SSISTANT LEGISLATION
Definitions:
(1) The term "Anesthesiologist Assistant" as herein used refers to a
graduate of an approved program who is licensed to perform medical
services delegated and directly supervised by a supervising
anesthesiologist.
(2) The term "Approved Program" as herein used refers to a program for
the education and training of anesthesiologist assistants approved by the
Board of Medicine and the Board of Osteopathic Medicine.
(3) The term "direct supervision" as used herein means the on-site,
personal supervision by an anesthesiologist who is present in the office
when the procedure is being performed in that office, or is present in the
surgical or obstetrical suite when the procedure is being performed in that
surgical or obstetrical suite and who is in all instances immediately
available to provide assistance and direction to the anesthesiologist
assistant while anesthesia services are being performed. Specific Authority
458.309, 458.3475, 459.005, 459.023 FS. Law Implemented 458.3475,
459.023 FS.
*64B8-31.002 and 64B15-7.002. Examination for Licensure. The
Board hereby approves the examination administered through the National
Commission on Certification of Anesthesiologist Assistants (NCCAA) as the
proficiency examination required for
licensure as an anesthesiologist assistant. Specific Authority 458.309,
458.3475, 459.005, 459.023 FS. Law Implemented 458.3475, 459.023 FS.
Approved by Anesthesiologist Assistant Committee on 9/21/04.
64B8-31.001 and 64B15-7.001. DRAFT RULES TO IMPLEMENT
MESSAGE BOARD!
Requirements for Anesthesiologist Assistants.
(1) Application for Licensure.
(a) All persons applying for licensure as an anesthesiologist assistant shall submit an
application to the Department on forms approved by Boards and provided by the Department.
(b) The application may not be used for more than one year from the date of original
submission of the application and fee. Fees are found in Rule 64B8-31.012 and 64B15-7.012,
F.A.C. After one year from the date that the original application and fee have been received in
the Board office, a new application and fee shall be required from any applicant who desires
licensure as an anesthesiologist assistant.
(c) All application information must be submitted no later than 15 days prior to the meeting at
which the applicant desires his or her application to be considered.
(2) Requirements for Licensure.
(a) All applicants for licensure as an anesthesiologist assistant must submit an application as
set forth in paragraph (1) above. The applicant must meet all of the requirements of Section
458.3475 or 459.023, F.S., and the applicant must submit two personalized and individualized
letters of recommendation from anesthesiologists. Letters of recommendation must be
composed and signed by the applicant’s supervising physician, or, for recent graduates, the
faculty physician, and give details of the applicant’s clinical skills and ability. Each letter must
be addressed to the Board and must have been written no more than six months prior to the
filing of the application for licensure.
(b) The applicant must have obtained a passing score on the examination administered
through the NCCAA. The passing score shall be established by the NCCAA.
(c) The applicant must be certified in advanced cardiac life support.
(d) The applicant must submit notarized statements containing the following information:
1. Completion of three hours of all Category I, American Medical Association Continuing
Medical Education or American Osteopathic Association approved Category I-A continuing
education related to the practice of osteopathic medicine or under osteopathic auspices which
includes the topics of Human Immunodeficiency Virus and Acquired Immune Deficiency
Syndrome: the disease and its spectrum of clinical manifestations; epidemiology of the
disease; related infections including TB; treatment, counseling, and prevention; transmission
from healthcare worker to patient and patient to healthcare worker; universal precautions and
isolation techniques; and legal issues related to the disease. If the applicant has not already
completed the required continuing medical education, upon submission of an affidavit of good
cause, the applicant will be allowed six months to complete this requirement.
