Anesthesiologist assistants.

21LSO-0512
2021
STATE OF WYOMING
21LSO-0512
Numbered
2.0

SENATE FILE NO. SF0104

Anesthesiologist assistants.

Sponsored by: Senator(s) Pappas and Furphy and Representative(s) Hallinan, Stith, Sweeney and Zwonitzer

A BILL

for

AN ACT relating to professions and occupations; providing for the licensing of anesthesiologist assistants and specifying scope of practice; creating and amending definitions; creating an advisory committee to the board of medicine; providing for the imposition of fees; creating a criminal penalty; providing for a hearing; requiring rulemaking; and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1
.

W.S. 33
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26
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801 through 33
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26
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811 are created to read:

ARTICLE 8
ANESTHESIOLOGISTS ASSISTANTS

33
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26
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801.

Definitions.

(a)

As used in this article:

(i)

"Anesthesiologist" means a physician who has completed a residency in anesthesiology approved by the American Board of Anesthesiology, the American Osteopathic Board of Anesthesiology or its predecessor or successor organization and is licensed under article 3 of this chapter;

(ii)

"Anesthesiologist assistant" means any person licensed under this article who:

(A)

Graduates from an anesthesiologist assistant education program approved by
CAAHEP
or its predecessor or successor agency;

(B)

Satisfactorily completes a certification examination administered by
NCCAA
or other national anesthesiologist assistant certifying agency that has been reviewed and approved by the board, and is currently certified; and

(C)

Is approved by the board to assist in the practice of medicine under the supervision of an anesthesiologist or group of anesthesiologists approved by the board to supervise the person.

(iii)

"Assists" means the anesthesiologist assistant may personally perform those duties and responsibilities delegated to the anesthesiologist assistant by the supervising anesthesiologist with the supervising anesthesiologist being physically present in the same facility;

(iv)

"Back
‑
up anesthesiologist" means an anesthesiologist designated by the supervising anesthesiologist to ensure supervision of the anesthesiologist assistant in the supervising
anesthesiologist's absence. A back
‑
up anesthesiologist is subject to the same requirements imposed upon the supervising anesthesiologist if the back
‑
up anesthesiologist is acting as a supervising anesthesiologist;

(v)

"Certification examination" means the initial certifying examination approved by the board for the certification of anesthesiologist assistants including the examination administered by
NCCAA
or other national anesthesiologist assistant certifying agency that has been reviewed and approved by the board;

(vi)

"License" means a license to practice as an anesthesiologist assistant in this state;

(vii)

"Licensee" means a person licensed to practice as an anesthesiologist assistant under this act;

(viii)

"
NCCAA
" means the national commission on the certification of anesthesiologist assistants;

(ix)

"On
‑
site" means within the facility where anesthesia services may be needed including the operating room suites, intensive care unit, emergency room, obstetric suite, endoscopy suite, radiology suite, cardiac services suite and recovery room;

(x)

"Supervising anesthesiologist" means an anesthesiologist approved by the board to supervise an anesthesiologist assistant and:

(A)

Who agrees to be responsible for the medical acts of an anesthesiologist assistant; or

(B)

A back
‑
up anesthesiologist when acting in the absence of the supervising anesthesiologist.

(xi)

"Supervision" means the ready, on
‑
site availability of the supervising anesthesiologist for consultation and direction of the activities of the anesthesiologist assistant.

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802.

Scope.

(a)

This article does not apply to persons enrolled in an anesthesiologist assistant program.

(b)

The anesthesiologist assistant may perform those duties and responsibilities delegated to the anesthesiologist assistant by the supervising anesthesiologist under the supervision of a supervising anesthesiologist. A supervising anesthesiologist may delegate duties to an anesthesiologist assistant within the scope of the supervising anesthesiologist's practice and expertise and within the skills of the anesthesiologist assistant including the following:

(i)

Perform preoperative anesthetic evaluations, postoperative anesthetic evaluations and patient progress notes, all to be cosigned by the supervising anesthesiologist within twenty
‑
four (24) hours;

(ii)

Order and perform preoperative consultations;

(iii)

Order preoperative medications, including controlled substances, which may be administered prior to the co
‑
signature by the supervising anesthesiologist;

(iv)

Change or discontinue a medical treatment plan after consultation with the supervising anesthesiologist;

(v)

Obtain informed consent for anesthesia or related procedures;

(vi)

Order the perioperative continuation of current medications, which may be administered prior to the co
‑
signature by the supervising anesthesiologist;

(vii)

Calibrate anesthesia delivery systems and obtain and interpret information from the systems and monitors, in consultation with the supervising anesthesiologist;

