S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5435
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               March 4, 2021
                                ___________
 
 Introduced  by  Sen.  COONEY -- read twice and ordered printed, and when
   printed to be committed to the Committee on Higher Education
 
 AN ACT to amend the education law, in relation to  certified  registered
   nurse anesthetists
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. The education law is amended by adding a new article  139-A
 to read as follows:
                               ARTICLE 139-A
                  CERTIFIED REGISTERED NURSE ANESTHETIST
 SECTION 6912. INTRODUCTION.
         6913. DEFINITIONS.
         6914. DEFINITION OF PRACTICE OF CERTIFIED NURSE ANESTHETIST.
         6915. PRACTICE OF CERTIFIED REGISTERED NURSE ANESTHETIST AND USE
                 OF THE TITLE "CERTIFIED REGISTERED NURSE ANESTHETIST" OR
                 "NURSE ANESTHETIST."
         6916. STATE BOARD FOR NURSING.
         6917. REQUIREMENTS FOR A LICENSE AS A CERTIFIED REGISTERED NURSE
                 ANESTHETIST.
         6918. LIMITED PERMITS.
         6919. EXEMPT PERSONS.
         6920. SPECIAL PROVISIONS.
   § 6912. INTRODUCTION. THIS ARTICLE APPLIES TO THE PROFESSION OF CERTI-
 FIED  REGISTERED  NURSE  ANESTHETISTS.  THE  GENERAL  PROVISIONS FOR ALL
 PROFESSIONS CONTAINED IN ARTICLE ONE HUNDRED THIRTY OF THIS TITLE  SHALL
 APPLY TO THIS ARTICLE.
   §  6913.  DEFINITIONS.  AS USED IN THIS ARTICLE: 1. "ADMINISTRATION OF
 ANESTHESIA SERVICES."   (A)  IN  THE  HOSPITAL  OR  AMBULATORY  SURGICAL
 CENTER,   "ADMINISTRATION   OF  ANESTHESIA  SERVICES"  MEANS  ANESTHESIA
 SERVICES SHALL BE DIRECTED BY A PHYSICIAN WHO HAS RESPONSIBILITY FOR THE
 CLINICAL ASPECTS OF ORGANIZATION AND DELIVERY OF ALL ANESTHESIA SERVICES

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD10346-01-1

 S. 5435                             2
 
 PROVIDED BY THE HOSPITAL OR AMBULATORY 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 SUPERVISION AS APPROPRIATE.
   (B) IN OFFICE BASED  SURGERY  VENUES,  "ADMINISTRATION  OF  ANESTHESIA
 SERVICES" MEANS THE ANESTHESIA COMPONENT OF THE MEDICAL OR DENTAL PROCE-
 DURE  SHALL  BE SUPERVISED BY AN ANESTHESIOLOGIST, PHYSICIAN, DENTIST OR
 PODIATRIST QUALIFIED TO SUPERVISE THE ADMINISTRATION OF  ANESTHESIA  AND
 WHO IS AVAILABLE TO IMMEDIATELY DIAGNOSE AND TREAT THE PATIENT FOR ANES-
 THESIA  COMPLICATIONS  OR  EMERGENCIES,  AND  CERTIFIED REGISTERED NURSE
 ANESTHETISTS MAY BE PERMITTED TO ADMINISTER MONITORED  ANESTHESIA  CARE,
 AND/OR  GENERAL  ANESTHESIA,  REGIONAL  ANESTHESIA,  AND/OR  MONITOR THE
 PATIENT.
   2. "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.
   3. "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.
   4.  "MONITORED  ANESTHESIA CARE" MEANS (A) A MINIMALLY DEPRESSED LEVEL
 OF CONSCIOUSNESS THAT RETAINS THE PATIENT'S ABILITY TO MAINTAIN ADEQUATE
 CARDIORESPIRATORY FUNCTION AND THE ABILITY TO INDEPENDENTLY AND  CONTIN-
 UOUSLY  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 UNSUPPLEMENTED ORAL PRE-OPERA-
 TIVE MEDICATIONS OR NITROUS OXIDE ANALGESIA; OR
   (B) THE ADMINISTRATION OF MEDICATION BY THE ORAL, PARENTERAL, OR INHA-
 LATION  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.
   5.  "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 SATURATION, LEVEL OF
 CONSCIOUSNESS, BLOOD PRESSURE, AND RESPIRATION.
   6. "OFFICE-BASED SURGERY" MEANS ANY SURGICAL OR OTHER INVASIVE  PROCE-
 DURE,  REQUIRING  GENERAL ANESTHESIA, MONITORED ANESTHESIA CARE, AND ANY
 LIPOSUCTION PROCEDURE, WHERE SUCH SURGICAL OR OTHER  INVASIVE  PROCEDURE
 OR  LIPOSUCTION  IS  PERFORMED  BY A LICENSEE IN A LOCATION OTHER THAN A
 HOSPITAL, AS SUCH TERM IS DEFINED IN ARTICLE TWENTY-EIGHT OF THE  PUBLIC
 HEALTH  LAW, EXCLUDING MINOR PROCEDURES AND PROCEDURES REQUIRING MINIMAL
 SEDATION.

