S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1829
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 13, 2017
                                ___________
 
 Introduced  by  M.  of  A.  MORELLE,  SCHIMMINGER, ORTIZ, GUNTHER, COOK,
   LENTOL, ENGLEBRIGHT, STIRPE, ABINANTI, JAFFEE, CUSICK  --  Multi-Spon-
   sored  by -- M. of A. CROUCH, CYMBROWITZ, DINOWITZ, HIKIND, LUPINACCI,
   MAGEE, MAGNARELLI, PERRY, PRETLOW, RIVERA -- read once and referred to
   the Committee 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:
 
   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 TWELVE 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 ADMINIS-
 TRATION 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00936-01-7

 A. 1829                             2
 
 UNDER THIS TITLE AND IN ACCORDANCE WITH APPLICABLE  REGULATIONS  OF  THE
 COMMISSIONER OF HEALTH.
   (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 IN PHYSICAL PROXIMITY SO
 AS TO ALLOW  THE  ANESTHESIOLOGIST  TO  RETURN  TO  RE-ESTABLISH  DIRECT
 CONTACT  WITH  THE  PATIENT IN ORDER TO MEET THE PATIENT'S MEDICAL NEEDS
 AND ADDRESS ANY URGENT OR EMERGENT CLINICAL PROBLEMS.
   (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 GENERAL  ANESTHESIA,  MODERATE  SEDATION,  OR  DEEP
 SEDATION,  AND  ANY  LIPOSUCTION PROCEDURE, WHERE SUCH SURGICAL OR OTHER
 INVASIVE PROCEDURE OR LIPOSUCTION  IS  PERFORMED  BY  A  LICENSEE  IN  A

 A. 1829                             3
 
 LOCATION OTHER THAN A HOSPITAL, AS SUCH TERM IS DEFINED IN ARTICLE TWEN-
 TY-EIGHT OF THE PUBLIC HEALTH LAW, EXCLUDING MINOR PROCEDURES AND PROCE-
 DURES REQUIRING MINIMAL SEDATION.
   (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 SECTION 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.
   § 2. The education law is amended by adding a new section 6912 to read
 as follows:
   §  6912.  CERTIFICATION  OF  NURSE  ANESTHETISTS. 1. FOR ISSUANCE OF A
 CERTIFICATE TO PRACTICE AS  A  CERTIFIED  REGISTERED  NURSE  ANESTHETIST

 A. 1829                             4
 
 UNDER  SUBDIVISION  FOUR OF SECTION SIXTY-NINE HUNDRED TWO OF THIS ARTI-
 CLE, THE APPLICANT SHALL FULFILL THE FOLLOWING REQUIREMENTS:
   (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 IN  THIS  SECTION,  A  GRADUATE
 NURSE  ANESTHETIST AWAITING CERTIFICATION SHALL BE PERMITTED TO ADMINIS-
 TER ANESTHESIA ONLY  IN  THE  HOSPITAL  OR  AMBULATORY  SURGICAL  CENTER
 SETTING AS PROVIDED IN THIS SECTION;
   (D)  FEES:  PAY  TO  THE DEPARTMENT A FEE OF FIFTY DOLLARS FOR INITIAL
 CERTIFICATION AND A TRIENNIAL REGISTRATION FEE OF THIRTY DOLLARS.  AFTER
 A  CERTIFIED REGISTERED NURSE ANESTHETIST'S INITIAL REGISTRATION, REGIS-
 TRATION UNDER THIS SECTION  SHALL  BE  COTERMINOUS  WITH  THE  CERTIFIED
 REGISTERED 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  ANESTHETIST  OR  AN  ANESTHESIOLOGIST. THE CERTIFIED
 REGISTERED NURSE ANESTHETIST OR ANESTHESIOLOGIST SHALL  BE  CONTINUOUSLY
 PRESENT.
   4.  THE  COMMISSIONER  MAY  PROMULGATE  REGULATIONS  TO IMPLEMENT THIS
 SECTION.
   § 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  effective  date  of
 sections  one  and two of this act may administer anesthesia as a certi-
 fied 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
 the  effective  date  of sections one and two of this act; 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.
   §  4. This act shall take effect immediately, 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.