(viii)

Assist the supervising anesthesiologist with the implementation of medically accepted monitoring techniques;

(ix)

Perform basic and advanced airway interventions, including endotracheal intubation, laryngeal mask insertion, and other advanced airways techniques;

(x)

Establish peripheral intravenous lines, including subcutaneous lidocaine use;

(xi)

Establish radial and dorsalis pedis arterial lines and central lines;

(xii)

Perform general anesthesia, including induction, maintenance and emergence;

(xiii)

Perform procedures associated with general anesthesia, such as gastric intubation;

(xiv)

Administer intermittent vasoactive drugs and start and titrate vasoactive infusions for the treatment of patient responses to anesthesia;

(xv)

Perform epidural, spinal and intravenous regional anesthesia;

(xvi)

Maintain and manage established neuraxial and regional anesthesia;

(xvii)

Perform monitored anesthesia care;

(xviii)

Evaluate and manage patient controlled analgesia, epidural catheters and peripheral nerve catheters;

(xix)

Obtain venous and arterial blood samples;

(xx)

Perform, order and interpret appropriate preoperative, point of care, intraoperative or postoperative diagnostic tests or procedures as authorized by the supervising anesthesiologist;

(xxi)

Obtain and administer perioperative anesthesia and related pharmaceutical agents including intravenous fluids and blood products;

(xxii)

Participate in management of the patient while in the preoperative suite and recovery area;

(xxiii)

Order postoperative sedation, anxiolysis and analgesia that may be administered prior to the co
‑
signature by the supervising anesthesiologist;

(xxiv)

Order postoperative oxygen therapy, including initial ventilator therapy, which may be administered prior to the co
‑
signature by the supervising anesthesiologist;

(xxv)

Order post
‑
operative respiratory therapy and medicines for the treatment of patient responses to anesthesia, which may be administered prior to the co
‑
signature by the supervising anesthesiologist;

(xxvi)

Provide assistance to a cardiopulmonary resuscitation team in response to a life
‑
threatening situation;

(xxvii)

Participate in administrative, research and clinical teaching activities as authorized by the supervising anesthesiologist;

(xxviii)

Perform other tasks not prohibited by law under the supervision of the supervising anesthesiologist that an anesthesiologist assistant has been trained and is proficient to perform.

(c)

Nothing in this article shall be construed to prevent an anesthesiologist assistant from having access to and being able to obtain drugs as directed by the supervising anesthesiologist.

(d)

Nothing in this article shall be construed to conflict with or alter the provisions and requirements of W.S. 33
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101 through 33
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410 and 33
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601 through 33
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26
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703.

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803.

Board powers and duties.

(a)

The board shall pass upon the qualifications and determine the fitness of all persons desiring to practice as anesthesiologist assistants.

(b)

The board shall:

(i)

Grant, renew, refuse to grant or renew, suspend, restrict, revoke and reinstate licenses;

(ii)

Investigate allegations that an anesthesiologist assistant or supervising anesthesiologist has engaged in conduct constituting a ground for revocation in W.S. 33
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26
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402 or 33
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808(c);

(iii)

Conduct informal interviews and contested cases;

(iv)

Promulgate rules governing the licensure and practice of anesthesiologist assistants;

(v)

Appoint members to serve on an advisory committee to the board of medicine.

At least two (2) of the members shall be anesthesiologist assistants and two (2) members shall be anesthesiologists.

The committee members are responsible to and shall serve at the board's pleasure.

The advisory committee shall review and make recommendations to the board regarding all matters relating to anesthesiologist assistants that come before the board, including:

(A)

Applications for licensure, renewals or reinstatements;

(B)

Education standards;

(C)

Scope of practice;

(D)

Licensure requirements;

(E)

Continuing medical education.

(vi)

Retain jurisdiction over only those licensees to whom temporary or full licenses were granted, regardless of whether the license expired, lapsed or was relinquished during or after the alleged occurrence of conduct proscribed in W.S. 33
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402 by the licensee or after the board receives a court order pursuant to W.S. 33
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26
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808(c) for the licensee;

(vii)

Pass upon the qualifications and ability of physicians desiring to serve as a supervising anesthesiologist or back
‑
up anesthesiologist including the compatibility of the supervising anesthesiologist's or back
‑
up anesthesiologist's specialty and scope of practice with that of the anesthesiologist assistant to be supervised.

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804.

License required; application; qualifications; consideration of applications.

(a)

No person shall practice as an anesthesiologist assistant or represent that he is a "certified anesthesiologist assistant", "licensed anesthesiologist
assistant", "anesthesiologist assistant", "C.A.A." or "A.A." without a license granted by the board.