 S. 5435                             3
 
   7. "PATIENT" MEANS AN INDIVIDUAL WHO IS UNDER THE CARE OF A PHYSICIAN,
 DENTIST, ORAL SURGEON OR PODIATRIST IN A  LICENSED  FACILITY  OR  IN  AN
 OFFICE.
   8.  "PERI-ANESTHETIC  PERIOD" MEANS THE PERIOD OF TIME COMMENCING UPON
 THE PRE-OPERATIVE EVALUATION OF THE PATIENT BEFORE  SURGERY  AND  ENDING
 UPON THE PATIENT'S POST-OPERATIVE DISCHARGE FROM THE RECOVERY ROOM.
   9.  "REGIONAL ANESTHESIA" MEANS THE ADMINISTRATION OF LOCAL ANESTHESIA
 AGENTS TO INTERRUPT NERVE IMPULSES  IN  A  MAJOR  REGION  OF  THE  BODY;
 INCLUDING  BUT  NOT  LIMITED  TO  IN THIS CATEGORY ARE SPINAL, EPIDURAL,
 CAUDAL, UPPER OR LOWER EXTREMITY PLEXUS BLOCK ANESTHESIA,  AND  INTRAVE-
 NOUS REGIONAL ANESTHESIA.
   10.  "SUPPLEMENTED LOCAL ANESTHESIA" MEANS THE USE OF LOCAL ANESTHESIA
 SUPPLEMENTED WITH MONITORED ANESTHESIA CARE.
   11. "UNSUPPLEMENTED LOCAL ANESTHESIA" MEANS THE  USE  OF  LOCAL  ANES-
 THESIA WITHOUT SUPPLEMENTING WITH MONITORED ANESTHESIA CARE.
   §  6914. DEFINITION OF PRACTICE OF CERTIFIED REGISTERED NURSE ANESTHE-
 TIST. 1. IN ADDITION  TO  THE  PROVISIONS  OF  PRACTICE  FOR  REGISTERED
 PROFESSIONAL  NURSING OUTLINED IN SECTION SIXTY-NINE HUNDRED TWO OF THIS
 TITLE, THE PRACTICE OF A CERTIFIED REGISTERED NURSE ANESTHETIST  FURTHER
 INCLUDES,  BUT  IS  NOT  LIMITED TO, ADMINISTRATION OF ANESTHESIA, WHICH
 INCLUDES GENERAL ANESTHESIA,  MONITORED  ANESTHESIA  CARE,  LOCAL  ANES-
 THESIA,   REGIONAL  ANESTHESIA,  SPINAL,  EPIDURAL,  CAUDAL  ANESTHESIA,
 SUPPLEMENTED LOCAL ANESTHESIA, AND UNSUPPLEMENTED LOCAL ANESTHESIA TO  A
 PATIENT  DURING THE PERI-ANESTHETIC PERIOD; PERFORMING AND DOCUMENTING A
 PREANESTHETIC  ASSESSMENT  AND  EVALUATION  OF  THE  PATIENT,  INCLUDING
 REQUESTING  CONSULTATIONS  AND DIAGNOSTIC STUDIES; SELECTING, OBTAINING,
 ORDERING, AND ADMINISTERING PREANESTHETIC MEDICATIONS  AND  FLUIDS;  AND
 OBTAINING  INFORMED  CONSENT FOR ANESTHESIA, DEVELOPING AND IMPLEMENTING
 AN ANESTHETIC PLAN; INITIATING THE ANESTHETIC TECHNIQUE; MONITORING  THE
 PATIENT  INCLUDING SELECTING, APPLYING, AND INSERTING APPROPRIATE NONIN-
 VASIVE AND INVASIVE MONITORING MODALITIES FOR CONTINUOUS  EVALUATION  OF
 THE  PATIENT'S  PHYSICAL STATUS; SELECTING, OBTAINING, AND ADMINISTERING
 THE ANESTHETICS, ADJUVANT AND ACCESSORY DRUGS, AND FLUIDS  NECESSARY  TO
 MANAGE  THE ANESTHETIC; MANAGING A PATIENT'S AIRWAY AND PULMONARY STATUS
 USING CURRENT PRACTICE MODALITIES; FACILITATING EMERGENCE  AND  RECOVERY
 FROM  ANESTHESIA  BY  SELECTING,  OBTAINING,  ORDERING AND ADMINISTERING
 MEDICATIONS, FLUIDS, AND VENTILATORY SUPPORT;  DISCHARGING  THE  PATIENT
 FROM  A  POSTANESTHESIA CARE AREA AND PROVIDING POSTANESTHESIA FOLLOW-UP
 EVALUATION AND CARE; IMPLEMENTING  ACUTE  AND  CHRONIC  PAIN  MANAGEMENT
 MODALITIES;  AND  RESPONDING TO EMERGENCY SITUATIONS BY PROVIDING AIRWAY
 MANAGEMENT, ADMINISTRATION OF EMERGENCY  FLUIDS  AND  DRUGS,  AND  USING
 BASIC OR ADVANCED CARDIAC LIFE SUPPORT TECHNIQUES.
   2.  NURSE ANESTHESIA MUST BE PROVIDED IN COLLABORATION WITH A LICENSED
 PHYSICIAN QUALIFIED TO  DETERMINE  THE  NEED  FOR  ANESTHESIA  SERVICES,
 PROVIDED  SUCH SERVICES ARE PERFORMED IN ACCORDANCE WITH A WRITTEN PRAC-
 TICE AGREEMENT AND WRITTEN PRACTICE PROTOCOLS AS SET FORTH  IN  SUBDIVI-
 SION  FOUR OF THIS SECTION OR PURSUANT TO COLLABORATIVE RELATIONSHIPS AS
 SET FORTH IN SUBDIVISION FIVE OF THIS SECTION, WHICHEVER IS APPLICABLE.
   3. PRESCRIPTIONS FOR DRUGS, DEVICES, AND ANESTHETIC AGENTS, ANESTHESIA
 RELATED AGENTS, AND PAIN MANAGEMENT AGENTS MAY BE ISSUED BY A  CERTIFIED
 REGISTERED  NURSE  ANESTHETIST  DURING  THE  PERI-ANESTHETIC  PERIOD, IN
 ACCORDANCE WITH THE WRITTEN  PRACTICE  AGREEMENT  AND  WRITTEN  PRACTICE
 PROTOCOLS  DESCRIBED  IN SUBDIVISION FOUR OF THIS SECTION IF APPLICABLE.
 THE CERTIFIED REGISTERED NURSE ANESTHETIST SHALL  OBTAIN  A  CERTIFICATE
 FROM  THE DEPARTMENT UPON SUCCESSFULLY COMPLETING A PROGRAM INCLUDING AN
 APPROPRIATE PHARMACOLOGY COMPONENT, OR ITS EQUIVALENT, AS ESTABLISHED BY

 S. 5435                             4
 
 THE COMMISSIONER'S REGULATIONS, PRIOR TO PRESCRIBING UNDER THIS SUBDIVI-
 SION. THE LICENSE ISSUED UNDER THIS  ARTICLE  SHALL  STATE  WHETHER  THE
 CERTIFIED REGISTERED NURSE ANESTHETIST HAS SUCCESSFULLY COMPLETED SUCH A
 PROGRAM OR EQUIVALENT AND IS AUTHORIZED TO PRESCRIBE UNDER THIS SUBDIVI-
 SION.
   4.  A CERTIFIED REGISTERED NURSE ANESTHETIST LICENSED UNDER THIS ARTI-
 CLE AND PRACTICING FOR THIRTY-SIX HUNDRED HOURS OR LESS SHALL DO  SO  IN
 ACCORDANCE WITH A WRITTEN PRACTICE AGREEMENT AND WRITTEN PRACTICE PROTO-
 COLS  AGREED  UPON  BY  A  LICENSED PHYSICIAN QUALIFIED BY EDUCATION AND
 EXPERIENCE TO DETERMINE THE NEED FOR ANESTHESIA.
   (A) THE WRITTEN PRACTICE AGREEMENT SHALL INCLUDE  EXPLICIT  PROVISIONS
 FOR  THE RESOLUTION OF ANY DISAGREEMENT BETWEEN THE COLLABORATING PHYSI-
 CIAN AND THE CERTIFIED REGISTERED NURSE ANESTHETIST REGARDING  A  MATTER
 OF  ANESTHESIA  OR PAIN MANAGEMENT TREATMENT THAT IS WITHIN THE SCOPE OF
 PRACTICE OF BOTH. TO THE EXTENT  THE  PRACTICE  AGREEMENT  DOES  NOT  SO
 PROVIDE, THEN THE COLLABORATING PHYSICIAN'S TREATMENT SHALL PREVAIL.
   (B)  EACH  PRACTICE AGREEMENT SHALL PROVIDE FOR PATIENT RECORDS REVIEW
 BY THE COLLABORATING PHYSICIAN IN A TIMELY FASHION BUT IN NO EVENT  LESS
 OFTEN  THAN  EVERY  THREE  MONTHS. THE NAMES OF THE CERTIFIED REGISTERED
 NURSE ANESTHETIST AND THE COLLABORATING PHYSICIAN SHALL BE CLEARLY POST-
 ED IN THE PRACTICE SETTING OF THE CERTIFIED  REGISTERED  NURSE  ANESTHE-
 TIST.
   (C)  THE  PRACTICE PROTOCOL SHALL REFLECT CURRENT ACCEPTED MEDICAL AND
 NURSING PRACTICE. THE PROTOCOLS SHALL BE FILED WITH THE DEPARTMENT WITH-
 IN NINETY DAYS OF THE COMMENCEMENT OF THE PRACTICE AND  MAY  BE  UPDATED
 PERIODICALLY.  THE  COMMISSIONER SHALL MAKE REGULATIONS ESTABLISHING THE
 PROCEDURE FOR THE REVIEW OF PROTOCOLS AND THE DISPOSITION OF ANY  ISSUES
 ARISING FROM SUCH REVIEW.
   5.  A CERTIFIED REGISTERED NURSE ANESTHETIST LICENSED UNDER THIS ARTI-
 CLE AND PRACTICING FOR MORE THAN THIRTY-SIX  HUNDRED  HOURS  SHALL  HAVE
 COLLABORATIVE  RELATIONSHIPS WITH ONE OR MORE LICENSED PHYSICIANS QUALI-
 FIED TO DETERMINE THE  NEED  FOR  ANESTHESIA  SERVICES  OR  A  HOSPITAL,
 LICENSED  UNDER  ARTICLE  TWENTY-EIGHT  OF  THE  PUBLIC HEALTH LAW, THAT
 PROVIDES SERVICES THROUGH LICENSED PHYSICIANS QUALIFIED TO DETERMINE THE
 NEED FOR ANESTHESIA SERVICES AND HAVING PRIVILEGES AT SUCH INSTITUTION.
   (A) FOR PURPOSES  OF  THIS  PARAGRAPH,  "COLLABORATIVE  RELATIONSHIPS"
 SHALL  MEAN THAT THE CERTIFIED REGISTERED NURSE ANESTHETIST SHALL COMMU-
 NICATE, WHETHER IN PERSON, BY TELEPHONE OR  THROUGH  WRITTEN  (INCLUDING
 ELECTRONIC)  MEANS, WITH A LICENSED PHYSICIAN QUALIFIED TO DETERMINE THE
 NEED FOR ANESTHESIA SERVICES OR, IN THE CASE OF A HOSPITAL,  COMMUNICATE
 WITH A LICENSED PHYSICIAN QUALIFIED TO DETERMINE THE NEED FOR ANESTHESIA
 SERVICES  AND  HAVING  PRIVILEGES  AT SUCH HOSPITAL, FOR THE PURPOSES OF
 EXCHANGING INFORMATION, AS NEEDED, IN  ORDER  TO  PROVIDE  COMPREHENSIVE
 PATIENT CARE AND TO MAKE REFERRALS AS NECESSARY.
   (B)  AS EVIDENCE THAT THE CERTIFIED REGISTERED NURSE ANESTHETIST MAIN-
 TAINS  COLLABORATIVE  RELATIONSHIPS,  THE  CERTIFIED  REGISTERED   NURSE
 ANESTHETIST  SHALL  COMPLETE AND MAINTAIN A FORM, CREATED BY THE DEPART-
 MENT, TO WHICH THE CERTIFIED REGISTERED NURSE ANESTHETIST SHALL  ATTEST,
 THAT  DESCRIBES  SUCH  COLLABORATIVE RELATIONSHIPS. SUCH FORM SHALL ALSO
 REFLECT THE CERTIFIED  REGISTERED  NURSE  ANESTHETIST'S  ACKNOWLEDGEMENT
 THAT  IF  REASONABLE  EFFORTS TO RESOLVE ANY DISPUTE THAT MAY ARISE WITH
 THE COLLABORATING PHYSICIAN OR, IN THE CASE OF A  COLLABORATION  WITH  A
 HOSPITAL,  WITH A LICENSED PHYSICIAN QUALIFIED TO DETERMINE THE NEED FOR
 ANESTHESIA SERVICES AND HAVING PRIVILEGES  AT  SUCH  HOSPITAL,  ABOUT  A
 PATIENT'S  CARE  ARE NOT SUCCESSFUL, THE RECOMMENDATION OF THE PHYSICIAN
 SHALL PREVAIL. SUCH FORM SHALL BE UPDATED AS NEEDED AND MAY  BE  SUBJECT

