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AS PASSED BY THE SENATE
April 10, 2001
S. 343
S. Printed 4/10/01--S. [SEC 4/11/01 3:57 PM]
Read the first time February 15, 2001.
TO AMEND CHAPTER 47, TITLE 40, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO PHYSICIANS, SURGEONS, AND OSTEOPATHS BY ADDING ARTICLE 9 SO AS TO PROVIDE FOR THE LICENSURE AND REGULATION OF ANESTHESIOLOGIST'S ASSISTANTS, TO ESTABLISH AN ANESTHESIOLOGIST'S ASSISTANT ADVISORY COMMITTEE TO THE BOARD OF MEDICAL EXAMINERS, TO PROVIDE FOR THE POWERS AND DUTIES OF BOTH WITH REGARD TO ANESTHESIOLOGIST'S ASSISTANTS, TO DEFINE THE ROLE AND RESPONSIBILITIES OF A SUPERVISORY PHYSICIAN FOR AN ANESTHESIOLOGIST'S ASSISTANT, TO PROVIDE GENERAL PRACTICE PARAMETERS AND PROCEDURES FOR ESTABLISHING SCOPE OF PRACTICE PROTOCOLS, TO FURTHER PROVIDE FOR THE REGULATION OF ANESTHESIOLOGIST'S ASSISTANTS, AND TO PROVIDE PENALTIES FOR VIOLATIONS.
Amend Title To Conform
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 47, Title 40 of the 1976 Code is amended by adding:
Section 40-47-1205. This article may be cited as the 'South Carolina Anesthesiologist's Assistants Practice Act'.
Section 40-47-1210. As used in this article:
(1) 'Anesthesiologist' means a physician who has successfully completed an approved anesthesiology training program including, but not limited to, a program approved by the Accreditation Committee on Graduate Medical Education, or its equivalent or successor.
(2) 'Anesthesiologist's assistant' means an allied health graduate of an accredited anesthesiologist's assistant program who is currently certified by the National Commission for Certification of Anesthesiologist's Assistants and who works under the direct supervision of an anesthesiologist who is immediately available in the operating suite and is physically present during the most demanding portions of the anesthetic including, but not limited to, induction and emergence.
(3) 'Board' means the Board of Medical Examiners of South Carolina.
(4) 'Committee' means the Anesthesiologist's Assistant Committee as established by this article as an advisory committee responsible to the board.
(5) 'NCCAA' means the National Commission on Certification of Anesthesiologist's Assistants, Inc., the agency recognized to examine and evaluate the education of anesthesiologist's assistants, or its successor organization as recognized by the board.
(6) 'Sponsoring anesthesiologist' means the physician specialist in anesthesiology who signs the anesthesiologist's assistant's application for licensure.
(7) 'Supervising anesthesiologist' means a South Carolina licensed physician currently possessing an active, unrestricted license to practice medicine in South Carolina who practices in the medical specialty of anesthesiology and has successfully completed a residency in anesthesiology, approved by the Accreditation Committee on Graduate Medical Education, or its equivalent or successor.
(8) 'Supervision' means medically directing and accepting responsibility for the anesthesia services rendered by an anesthesiologist's assistant in a manner approved by the board. The supervising anesthesiologist must be in the hospital and in the anesthetizing or operative area such that he can be immediately available to participate directly in the care of the patient with whom the anesthesiologist's assistant and the anesthesiologist are jointly involved.
Section 40-47-1215. This article does not apply to a person who is employed as an anesthesiologist's assistant by the United States Government, where such services are provided solely under the direction or control of the United States Government.
Section 40-47-1220. The Director of the Department of Labor, Licensing and Regulation may employ additional staff as necessary for the performance of the department's duties under this article.
Section 40-47-1225. (A) There is created the Anesthesiologist's Assistant Committee as an advisory committee to the Board of Medical Examiners which consists of nine members to be appointed by the board. Three of the members must be licensed anesthesiologist's assistants with a minimum of three years of patient care experience. Two members must be consumers, and three members must be physicians who are licensed to practice in this State. Of the three physician members, at least one must regularly employ an anesthesiologist's assistant. One member of the Board of Medical Examiners shall serve on the committee ex officio, with full rights to participate and vote. All organizations, groups, or interested individuals may submit recommendations to the board of at least two individuals for each position to be filled on the committee.
(B) The members shall serve for terms of four years and until their successors are appointed and qualify, except the initial term of two anesthesiologist's assistants, the consumer member, and one physician are for two years. Vacancies must be filled in the manner of the original appointment for the unexpired portion of the term. The board, after notice and opportunity for hearing, may remove any member of the committee for negligence, neglect of duty, incompetence, revocation or suspension of license, or other dishonorable conduct. Members of the committee shall receive mileage, subsistence, and per diem as provided by law for members of state boards, commissions, and committees for each meeting attended. No member may serve more than two full four-year terms consecutively but may be eligible for reappointment four years from the date the last full four-year term expired.
