S T A T E O F N E W Y O R K
________________________________________________________________________
1515
2009-2010 Regular Sessions
I N S E N A T E
February 2, 2009
___________
Introduced by Sens. DeFRANCISCO, VOLKER -- read twice and ordered print-
ed, and when printed to be committed to the Committee on Higher Educa-
tion
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:
Section 1. Section 6902 of the education law is amended by adding a
new subdivision 4 to read as follows:
4. (A) THE ADMINISTRATION OF ANESTHESIA TO A PATIENT SHALL BE
PERFORMED ONLY BY A QUALIFIED ANESTHESIA PRACTITIONER AS LEGALLY AUTHOR-
IZED UNDER THIS TITLE.
(B) THE PRACTICE OF PROFESSIONAL NURSING BY A REGISTERED NURSE ANESTH-
ETIST, CERTIFIED UNDER SECTION SIXTY-NINE HUNDRED ELEVEN OF THIS ARTI-
CLE, SHALL (I) INCLUDE THE ADMINISTRATION OF ANESTHESIA TO A PATIENT BUT
ONLY UNDER THE SUPERVISION OF AN ANESTHESIOLOGIST WHO IS IMMEDIATELY
AVAILABLE; OR UNDER THE SUPERVISION OF THE OPERATING PHYSICIAN WHO IS
PHYSICALLY PRESENT; OR UNDER THE SUPERVISION OF A DENTIST, ORAL SURGEON
OR PODIATRIST WHO IS PHYSICALLY PRESENT AND WHO IS AUTHORIZED BY LAW TO
ADMINISTER ANESTHESIA, TO THE EXTENT SUCH PERSON IS QUALIFIED BY LAW,
REGULATION, OR HOSPITAL APPOINTMENT TO PERFORM AND SUPERVISE THE ADMIN-
ISTRATION OF ANESTHESIA; AND
(II) INCLUDE THE EXECUTION OF MEDICAL REGIMENS PRESCRIBED BY THE
SUPERVISORY PHYSICIAN, DENTIST, ORAL SURGEON OR PODIATRIST WHO IS
AUTHORIZED BY LAW TO PRESCRIBE; AND
(III) BE CONSISTENT WITH POLICIES AND PROCEDURES APPROVED BY THE
MEDICAL STAFF AND GOVERNING BODY OF THE HEALTH CARE FACILITY, OR FREE
STANDING AMBULATORY SURGICAL CENTER DEFINED UNDER ARTICLE TWENTY-EIGHT
OF THE PUBLIC HEALTH LAW, WHERE APPLICABLE, AND AS LEGALLY AUTHORIZED
UNDER THIS TITLE AND IN ACCORDANCE WITH APPLICABLE REGULATIONS OF THE
COMMISSIONER OF HEALTH.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02130-01-9
S. 1515 2
(C) THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
(I) "ADMINISTRATION OF ANESTHESIA" IN THE HOSPITAL OR AMBULATORY
SURGICAL CENTER MEANS ANESTHESIA SERVICES SHALL BE DIRECTED BY A PHYSI-
CIAN WHO HAS RESPONSIBILITY FOR THE CLINICAL ASPECTS OF ORGANIZATION AND
DELIVERY OF ALL ANESTHESIA SERVICES PROVIDED BY THE HOSPITAL OR AMBULA-
TORY SURGICAL CENTER. THAT PHYSICIAN OR ANOTHER INDIVIDUAL QUALIFIED BY
EDUCATION AND EXPERIENCE SHALL DIRECT THE ADMINISTRATIVE ASPECTS OF THE
SERVICE, AND SHALL BE RESPONSIBLE, IN CONJUNCTION WITH THE MEDICAL
STAFF, FOR RECOMMENDING TO THE GOVERNING BODY PRIVILEGES TO THOSE
PERSONS QUALIFIED TO ADMINISTER ANESTHETICS, INCLUDING THE PROCEDURES
EACH PERSON IS QUALIFIED TO PERFORM AND THE LEVELS OF REQUIRED SUPER-
VISION AS APPROPRIATE. ADMINISTRATION OF ANESTHESIA IN OFFICE BASED
SURGERY VENUES MEANS THE ANESTHESIA COMPONENT OF THE MEDICAL OR DENTAL
PROCEDURE SHALL BE SUPERVISED BY AN ANESTHESIOLOGIST, PHYSICIAN, DENTIST
OR PODIATRIST QUALIFIED TO SUPERVISE THE ADMINISTRATION OF ANESTHESIA
WHO IS PHYSICALLY PRESENT AND AVAILABLE TO IMMEDIATELY DIAGNOSE AND
TREAT THE PATIENT FOR ANESTHESIA COMPLICATIONS OR EMERGENCIES, AND NURSE
ANESTHETISTS WITH THE APPROPRIATE TRAINING AND EXPERIENCE MAY BE PERMIT-
TED TO ADMINISTER UNCONSCIOUS OR DEEP SEDATION, AND/OR GENERAL ANES-
THESIA, REGIONAL ANESTHESIA, AND/OR MONITOR THE PATIENT.