 S. 5435                             5
 
 TO  REVIEW BY THE DEPARTMENT. THE CERTIFIED REGISTERED NURSE ANESTHETIST
 SHALL MAINTAIN DOCUMENTATION THAT SUPPORTS SUCH COLLABORATIVE  RELATION-
 SHIPS.
   6.  NOTHING  IN  THIS SECTION SHALL BE DEEMED TO LIMIT OR DIMINISH THE
 PRACTICE OF THE PROFESSION OF NURSING AS A REGISTERED PROFESSIONAL NURSE
 UNDER THIS ARTICLE OR ANY OTHER LAW, RULE, REGULATION OR  CERTIFICATION,
 NOR TO DENY ANY REGISTERED PROFESSIONAL NURSE THE RIGHT TO DO ANY ACT OR
 ENGAGE  IN  ANY  PRACTICE  AUTHORIZED  BY THIS ARTICLE OR ANY OTHER LAW,
 RULE, REGULATION OR CERTIFICATION.
   § 6915. PRACTICE OF CERTIFIED REGISTERED NURSE ANESTHETISTS AND USE OF
 THE TITLE "CERTIFIED REGISTERED NURSE ANESTHETIST"  OR  "NURSE  ANESTHE-
 TIST." ONLY A PERSON LICENSED OR OTHERWISE AUTHORIZED UNDER THIS ARTICLE
 SHALL  PRACTICE CERTIFIED REGISTERED NURSE ANESTHETIST OR NURSE ANESTHE-
 TIST.
   § 6916. STATE BOARD FOR NURSING. THE STATE BOARD FOR NURSING AS ESTAB-
 LISHED IN SECTION SIX THOUSAND NINE HUNDRED FOUR OF THIS TITLE SHALL  BE
 THE GOVERNING STATE BOARD FOR CERTIFIED REGISTERED NURSE ANESTHETISTS.
   §  6917.  REQUIREMENTS  FOR  A LICENSE AS A CERTIFIED REGISTERED NURSE
 ANESTHETIST. TO QUALIFY FOR A LICENSE AS A  CERTIFIED  REGISTERED  NURSE
 ANESTHETIST, AN APPLICANT SHALL FULFILL THE FOLLOWING REQUIREMENTS:
   1. APPLICATION: FILE AN APPLICATION WITH THE DEPARTMENT;
   2.  EDUCATION:  HAVE RECEIVED A MASTER'S DEGREE OR HIGHER IN A PROGRAM
 OF NURSE ANESTHESIA IN ACCORDANCE WITH THE COMMISSIONER'S REGULATIONS;
   3. EXAMINATION: MEET THE STANDARDS TO  SIT  FOR  THE  CERTIFYING  EXAM
 PROVIDED BY THE NATIONAL BOARD;
   4. AGE: BE AT LEAST 18 YEARS OF AGE;
   5.  CHARACTER: BE OF GOOD MORAL CHARACTER AS DETERMINED BY THE DEPART-
 MENT;
   6. FEES: PAY A FEE OF FIFTY DOLLARS TO THE DEPARTMENT FOR  AN  INITIAL
 LICENSE  AND  A  FEE  OF  THIRTY DOLLARS FOR EACH TRIENNIAL REGISTRATION
 PERIOD; AND
   7. INFORMATION AND DOCUMENTATION: IN CONJUNCTION WITH AND AS A  CONDI-
 TION  OF EACH TRIENNIAL REGISTRATION, PROVIDE TO THE DEPARTMENT, AND THE
 DEPARTMENT SHALL COLLECT, SUCH INFORMATION AND DOCUMENTATION REQUIRED BY
 THE DEPARTMENT, IN CONSULTATION WITH THE DEPARTMENT  OF  HEALTH,  AS  IS
 NECESSARY TO ENABLE THE DEPARTMENT OF HEALTH TO EVALUATE ACCESS TO NEED-
 ED  SERVICES  IN THIS STATE, INCLUDING, BUT NOT LIMITED TO, THE LOCATION
 AND TYPE OF SETTING WHEREIN THE CERTIFIED REGISTERED  NURSE  ANESTHETIST
 PRACTICES AND OTHER INFORMATION THE DEPARTMENT, IN CONSULTATION WITH THE
 DEPARTMENT  OF  HEALTH,  DEEMS  RELEVANT.  THE  DEPARTMENT OF HEALTH, IN
 CONSULTATION WITH THE DEPARTMENT, SHALL  MAKE  SUCH  DATA  AVAILABLE  IN
 AGGREGATE,  DE-IDENTIFIED  FORM  ON A PUBLICLY ACCESSIBLE WEBSITE. ADDI-
 TIONALLY, IN CONJUNCTION WITH EACH TRIENNIAL REGISTRATION,  THE  DEPART-
 MENT,  IN  CONSULTATION  WITH  THE  DEPARTMENT  OF HEALTH, SHALL PROVIDE
 INFORMATION ON REGISTERING IN THE DONATE LIFE  REGISTRY  FOR  ORGAN  AND
 TISSUE DONATION, INCLUDING THE WEBSITE ADDRESS FOR SUCH REGISTRY.
   § 6918. LIMITED PERMITS. 1. A PERMIT TO PRACTICE AS A CERTIFIED REGIS-
 TERED  NURSE ANESTHETIST MAY BE ISSUED BY THE DEPARTMENT UPON THE FILING
 OF AN APPLICATION FOR A LICENSE AS A CERTIFIED REGISTERED NURSE ANESTHE-
 TIST AND SUBMISSION OF SUCH OTHER  INFORMATION  AS  THE  DEPARTMENT  MAY
 REQUIRE  TO:  (I) GRADUATES OF SCHOOLS OF NURSE ANESTHESIA REGISTERED BY
 THE DEPARTMENT; OR (II)  GRADUATES  OF  SCHOOLS  OF  NURSING  ANESTHESIA
 APPROVED IN ANOTHER STATE, PROVINCE, OR COUNTRY.
   2. SUCH LIMITED PERMIT SHALL EXPIRE ONE YEAR FROM THE DATE OF ISSUANCE
 OR  UPON  NOTICE TO THE APPLICANT BY THE DEPARTMENT THAT THE APPLICATION

