AMCNO follow up to amicus brief regarding Anesthesiologist Assistants - Ohio Supreme Court removes medical board rule

In a victory for the AMCNO and other organizations in the community, the Ohio Supreme Court has struck down an administrative rule adopted by the State Medical Board that would have barred AAs from performing certain procedures.

History: On December 28, 2005, the Ohio Supreme Court agreed to hear the appeal filed by Joseph Hoffman challenging the Medical Board’s regulation prohibiting anesthesiologist assistants (“AAs”) from performing epidural and spinal anesthetic procedures and implementing medically accepted monitoring techniques. The appeal was filed after the Tenth District Court of Appeals reversed the decision of the trial court, which had invalidated Ohio Administrative Code § 4731-24-04(A) (the “Rule”).

The Rule states “[n]othing in this chapter of the Administrative Code shall permit an anesthesiologist assistant to perform any anesthetic procedure not specifically authorized by Chapter 4760 of the Revised Code, including epidural and spinal anesthetic procedures and invasive medically accepted monitoring techniques.” Arguing that the Rule was in direct conflict with the statute, Joseph Hoffman, an AA practicing in Cleveland, filed suit on June 10, 2003 against the Ohio State Medical Board demanding a declaration that the rule conflicted with the statute and was therefore invalid. The trial court agreed holding that the Medical Board specifically negated Ohio Revised Code § 4760.09 which permitted AAs to assist with spinal and epidural procedures as well as medically accepted monitoring techniques by enacting a rule prohibiting AAs from performing these procedures. Additionally, the court held that it would be unreasonable to allow “assist” to mean to carry out procedures as requested by the supervising anesthesiologist everywhere else but in the Rule at issue here. 

The trial court also found it compelling that the Ohio General Assembly had prohibited certain anesthesia related practices with regards to certified registered nurse anesthetists and medical assistants, indicating that the Ohio General Assembly chose not to limit AAs from performing spinals, epidurals and medically accepted patient monitoring techniques. 

The Medical Board appealed the trial court’s decision to the Tenth District Court of Appeals in Franklin County. The Board argued that resolution of this issue depended upon whether the word “assist” is defined according to its “ordinary” definition or its technical definition as used in the medical field. Mr. Hoffman maintained that the Rule conflicts with the statute regardless of which definition is applied to the term “assist.” Additionally, amici curiae briefs in support of Mr. Hoffman were filed by the American Academy of Anesthesiologist Assistants, the Ohio Academy of Anesthesiologist Assistants, Case Western Reserve University, University Hospitals of Cleveland, Parma Anesthesia Associates, Inc., The Anesthesia Associates of Cincinnati, Mercy Anesthesiologists, Inc. and the members of The Academy of Medicine of Cleveland/Northern Ohio Medical Association.

On July 21, 2005, the Court of Appeals issued its decision reversing the trial court. The Court of Appeals held the ordinary meaning of “assist” was consistent with a regulatory prohibition upon the performance of the enumerated procedures under the Rule. Although finding that the Medical Board had compromised its position by adopting a definition of “assist” that supported Mr. Hoffman’s position, the Court of Appeals held that the existence of a specialized meaning within the profession, of itself, was not dispositive of the meaning intended by the legislature in drafting the statute as the legislature clearly intended for an everyday meaning to be inferred. On August 11, 2005, the Court of Appeals granted Mr. Hoffman’s unopposed motion for a stay of the Court of Appeals’ opinion pending his appeal to the Supreme Court. Once again, the AMCNO and other organizations filed an amicus curiae brief in support.

Ohio Supreme Court Decision: Justices said in a 7-0 opinion that the rule blocking the assistants from performing epidural and spinal procedures was invalid because state law allows them to do so under supervision of an anesthesiologist. At issue, Justice Judith Lanzinger said in the decision, was the meaning of the word “assist” as used in the statute. Justice Lanzinger said the statute authorizes the practitioners in question to “assist the supervising anesthesiologist with the implementation of medically accepted monitoring techniques.” The law also allows them to “assist the supervising anesthesiologist with the performance of epidural anesthetic procedures and spinal anesthetic procedures.” The medical board argued that by using the word “assist” in the law, legislators intended to preclude the assistants from actually inserting a needle during the procedures.

Mr. Hoffman, however, contended legislators used the word in its technical sense to perform procedures as requested by a supervising doctor. Justices agreed with his analysis. “(Because) the word ‘assist’ has a technical meaning in the field of anesthesiology … we believe that the General Assembly intended that technical meaning to apply,” Justice Lanzinger said.