(b)

The board may grant an anesthesiologist assistant license to an applicant who:

(i)

Has graduated from an anesthesiologist assistant program accredited by
CAAHEP
or its predecessor or successor organization;

(ii)

Has satisfactorily completed a certification examination administered by
NCCAA
or other national certifying agency that has been reviewed and approved by the board and is currently certified;

(iii)

Completes an application on a form approved by the board; and

(iv)

Pays the fees set forth in W.S. 33
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26
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807.

(c)

The board may issue a temporary license to any person who successfully completes a
CAAHEP
or other board
approved program for the education and training of an anesthesiologist assistant but has not yet passed a certification examination.

To allow the opportunity to take the next available certification examination, any temporary license issued pursuant to this subsection shall be issued for a period not to exceed one (1) year and under conditions as the board determines pursuant to W.S. 33
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805.

(d)

The board shall promulgate rules governing the board's consideration of applications by an anesthesiologist to supervise anesthesiologist assistants.

Any application shall include at a minimum:

(i)

The qualifications of the anesthesiologist assistant to be employed, including experience;

(ii)

The professional background of the anesthesiologist;

(iii)

A description by the anesthesiologist of that anesthesiologist's practice and the way in which the
anesthesiologist assistant will be utilized, including method of supervision.

(e)

The board, with the concurrence of the advisory committee, shall approve an application by an anesthesiologist to supervise anesthesiologist assistants if the board is satisfied that each proposed anesthesiologist assistant is fully qualified to assist in the practice of medicine under the responsible supervision of a licensed anesthesiologist and that the supervising anesthesiologist is compatible in specialty scope and is responsible and qualified to supervise an anesthesiologist assistant. The board shall provide by rule for requirements and limitations on the practice by and supervision of anesthesiologist assistants including the number of anesthesiologist assistants who may be supervised concurrently, but the board shall not allow an anesthesiologist to supervise more than four (4) anesthesiologist assistants at any time.

(f)

The board may provide by rule for arrangements for other anesthesiologists to serve as back
‑
up or on call anesthesiologists for multiple anesthesiologist assistants.

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805.

Temporary licenses.

(a)

The board may grant a temporary license to practice as an anesthesiologist assistant to a person who:

(i)

Completes a temporary license application;

(ii)

Meets the requirements of W.S. 33
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804(b); and

(iii)

Pays the temporary license fee set forth in W.S. 33
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807.

(b)

Unless revoked, a temporary license is valid until the next board meeting following the date of issuance. The board may extend the temporary license at its discretion upon a showing of good cause for a period not to
exceed one (1) year from the original date of issuance of the temporary license.

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806.

Term of license; renewal; duplicates.

(a)

All licenses other than temporary licenses expire annually on December 31. An anesthesiologist assistant may renew a license by completing and submitting a renewal application form published by the board and paying a renewal fee to the board prior to expiration of the current license.

(b)

The board may reinstate a lapsed license if the applicant pays a reinstatement fee and meets the requirements for the granting of an initial license.

(c)

An anesthesiologist assistant may apply to the board for a duplicate license if the anesthesiologist assistant's license is stolen, lost or destroyed. Upon proof of proper identification and submission of other information as the board may require, the board shall issue a duplicate license bearing on its face the word
"DUPLICATE" and shall establish and require payment of appropriate charges for a duplicate license.

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807.

License fees.

(a)

The board shall by rule set appropriate license application, renewal and reinstatement fees, examination fees and fees for information verification or document production and other services of the board under this chapter.

(b)

Fees shall be deposited as provided in W.S. 33
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307(b).

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808.

Suspension, restriction, revocation or nonrenewal of license.

(a)

The board may refuse to renew and may revoke, suspend or restrict a license or take other disciplinary action, including the imposition of conditions or restrictions upon a license on one (1) or more of the grounds enumerated under W.S. 33
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402(a)(i) through (x),
(xii) and (xiv) through (xxxiv) except that for purposes of this section, "practice of medicine" or "practice medicine," as used in W.S. 33
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402(a) means "practice as an anesthesiologist assistant."

(b)

Upon a finding of ineligibility for licensure, refusal to grant, suspension, restriction, refusal to renew or revocation of a license under subsection (a) of this section, the board shall adopt and enter its written order and findings.

(c)

Upon receipt from the department of family services of a certified copy of an order from a court to withhold, suspend or otherwise restrict a license issued by the board, the board shall notify the party named in the court order of the withholding, suspension or restriction of the license in accordance with the terms of the court order. No appeal under the Wyoming Administrative Procedure Act shall be allowed for a license withheld, suspended or restricted under this subsection.