 S. 5435                             6
 
 FOR LICENSE HAS BEEN DENIED. THE LIMITED PERMIT MAY BE RENEWED,  AT  THE
 DISCRETION OF THE DEPARTMENT, FOR ONE ADDITIONAL YEAR.
   3.  A  LIMITED  PERMIT  SHALL ENTITLE THE HOLDER TO PRACTICE CERTIFIED
 REGISTERED NURSE ANESTHESIA ONLY UNDER THE SUPERVISION  OF  A  CERTIFIED
 REGISTERED NURSE ANESTHETIST CURRENTLY REGISTERED IN THIS STATE AND WITH
 THE ENDORSEMENT OF THE EMPLOYING AGENCY.
   4. FEES. THE FEE FOR EACH LIMITED PERMIT SHALL BE THIRTY-FIVE DOLLARS.
   5.  GRADUATES  OF  SCHOOLS  OF  NURSING  ANESTHESIA  REGISTERED BY THE
 DEPARTMENT MAY BE EMPLOYED TO PRACTICE  NURSE  ANESTHESIA  UNDER  SUPER-
 VISION  OF A CERTIFIED REGISTERED NURSE ANESTHETIST CURRENTLY REGISTERED
 IN THIS STATE AND WITH THE ENDORSEMENT OF THE EMPLOYING AGENCY FOR NINE-
 TY DAYS IMMEDIATELY FOLLOWING GRADUATION FROM A PROGRAM IN  NURSE  ANES-
 THESIA  AND PENDING RECEIPT OF A LIMITED PERMIT FOR WHICH AN APPLICATION
 HAS BEEN FILED AS PROVIDED IN THIS SECTION.
   § 6919. EXEMPT PERSONS. THIS ARTICLE SHALL NOT BE CONSTRUED:
   1. AS MODIFYING 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. AS APPLYING TO ANY ACTIVITY AUTHORIZED, PURSUANT TO STATUTES,  RULE
 OR  REGULATION,  TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE IN A
 HOSPITAL AS DEFINED IN ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW;
   3. AS PROHIBITING AN INDIVIDUAL WHO HAS BEEN LICENSED AS A NURSE PRAC-
 TITIONER IN THE ACUTE CARE SPECIALTY AREA FROM PERFORMING THE DUTIES  OF
 A CERTIFIED REGISTERED NURSE ANESTHETIST;
   4.  AS  PROHIBITING THE FURNISHING OF NURSING ANESTHESIA ASSISTANCE IN
 CASE OF AN EMERGENCY;
   5. AS PROHIBITING SUCH PERFORMANCE OF NURSING  ANESTHESIA  SERVICE  BY
 STUDENTS ENROLLED IN REGISTERED SCHOOLS OR PROGRAMS AS MAY BE INCIDENTAL
 TO THEIR COURSE OF STUDY;
   6.  AS PROHIBITING OR PREVENTING THE PRACTICE OF NURSING ANESTHESIA IN
 THIS STATE BY ANY LEGALLY QUALIFIED NURSE OR PRACTICAL NURSE OF  ANOTHER
 STATE,  PROVINCE,  OR  COUNTRY  WHOSE  ENGAGEMENT REQUIRES HIM OR HER TO
 ACCOMPANY AND CARE FOR A PATIENT  TEMPORARILY  RESIDING  IN  THIS  STATE
 DURING  THE  PERIOD  OF  SUCH  ENGAGEMENT  PROVIDED SUCH PERSON DOES NOT
 REPRESENT OR HOLD HIMSELF OR HERSELF OUT AS A CERTIFIED REGISTERED NURSE
 ANESTHETIST REGISTERED TO PRACTICE IN THIS STATE;
   7. AS PROHIBITING OR PREVENTING THE PRACTICE OF NURSING ANESTHESIA  IN
 THIS  STATE  DURING  AN  EMERGENCY  OR DISASTER BY ANY LEGALLY QUALIFIED
 NURSE ANESTHETIST OF ANOTHER STATE, PROVINCE,  OR  COUNTRY  WHO  MAY  BE
 RECRUITED  BY  THE  AMERICAN NATIONAL RED CROSS OR PURSUANT TO AUTHORITY
 VESTED IN THE STATE CIVIL  DEFENSE  COMMISSION  FOR  SUCH  EMERGENCY  OR
 DISASTER  SERVICE,  PROVIDED  SUCH  PERSON  DOES  NOT  REPRESENT OR HOLD
 HIMSELF OR HERSELF OUT  AS  A  CERTIFIED  REGISTERED  NURSE  ANESTHETIST
 REGISTERED TO PRACTICE IN THIS STATE;
   8.  AS PROHIBITING OR PREVENTING THE PRACTICE OF NURSING ANESTHESIA IN
 THIS STATE, IN OBEDIENCE TO THE REQUIREMENTS OF THE LAWS OF  THE  UNITED
 STATES, BY ANY COMMISSIONED NURSE ANESTHETIST OFFICER IN THE ARMED FORC-
 ES  OF  THE  UNITED  STATES  OR BY ANY NURSE ANESTHETIST EMPLOYED IN THE
 UNITED STATES VETERANS ADMINISTRATION OR  UNITED  STATES  PUBLIC  HEALTH
 SERVICE WHILE ENGAGED IN THE PERFORMANCE OF THE ACTUAL DUTIES PRESCRIBED
 FOR  HIM  OR  HER UNDER THE UNITED STATES STATUTES, PROVIDED SUCH PERSON
 DOES NOT REPRESENT OR HOLD HIMSELF OR HERSELF OUT AS A CERTIFIED  REGIS-
 TERED NURSE ANESTHETIST REGISTERED TO PRACTICE IN THIS STATE; OR

 S. 5435                             7
 
   9.  AS  PROHIBITING  THE CARE OF THE SICK WHEN DONE IN CONNECTION WITH
 THE PRACTICE OF THE RELIGIOUS TENETS OF ANY CHURCH.
   §  6920.  SPECIAL PROVISIONS. A CERTIFIED REGISTERED NURSE ANESTHETIST
 LICENSED UNDER THIS ARTICLE IS REQUIRED TO  PURCHASE  AND  MAINTAIN,  OR
 OTHERWISE  BE  COVERED BY, PROFESSIONAL LIABILITY INSURANCE IN AN AMOUNT
 NOT LESS ONE MILLION DOLLARS PER CLAIM WITH AN AGGREGATE  LIABILITY  FOR
 ALL  CLAIMS  DURING  THE  YEAR  OF  THREE  MILLION DOLLARS. PROFESSIONAL
 LIABILITY INSURANCE REQUIRED BY THIS SECTION SHALL COVER ALL ACTS WITHIN
 THE SCOPE OF PRACTICE OF REGISTERED NURSE ANESTHETIST.
   § 2. Section 6903 of the education law, as amended by chapter  323  of
 the laws of 2006, is amended to read as follows:
   § 6903. Practice  of nursing and use of title "registered professional
 nurse" or "licensed practical nurse". Only a person licensed  or  other-
 wise  authorized  under  this  article shall practice nursing and only a
 person licensed under section sixty-nine hundred five  of  this  article
 shall  use  the  title "registered professional nurse" and only a person
 licensed under section sixty-nine hundred six of this article shall  use
 the  title  "licensed  practical  nurse".  No person shall use the title
 "nurse" or any other title or abbreviation that would represent  to  the
 public  that  the  person  is  authorized to practice nursing unless the
 person is licensed or otherwise authorized under this article OR ARTICLE
 ONE HUNDRED THIRTY-NINE-A OF THIS TITLE.
   § 3. Section 6904 of the education law, as amended by chapter  994  of
 the laws of 1971 and as renumbered by chapter 50 of the laws of 1972, is
 amended to read as follows:
   § 6904. State  board  for nursing.  A state board for nursing shall be
 appointed by the board of regents on recommendation of the  commissioner
 for  the purpose of assisting the board of regents and the department on
 matters of professional licensing and professional conduct in accordance
 with section sixty-five hundred eight of this title. The board shall  be
 composed  of  not  less than [fifteen] SEVENTEEN members, eleven of whom
 shall be registered professional nurses,  and  four  of  whom  shall  be
 licensed  practical nurses AND TWO OF WHOM SHALL BE CERTIFIED REGISTERED
 NURSE ANESTHETISTS all licensed and practicing  in  this  state  for  at
 least  five  years.    An  executive  secretary  to  the  board shall be
 appointed by the board of regents on recommendation of the  commissioner
 and shall be a registered professional nurse registered in this state.
   § 4. This act shall take effect immediately.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5435--A
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               March 4, 2021
                                ___________
 
 Introduced  by  Sen.  COONEY -- read twice and ordered printed, and when
   printed to be committed  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 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:
 
