Amends TCA Title 63 and Title 68.

As described below, this bill establishes the scope of practice, licensure, and regulation for anesthesiologist assistants. LICENSURE This bill requires the board of medical examiners to review and determine the qualifications and fitness of applicants for a license to practice as an anesthesiologist assistant. The board is required to grant, deny, revoke, and reinstate licenses; investigate allegations that an anesthesiologist assistant or the supervising anesthesiologist has engaged in conduct constituting a ground for revocation; conduct informal interviews and hearings; adopt rules governing the practice of anesthesiologist assistants; and retain jurisdiction over only those licensees to whom temporary or full licenses are granted pursuant to this bill, regardless of whether the license has expired or lapsed or was relinquished during or after any alleged occurrence of conduct. The board may grant an anesthesiologist assistant license to an applicant who meets the following requirements: (1) Graduated from an anesthesiologist assistant program accredited by the Commission on Accreditation of Allied Health Education Programs or its predecessor or successor organization; (2) Satisfactorily completed a certification examination administered by the national Commission for the Certification of Anesthesiologist Assistants or another national certifying agency that has been reviewed and approved by the board and that is currently certified; (3) Completes an application form; and (4) Pays the required application and licensure fees as prescribed by rule. The license issued, including a temporary license, is valid for a period of two years and must be renewed every other year on or before January 31 by completing a renewal application form and the prescribed renewal fee before the current license expires. The board is required to provide renewal notices to licensees at least one month before the expiration date. The board is also authorized to reinstate a lapsed license if the applicant pays a reinstatement fee and meets the requirements for initial licensure. This bill authorizes the board to also issue a temporary license to a person who meets the following criteria: (1) Completes a temporary license application; (2) Pays the required temporary license fee as prescribed by rule; and (3) Successfully completes a Commission on Accreditation of Allied Health Education program or another board-approved program for educating and training anesthesiologist assistants but who has not passed. The person must take the next available certification examination after receiving a temporary license. A temporary license must not be issued for a period of more than one year and is subject to other requirements the board adopts by rule. The board may refuse to renew and may revoke, suspend, or restrict a license or take any other disciplinary action, including imposing conditions or restrictions on a license pursuant to this bill and the rules adopted. If the board determines that a person is ineligible for licensure, that an application for licensure should be denied, that a license should be suspended, or that another action should be taken on a current license, the board must adopt and enter its written order and findings. The board may also issue a new license to an assistant whose license was previously revoked by the board if the applicant applies in writing to the board and demonstrates to the board's satisfaction that the applicant is completely rehabilitated with respect to the conduct that was the basis for the revocation. In making its decision, the board must determine the following matters: (1) That the applicant has not engaged in conduct during the revocation period that would constitute a basis for revocation pursuant to rules adopted by the board; (2) If a criminal conviction was a basis of the revocation, that the applicant’s civil rights have been fully restored pursuant to statute or another applicable recognized judicial or gubernatorial order; (3) That the applicant has made restitution to an aggrieved person as ordered by a court of competent jurisdiction; (4) That the applicant demonstrates another standard of rehabilitation the board determines is appropriate. Unless a license revocation was based on a conviction of a felony or an offense involving moral turpitude and that conviction has been reversed on appeal, a person must not apply for license reinstatement fewer than two years after the date of revocation. If, however, a license revocation was based on a conviction of a felony or an offense involving moral turpitude and that conviction has been reversed on appeal, then the board must vacate its previous order to revoke the license and the anesthesiologist assistant may apply for reinstatement after the court enters the reversal. An applicant for reinstatement must comply with all initial licensure requirements prescribed by this bill. SCOPE OF PRACTICE This bill authorizes an anesthesiologist assistant to assist in the practice of medicine only under the supervision of an anesthesiologist. The assistant may perform only those duties and responsibilities delegated by the supervising anesthesiologist. The duty of supervision owed refers to the availability of a physician anesthesiologist who can delegate, coordinate, direct, consult, or