2. Completion of one hour of continuing medical education on domestic violence which
includes information on the number of patients in that professional's practice who are likely to
be victims of domestic violence and the number who are likely to be perpetrators of domestic
violence, screening procedures for determining whether a patient has any history of being
either a victim or a perpetrator of domestic violence, and instruction on how to provide such
patients with information on, or how to refer such patients to, resources in the local
community, such as domestic violence centers and other advocacy groups, that provide legal
aid, shelter, victim counseling, batterer counseling, or child protection services, and which is
approved by any state or federal government agency, or nationally affiliated professional
association, or any provider of Category I or II American Medical Association Continuing
Medical Education or American Osteopathic Association approved Category I-A continuing
education related to the practice of osteopathic medicine or under osteopathic auspices.
Home study courses approved by the above agencies will be acceptable. If the applicant has
not already completed the required continuing medical education, upon submission of an
affidavit of good cause, the applicant will be allowed six months to complete this requirement.
3. Completion of two hours of continuing medical education relating to prevention of medical
errors which includes a study of root cause analysis, error reduction and prevention, and
patient safety, and which is approved by any state or federal government agency, or
nationally affiliated professional association, or any provider of Category I or II American
Medical Association Continuing Medical Education or American Osteopathic Association
approved Category I-A continuing education related to the practice of osteopathic medicine or
under osteopathic auspices. One hour of a two hour course which is provided by a facility
licensed pursuant to Chapter 395, F.S., for its employees may be used to partially meet this
requirement.
(e) Demonstrate compliance with the financial responsibility pursuant to Section 456.048, F.S.,
and as outlined in Rule 64B8-31.006 and 64B15-7.006, below. (3) Restrictions. For purposes
of carrying out the provisions of Sections 458.3475 and 459.023, F.S., every anesthesiologist
assistant is prohibited
from being supervised by any physician whose license to practice medicine is on probation.
Specific Authority 458.309, 458.3475, 459.005, 459.023 FS. Law Implemented 458.3475,
459.023 FS.
*64B8-31.004 and 64B15-7.004. Requirements for Approval of Training Programs.
Anesthesiologist Assistant programs approved and recognized by the State of Florida must
hold full accreditation or provisional (initial) accreditation from the Committee on Accreditation
of Allied Health Education Programs (CAAHEP), or its successor. Specific Authority 458.309,
458.3475 459.005, 459.023 FS. Law Implemented 458.3475, 459.023 FS. History--New .
*64B8-31.005 and 64B15-7.005. Anesthesiologist Assistant Protocols and
Performance.
(1) Every anesthesiologist or group of anesthesiologists, upon entering into a supervisory
relationship with an anesthesiologist assistant must file with the Board a written protocol, to
include, at a minimum, the following:
(a) Name, address, and license number of the anesthesiologist assistant;
(b) Name, address, license number and federal Drug Enforcement Administration (DEA)
number of each anesthesiologist who will supervise the anesthesiologist assistant;
(c) Address of the anesthesiologist assistant’s primary practice location and any other
locations where the assistant may practice;
(d) The date the protocol was developed and the dates of all revisions;
(e) The designation and signature of the primary supervising anesthesiologist;
(f) Signatures of the anesthesiologist assistant and all supervising anesthesiologists;
(g) The duties and functions of the anesthesiologist assistant;
(h) Conditions or procedures that require the personal provision of care by an
anesthesiologist;
(i) The procedures to be followed in the event of an anesthetic emergency.
(2) The protocol must be on file with the Board prior to the time the anesthesiologist assistant
begins practice with the anesthesiologist or the anesthesiology group.
(3) The protocol must be updated biennially.
(4) Anesthesiologist assistants may perform the following duties under the direct supervision
of an anesthesiologist and as set forth in the protocol outlined in paragraph (1) above:
(a) Obtaining a comprehensive patient history and presenting the history to the supervising
anesthesiologist;
(b) Pretesting and calibration of anesthesia delivery systems and monitoring, obtaining and
interpreting information from the systems and monitors;
(c) Assisting the anesthesiologist with implementation of monitoring techniques;
(d) Establishing basic and advanced airway interventions, including intubations of the trachea
and performing ventilatory support;
(e) Administering intermittent vasoactive drugs and starting and adjusting vasoactive infusions;
(f) Administering anesthetic drugs, adjuvant drugs, and accessory drugs;
(g) Assisting the anesthesiologist with the performance of epidural anesthetic procedures and
spinal anesthetic procedures;
(h) Administering blood, blood products, and supportive fluids;
(i) Supporting life functions during anesthesia health care, including induction and intubation
procedures, the use of appropriate mechanical supportive devices, and the management of
fluid, electrolyte, and blood component balances.