   Section 1. The education law is amended by adding a new article  139-A
 to read as follows:
                               ARTICLE 139-A
                  CERTIFIED REGISTERED NURSE ANESTHETIST
 SECTION 6912. INTRODUCTION.
         6913. DEFINITIONS.
         6914.  DEFINITION  OF  PRACTICE  OF  CERTIFIED  REGISTERED NURSE
                 ANESTHETIST.
         6915. PRACTICE OF CERTIFIED REGISTERED NURSE ANESTHETIST AND USE
                 OF THE TITLE "CERTIFIED REGISTERED NURSE ANESTHETIST" OR
                 "NURSE ANESTHETIST."
         6916. STATE BOARD FOR NURSING.
         6917. REQUIREMENTS FOR A LICENSE AS A CERTIFIED REGISTERED NURSE
                 ANESTHETIST.
         6918. LIMITED PERMITS.
         6919. EXEMPT PERSONS.
         6920. SPECIAL PROVISIONS.
   § 6912. INTRODUCTION. THIS ARTICLE APPLIES TO THE PROFESSION OF CERTI-
 FIED REGISTERED  NURSE  ANESTHETIST.  THE  GENERAL  PROVISIONS  FOR  ALL
 PROFESSIONS  CONTAINED IN ARTICLE ONE HUNDRED THIRTY OF THIS TITLE APPLY
 TO THIS ARTICLE.
   § 6913. DEFINITIONS. AS USED IN THIS ARTICLE:  1.  "ADMINISTRATION  OF
 ANESTHESIA SERVICES." (A) IN THE HOSPITAL OR AMBULATORY SURGICAL CENTER,
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD10346-02-1

 S. 5435--A                          2
 
 "ADMINISTRATION  OF ANESTHESIA SERVICES" MEANS ANESTHESIA SERVICES SHALL
 BE DIRECTED BY A PHYSICIAN  WHO  HAS  RESPONSIBILITY  FOR  THE  CLINICAL
 ASPECTS OF ORGANIZATION AND DELIVERY OF ALL ANESTHESIA SERVICES PROVIDED
 BY THE HOSPITAL OR AMBULATORY SURGICAL CENTER. THAT PHYSICIAN OR ANOTHER
 INDIVIDUAL QUALIFIED BY EDUCATION AND EXPERIENCE SHALL DIRECT THE ADMIN-
 ISTRATIVE  ASPECTS OF THE SERVICE, AND SHALL BE RESPONSIBLE, IN CONJUNC-
 TION WITH THE MEDICAL STAFF, FOR  RECOMMENDING  TO  THE  GOVERNING  BODY
 PRIVILEGES TO THOSE PERSONS QUALIFIED TO ADMINISTER ANESTHETICS, INCLUD-
 ING THE PROCEDURES EACH PERSON IS QUALIFIED TO PERFORM AND THE LEVELS OF
 REQUIRED SUPERVISION AS APPROPRIATE.
   (B)  IN  OFFICE  BASED  SURGERY  VENUES, "ADMINISTRATION OF ANESTHESIA
 SERVICES" MEANS THE ANESTHESIA COMPONENT OF THE MEDICAL OR DENTAL PROCE-
 DURE SHALL BE SUPERVISED BY AN ANESTHESIOLOGIST, PHYSICIAN,  DENTIST  OR
 PODIATRIST  QUALIFIED  TO SUPERVISE THE ADMINISTRATION OF ANESTHESIA AND
 WHO IS AVAILABLE TO IMMEDIATELY DIAGNOSE AND TREAT THE PATIENT FOR ANES-
 THESIA COMPLICATIONS OR  EMERGENCIES,  AND  CERTIFIED  REGISTERED  NURSE
 ANESTHETISTS  MAY  BE PERMITTED TO ADMINISTER MONITORED ANESTHESIA CARE,
 AND/OR GENERAL  ANESTHESIA,  REGIONAL  ANESTHESIA,  AND/OR  MONITOR  THE
 PATIENT.
   2.  "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 INABIL-
 ITY  TO  RESPOND  PURPOSEFULLY  TO VERBAL COMMANDS AND/OR TACTILE STIMU-
 LATION.
   3. "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.
   4. "MONITORED ANESTHESIA CARE" MEANS: (A) A MINIMALLY DEPRESSED  LEVEL
 OF CONSCIOUSNESS THAT RETAINS THE PATIENT'S ABILITY TO MAINTAIN ADEQUATE
 CARDIORESPIRATORY  FUNCTION AND THE ABILITY TO INDEPENDENTLY AND CONTIN-
 UOUSLY 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 UNSUPPLEMENTED ORAL PRE-OPERA-
 TIVE MEDICATIONS OR NITROUS OXIDE ANALGESIA; OR
   (B) THE ADMINISTRATION OF MEDICATION BY THE ORAL, PARENTERAL, OR INHA-
 LATION   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.
   5. "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 SATURATION, LEVEL OF
 CONSCIOUSNESS, BLOOD PRESSURE, AND RESPIRATION.
   6.  "OFFICE-BASED SURGERY" MEANS ANY SURGICAL OR OTHER INVASIVE PROCE-
 DURE, REQUIRING GENERAL ANESTHESIA, MONITORED ANESTHESIA CARE,  AND  ANY
 LIPOSUCTION  PROCEDURE,  WHERE SUCH SURGICAL OR OTHER INVASIVE PROCEDURE
 OR LIPOSUCTION IS PERFORMED BY A LICENSEE IN A  LOCATION  OTHER  THAN  A