(C) The committee shall meet at least two times yearly and at other times as may be necessary. A majority of the members currently serving, not less than two of whom must be physician members, constitutes a quorum. At its initial meeting, and at the beginning of each year thereafter, the committee shall elect from its membership a chairman, vice-chairman, and secretary to serve for a term of one year.
Section 40-47-1230. (A) The committee shall evaluate the qualifications for licensure and make recommendations to the board.
(B) The committee:
(1) may recommend regulations to the board relating to professional conduct to carry out the provisions of this article including, but not limited to, professional certification and the establishment of ethical standards of practice for persons holding a license to practice as an anesthesiologist's assistant in this State;
(2) shall conduct hearings and keep records and minutes necessary to carry out its functions;
(3) shall provide notice of all hearings authorized under this article pursuant to the Administrative Procedures Act;
(4) shall determine the additional qualifications and make recommendations regarding the issuance of licenses to qualified anesthesiologist's assistants; however, these recommendations may not be less stringent than the requirements for national licensure;
(5) shall recommend to the board whether to issue or renew licenses under those conditions prescribed in this article;
(6) may recommend requirements to the board for continuing professional education of anesthesiologist's assistants;
(7) shall keep a record of its proceedings and a register of all licensees, including names and last known places of employment and residence. The board shall annually compile and make available a list of anesthesiologist's assistants authorized to practice in this State. An interested person may obtain a copy of this list upon application to the board and payment of an amount sufficient to cover the cost of printing and mailing;
(8) shall report annually to the board on duties performed, actions taken, and recommendations;
(9) shall hear disciplinary cases and recommend findings of fact, conclusions of law, and sanctions to the board. The board shall conduct a final order hearing at which it shall make a final decision;
(10) shall perform such duties and tasks as may be delegated to the committee by the board.
Section 40-47-1235. Anesthesiologist's assistants may perform medical tasks and services within the framework of a written practice protocol developed for the anesthesiologist's assistant. Within this practice protocol the anesthesiologist's assistant, under the direction of the anesthesiologist may engage in these functions and duties:
(1) obtaining relevant preoperative health history by record or chart review and by direct contact with the patient in the preoperative period;
(2) presenting preoperative health information to the supervising anesthesiologist for the collaborative formulation of an anesthetic plan;
(3) performing initial acute cardio-pulmonary resuscitation in life-threatening situations as directed by a physician;
(4) initiating medically directed multi-parameter monitoring before anesthesia and in other acute care settings. Modalities that may be used include, but are not limited to, American Society of Anesthesiologists Standard Monitors, arterial and venous catheters, or any other current medically accepted modality. The anesthesiologist's assistant may obtain data from monitors or devices that are indicated and may initiate medically directed therapy. The anesthesiologist's assistant may administer drugs used in anesthetic practice by written protocol or as directed by the supervising anesthesiologist;
(5) using current advanced treatment modalities to effect the prescribed anesthetic plan during the procedure. These advanced treatment modalities may include, but are not limited to, basic and advanced airway interventions, including intubation of the trachea; administering intermittent vasoactive drugs, starting and adjusting vasoactive infusions, administering anesthetic, adjuvant, and accessory drugs; administering blood and blood products; and any other treatment modalities prescribed by the medically directing anesthesiologist and within the training and expertise of the anesthesiologist's assistant;
(6) supporting the patient upon emergence and recovery from an anesthetic by airway intervention or ventilatory support and administering any supportive medication and fluids;
(7) participating in administrative, educational, and research activities as appropriate.
An anesthesiologist's assistant may not present himself or herself as an anesthesiologist, any other type of physician, or a nurse anesthetist. The required nomenclature is: 'Anesthesiologist's Assistant'.
