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  • 1. BILL AS INTRODUCED H.375 2003 Page 1 1 H.375 2 Introduced by Representatives Morrissey of Bennington, Krawczyk (Joseph) 3 of Bennington, Botzow of Pownal, Corcoran of Bennington, 4 Masland of Thetford and Miller of Shaftsbury 5 Referred to Committee on 6 Date: 7 Subject: Professions and occupations; anesthesiologist assistants; certification 8 Statement of purpose: This bill proposes to establish a system for certifying 9 anesthesiologist assistants. 10 AN ACT RELATING TO CERTIFYING ANESTHESIOLOGIST 11 ASSISTANTS 12 It is hereby enacted by the General Assembly of the State of Vermont: 13 Sec. 1. 26 V.S.A. chapter 23, subchapter 6 is added to read: 14 Subchapter 6. Anesthesiologist Assistants 15 § 1461. POLICY AND PURPOSE 16 The general assembly recognizes the need to provide means by which 17 anesthesiologists in this state may increase the scope and efficiency of their 18 practice in order to ensure that quality anesthesia services are available to all 19 Vermonters at reasonable cost. 20 www.leg.state.vt.us
  • 2. BILL AS INTRODUCED H.375 2003 Page 2 1 § 1462. DEFINITIONS 2 As used in this chapter: 3 (1) “Anesthesiologist assistant” means a person certified by the state of 4 Vermont under this chapter who is qualified by education, training, experience, 5 and personal character to provide medical services under the direction and 6 supervision of a Vermont licensed physician whose practice is anesthesiology. 7 “Under the direction and supervision” means that an anesthesiologist is readily 8 available at the facility for consultation and intervention. 9 (2) “Board” means the state board of medical practice established under 10 this chapter. 11 (3) “Contract” means a legally binding agreement, expressed in writing, 12 containing the terms of employment of an anesthesiologist assistant. 13 (4) “Disciplinary action” means any action taken against a certified 14 anesthesiologist assistant or an applicant by the board, the appellate officer, or 15 an appeal of that action, when that action suspends, revokes, limits, or 16 conditions certification in any way, and includes reprimands. 17 (5) “Physician” means an person licensed to practice medicine under 18 this chapter. 19 (6) “Protocol” means a detailed description of the duties and scope of 20 practice delegated by an anesthesiologist to an anesthesiologist assistant. 21 (7) “Supervision” means the direction and review by the supervising www.leg.state.vt.us
  • 3. BILL AS INTRODUCED H.375 2003 Page 3 1 physician, as determined to be appropriate by the board, of the medical 2 services provided by the anesthesiologist assistant. 3 § 1463. APPLICATION 4 (a) The state board of medical practice shall certify anesthesiologist 5 assistants and shall adopt rules regarding the training, practice, and 6 qualification of anesthesiologist assistants. 7 (b) Applications for certification shall be accompanied by an application by 8 the proposed supervising physician that shall contain a statement that the 9 physician shall be responsible for all medical activities of the anesthesiologist 10 assistant. 11 (c) Applications for certification shall be accompanied by a protocol signed 12 by the supervising physician and a copy of the anesthesiologist assistant 13 employment contract. 14 § 1464. ELIGIBILITY 15 To be eligible for certification as an anesthesiologist assistant, an applicant 16 shall have: 17 (1) graduated from a board-approved anesthesiologist assistant program 18 sponsored by an institution of higher education accredited by the Committee 19 on Allied Health Education and Accreditation, the Commission on 20 Accreditation of Allied Health Education Programs, or their successor 21 agencies; and www.leg.state.vt.us
  • 4. BILL AS INTRODUCED H.375 2003 Page 4 1 (2) satisfactorily completed the certification examination given by the 2 National Commission of Certification of Anesthesiologist Assistants 3 (NCCAA). 4 § 1465. TEMPORARY CERTIFICATION 5 (a) The board may issue a temporary certification to a person who applies 6 for certification for the first time in this state and meets the educational 7 requirements under subsection 1464(a) of this title. 8 (b) Temporary certification may be issued only for the purpose of allowing 9 an otherwise qualified applicant to practice as an anesthesiologist assistant 10 until the applicant takes the next NCCAA examination, and a determination is 11 made of his or her qualifications to practice in this state. 12 (c) Temporary certification shall be issued on payment of the specified fee 13 for a fixed period of time to be determined by the board and shall only be 14 renewed by the board if the applicant demonstrates proof of an exceptional 15 cause. 16 § 1466. RENEWAL OF CERTIFICATION 17 (a) Certifications shall be renewable every two years without examination 18 and on payment of the required fee. 19 (b) A certification that has lapsed may be reinstated on payment of a 20 renewal fee and a late renewal fee. The applicant shall not be required to pay 21 renewal fees during periods when certification was lapsed. However, if such www.leg.state.vt.us
