PRINTER'S NO. 2237
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1956
Session of
2021
INTRODUCED BY SCHLEGEL CULVER, PICKETT, ZIMMERMAN, JAMES, KULIK,
HARKINS, MILLARD, MULLINS, CIRESI, SONNEY, FEE, MENTZER AND
THOMAS, OCTOBER 5, 2021
REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, OCTOBER 5, 2021
AN ACT
Amending the act of December 20, 1985 (P.L.457, No.112),
entitled "An act relating to the right to practice medicine
and surgery and the right to practice medically related acts;
reestablishing the State Board of Medical Education and
Licensure as the State Board of Medicine and providing for
its composition, powers and duties; providing for the
issuance of licenses and certificates and the suspension and
revocation of licenses and certificates; provided penalties;
and making repeals," further providing for definitions;
providing for anesthesiologist assistants and for regulation
of anesthesia services; and making editorial changes.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The definitions of "board regulated practitioner"
and "hospital" in section 2 of the act of December 20, 1985
(P.L.457, No.112), known as the Medical Practice Act of 1985,
are amended and the section is amended by adding definitions to
read:
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
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* * *
"Anesthesiologist." A physician who has been granted a
license without restriction to practice medicine and surgery by
the board or a license without restriction to practice
osteopathic medicine and surgery by the State Board of
Osteopathic Medicine who either:
(1) has successfully completed graduate medical training
in anesthesiology;
(2) is certified by the American Board of
Anesthesiology, the American Osteopathic Board of
Anesthesiology or their predecessor or successor
organizations; or
(3) is credentialed by a licensed health care facility
in this Commonwealth to practice the medical specialty of
anesthesiology.
"Anesthesiologist assistant." An individual who:
(1) Graduated from an anesthesiologist assistant
education program approved by CAAHEP or its predecessor or a
successor agency.
(2) Satisfactorily completed an anesthesiologist
assistant certification examination administered by NCCAA or
another national anesthesiologist assistant certifying agency
established for such purposes which has been reviewed and
approved by the board and is currently certified.
(3) Is approved by the board to practice medicine under
the supervision of an anesthesiologist.
"Anesthesiologist assistant certification examination." The
initial certifying examination for an anesthesiologist assistant
established for the purpose of certification and reviewed and
approved by the board.
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"Anesthesiology." The practice of medicine and surgery or
the practice of osteopathic medicine and surgery dedicated to
the relief of pain and the total care of a patient before,
during and after a surgical, obstetrical or other necessary
procedure that may induce pain. The term includes:
(1) The evaluation and optimization of preexisting
medical conditions.
(2) The perioperative management of coexisting disease.
(3) The delivery of anesthesia and sedation, including
regional, and neuraxial anesthesia.
(4) The management of postanesthetic recovery.
(5) The prevention and management of periprocedural
complications.
(6) The practice of acute and chronic pain medicine.
(7) The practice of critical care medicine, including
line placement, and procedures.
* * *
"Assist." The action of an individual who is an
anesthesiologist assistant personally performing duties and
responsibilities delegated to the individual by an
anesthesiologist under the supervision of an anesthesiologist.
* * *
"Board regulated practitioner." A medical doctor, midwife,
physician assistant, anesthesiologist assistant, respiratory
therapist, licensed athletic trainer or drugless therapist or an
applicant for a license or certificate the board may issue.
* * *
"CAAHEP." The Commission on Accreditation of Allied Health
Education Programs.
* * *
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"Certified registered nurse anesthetist." As defined in the
act of May 22, 1951 (P.L.317, No.69), known as The Professional
Nursing Law.
"Hospital." An institution licensed or regulated as a
hospital by the Department of Health or the Department of
[Public Welfare] Human Services or a facility owned or operated
by the Federal Government and accredited by the Joint Commission
on Accreditation of Hospitals as a hospital.
* * *
"NCCAA." The National Commission on the Certification of
Anesthesiologist Assistants.
* * *
Section 2. Section 13(c.2)(1) of the act is amended to read:
Section 13. Physician assistants.
* * *
(c.2) Nothing in this section shall be construed to:
(1) Supersede the authority of the Department of Health
and the Department of [Public Welfare] Human Services to
regulate the types of health care professionals who are
eligible for medical staff membership or clinical privileges.
