HCS HB 390 -- ANESTHESIOLOGIST ASSISTANTS

SPONSOR:  Behnen

COMMITTEE ACTION:  Voted "do pass" by the Committee on
Professional Registration and Licensing by a vote of 11 to 5.

This substitute establishes registration for anesthesiologist
assistants under the State Board of Registration for the Healing
Arts.  The substitute:

(1)  Allows anesthesiologist assistants to assist a supervising
anesthesiologist in formulating and executing an anesthesia care
plan for patients.  Anesthesiologist assistants are given
authority to obtain patient history, perform relevant physical
exams, pretest and calibrate anesthesia delivery systems,
interpret information while in consultation with an
anesthesiologist, establish airway intervention, administer
vasoactive and other anesthetic drugs, adjust vasoactive
infusions, and provide tasks not prohibited by law while under
the supervision of an anesthesiologist;

(2)  Requires an anesthesiologist to be responsible for the
oversight of the health care services rendered by an
anesthesiologist assistant;

(3)  Prohibits anesthesiologist assistants from prescribing
medications and controlled substances, conducting activities
which are beyond the scope of practice of the supervising
anesthesiologist, practicing without the supervision of an
anesthesiologist, and holding themselves out as being a
physician;

(4)  Prohibits anesthesiologists from billing for services
performed by an anesthesiologist assistant;

(5)  Requires applicants for licensure to make application with
the board and pay the required fees;

(6)  Allows the board to issue temporary and inactive licenses;

(7)  Requires retiring anesthesiologists assistants to file an
affidavit with the board stating their intentions and the date of
retirement;

(8)  Gives the board the authority to negotiate reciprocal
compacts with other states and to license qualified applicants
from other states;

(9)  Requires the board to promulgate rules pertaining to
application forms, certification, registration, and fees;

(10)  Grants the board the authority to refuse to issue, suspend,
or renew licenses and describes the allowable causes for the
board to file complaints with the Administrative Hearing
Commission;

(11)  Prohibits any person from practicing as an anesthesiologist
assistant without a license, unless the person is in a certified
program under direct supervision of an anesthesiologist or is in
a hospital residency program to become an anesthesiologist;

(12)  Requires that all continuing education be met prior to
license renewal;

(13)  Requires all fees collected by the Division of Professional
Registration to be deposited to the credit of the Board of
Registration for the Healing Arts Fund;

(14)  Requires all supervising anesthesiologists to adopt
protocols that delineate the services provided and the manner of
supervision;

(15)  Gives the governing boards of hospitals the authority to
limit the functions and activities of anesthesiologist
assistants;

(16)  Prohibits persons from holding themselves out as being
anesthesiologist assistants without being duly licensed by the
board; and

(17)  Establishes the Advisory Commission for Anesthesiologist
Assistants.

Violation of any provision of the substitute is a class A
misdemeanor.

FISCAL NOTE:  Estimated Net Effect on Board of Registration for
Healing Arts Fund of $0 in FY 2004, an income of $19,839 in FY
2005, and a cost of $10,146 in FY 2006.

PROPONENTS:  Supporters say that there is a shortage in the
anesthesia profession, particularly in rural areas.  Currently,
certified registered nurse anesthetists are the only persons who
are providing anesthesia services, and there are not enough
practicing in this state to fill the void.  This bill in no way
restricts the practice of nurse anesthetists and would help to
relieve that shortage by accessing professionals from another
source.

Testifying for the bill were Representative Behnen; Dr. Toni
Smith; Missouri Society of Anesthesiologists; Dr. Nathan Berry;
Dr. Kent Blankey; Dr. Chris Felling; Missouri Hospital
Association; Missouri State Medical Association; and Missouri
Association of Osteopathic Physicians and Surgeons.

OPPONENTS:  Those who oppose the bill say that there are certain
safety concerns regarding anesthesiologist assistants.  This
profession has been around for 30 years, but there are only two
schools in the United States.  There are differences in the
educational and training background between anesthesiologist
assistants and certified registered nurse anesthetists.  It is
felt that anesthesiologist assistants don't possess the concept
of total patient care because of their training background.  They
also feel that this will not address the rural problem, due to
the high salaries in metropolitan areas.

Testifying against the bill were Missouri Association of
Certified Registered Nurse Anesthetists; Missouri Nurses
Association; Mark Miller; and Kevin Schnieder.

Bob Dominique, Legislative Analyst

Missouri House of Representatives
Last Updated July 25, 2003 at 10:11 am