 S. 5435--A                          3
 
 HOSPITAL,  AS SUCH TERM IS DEFINED IN ARTICLE TWENTY-EIGHT OF THE PUBLIC
 HEALTH LAW, EXCLUDING MINOR PROCEDURES AND PROCEDURES REQUIRING  MINIMAL
 SEDATION.
   7. "PATIENT" MEANS AN INDIVIDUAL WHO IS UNDER THE CARE OF A PHYSICIAN,
 DENTIST,  ORAL  SURGEON  OR  PODIATRIST  IN A LICENSED FACILITY OR IN AN
 OFFICE.
   8. "PERI-ANESTHETIC PERIOD" MEANS THE PERIOD OF TIME  COMMENCING  UPON
 THE  PRE-OPERATIVE  EVALUATION  OF THE PATIENT BEFORE SURGERY AND ENDING
 UPON THE PATIENT'S POST-OPERATIVE DISCHARGE FROM THE RECOVERY ROOM.
   9. "REGIONAL ANESTHESIA" MEANS THE ADMINISTRATION OF LOCAL  ANESTHESIA
 AGENTS  TO  INTERRUPT  NERVE  IMPULSES  IN  A  MAJOR REGION OF THE BODY.
 INCLUDING BUT NOT LIMITED TO IN  THIS  CATEGORY  ARE  SPINAL,  EPIDURAL,
 CAUDAL,  UPPER  OR LOWER EXTREMITY PLEXUS BLOCK ANESTHESIA, AND INTRAVE-
 NOUS REGIONAL ANESTHESIA.
   10. "SUPPLEMENTED LOCAL ANESTHESIA" MEANS THE USE OF LOCAL  ANESTHESIA
 SUPPLEMENTED WITH MONITORED ANESTHESIA CARE.
   11.  "UNSUPPLEMENTED  LOCAL  ANESTHESIA"  MEANS THE USE OF LOCAL ANES-
 THESIA WITHOUT SUPPLEMENTING WITH MONITORED ANESTHESIA CARE.
   § 6914. DEFINITION OF PRACTICE OF CERTIFIED REGISTERED NURSE  ANESTHE-
 TIST.  1.  IN  ADDITION  TO  THE  PROVISIONS  OF PRACTICE FOR REGISTERED
 PROFESSIONAL NURSING OUTLINED IN SECTION SIXTY-NINE HUNDRED TWO OF  THIS
 TITLE,  THE PRACTICE OF A CERTIFIED REGISTERED NURSE ANESTHETIST FURTHER
 INCLUDES, BUT IS NOT LIMITED TO,  ADMINISTRATION  OF  ANESTHESIA,  WHICH
 INCLUDES  GENERAL  ANESTHESIA,  MONITORED  ANESTHESIA  CARE, LOCAL ANES-
 THESIA,  REGIONAL  ANESTHESIA,  SPINAL,  EPIDURAL,  CAUDAL   ANESTHESIA,
 SUPPLEMENTED  LOCAL ANESTHESIA, AND UNSUPPLEMENTED LOCAL ANESTHESIA TO A
 PATIENT DURING THE PERI-ANESTHETIC PERIOD; PERFORMING AND DOCUMENTING  A
 PREANESTHETIC  ASSESSMENT  AND  EVALUATION  OF  THE  PATIENT,  INCLUDING
 REQUESTING CONSULTATIONS AND DIAGNOSTIC STUDIES;  SELECTING,  OBTAINING,
 ORDERING,  AND  ADMINISTERING  PREANESTHETIC MEDICATIONS AND FLUIDS; AND
 OBTAINING INFORMED CONSENT FOR ANESTHESIA, DEVELOPING  AND  IMPLEMENTING
 AN  ANESTHETIC PLAN; INITIATING THE ANESTHETIC TECHNIQUE; MONITORING THE
 PATIENT INCLUDING SELECTING, APPLYING, AND INSERTING APPROPRIATE  NONIN-
 VASIVE  AND  INVASIVE MONITORING MODALITIES FOR CONTINUOUS EVALUATION OF
 THE PATIENT'S PHYSICAL STATUS; SELECTING, OBTAINING,  AND  ADMINISTERING
 THE  ANESTHETICS,  ADJUVANT AND ACCESSORY DRUGS, AND FLUIDS NECESSARY TO
 MANAGE THE ANESTHETIC; MANAGING A PATIENT'S AIRWAY AND PULMONARY  STATUS
 USING  CURRENT  PRACTICE MODALITIES; FACILITATING EMERGENCE AND RECOVERY
 FROM ANESTHESIA BY  SELECTING,  OBTAINING,  ORDERING  AND  ADMINISTERING
 MEDICATIONS,  FLUIDS,  AND  VENTILATORY SUPPORT; DISCHARGING THE PATIENT
 FROM A POSTANESTHESIA CARE AREA AND PROVIDING  POSTANESTHESIA  FOLLOW-UP
 EVALUATION  AND  CARE;  IMPLEMENTING  ACUTE  AND CHRONIC PAIN MANAGEMENT
 MODALITIES; AND RESPONDING TO EMERGENCY SITUATIONS BY  PROVIDING  AIRWAY
 MANAGEMENT,  ADMINISTRATION  OF  EMERGENCY  FLUIDS  AND DRUGS, AND USING
 BASIC OR ADVANCED CARDIAC LIFE SUPPORT TECHNIQUES.
   2. NURSE ANESTHESIA MUST BE PROVIDED IN COLLABORATION WITH A  LICENSED
 PHYSICIAN  QUALIFIED  TO  DETERMINE  THE  NEED  FOR ANESTHESIA SERVICES,
 PROVIDED SUCH SERVICES ARE PERFORMED IN ACCORDANCE WITH A WRITTEN  PRAC-
 TICE  AGREEMENT  AND WRITTEN PRACTICE PROTOCOLS AS SET FORTH IN SUBDIVI-
 SION FOUR OF THIS SECTION OR PURSUANT TO COLLABORATIVE RELATIONSHIPS  AS
 SET FORTH IN SUBDIVISION FIVE OF THIS SECTION, WHICHEVER IS APPLICABLE.
   3. PRESCRIPTIONS FOR DRUGS, DEVICES, AND ANESTHETIC AGENTS, ANESTHESIA
 RELATED  AGENTS, AND PAIN MANAGEMENT AGENTS MAY BE ISSUED BY A CERTIFIED
 REGISTERED NURSE  ANESTHETIST  DURING  THE  PERI-ANESTHETIC  PERIOD,  IN
 ACCORDANCE  WITH  THE  WRITTEN  PRACTICE  AGREEMENT AND WRITTEN PRACTICE
 PROTOCOLS DESCRIBED IN SUBDIVISION FOUR OF THIS SECTION  IF  APPLICABLE.

 S. 5435--A                          4
 
 THE  CERTIFIED  REGISTERED  NURSE ANESTHETIST SHALL OBTAIN A CERTIFICATE
 FROM THE DEPARTMENT UPON SUCCESSFULLY COMPLETING A PROGRAM INCLUDING  AN
 APPROPRIATE PHARMACOLOGY COMPONENT, OR ITS EQUIVALENT, AS ESTABLISHED BY
 THE COMMISSIONER'S REGULATIONS, PRIOR TO PRESCRIBING UNDER THIS SUBDIVI-
 SION.  THE  LICENSE  ISSUED  UNDER  THIS ARTICLE SHALL STATE WHETHER THE
 CERTIFIED REGISTERED NURSE ANESTHETIST HAS SUCCESSFULLY COMPLETED SUCH A
 PROGRAM OR EQUIVALENT AND IS AUTHORIZED TO PRESCRIBE UNDER THIS SUBDIVI-
 SION.
   4. A CERTIFIED REGISTERED NURSE ANESTHETIST LICENSED UNDER THIS  ARTI-
 CLE  AND  PRACTICING FOR THIRTY-SIX HUNDRED HOURS OR LESS SHALL DO SO IN
 ACCORDANCE WITH A WRITTEN PRACTICE AGREEMENT AND WRITTEN PRACTICE PROTO-
 COLS AGREED UPON BY A LICENSED  PHYSICIAN  QUALIFIED  BY  EDUCATION  AND
 EXPERIENCE TO DETERMINE THE NEED FOR ANESTHESIA.
   (A)  THE  WRITTEN PRACTICE AGREEMENT SHALL INCLUDE EXPLICIT PROVISIONS
 FOR THE RESOLUTION OF ANY DISAGREEMENT BETWEEN THE COLLABORATING  PHYSI-
 CIAN  AND  THE CERTIFIED REGISTERED NURSE ANESTHETIST REGARDING A MATTER
 OF ANESTHESIA OR PAIN MANAGEMENT TREATMENT THAT IS WITHIN THE  SCOPE  OF
 PRACTICE  OF  BOTH.  TO  THE  EXTENT  THE PRACTICE AGREEMENT DOES NOT SO
 PROVIDE, THEN THE COLLABORATING PHYSICIAN'S TREATMENT SHALL PREVAIL.
   (B) EACH PRACTICE AGREEMENT SHALL PROVIDE FOR PATIENT  RECORDS  REVIEW
 BY  THE COLLABORATING PHYSICIAN IN A TIMELY FASHION BUT IN NO EVENT LESS
 OFTEN THAN EVERY THREE MONTHS. THE NAMES  OF  THE  CERTIFIED  REGISTERED
 NURSE ANESTHETIST AND THE COLLABORATING PHYSICIAN SHALL BE CLEARLY POST-
 ED  IN  THE  PRACTICE SETTING OF THE CERTIFIED REGISTERED NURSE ANESTHE-
 TIST.
   (C) THE PRACTICE PROTOCOL SHALL REFLECT CURRENT ACCEPTED  MEDICAL  AND
 NURSING PRACTICE. THE PROTOCOLS SHALL BE FILED WITH THE DEPARTMENT WITH-
 IN  NINETY  DAYS  OF THE COMMENCEMENT OF THE PRACTICE AND MAY BE UPDATED
 PERIODICALLY. THE COMMISSIONER SHALL MAKE REGULATIONS  ESTABLISHING  THE
 PROCEDURE  FOR THE REVIEW OF PROTOCOLS AND THE DISPOSITION OF ANY ISSUES
 ARISING FROM SUCH REVIEW.
   5. A CERTIFIED REGISTERED NURSE ANESTHETIST LICENSED UNDER THIS  ARTI-
 CLE  AND  PRACTICING  FOR  MORE THAN THIRTY-SIX HUNDRED HOURS SHALL HAVE
 COLLABORATIVE RELATIONSHIPS WITH ONE OR MORE LICENSED PHYSICIANS  QUALI-
 FIED  TO  DETERMINE  THE  NEED  FOR  ANESTHESIA  SERVICES OR A HOSPITAL,
 LICENSED UNDER ARTICLE TWENTY-EIGHT  OF  THE  PUBLIC  HEALTH  LAW,  THAT
 PROVIDES SERVICES THROUGH LICENSED PHYSICIANS QUALIFIED TO DETERMINE THE
 NEED FOR ANESTHESIA SERVICES AND HAVING PRIVILEGES AT SUCH INSTITUTION.
   (A)  FOR  PURPOSES  OF THIS SUBDIVISION, "COLLABORATIVE RELATIONSHIPS"
 SHALL MEAN THAT THE CERTIFIED REGISTERED NURSE ANESTHETIST SHALL  COMMU-
 NICATE,  WHETHER  IN  PERSON, BY TELEPHONE OR THROUGH WRITTEN (INCLUDING
 ELECTRONIC) MEANS, WITH A LICENSED PHYSICIAN QUALIFIED TO DETERMINE  THE
 NEED  FOR ANESTHESIA SERVICES OR, IN THE CASE OF A HOSPITAL, COMMUNICATE
 WITH A LICENSED PHYSICIAN QUALIFIED TO DETERMINE THE NEED FOR ANESTHESIA
 SERVICES AND HAVING PRIVILEGES AT SUCH HOSPITAL,  FOR  THE  PURPOSES  OF
 EXCHANGING  INFORMATION,  AS  NEEDED,  IN ORDER TO PROVIDE COMPREHENSIVE
 PATIENT CARE AND TO MAKE REFERRALS AS NECESSARY.
   (B) AS EVIDENCE THAT THE CERTIFIED REGISTERED NURSE ANESTHETIST  MAIN-
 TAINS   COLLABORATIVE  RELATIONSHIPS,  THE  CERTIFIED  REGISTERED  NURSE
 ANESTHETIST SHALL COMPLETE AND MAINTAIN A FORM, CREATED BY  THE  DEPART-
 MENT,  TO WHICH THE CERTIFIED REGISTERED NURSE ANESTHETIST SHALL ATTEST,
 THAT DESCRIBES SUCH COLLABORATIVE RELATIONSHIPS. SUCH  FORM  SHALL  ALSO
 REFLECT  THE  CERTIFIED  REGISTERED  NURSE ANESTHETIST'S ACKNOWLEDGEMENT
 THAT IF REASONABLE EFFORTS TO RESOLVE ANY DISPUTE THAT  MAY  ARISE  WITH
 THE  COLLABORATING  PHYSICIAN  OR, IN THE CASE OF A COLLABORATION WITH A
 HOSPITAL, WITH A LICENSED PHYSICIAN QUALIFIED TO DETERMINE THE NEED  FOR