Section 40-47-1240. Except as otherwise provided in this article, an individual must obtain a license in accordance with this article before the individual may practice as an anesthesiologist's assistant. The board shall grant a license as an anesthesiologist's assistant to an applicant who has:
(1) submitted a completed application on forms provided by the board;
(2) paid the nonrefundable application fees established in this article;
(3) certified that he or she is mentally and physically able to engage safely in practice as an anesthesiologist's assistant;
(4) submitted evidence to the board that the applicant has obtained a baccalaureate or higher degree from an institution of higher education accredited by an organization recognized by the Commission on Higher Education. This degree program must have included courses in these areas of study:
(a) general biology;
(b) general chemistry;
(c) organic chemistry;
(d) physics;
(e) calculus; and
(5) submitted evidence to the board that the applicant has obtained a graduate-level degree from a program accredited by the Commission on Accreditation of Allied Health Education Programs, or any of the commission's successor organizations, and the graduate degree program must have included the following:
(a) courses in the basic sciences of anesthesia, including general pharmacology, physiology, pathophysiology, anatomy, and biochemistry, and these courses must be presented as a continuum of didactic courses designed to teach students the foundations of human biological existence on which clinical correlations to anesthesia practice are based;
(b) pharmacology for the anesthetic sciences which must include instruction in the anesthetic principles of pharmacology, pharmacodynamics, pharmacokinetics, uptake and distribution, intravenous anesthetics and narcotics, and volatile anesthetics;
(c) physics in anesthesia; and
(d) fundamentals of anesthetic sciences, presented as a continuum of courses covering a series of topics in basic medical sciences with special emphasis on the effects of anesthetics on normal physiology and pathophysiology;
(6) submitted evidence satisfactory to the board that the applicant holds current certification from the National Commission for Certification of Anesthesiologist's Assistants and that the requirements for receiving the certification included passage of an examination to determine the individual's competence to practice as an anesthesiologist's assistant;
(7) no licensure, certificate, or registration as an anesthesiologist's assistant under current discipline, revocation, suspension, probation, or investigation for cause resulting from the applicant's practice as an anesthesiologist's assistant in any jurisdiction;
(8) appeared before a board member with his or her sponsoring anesthesiologist, presenting all original diplomas and certificates and demonstrated knowledge of the contents of this article; and
(9) submitted to the board any other information the board considers necessary to evaluate the applicant's qualifications.
Section 40-47-1245. An anesthesiologist who agrees to act as the supervising anesthesiologist of an anesthesiologist's assistant shall adopt a written practice protocol that delineates the service that the anesthesiologist's assistant is authorized to provide and the manner in which the anesthesiologist will supervise the anesthesiologist's assistant. The anesthesiologist shall base the provisions of the protocol on consideration of relevant quality assurance standards, including being present at the most important times of the case and timely review of the patient's anesthesia record at appropriate times during the course of the anesthetic procedure. The protocol must be reviewed by the anesthesiologist at least once a year.
Section 40-47-1250. An anesthesiologist's assistant shall practice only under the supervision of a physician who is actively and directly engaged in the clinical practice of medicine as an anesthesiologist. An anesthesiologist may not supervise more than two anesthesiologist's assistants at any one time.
Section 40-47-1255. An anesthesiologist's assistant practicing at all sites shall practice pursuant to written scope of practice protocols signed by all supervising anesthesiologists and the anesthesiologist's assistant. Copies of the protocols must be on file at all practice sites. The protocols shall include at a minimum the:
(1) name, license number, and practice addresses of the sponsoring anesthesiologist;
(2) name and practice address of the anesthesiologist's assistant;
(3) date the protocol was developed and dates it was reviewed or amended;
(4) situations that require direct evaluation by or immediate referral to the anesthesiologist.
Section 40-47-1260. An anesthesiologist's assistant may not:
(1) perform a task which has not been listed and approved on the scope of the practice protocol currently on file with the board;
(2) prescribe drugs, medications, or devices of any kind.
Section 40-47-1265. The board or a person designated by the board may make unscheduled inspections of any office or facility employing an anesthesiologist's assistant.
Section 40-47-1270. An anesthesiologist's assistant must clearly identify himself or herself as an anesthesiologist's assistant to ensure that the anesthesiologist's assistant is not mistaken or misrepresented as a physician. An anesthesiologist's assistant shall wear a clearly legible identification badge or other adornment at least one inch by three inches in size bearing the anesthesiologist's assistant's name and the words 'Anesthesiologist's Assistant'. Patients in facilities utilizing anesthesiologist's assistants must be informed when an anesthesiologist's assistant will be involved in their anesthesia care.
Section 40-47-1275. If the supervisory relationship between an anesthesiologist's assistant and the supervising anesthesiologist is terminated for any reason, both the anesthesiologist's assistant and the supervising anesthesiologist shall inform the board immediately in writing of the termination, including the reasons for the termination. The approval of the practice setting terminates coterminous with the termination of the relationship, and practice shall cease until a new application is submitted by a supervising anesthesiologist and is approved by the board.
Section 40-47-1280. (A) It is unlawful for a person who is not licensed under this article to hold himself out as an anesthesiologist's assistant. A person who holds himself out as an anesthesiologist's assistant without being licensed under this article, during a period of suspension, or after his license has been revoked by the board is guilty of a misdemeanor and, upon conviction, must be fined not more than three hundred dollars or imprisoned for not more than ninety days, or both.