  • 5. BILL AS INTRODUCED H.375 2003 Page 5 1 certification remains lapsed for a period of three years, the board may, after 2 notice and an opportunity for hearing, require reexamination as a condition of 3 renewal. 4 § 1467. SUPERVISION AND SCOPE OF PRACTICE 5 (a) The number of anesthesiologist assistants permitted to practice under 6 the direction and supervision of a physician shall be determined by the board 7 after review of the system of care delivery in which the physician and 8 anesthesiologist assistants propose to practice. The authority of an 9 anesthesiologist assistant to practice shall terminate immediately upon 10 dissolution of the anesthesiologist assistant’s employment contract, and the 11 supervising physician shall immediately notify the board and the director of the 12 office of professional regulation of such termination. The anesthesiologist 13 assistant’s authority to practice shall not resume until he or she provides proof 14 of another employment contract and protocol as approved under this chapter. 15 (b) The anesthesiologist assistant’s scope of practice shall be limited to that 16 delegated to the anesthesiologist assistant by the supervising physician and for 17 which the anesthesiologist assistant is qualified by education, training, and 18 experience. At no time shall the practice of the anesthesiologist assistant 19 exceed the normal scope of the supervising physician’s practice. 20 § 1468. UNPROFESSIONAL CONDUCT 21 (a) The following conduct by a certified anesthesiologist assistant www.leg.state.vt.us
  • 6. BILL AS INTRODUCED H.375 2003 Page 6 1 constitutes unprofessional conduct. When that conduct is by an applicant or 2 person who later becomes an applicant, it may constitute grounds for denial of 3 certification: 4 (1) fraudulent procuring or use of certification; 5 (2) occupational advertising that is intended or has a tendency to deceive 6 the public; 7 (3) exercising undue influence on, or taking improper advantage of, a 8 person using the person’s services, or promoting the sale of professional goods 9 or services in a manner that exploits a person for the financial gain of the 10 practitioner or of a third party; 11 (4) failing to comply with provisions of federal or state statutes or rules 12 governing the profession; 13 (5) conviction of a crime related to the profession; 14 (6) conduct that evidences unfitness to practice in the profession. 15 (b) Unprofessional conduct includes the following actions by a certified 16 anesthesiologist assistant: 17 (1) making or filing false professional reports or records, impeding or 18 obstructing the proper making or filing of professional reports or records, or 19 failing to file the proper professional report or record; 20 (2) practicing the profession when mentally or physically unfit to do so; 21 (3) professional negligence; www.leg.state.vt.us
  • 7. BILL AS INTRODUCED H.375 2003 Page 7 1 (4) accepting and performing responsibilities that the person knows or 2 has reason to know that he or she is not competent to perform; 3 (5) making any material misrepresentation in the practice of the 4 profession, whether by commission or omission; 5 (6) the act of holding one’s self out as, or permitting one’s self to be 6 represented as, a licensed physician; 7 (7) performing otherwise than at the direction and under the supervision 8 of a physician licensed by the board; 9 (8) accepting the delegation of, or performing or offering to perform, a 10 task or tasks beyond the person’s scope as defined by the board; 11 (9) administering, dispensing, or prescribing any controlled substance 12 other than as authorized by law. 13 (c) A person aggrieved by a determination of the board may appeal in the 14 manner provided under 3 V.S.A. § 130. 15 § 1469. DISPOSITION OF COMPLAINTS 16 (a) Complaints and allegations of unprofessional conduct shall be 17 processed in accordance with the rules of procedure of the board of medical 18 practice. 19 (b) The board shall accept complaints from a member of the public, a 20 physician, an anesthesiologist assistant, a state or federal agency, or the 21 attorney general. The board may initiate disciplinary action in a complaint www.leg.state.vt.us