 S. 5435--A                          5
 
 ANESTHESIA  SERVICES  AND  HAVING  PRIVILEGES  AT SUCH HOSPITAL, ABOUT A
 PATIENT'S CARE ARE NOT SUCCESSFUL, THE RECOMMENDATION OF  THE  PHYSICIAN
 SHALL  PREVAIL.  SUCH FORM SHALL BE UPDATED AS NEEDED AND MAY BE SUBJECT
 TO  REVIEW BY THE DEPARTMENT. THE CERTIFIED REGISTERED NURSE ANESTHETIST
 SHALL MAINTAIN DOCUMENTATION THAT SUPPORTS SUCH COLLABORATIVE  RELATION-
 SHIPS.
   6.  NOTHING  IN  THIS SECTION SHALL BE DEEMED TO LIMIT OR DIMINISH THE
 PRACTICE OF THE PROFESSION OF NURSING AS A REGISTERED PROFESSIONAL NURSE
 UNDER ARTICLE ONE HUNDRED THIRTY-NINE OF THIS TITLE OR  ANY  OTHER  LAW,
 RULE,  REGULATION  OR  CERTIFICATION, NOR TO DENY ANY REGISTERED PROFES-
 SIONAL NURSE THE RIGHT TO DO ANY ACT OR ENGAGE IN ANY  PRACTICE  AUTHOR-
 IZED  BY ARTICLE ONE HUNDRED THIRTY-NINE OF THIS TITLE OR ANY OTHER LAW,
 RULE, REGULATION OR CERTIFICATION.
   § 6915. PRACTICE OF CERTIFIED REGISTERED NURSE ANESTHETIST AND USE  OF
 THE  TITLE  "CERTIFIED  REGISTERED NURSE ANESTHETIST" OR "NURSE ANESTHE-
 TIST." ONLY A PERSON LICENSED OR OTHERWISE AUTHORIZED UNDER THIS ARTICLE
 SHALL PRACTICE CERTIFIED REGISTERED NURSE ANESTHETIST OR NURSE  ANESTHE-
 TIST.
   § 6916. STATE BOARD FOR NURSING. THE STATE BOARD FOR NURSING AS ESTAB-
 LISHED  IN  SECTION  SIXTY-NINE  HUNDRED FOUR OF THIS TITLE SHALL BE THE
 GOVERNING STATE BOARD FOR CERTIFIED REGISTERED NURSE ANESTHETISTS.
   § 6917. REQUIREMENTS FOR A LICENSE AS  A  CERTIFIED  REGISTERED  NURSE
 ANESTHETIST.  TO  QUALIFY  FOR A LICENSE AS A CERTIFIED REGISTERED NURSE
 ANESTHETIST, AN APPLICANT SHALL FULFILL THE FOLLOWING REQUIREMENTS:
   1. APPLICATION: FILE AN APPLICATION WITH THE DEPARTMENT;
   2. EDUCATION: HAVE RECEIVED A MASTER'S DEGREE OR HIGHER IN  A  PROGRAM
 OF NURSE ANESTHESIA IN ACCORDANCE WITH THE COMMISSIONER'S REGULATIONS;
   3.  EXAMINATION:  MEET  THE  STANDARDS  TO SIT FOR THE CERTIFYING EXAM
 PROVIDED BY THE NATIONAL BOARD;
   4. AGE: BE AT LEAST EIGHTEEN YEARS OF AGE;
   5. CHARACTER: BE OF GOOD MORAL CHARACTER AS DETERMINED BY THE  DEPART-
 MENT;
   6.  FEES:  PAY A FEE OF FIFTY DOLLARS TO THE DEPARTMENT FOR AN INITIAL
 LICENSE AND A FEE OF THIRTY  DOLLARS  FOR  EACH  TRIENNIAL  REGISTRATION
 PERIOD; AND
   7.  INFORMATION AND DOCUMENTATION: IN CONJUNCTION WITH AND AS A CONDI-
 TION OF EACH TRIENNIAL REGISTRATION, PROVIDE TO THE DEPARTMENT, AND  THE
 DEPARTMENT SHALL COLLECT, SUCH INFORMATION AND DOCUMENTATION REQUIRED BY
 THE  DEPARTMENT,  IN  CONSULTATION  WITH THE DEPARTMENT OF HEALTH, AS IS
 NECESSARY TO ENABLE THE DEPARTMENT OF HEALTH TO EVALUATE ACCESS TO NEED-
 ED SERVICES IN THIS STATE, INCLUDING, BUT NOT LIMITED TO,  THE  LOCATION
 AND  TYPE  OF SETTING WHEREIN THE CERTIFIED REGISTERED NURSE ANESTHETIST
 PRACTICES AND OTHER INFORMATION THE DEPARTMENT, IN CONSULTATION WITH THE
 DEPARTMENT OF HEALTH, DEEMS  RELEVANT.  THE  DEPARTMENT  OF  HEALTH,  IN
 CONSULTATION  WITH  THE  DEPARTMENT,  SHALL  MAKE SUCH DATA AVAILABLE IN
 AGGREGATE, DE-IDENTIFIED FORM ON A PUBLICLY ACCESSIBLE WEBSITE.    ADDI-
 TIONALLY,  IN  CONJUNCTION WITH EACH TRIENNIAL REGISTRATION, THE DEPART-
 MENT, IN CONSULTATION WITH  THE  DEPARTMENT  OF  HEALTH,  SHALL  PROVIDE
 INFORMATION  ON  REGISTERING  IN  THE DONATE LIFE REGISTRY FOR ORGAN AND
 TISSUE DONATION, INCLUDING THE WEBSITE ADDRESS FOR SUCH REGISTRY.
   § 6918. LIMITED PERMITS. 1. A PERMIT TO PRACTICE AS A CERTIFIED REGIS-
 TERED NURSE ANESTHETIST MAY BE ISSUED BY THE DEPARTMENT UPON THE  FILING
 OF AN APPLICATION FOR A LICENSE AS A CERTIFIED REGISTERED NURSE ANESTHE-
 TIST  AND  SUBMISSION  OF  SUCH  OTHER INFORMATION AS THE DEPARTMENT MAY
 REQUIRE TO (A) GRADUATES OF SCHOOLS OF NURSE  ANESTHESIA  REGISTERED  BY