* * *
Section 3. The act is amended by adding sections to read:
Section 13.7. Anesthesiologist assistants.
(a) General rule.--An anesthesiologist assistant may assist
an anesthesiologist in the medical practice of anesthesiology.
(b) Authorized services.--An anesthesiologist assistant may
only perform anesthesia services and procedures delegated by an
anesthesiologist, including, but not limited to, the following
duties:
(1) Developing and implementing an anesthesia care plan
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for a patient.
(2) Obtaining a comprehensive patient history and
performing relevant elements of a physical exam.
(3) Performing preoperative and post-operative
anesthetic evaluations and maintaining patient progress
notes.
(4) Ordering and performing preoperative patient
consultations.
(5) Ordering preoperative medications, including
controlled substances, that may be administered before the
supervising anesthesiologist cosigns.
(6) Changing or discontinuing a medical treatment plan
after consulting with the supervising anesthesiologist.
(7) Obtaining informed consent for anesthesia or related
procedures.
(8) Ordering the perioperative continuation of current
medications that may be administered before the supervising
anesthesiologist cosigns.
(9) Pretesting and calibrating anesthesia delivery
systems and obtaining and interpreting information from the
systems and from monitors.
(10) Implementing medically accepted monitoring
techniques.
(11) Performing basic and advanced airway interventions,
including, but not limited to, endotracheal intubation,
laryngeal mask insertion and other advanced airways
techniques.
(12) Establishing peripheral intravenous lines,
including subcutaneous lidocaine use.
(13) Performing invasive procedures, including, but not
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limited to, arterial lines, central lines, transesophageal
echocardiograms and Swan Ganz catheters.
(14) Performing general anesthesia, including induction,
maintenance, emergence and procedures associated with general
anesthesia, such as gastric intubation.
(15) Administering anesthetic drugs, adjuvant drugs and
accessory drugs.
(16) Administering vasoactive drugs and starting and
titrating vasoactive infusions to treat patient responses to
anesthesia.
(17) Performing, maintaining, evaluating and managing
epidural, spinal and regional anesthesia, including
catheters.
(18) Performing monitored anesthesia care.
(19) Obtaining venous and arterial blood samples.
(20) Administering blood, blood products and supportive
fluids.
(21) Performing, ordering and interpreting appropriate
preoperative, point of care, intra-operative or postoperative
diagnostic tests or procedures.
(22) Obtaining and administering perioperative
anesthesia and related pharmaceutical agents, including
intravenous fluids and blood products.
(23) Managing the patient while in the preoperative
suite, recovery area or labor suites.
(24) Ordering postoperative sedation, anxiolysis or
analgesia, postoperative respiratory therapy and medicines to
treat patient responses to anesthesia and ordering
postoperative oxygen therapy, including initial ventilator
therapy and ordering, that may be administered before the
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supervising anesthesiologist cosigns.
(25) Initiating and managing cardiopulmonary
resuscitation in response to a life-threatening situation.
(26) Participating in administrative, research and
clinical teaching activities including supervising student
anesthesiologist assistants and other students involved in
anesthesia education.
(27) Performing other tasks not prohibited by law that
an anesthesiologist assistant has been trained and is
proficient to perform.
(c) Regulations.--The board may promulgate regulations
consistent with this act that define the circumstances under
which an anesthesiologist assistant may perform anesthesia
services and procedures.
(d) Use of title.--An anesthesiologist assistant may use the
title anesthesiologist assistant, certified anesthesiologist
assistant, anesthetist or an appropriate abbreviation, such as
"C.A.A.". No other person may use that title.
(e) Supervision.--
(1) An anesthesiologist assistant shall not perform an
anesthesia service or procedure without the supervision of an
anesthesiologist.
(2) For the purposes of this subsection, "supervision"
means the management, or direction, or control by an
anesthesiologist of a service delegated to an
anesthesiologist assistant and which anesthesiologist is
immediately available to the anesthesiologist assistant who
assists in the delivery of medical care such that the
anesthesiologist is able to intervene if needed.
(3) An anesthesiologist assistant may be employed by a
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health care facility licensed under the act of July 19, 1979
(P.L.130, No.48), known as the Health Care Facilities Act,
under the supervision of an anesthesiologist or group of
anesthesiologists.
