period of such engagement provided such person does not 39 represent or hold himself or herself out as a certified registered nurse 40 anesthetist registered to practice in this state; 41 (g) as prohibiting or preventing the practice of nursing anesthesia in 42 this state during an emergency or disaster by any legally qualified 43 nurse anesthetist of another state, province, or country who may be 44 recruited by the American National Red Cross or pursuant to authority 45 vested in the state civil defense commission for such emergency or 46 disaster service, provided such person does not represent or hold 47 himself or herself out as a certified registered nurse anesthetist 48 registered to practice in this state; 49 (h) as prohibiting or preventing the practice of nursing anesthesia in 50 this state, in obedience to the requirements of the laws of the United 51 States, by any commissioned nurse anesthetist officer in the armed forc- 52 es of the United States or by any nurse anesthetist employed in the 53 United States veterans administration or United States public health 54 service while engaged in the performance of the actual duties prescribed 55 for him or her under the United States statutes, provided such personA. 7268 7 1 does not represent or hold himself or herself out as a certified regis- 2 tered nurse anesthetist registered to practice in this state; or 3 (i) as prohibiting the care of the sick when done in connection with 4 the practice of the religious tenets of any church. 5 § 6920. Special provisions. A certified registered nurse anesthetist 6 licensed under this article is required to purchase and maintain, or 7 otherwise be covered by, professional liability insurance in an amount 8 not less one million dollars per claim with an aggregate liability for 9 all claims during the year of three million dollars. Professional 10 liability insurance required by this section shall cover all acts within 11 the scope of practice of registered nurse anesthetist. 12 § 2. Section 6903 of the education law, as amended by chapter 323 of 13 the laws of 2006, is amended to read as follows: 14 § 6903. Practice of nursing and use of title "registered professional 15 nurse" or "licensed practical nurse". Only a person licensed or other- 16 wise authorized under this article shall practice nursing and only a 17 person licensed under section sixty-nine hundred five of this article 18 shall use the title "registered professional nurse" and only a person 19 licensed under section sixty-nine hundred six of this article shall use 20 the title "licensed practical nurse". No person shall use the title 21 "nurse" or any other title or abbreviation that would represent to the 22 public that the person is authorized to practice nursing unless the 23 person is licensed or otherwise authorized under this article or article 24 one hundred thirty-nine-A of this title. 25 § 3. Section 6904 of the education law, as amended by chapter 994 of 26 the laws of 1971 and as renumbered by chapter 50 of the laws of 1972, is 27 amended to read as follows: 28 § 6904. State board for nursing. A state board for nursing shall be 29 appointed by the board of regents on recommendation of the commissioner 30 for the purpose of assisting the board of regents and the department on 31 matters of professional licensing and professional conduct in accordance 32 with section sixty-five hundred eight of this title. The board shall be 33 composed of not less than [fifteen] seventeen members, eleven of whom 34 shall be registered professional nurses and four of whom shall be 35 licensed practical nurses and two of whom shall be certified registered 36 nurse anesthetists all licensed and practicing in this state for at 37 least five years. An executive secretary to the board shall be 38 appointed by the board of regents on recommendation of the commissioner 39 and shall be a registered professional nurse registered in this state. 40 § 4. This act shall take effect immediately.