oversee the implementation of the physician anesthesiologist’s intentions. The supervision may be in a manner consistent with federal rules or regulations for reimbursement for anesthesia services. This bill requires the supervising anesthesiologist to be immediately available to the assistant who assists in the delivery of medical care such that the supervising anesthesiologist is able to intervene if needed. An assistant's practice must not exceed the assistant's education and training, and the scope of practice of the supervising anesthesiologist. This bill prohibits a medical care task assigned by the supervising anesthesiologist to the assistant from being delegated by the assistant to another person. This bill authorizes the following as delegable duties: (1) Developing and implementing an anesthesia care plan for a patient; (2) Obtaining a comprehensive patient history and performing relevant elements of a physical exam; (3) Performing preoperative and post-operative anesthetic evaluations and maintaining patient progress notes; (4) Ordering and performing preoperative patient consultations; (5) Ordering preoperative medications, including controlled substances, which may be administered before the supervising anesthesiologist cosigns; (6) Changing or discontinuing a medical treatment plan after consulting with the supervising anesthesiologist; (7) Obtaining informed consent for anesthesia or related procedures; (8) Ordering the preoperative continuation of current medications, which may be administered before the supervising anesthesiologist cosigns; (9) Pretesting and calibrating anesthesia delivery systems and obtaining and interpreting information from the systems and from monitors; (10) Implementing medically accepted monitoring techniques; (11) Performing basic and advanced airway interventions; (12) Establishing peripheral intravenous lines, including subcutaneous lidocaine use; (13) Performing invasive procedures; (14) Performing general anesthesia; (15) Administering anesthetic drugs, adjuvant drugs, and accessory drugs; (16) Administering vasoactive drugs and starting and titrating vasoactive infusions to treat patient responses to anesthesia; (17) Performing, maintaining, evaluating, and managing epidural, spinal, and regional anesthesia; (18) Performing monitored anesthesia care; (19) Obtaining venous and arterial blood samples; (20) Administering blood, blood products, and supportive fluids; (21) Performing, ordering, and interpreting appropriate preoperative, point of care, intra-operative, or postoperative diagnostic tests or procedures; (22) Obtaining and administering preoperative anesthesia and related pharmaceutical agents; (23) Managing the patient while in the preoperative suite, recovery area, or labor suites; (24) Ordering postoperative sedation, anxiolysis or analgesia, postoperative respiratory therapy and medicines to treat patient responses to anesthesia and ordering postoperative oxygen therapy, which may be administered before the supervising anesthesiologist cosigns; (25) Initiating and managing cardiopulmonary resuscitation in response to a life-threatening situation; (26) Participating in administrative, research, and clinical teaching activities; and (27) Performing such other tasks not prohibited by law that an anesthesiologist assistant has been trained and is proficient to perform. This bill, however, does not prevent an anesthesiologist assistant from having access to and being able to obtain prescription drugs as directed by the supervising anesthesiologist. PENALTIES This bill prohibits a person from practicing in Tennessee as an anesthesiologist assistant or using the title or representing that the person is a certified anesthesiologist assistant, or using the abbreviations "C.A.A." or "A.A." without having a license granted by the board. A violation is a Class B misdemeanor, punishable by a fine of not more than $1,000 or by a term of imprisonment for not more than one year, or both. Each violation constitutes a separate offense. This bill also prohibits a supervising anesthesiologist from employing a person to practice as an anesthesiologist assistant who is not licensed pursuant to this bill. A violation is a Class B misdemeanor, punishable by a fine of not more than $1,000 or by a term of imprisonment for not more than one year, or both. Each violation constitutes a separate offense. BOARD MEMBERSHIP Present law generally provides that the board must consist of 12 members, nine of which must be licensed physicians, that must meet the following qualification among others. Three members must be nonphysicians who are consumers of health care and who neither own nor have any financial or other interest in any health care facility or business or school of medicine or other allied health care practitioner educational program and who must represent the public at large. The bill clarifies that out of those three nonphysician members, two must meet the above-mentioned provision, while the third member must be a licensed anesthesiologist assistant, whose initial term begins upon the expiration of the next of the three current nonphysician members’ terms of office. APPLICABILITY This bill does not apply to people who are enrolled in an anesthesiologist assistant education program approved by the board.