(f) Drugs.--
(1) An anesthesiologist assistant may dispense and
administer drugs, including legend drugs and Schedule II
through Schedule V controlled substances as defined in act of
April 14, 1972 (P.L.233, No.64), known as The Controlled
Substance, Drug, Device and Cosmetic Act, that are required
to perform anesthesia services or procedures delegated to
them by an anesthesiologist.
(2) The dispensing and administration of drugs shall be
at all times under the supervision of an anesthesiologist.
(3) An anesthesiologist assistant shall not
independently prescribe or dispense drugs.
(4) The board may promulgate regulations consistent with
this section defining the circumstances under which
anesthesiologist assistants may dispense and administer
drugs.
(g) Construction.--
(1) Nothing in this section or the regulations
authorized by this section shall be construed to prohibit an
anesthesiologist assistant who is licensed or certified to
practice another profession by a Commonwealth agency or board
from practicing within the scope of that license or
certificate or as otherwise authorized by law.
(2) Nothing in this section shall be construed to:
(i) Supersede the authority of the Department of
Health and the Department of Human Services to regulate
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the types of health care professionals who are eligible
for medical staff membership or clinical privileges.
(ii) Restrict the authority of a health care
facility to determine the scope of practice and
supervision or other oversight requirements for health
care professionals practicing within the facility.
Section 36.3. Anesthesiologist assistant license.
(a) General rule.--An anesthesiologist assistant license
empowers the holder to practice medicine and perform anesthesia
under the delegation of an anesthesiologist in the provision of
medical care and services as provided in this act.
(b) Requirements.--No anesthesiologist assistant license may
be issued to the applicant unless the requirements specified by
this act and such rules and regulations issued by the board are
met, including requirements for the anesthesiologist assistant
training and educational programs which shall be formulated by
the board in accordance with such national criteria as are
established by national organizations or societies as the board
may accept.
(c) Criteria.--The board shall grant anesthesiologist
assistant licenses to applicants who have fulfilled the
following criteria:
(1) Satisfactory completion of a program for the
training and education of anesthesiologist assistants
certified by CAAHEP or its predecessor or a successor agency.
(2) Satisfactory performance on an anesthesiologist
assistant certification examination administered by NCCAA or
another national anesthesiologist assistant certifying agency
established for such purposes and approved by the board.
(d) Biennial renewal.--An anesthesiologist assistant license
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shall be subject to biennial renewal by the board. As part of
biennial renewal, an anesthesiologist assistant shall complete
continuing medical education as required by the National
Commission on Certification of Anesthesiologist Assistants.
(e) Penalties.--The board may refuse to renew, and may
revoke, suspend or restrict a license or take other disciplinary
action.
Section 45.1. Provision and supervision of anesthesiology and
anesthesia services.
(a) General rule.--The practice of anesthesiology,
including, but not limited to, anesthesia services provided in
hospitals, ambulatory care facilities and other health care
facilities, shall be regulated by the board.
(b) Anesthesia services.--Anesthesia services in a health
care facility shall only be provided by:
(1) An anesthesiologist.
(2) A physician enrolled in a graduate medical training
program in anesthesiology or oral and maxillofacial surgery.
(3) A dentist permitted by the State Board of Dentistry
or the act of May 1, 1933 (P.L.216, No.76), known as The
Dental Law, to administer, supervise or direct anesthesia
services.
(4) A certified registered nurse anesthetist under the
overall direction of the following:
(i) an anesthesiologist;
(ii) the physician or podiatrist performing the
operation or other procedure requiring anesthesia
services; or
(iii) a dentist permitted by the State Board of
Dentistry or The Dental Law to administer, supervise or
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direct anesthesia services.
(5) An anesthesiologist assistant under the supervision
of an anesthesiologist as required by this act.
(6) A supervised student nurse trainee enrolled in a
course approved by the American Association of Nurse
Anesthetists.
(7) A supervised student anesthesiologist assistant
enrolled in a course approved by CAAHEP.
(c) Construction.--Nothing in this section shall be
construed to:
(1) Supersede the authority of the Department of Health
and the Department of Human Services to regulate the types of
health care professionals who are eligible for medical staff
membership or clinical privileges.
(2) Restrict the authority of a health care facility to
determine the scope of practice and supervision or other
oversight requirements for health care professionals
practicing within the facility.
Section 4. This act shall take effect in 60 days.
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