In early March, the State Medical Board of Ohio filed the anesthesia assistant rules (option A) with the Joint Committee on Agency Rule Review (JCARR); however, before JCARR could meet on the rules the Medical Board sent a letter to JCARR stating their intention to refile the rules in attempt to address concerns brought up by the Academy of Medicine of Cleveland and the Ohio Association of Anesthesiologist Assistants. On Tuesday, April 1, 2003 the Medical Board met to discuss the anesthesia assistant rules (4731-24-01 through 4731-24-04). At the meeting the Board voted to reaffirm their original decision to file option A, voted to amend rule 4731-24-04 to allow anesthesia assistants to perform brachial procedures, and decided not to continue the Anesthesiologist Assistants Advisory Committee. The Board then refiled the rules with JCARR and JCARR met on the rules on April 10, 2003. The rules will be filed in final form in the near future. The AMC/NOMA had testified in favor of retaining the type of practice AAs had performed in Ohio for the last twenty-five years.
The following is a brief summary of Option A of the anesthesiologist assistant rules as refiled:
Rule 4721-24-02 deals with definitions and establishes that "administer" means to apply directly a drug, whether by injection, inhalation, ingestion, or any other means, and the infusion of blood, blood products and supportive fluids. "Assist" means to carry out procedures as requested by the supervising anesthesiologist, provided that the requested procedure is within the anesthesiologist assistant's training and scope of practice, is authorized by the practice protocol adopted by the supervising anesthesiologist, and is not prohibited by the Ohio Revised Code or the Administrative Code.
Rule 4721-24-02 deals with the supervision of anesthesiologist assistants and establishes that the supervising anesthesiologist is to supervise an anesthesiologist assistant within the terms, conditions, and limitations set forth in a written practice protocol that is consistent with the Ohio Revised Code and the Ohio Administrative Code. This supervision is to be direct supervision and in the immediate presence of an anesthesiologist assistant. "Direct supervision and in the immediate presence of" means all of the following:
The supervising anesthesiologist is to remain physically present and available for immediate diagnosis and treatment of emergencies;
The supervising anesthesiologist is to remain physically present in the anesthetizing area or operating suite, as defined by the hospital or ambulatory surgical facility, and accessible by beeper, phone, or overhead page, such is that he or she is immediately available to participate directly in the care of the patient with whom the anesthesiologist assistant and the supervising anesthesiologist are jointly involved;
The supervising anesthesiologist is to personally participate in the most demanding procedures in the anesthesia plan, which is to include induction and emergence.
"Direct supervision and in the immediate presence of" is not to be interpreted to require the supervising anesthesiologist's presence in the same room as the anesthesiologist assistant for the duration of anesthetic management; or to prohibit the supervising anesthesiologist from addressing an emergency of short duration, administering labor analgesia or performing duties of short duration as required of a perioperative specialist in another location in the hospital or ambulatory surgical facility.
The anesthesiologist assistant is to only perform those tasks assigned on a case-by-case basis by the supervising anesthesiologist and is to implement the personalized plan for each patient as individually prescribed by the supervising anesthesiologist after that physician has completed a specific assessment of each patient. In determining which anesthetic procedures to assign to an anesthesiologist assistant, a supervising anesthesiologist is to consider all of the following:
The supervising anesthesiologist retains responsibility for the anesthetic management in which the anesthesiologist assistant has participated. During the first four years of an anesthesiologist assistant's practice, the supervising anesthesiologist is to provide enhanced supervision.
Rule 4721-24-03 deals with the enhanced supervision of anesthesiologist assistants and establishes that a supervising anesthesiologist is to provide enhanced supervision during the first four years of the anesthesiologist assistant's practice. "Enhanced supervision" means the following:
A supervising anesthesiologist is to require regular, documented quality assurance interactions between a supervising anesthesiologist and the anesthesiologist assistant in his or her first four years of practice. These regularly scheduled quality assurance interactions are to occur in greater number and with greater frequency during the first four years of an anesthesiologist assistant's practice than would be required for quality assurance purposes for anesthesiologist assistants in practice for more than four years and are to take place no less frequently than once every three months. An anesthesiologist assistant is to be required to file on a monthly basis the first two years of practice a separate record of the cases of anesthetic management in which he or she participated. The record is to be reviewed by a supervising anesthesiologist as a component of the quality assurance interactions. The reviewing anesthesiologist is to file a report of each quality assurance interaction with the appropriate committee.
The supervising anesthesiologist is to make direct observations of the anesthesiologist assistant during the course of each case of anesthetic management. During the first year of an anesthesiologist assistant's practice, these direct observations are to be made more frequently than for comparable procedures for anesthesiologist assistants practicing beyond their first year, for each case of anesthetic management, in addition to induction and emergence. The supervising anesthesiologist is to document the enhanced supervision in the anesthetic record.
Anesthesiologist assistants who have practiced in another state prior to beginning their practice in Ohio are to receive credit for the time they practiced on a year-by-year basis except that the supervising anesthesiologist of an anesthesiologist assistant who has practiced for a minimum of four years in another state is to be required to provide, for the first three months of the anesthesiologist assistant's practice, enhanced supervision.
Rule 4721-24-04 deals with prohibitions on anesthesiologist assistants and establishes that an anesthesiologist assistant is not permitted to perform any anesthetic procedure not specifically authorized by Chapter 4760 of the Ohio Revised Code, including epidural and spinal anesthetic procedures and invasive medically accepted monitoring techniques. For the purposes of this Chapter of the Administrative Code, "invasive medically accepted monitoring techniques" means pulmonary artery catheterization, central venous catheterization, and all forms of arterial catheterization with the exception of brachial, radial and dorsalis pedis cannulation. An anesthesiologist assistant is not to practice in any location other than a hospital or ambulatory surgical facility and is not to practice except under the direct supervision and in the immediate presence of a supervising anesthesiologist.