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809.

Reinstatement.

(a)

Except as provided in subsection (b) of this section, any person whose license has been revoked, restricted or suspended under this chapter, voluntarily or by action of the board, may petition for reinstatement of the license or for removal of any restrictions or conditions placed upon the license pursuant to W.S. 33
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26
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808 not less than six (6) months after final judicial review of a board order revoking, restricting or suspending the petitioner's license or six (6) months after the date of the board order if there is no judicial review or six (6) months after the date of the board agreement to accept a relinquished, restricted or conditioned license. The petitioner shall submit a written petition to the board that, at a minimum, sets forth and provides information regarding the petitioner's fulfillment of all conditions or compliance with all restrictions imposed upon petitioner by any prior order of the board or success in correcting the conduct that formed the basis for revocation of the petitioner's license.

(b)

If a license is suspended under W.S. 33
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26
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808(c), the license may be reinstated without a hearing as provided in this section upon receipt from the department of family services of notice that the applicant has complied with the terms of the court order that resulted in the suspension or restriction of the license under W.S. 33
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26
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808(c).

(c)

The burden of proof upon the petitioner at the hearing provided by subsection (b) of this section shall be to demonstrate by a preponderance of evidence that the petitioner has:

(i)

Corrected the conduct that formed the basis for the revocation of petitioner's license and that petitioner is able to safely, skillfully and competently resume practice as an anesthesiologist assistant; or

(ii)

Fulfilled all conditions or complied with all restrictions imposed upon petitioner by any prior order of the board, has otherwise corrected the conduct or condition that formed the basis for the restrictions or
conditions placed on petitioner's license and that petitioner is able to safely, skillfully and competently practice as an anesthesiologist assistant.

(d)

Upon receipt of a petition that contains the information required by subsection (a) of this section, the board shall set the matter for a contested case hearing in accordance with the Wyoming Administrative Procedure Act.

(e)

After a hearing conducted pursuant to this section, the board shall issue specific findings of facts, conclusions of law and a final order:

(i)

Reinstating the license;

(ii)

Reinstating the license subject to restrictions or conditions;

(iii)

Removing or modifying the restrictions or conditions of the license; or

(iv)

Denying reinstatement of the license or removal of the restrictions or conditions on the license.

(f)

Any final order issued by the board shall be subject to judicial review as provided for by W.S. 33
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407.

(g)

If the board denies a reinstatement or removal of restrictions or conditions, future petitions for reinstatement or removal of restrictions or conditions may be submitted not less than one (1) year after the board's final order denying reinstatement or removal of restrictions or conditions.

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810.

Penalties.

Any person practicing as an anesthesiologist assistant or representing that the person is an anesthesiologist assistant or any person employing an unlicensed person to practice as an anesthesiologist assistant without a license is guilty of a misdemeanor and upon conviction shall be punished by a fine of not more than one thousand dollars
($1,000.00), imprisonment for not more than one (1) year, or both.

Each violation constitutes a separate offense for which the penalty in this section may be assessed.

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811.

Voluntary and mandatory revocation; restriction; suspension.

(a)

A licensee may request the board, in writing, to accept the voluntary relinquishment, restriction or suspension of the licensee's license.

The board may accept the relinquished license, grant the request for restriction or suspension, attach conditions to the license or waive the commencement of any proceedings under this article. The board shall put in writing any agreement with the licensee. Removal of a voluntary relinquishment, restriction or suspension is subject to the procedure for reinstatement of a license pursuant to W.S. 33
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809.

(b)

Unless the board and the licensee have agreed to the relinquishment of or imposition of restrictions or conditions on a license, the board shall conduct a proceeding to suspend, restrict, refuse to renew or revoke
a license pursuant to W.S. 33
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26
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808(a) as a contested case under the Wyoming Administrative Procedure Act.

(c)

If the public health, safety or welfare requires emergency action the board may temporarily suspend the license of any licensee without a hearing pursuant to W.S. 16
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3
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113(c).

Section 2
.

W.S. 33
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26
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102(a)(intro) and by creating new paragraphs (xxx) and (xxxi) is amended to read:

33
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26
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102.

Definitions.

(a)

Except as otherwise provided, a
s used in this chapter:

(xxx)

"
CAAHEP
" means the commission on accreditation of allied health education programs;

(xxxi)

"
CAHEA
" means the committee on allied health education and accreditation;

Section 3.

W.S. 33
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26
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501(a)(viii) and (ix) is repealed.

Section 4
.

This act is effective July 1, 2021
.

(END)

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SF0104