 S. 5435--A                          6
 
 THE  DEPARTMENT  OR  (B)  GRADUATES  OF  SCHOOLS  OF  NURSING ANESTHESIA
 APPROVED IN ANOTHER STATE, PROVINCE, OR COUNTRY.
   2. SUCH LIMITED PERMIT SHALL EXPIRE ONE YEAR FROM THE DATE OF ISSUANCE
 OR  UPON  NOTICE TO THE APPLICANT BY THE DEPARTMENT THAT THE APPLICATION
 FOR LICENSE HAS BEEN DENIED. THE LIMITED PERMIT MAY BE RENEWED,  AT  THE
 DISCRETION OF THE DEPARTMENT, FOR ONE ADDITIONAL YEAR.
   3.  A  LIMITED  PERMIT  SHALL ENTITLE THE HOLDER TO PRACTICE CERTIFIED
 REGISTERED NURSE ANESTHESIA ONLY UNDER THE SUPERVISION  OF  A  CERTIFIED
 REGISTERED NURSE ANESTHETIST CURRENTLY REGISTERED IN THIS STATE AND WITH
 THE ENDORSEMENT OF THE EMPLOYING AGENCY.
   4. FEES. THE FEE FOR EACH LIMITED PERMIT SHALL BE THIRTY-FIVE DOLLARS.
   5.  GRADUATES  OF  SCHOOLS  OF  NURSING  ANESTHESIA  REGISTERED BY THE
 DEPARTMENT MAY BE EMPLOYED TO PRACTICE  NURSE  ANESTHESIA  UNDER  SUPER-
 VISION  OF A CERTIFIED REGISTERED NURSE ANESTHETIST CURRENTLY REGISTERED
 IN THIS STATE AND WITH THE ENDORSEMENT OF THE EMPLOYING AGENCY FOR NINE-
 TY DAYS IMMEDIATELY FOLLOWING GRADUATION FROM A PROGRAM IN  NURSE  ANES-
 THESIA  AND PENDING RECEIPT OF A LIMITED PERMIT FOR WHICH AN APPLICATION
 HAS BEEN FILED AS PROVIDED IN THIS SECTION.
   § 6919. EXEMPT PERSONS. 1. THIS ARTICLE SHALL NOT BE CONSTRUED:
   (A) AS MODIFYING 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;
   (B) AS APPLYING TO ANY ACTIVITY AUTHORIZED, PURSUANT TO STATUTES, RULE
 OR REGULATION, TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE  IN  A
 HOSPITAL AS DEFINED IN ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW;
   (C)  AS  PROHIBITING  AN  INDIVIDUAL  WHO HAS BEEN LICENSED AS A NURSE
 PRACTITIONER IN THE ACUTE CARE SPECIALTY AREA FROM PERFORMING THE DUTIES
 OF A CERTIFIED REGISTERED NURSE ANESTHETIST;
   (D) AS PROHIBITING THE FURNISHING OF NURSING ANESTHESIA ASSISTANCE  IN
 CASE OF AN EMERGENCY;
   (E)  AS  PROHIBITING SUCH PERFORMANCE OF NURSING ANESTHESIA SERVICE BY
 STUDENTS ENROLLED IN REGISTERED SCHOOLS OR PROGRAMS AS MAY BE INCIDENTAL
 TO THEIR COURSE OF STUDY;
   (F) AS PROHIBITING OR PREVENTING THE PRACTICE OF NURSING ANESTHESIA IN
 THIS STATE BY ANY LEGALLY QUALIFIED NURSE OR PRACTICAL NURSE OF  ANOTHER
 STATE,  PROVINCE,  OR  COUNTRY  WHOSE  ENGAGEMENT REQUIRES HIM OR HER TO
 ACCOMPANY AND CARE FOR A PATIENT  TEMPORARILY  RESIDING  IN  THIS  STATE
 DURING  THE  PERIOD  OF  SUCH  ENGAGEMENT  PROVIDED SUCH PERSON DOES NOT
 REPRESENT OR HOLD HIMSELF OR HERSELF OUT AS A CERTIFIED REGISTERED NURSE
 ANESTHETIST REGISTERED TO PRACTICE IN THIS STATE;
   (G) AS PROHIBITING OR PREVENTING THE PRACTICE OF NURSING ANESTHESIA IN
 THIS STATE DURING AN EMERGENCY OR  DISASTER  BY  ANY  LEGALLY  QUALIFIED
 NURSE  ANESTHETIST  OF  ANOTHER  STATE,  PROVINCE, OR COUNTRY WHO MAY BE
 RECRUITED BY THE AMERICAN NATIONAL RED CROSS OR  PURSUANT  TO  AUTHORITY
 VESTED  IN  THE  STATE  CIVIL  DEFENSE  COMMISSION FOR SUCH EMERGENCY OR
 DISASTER SERVICE, PROVIDED  SUCH  PERSON  DOES  NOT  REPRESENT  OR  HOLD
 HIMSELF  OR  HERSELF  OUT  AS  A  CERTIFIED REGISTERED NURSE ANESTHETIST
 REGISTERED TO PRACTICE IN THIS STATE;
   (H) AS PROHIBITING OR PREVENTING THE PRACTICE OF NURSING ANESTHESIA IN
 THIS STATE, IN OBEDIENCE TO THE REQUIREMENTS OF THE LAWS OF  THE  UNITED
 STATES, BY ANY COMMISSIONED NURSE ANESTHETIST OFFICER IN THE ARMED FORC-
 ES  OF  THE  UNITED  STATES  OR BY ANY NURSE ANESTHETIST EMPLOYED IN THE
 UNITED STATES VETERANS ADMINISTRATION OR  UNITED  STATES  PUBLIC  HEALTH
 SERVICE WHILE ENGAGED IN THE PERFORMANCE OF THE ACTUAL DUTIES PRESCRIBED

 S. 5435--A                          7
 
 FOR  HIM  OR  HER UNDER THE UNITED STATES STATUTES, PROVIDED SUCH PERSON
 DOES NOT REPRESENT OR HOLD HIMSELF OR HERSELF OUT AS A CERTIFIED  REGIS-
 TERED NURSE ANESTHETIST REGISTERED TO PRACTICE IN THIS STATE; OR
   (I)  AS  PROHIBITING THE CARE OF THE SICK WHEN DONE IN CONNECTION WITH
 THE PRACTICE OF THE RELIGIOUS TENETS OF ANY CHURCH.
   § 6920. SPECIAL PROVISIONS. A CERTIFIED REGISTERED  NURSE  ANESTHETIST
 LICENSED  UNDER  THIS  ARTICLE  IS REQUIRED TO PURCHASE AND MAINTAIN, OR
 OTHERWISE BE COVERED BY, PROFESSIONAL LIABILITY INSURANCE IN  AN  AMOUNT
 NOT  LESS  ONE MILLION DOLLARS PER CLAIM WITH AN AGGREGATE LIABILITY FOR
 ALL CLAIMS DURING  THE  YEAR  OF  THREE  MILLION  DOLLARS.  PROFESSIONAL
 LIABILITY INSURANCE REQUIRED BY THIS SECTION SHALL COVER ALL ACTS WITHIN
 THE SCOPE OF PRACTICE OF REGISTERED NURSE ANESTHETIST.
   §  2.  Section 6903 of the education law, as amended by chapter 323 of
 the laws of 2006, is amended to read  as follows:
   § 6903. Practice of nursing and use of title "registered  professional
 nurse"  or  "licensed practical nurse". Only a person licensed or other-
 wise authorized under this article shall practice  nursing  and  only  a
 person  licensed  under  section sixty-nine hundred five of this article
 shall use the title "registered professional nurse" and  only  a  person
 licensed  under section sixty-nine hundred six of this article shall use
 the title "licensed practical nurse". No  person  shall  use  the  title
 "nurse"  or  any other title or abbreviation that would represent to the
 public that the person is authorized  to  practice  nursing  unless  the
 person is licensed or otherwise authorized under this article OR ARTICLE
 ONE HUNDRED THIRTY-NINE-A OF THIS TITLE.
   §  3.  Section 6904 of the education law, as amended by chapter 994 of
 the laws of 1971 and as renumbered by chapter 50 of the laws of 1972, is
 amended to read as follows:
   § 6904. State board for nursing.  A state board for nursing  shall  be
 appointed  by the board of regents on recommendation of the commissioner
 for the purpose of assisting the board of regents and the department  on
 matters of professional licensing and professional conduct in accordance
 with section sixty-five hundred eight of this title.  The board shall be
 composed  of  not  less than [fifteen] SEVENTEEN members, eleven of whom
 shall be registered professional  nurses  and  four  of  whom  shall  be
 licensed  practical nurses AND TWO OF WHOM SHALL BE CERTIFIED REGISTERED
 NURSE ANESTHETISTS all licensed and practicing  in  this  state  for  at
 least  five  years.    An  executive  secretary  to  the  board shall be
 appointed by the board of regents on recommendation of the  commissioner
 and shall be a registered professional nurse registered in this state.
   § 4. This act shall take effect immediately.