(II) "CONSCIOUS SEDATION" OR "SEDATION ANALGESIA" MEANS A MINIMALLY
DEPRESSED LEVEL OF CONSCIOUSNESS THAT RETAINS THE PATIENT'S ABILITY TO
MAINTAIN ADEQUATE CARDIORESPIRATORY FUNCTION AND THE ABILITY TO INDE-
PENDENTLY AND CONTINUOUSLY MAINTAIN AN OPEN AIRWAY, A REGULAR BREATHING
PATTERN, PROTECTIVE REFLEXES, AND RESPOND PURPOSEFULLY AND RATIONALLY TO
TACTILE STIMULATION AND VERBAL COMMAND. THIS DOES NOT INCLUDE UNSUPPLE-
MENTED ORAL PRE-OPERATIVE MEDICATIONS OR NITROUS OXIDE ANALGESIA.
(III) "GENERAL ANESTHESIA" MEANS THE ADMINISTRATION OF A MEDICATION BY
THE PARENTERAL OR INHALATION ROUTES WHICH RESULTS IN A CONTROLLED STATE
OF UNCONSCIOUSNESS ACCOMPANIED BY A COMPLETE LOSS OF PROTECTIVE REFLEXES
INCLUDING LOSS OF THE ABILITY TO INDEPENDENTLY AND CONTINUOUSLY MAINTAIN
PATIENT AIRWAY AND A REGULAR BREATHING PATTERN. THERE IS ALSO AN
INABILITY TO RESPOND PURPOSEFULLY TO VERBAL COMMANDS AND/OR TACTILE
STIMULATION.
(IV) "IMMEDIATELY AVAILABLE" MEANS REMAINING PHYSICALLY AVAILABLE FOR
THE IMMEDIATE TREATMENT OF EMERGENCIES AND PROVIDING INDICATED POST-OP-
ERATIVE CARE.
(V) "LOCAL ANESTHESIA" MEANS THE INTRODUCTION OF A LOCAL ANESTHETIC
AGENT INTO A LOCALIZED PART OF THE BODY BY TOPICAL APPLICATION OR LOCAL
INFILTRATION IN CLOSE PROXIMITY TO A NERVE, WHICH PRODUCES A TRANSIENT
AND REVERSIBLE LOSS OF SENSATION. ALL LOCAL ANESTHETICS POSSESS BOTH
EXCITATORY (SEIZURE) AND DEPRESSANT (LOSS OF CONSCIOUSNESS) CENTRAL
NERVOUS SYSTEM EFFECTS IN SUFFICIENT BLOOD LEVELS AND MAY HAVE PROFOUND
CARDIOVASCULAR DEPRESSANT EFFECTS. THERE MAY ALSO BE INTERACTIVE EFFECTS
BETWEEN LOCAL ANESTHETIC AGENTS AND SEDATIVE MEDICATIONS.