(B) For the purpose of any investigation or proceeding under this article, the board or a person designated by the board may administer oaths and affirmations, subpoena witnesses, take testimony, and require the production of any documents or records which the board considers relevant to the inquiry.
(C) If the board has sufficient evidence that a person is violating a provision of this article, the board, in addition to all other remedies, may order the person to immediately desist and refrain from this conduct. The board may apply to an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 for an injunction restraining the person from this conduct. An administrative law judge may issue a temporary injunction ex parte and upon notice and full hearing may issue any other order in the matter it considers proper. No bond may be required of the board by an administrative law judge as a condition to the issuance of any injunction or order contemplated by the provisions of this section.
(D) No provision of this article may be construed as prohibiting the respondent or his legal counsel from exercising the respondent's constitutional right of due process under the law or prohibiting the respondent from normal access to the charges and evidence filed against him as a part of due process under the law.
Section 40-47-1285. Misconduct constituting grounds for revocation, suspension, probation, reprimand, restrictions, or denial of a license must be found when an anesthesiologist's assistant:
(1) has knowingly allowed himself or herself to be misrepresented as a physician;
(2) has filed or has had filed on his or her behalf with the board any false, fraudulent, or forged statement or documents;
(3) has performed any work assignment, task, or other activity which is not on the anesthesiologist's assistant's written practice protocol;
(4) misuses alcohol or drugs to such a degree to render him or her unfit to practice as an anesthesiologist's assistant;
(5) has been convicted of a felony or a crime involving moral turpitude or drugs;
(6) has sustained any physical or mental disability which renders further practice dangerous to the public;
(7) has engaged in any dishonorable or unethical conduct that is likely to deceive or harm patients;
(8) has used or made any false or fraudulent statement in any document connected with practice or licensure as an anesthesiologist's assistant;
(9) has obtained or assisted another person in obtaining fees under dishonorable, false, or fraudulent circumstances;
(10) has violated or conspired with another person to violate any provision of this article; or
(11) otherwise demonstrates a lack of the ethical or professional competence required to act as an anesthesiologist's assistant.
Section 40-47-1290. An anesthesiologist's assistant's license must be renewed on or before the first of January of each licensure period. Upon payment of the nonrefundable renewal fee provided for in Section 40-47-1295 and submission of documentation that the anesthesiologist's assistant certificate issued by the National Commission for Certification of Anesthesiologist's Assistants, or its successor, is active and current, the board shall renew the anesthesiologist's assistant's license.
Section 40-47-1295. (A) Fees for anesthesiologist's assistant licensure are established as follows:
(1) initial licensing fee, not to exceed one thousand dollars;
(2) renewal of license fee, not to exceed three hundred dollars;
(3) late renewal fee, not to exceed the renewal fee doubled;
(4) reactivation application fee, not to exceed three hundred dollars;
(5) change in supervisor fee, not to exceed three hundred dollars.
(B) Fees may be adjusted biennially in accordance with Section 40-1-50 to ensure that they are sufficient but not excessive to cover expenses including the total of the direct and indirect costs to the State for the operations of the committee.
Section 40-47-1300. Nothing in this article may be construed to require third party reimbursement directly to an anesthesiologist's assistant for services rendered."
SECTION 2. If any section, subsection, paragraph, subparagraph, sentence, clause, phrase, or word of this act is for any reason held to be unconstitutional or invalid, such holding shall not affect the constitutionality or validity of the remaining portions of this act, the General Assembly hereby declaring that it would have passed this chapter, and each and every section, subsection, paragraph, subparagraph, sentence, clause, phrase, and word thereof, irrespective of the fact that any one or more other sections, subsections, paragraphs, subparagraphs, sentences, clauses, phrases, or words hereof may be declared to be unconstitutional, invalid, or otherwise ineffective.
SECTION 3. Notwithstanding the provisions of Section 40-47-1225 of the 1976 Code, as added by Section 1 of this act, until such time as the licensed anesthesiologist's assistants are able to be appointed to the board, the Anesthesiologist's Assistant Committee is composed of three physicians and two consumers to be appointed by the Board of Medical Examiners and a member of the board who shall serve ex officio with full rights to participate and vote.
SECTION 4. Two years after the effective date of this act the South Carolina Board of Medical Examiners shall evaluate the prohibition against an anesthesiologist supervising more than two anesthesiologist's assistants, as provided for in Section 40-47-1250 of the 1976 Code, as added by Section 1 of this act, and report its findings to the Senate Medical Affairs Committee and the House Medical, Military, Public and Municipal Affairs Committee, within three months after this two-year period, including any recommendations for statutory revisions.
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