  • 8. BILL AS INTRODUCED H.375 2003 Page 8 1 against an anesthesiologist assistant and may act without having received a 2 complaint. 3 (c) After giving opportunity for hearing, the board shall take disciplinary 4 action against an anesthesiologist assistant or applicant found guilty of 5 unprofessional conduct. 6 (d) The board may approve a negotiated agreement between the parties 7 when it is in the best interest of the public health, safety, or welfare to do so. 8 Such an agreement may include, without limitation, any of the following 9 conditions or restrictions which may be in addition to, or in lieu of, suspension: 10 (1) a requirement that the person submit to care or counseling; 11 (2) a restriction that the person practice only under supervision of a 12 named person or a person with specified credentials; 13 (3) a requirement that the person participate in continuing education in 14 order to overcome specified practical deficiencies; 15 (4) a requirement that the scope of practice permitted be restricted to a 16 specified extent. 17 (e) Upon application, the board may modify the terms of an order under 18 this section and, if certification has been revoked or suspended, order 19 reinstatement on terms and conditions it deems proper. 20 § 1470. USE OF TITLE 21 Any person who is certified to practice as an anesthesiologist assistant in www.leg.state.vt.us
  • 9. BILL AS INTRODUCED H.375 2003 Page 9 1 this state shall have the right to use the title “anesthesiologist assistant” and the 2 abbreviation “A.A.” No other person may assume that title or use that 3 abbreviation, or any other words, letters, signs, or devices to indicate that the 4 person using them is an anesthesiologist assistant. An anesthesiologist 5 assistant shall not so represent himself or herself unless there is currently in 6 existence a valid contract between the anesthesiologist assistant and his or her 7 employer or supervising physician, and unless the protocol under which the 8 anesthesiologist assistant’s duties are delegated is on file with, and has been 9 approved by, the board. 10 § 1471. LEGAL LIABILITY 11 (a) The supervising physician delegating activities to an anesthesiologist 12 assistant shall be legally liable for such activities of the anesthesiologist 13 assistant, and the anesthesiologist assistant shall in this relationship be the 14 physician’s agent. 15 (b) Nothing in this chapter shall be construed as prohibiting a physician 16 from delegating to an anesthesiologist assistant certain activities relating to 17 medical care and treatment now being carried out by custom and usage when 18 such activities are under the control of the physician. Nothing contained in this 19 chapter shall be construed to apply to nurses acting pursuant to chapter 28 of 20 this title. 21 www.leg.state.vt.us
  • 10. BILL AS INTRODUCED H.375 2003 Page 10 1 § 1472. INAPPROPRIATE USE OF SERVICES BY PHYSICIAN; 2 UNPROFESSIONAL CONDUCT 3 Use of the services of an anesthesiologist assistant by a physician in a 4 manner that is inconsistent with the provisions of this chapter shall constitute 5 unprofessional conduct by the physician, and such physician shall be subject to 6 disciplinary action by the board in accordance with the provisions of this 7 chapter 23. 8 § 1473. FEES 9 Applicants and persons regulated under this chapter shall pay the following 10 fees: 11 (1) (A)(i) Original application for certification $75.00; 12 (ii) Each additional application $50.00; 13 (B) The board shall use at least $10.00 of these fees to support the 14 costs of the creation and maintenance of a Vermont practitioner recovery 15 network which will monitor recovering chemically dependent licensees for the 16 protection of the public. 17 (2)(A)(i) Biennial renewal $75.00; 18 (ii) Each additional renewal $50.00; 19 (B) The board shall use at least $10.00 of these fees to support the 20 costs of the creation and maintenance of a Vermont practitioner recovery 21 network that will monitor recovering chemically dependent licensees for the www.leg.state.vt.us
  • 11. BILL AS INTRODUCED H.375 2003 Page 11 1 protection of the public. In addition to the fee, an applicant for certification 2 renewal shall submit evidence in a manner acceptable to the board that he or 3 she continues to meet the certification requirements of the NCCAA. 4 (3) Transfer of certification $15.00. 5 § 1474. NOTICE OF USE OF ANESTHESIOLOGIST ASSISTANT 6 A physician, clinic, or hospital that utilizes the services of an 7 anesthesiologist assistant shall post a notice to that effect in a prominent place. 8 § 1475. PENALTY 9 (a) A person who, not being certified, holds himself or herself out to the 10 public as being certified under this chapter shall be liable for a fine of not more 11 than $1,000.00. 12 (b) In addition to the penalty provided in subsection (a) of this section, the 13 attorney general or a state’s attorney may bring a civil action to restrain 14 continuing violations of this section. www.leg.state.vt.us