(VI) "MONITORING" MEANS THE CONTINUAL CLINICAL OBSERVATION OF A
PATIENT AND THE USE OF INSTRUMENTS TO MEASURE, DISPLAY, AND RECORD THE
VALUES OF CERTAIN PHYSIOLOGIC VARIABLES SUCH AS PULSE, OXYGEN SATU-
RATION, LEVEL OF CONSCIOUSNESS, BLOOD PRESSURE, AND RESPIRATION.
(VII) "OFFICE-BASED SURGERY" MEANS ANY SURGICAL OR OTHER INVASIVE
PROCEDURE REQUIRING ANESTHESIA, ANALGESIA OR SEDATION INCLUDING CRYOSUR-
GERY, LASER SURGERY, AND HIGH-VOLUME LIPOSUCTION WHICH IS PERFORMED BY A
PRACTITIONER IN A LOCATION OTHER THAN A HOSPITAL (AS DEFINED IN ARTICLE
TWENTY-EIGHT OF THE PUBLIC HEALTH LAW) OR A DIAGNOSTIC AND TREATMENT
CENTER INCLUDING FREESTANDING AMBULATORY SURGERY CENTERS AND WHICH
RESULTS IN A PATIENT STAY OF LESS THAN TWENTY-FOUR CONSECUTIVE HOURS.
S. 1515 3
(VIII) "PATIENT" MEANS AN INDIVIDUAL WHO IS UNDER THE CARE OF A PHYSI-
CIAN IN A LICENSED FACILITY OR, IN AN OFFICE, UNDER THE CARE OF A PHYSI-
CIAN, DENTIST, ORAL SURGEON OR PODIATRIST.
(IX) "PERI-OPERATIVE PERIOD" MEANS THE PERIOD OF TIME COMMENCING UPON
THE MEDICAL EVALUATION OF THE PATIENT BEFORE SURGERY AND ENDING UPON THE
PATIENT'S MEDICAL DISCHARGE FROM THE RECOVERY ROOM.
(X) "PHYSICALLY PRESENT" BY A PHYSICIAN MEANS THE ABILITY TO REACT AND
RESPOND IN AN IMMEDIATE AND APPROPRIATE MANNER SO AS TO MAKE POSSIBLE
THE CONTINUOUS EXERCISE OF MEDICAL JUDGMENT THROUGHOUT THE ADMINIS-
TRATION OF THE ANESTHESIA. "PHYSICALLY PRESENT" BY A DENTIST, ORAL
SURGEON OR PODIATRIST MEANS THE ABILITY OF SUCH PERSON WHO IS PERFORMING
THE PROCEDURE REQUIRING THE ADMINISTRATION OF ANESTHESIA TO REACT AND
RESPOND IN AN IMMEDIATE AND APPROPRIATE MANNER SO AS TO MAKE POSSIBLE
THE CONTINUOUS EXERCISE OF PROFESSIONAL JUDGMENT THROUGHOUT THE ADMINIS-
TRATION OF THE ANESTHESIA.
(XI) "QUALIFIED ANESTHESIA PRACTITIONER" MEANS A PHYSICIAN, DENTIST,
PODIATRIST OR CERTIFIED REGISTERED NURSE ANESTHETIST WHOSE PROFESSIONAL
PRACTICE IS SUBJECT TO THE DEPARTMENT OF HEALTH FOR PROFESSIONAL MEDICAL
OR PROFESSIONAL CONDUCT OR THE STATE EDUCATION DEPARTMENT OFFICE OF
PROFESSIONAL DISCIPLINE.
(XII) "REGIONAL ANESTHESIA" MEANS THE ADMINISTRATION OF LOCAL ANES-
THESIA AGENTS TO INTERRUPT NERVE IMPULSES IN A MAJOR REGION OF THE BODY.
INCLUDED IN THIS CATEGORY, FOR EXAMPLE, ARE SPINAL, EPIDURAL, CAUDAL,
UPPER OR LOWER EXTREMITY PLEXUS BLOCK ANESTHESIA, AND INTRAVENOUS
REGIONAL ANESTHESIA.
(XIII) "SUPERVISION" MEANS THAT A PHYSICIAN, DENTIST, ORAL SURGEON OR
PODIATRIST SHALL PERFORM A PRE-ANESTHETIC EXAMINATION AND EVALUATION,
PRESCRIBE THE ANESTHESIA, INCLUDING POST-OPERATIVE MEDICATIONS AS NEEDED
FOR PAIN AND DISCOMFORT, INCLUDING NAUSEA AND VOMITING, REMAIN PHYS-
ICALLY PRESENT DURING THE ENTIRE PERI-OPERATIVE PERIOD AND IMMEDIATELY
AVAILABLE FOR DIAGNOSIS, TREATMENT, AND MANAGEMENT OF ANESTHESIA-RELATED
COMPLICATIONS OR EMERGENCIES, AND ASSURE THE PROVISION OF INDICATED
POST-ANESTHESIA CARE.
(XIV) "SUPPLEMENTED LOCAL ANESTHESIA" MEANS THE USE OF LOCAL ANES-
THESIA SUPPLEMENTED WITH CONSCIOUS SEDATION.
(XV) "UNCONSCIOUS OR DEEP SEDATION" MEANS THE ADMINISTRATION OF MEDI-
CATION BY THE ORAL, PARENTERAL, OR INHALATION ROUTES WHICH RESULTS IN A
CONTROLLED STATE OF DEPRESSED CONSCIOUSNESS ACCOMPANIED BY PARTIAL LOSS
OF PROTECTIVE REFLEXES. THERE MAY BE AN INABILITY TO INDEPENDENTLY AND
CONTINUOUSLY MAINTAIN AN OPEN AIRWAY AND/OR REGULAR BREATHING PATTERN
WITH UNCONSCIOUS OR DEEP SEDATION, AND THE ABILITY TO APPROPRIATELY AND
RATIONALLY RESPOND TO PHYSICAL STIMULI AND VERBAL COMMANDS IS LOST.
(XVI) "UNSUPPLEMENTED LOCAL ANESTHESIA" MEANS THE USE OF LOCAL ANES-
THESIA WITHOUT SUPPLEMENTING WITH CONSCIOUS SEDATION.
(D) THE PROVISIONS OF THIS CHAPTER SHALL NOT OPERATE TO MODIFY THE
SCOPE OF PRACTICE OF CERTIFIED REGISTERED NURSE ANESTHETISTS PURSUANT TO
STATUTE OR THE RULES AND REGULATIONS OF THE COMMISSIONER OF HEALTH IN A
HOSPITAL OR IN A FREE-STANDING AMBULATORY SURGERY CENTER AS DEFINED IN
ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW.
S 2. The education law is amended by adding a new section 6911 to read
as follows:
S 6911. CERTIFICATION OF NURSE ANESTHETISTS. 1. FOR ISSUANCE OF A
CERTIFICATE TO PRACTICE AS A CERTIFIED REGISTERED NURSE ANESTHETIST
UNDER SUBDIVISION FOUR OF SECTION SIXTY-NINE HUNDRED TWO OF THIS ARTI-
CLE, THE APPLICANT SHALL FULFILL THE FOLLOWING REQUIREMENTS:
S. 1515 4
(A) APPLICATION: FILE AN APPLICATION WITH THE DEPARTMENT. SUCH APPLI-
CATION SHALL BE IN SUCH FORM AS PROVIDED BY THE COMMISSIONER;
(B) LICENSE: BE LICENSED AS A REGISTERED PROFESSIONAL NURSE IN THIS
STATE;
(C) EDUCATION: (I) HAVE SATISFACTORILY COMPLETED A PRESCRIBED COURSE
OF STUDY IN A SCHOOL OF NURSE ANESTHESIA ACCREDITED BY THE COUNCIL ON
ACCREDITATION OF NURSE ANESTHESIA EDUCATION PROGRAMS OR SCHOOLS OR OTHER
ACCREDITING BODY WHICH THE COMMISSIONER FINDS TO BE SUBSTANTIALLY EQUIV-
ALENT; AND
(II) HAVE PASSED THE NATIONAL CERTIFYING EXAMINATION GIVEN BY THE
COUNCIL ON CERTIFICATION OF NURSE ANESTHETISTS OR OTHER CERTIFYING EXAM-
INATION WHICH THE COMMISSIONER FINDS TO BE SUBSTANTIALLY EQUIVALENT; AND
(III) IS CURRENTLY CERTIFIED BY THE COUNCIL ON CERTIFICATION OF NURSE
ANESTHETISTS OR BY THE COUNCIL ON RECERTIFICATION OF NURSE ANESTHETISTS
OR OTHER ACCREDITING BODY WHICH THE COMMISSIONER FINDS TO BE SUBSTAN-
TIALLY EQUIVALENT. A REGISTERED PROFESSIONAL NURSE LICENSED AND CURRENT-
LY REGISTERED WITH THE DEPARTMENT WHO DOES NOT MEET THE REQUIREMENTS AS
SET FORTH IN THIS PARAGRAPH, SHALL BE PERMITTED TO CONTINUE THE PRACTICE
OF NURSE ANESTHESIA ONLY UNDER THE SUPERVISION OF A QUALIFIED ANESTHE-
SIOLOGIST UNTIL ONE YEAR AFTER THE EFFECTIVE DATE OF THIS SECTION.
NOTWITHSTANDING ANYTHING TO THE CONTRARY HEREIN, A GRADUATE NURSE
ANESTHETIST AWAITING CERTIFICATION SHALL BE PERMITTED TO ADMINISTER
ANESTHESIA ONLY IN THE HOSPITAL OR AMBULATORY SURGICAL CENTER SETTING AS
PROVIDED HEREIN;
(D) FEES: PAY TO THE DEPARTMENT A FEE OF FIFTY DOLLARS FOR INITIAL
CERTIFICATION AND A TRIENNIAL REGISTRATION FEE OF THIRTY DOLLARS. REGIS-
TRATION UNDER THIS SECTION SHALL BE COTERMINOUS WITH THE NURSE
ANESTHETIST'S REGISTRATION AS A PROFESSIONAL NURSE.
2. ONLY A PERSON CERTIFIED UNDER THIS SECTION SHALL USE THE TITLE
"NURSE ANESTHETIST" OR "CERTIFIED REGISTERED NURSE ANESTHETIST".
3. A REGISTERED PROFESSIONAL NURSE DULY ENROLLED IN A PROGRAM OF
EDUCATIONAL PREPARATION UNDER SUBDIVISION ONE OF THIS SECTION MAY ADMIN-
ISTER ANESTHESIA AS A STUDENT NURSE ANESTHETIST UNDER THE DIRECT
PERSONAL SUPERVISION OF A CERTIFIED REGISTERED NURSE ANESTHETIST WHO IS
SUPERVISED BY AN ANESTHESIOLOGIST OR AN ANESTHESIOLOGIST. THE CERTIFIED
REGISTERED NURSE ANESTHETIST OR ANESTHESIOLOGIST SHALL BE CONTINUOUSLY
PRESENT.
4. THE COMMISSIONER MAY PROMULGATE REGULATIONS TO IMPLEMENT THIS
SECTION.
S 3. Notwithstanding any other provision of law to the contrary, a
registered professional nurse certified as a certified registered nurse
anesthetist on, before, or within one year after the date on which
sections one and two of this act take effect may administer anesthesia
as a certified registered nurse anesthetist, and shall be deemed to be
certified as a certified registered nurse anesthetist under section 6911
of the education law as added by section two of this act, until one year
after sections one and two of this act shall take effect; provided that
certification under such section shall be by a national certifying body
that has been certifying registered nurse anesthetists for at least five
years prior to such section becoming a law.
S 4. This act shall take effect on the thirtieth day after it shall
have become a law, except that sections one and two of this act shall
take effect on the first of April next succeeding the date on which it
shall have become a law.