(j) Recognizing and taking appropriate corrective action for abnormal patient responses to
anesthesia, adjunctive medication or other forms of therapy;
(k) Participating in management of the patient while in the post-anesthesia recovery area,
including the administration of supporting fluids;
(l) Placing special peripheral and central venous and arterial lines for blood sampling and
monitoring as appropriate.
(5) The supervising anesthesiologist shall delegate only tasks and procedures to the
anesthesiologist assistant which are within the supervising physician's scope of practice. The
anesthesiologist assistant may work in any setting that is within the scope of practice of the
supervising anesthesiologist’s practice.
(6) Continuity of Supervision in practice settings requires the anesthesiologist assistant to
document in the anesthesia record any change in supervisor.
(7) All tasks and procedures performed by the anesthesiologist assistant must be documented
in the appropriate medical record. Specific Authority 458.309, 458.3475 459.005, 459.023 FS.
Law Implemented 458.3475, 459.023 FS. History--New .
*64B8-31.006 and 64B15-7.006 Financial Responsibility.
Pursuant to Section 456.048, Florida Statutes, all anesthesiologist assistants shall carry
malpractice insurance or demonstrate proof of financial responsibility. Any applicant for
licensure shall submit proof of compliance with Section 456.048 or exemption to the Board
office prior to licensure. All licensees shall submit such proof as a condition of biennial renewal
or reactivation. Acceptable proof of financial responsibility shall include:
(1) Professional liability coverage of at least $100,000 per claim with a minimum annual
aggregate of at least $300,000 from an authorized insurer under Section 624.09, F.S., a
surplus lines insurer under Section 626.914(2), F.S., a joint underwriting association under
Section 627.351(4), F.S., a self-insurance plan under Section 627.357, F.S., or a risk
retention group under Section 627.942, F.S.; or
(2) An unexpired irrevocable letter of credit as defined by Chapter 675, F.S., which is in the
amount of at least $100,000 per claim with a minimum aggregate availability of at least
$300,000 and which is payable to the anesthesiologist assistant as beneficiary. Any person
claiming exemption from the financial responsibility law pursuant to Section 456.048(2), F.S.,
must timely document such exemption at initial certification, biennial renewal, and reactivation.
Specific Authority 458.309, 458.3475 459.005, 459.023 FS. Law Implemented 458.3475,
459.023 FS. History--New .
*64B8-31.007 and 64B15-7.007 Anesthesiologist Assistant Licensure Renewal and
Reactivation.
(1) An anesthesiologist assistant must renew his licensure on a biennial basis. Upon request
by the Board or Department, the licensee must submit satisfactory documentation of
compliance with the requirements set forth below.
(2) Requirements for Renewal.
(a) Completion of the anesthesiologist assistant licensure renewal application on the
appropriate form approved by the Boards and provided by the Department.
(b) Submission of a signed, sworn statement of no felony convictions in the previous two years.
(c) Submission of a written statement attesting to completion of 40 hours of Continuing
Medical Education in the previous two years, or provide documentation of current certification
issued by the NCCAA.
(d) For all licensees no more and no less than one hour shall consist of training in domestic
violence which includes information on the number of patients in that professional's practice
who are likely to be victims of domestic violence and the number who are likely to be
perpetrators of domestic violence, screening procedures for determining whether a patient
has any history of being either a victim or a perpetrator of domestic violence, and instruction
on how to provide such patients with information on, or how to refer such patients to,
resources in the local community, such as domestic violence centers and other advocacy
groups, that provide legal aid, shelter, victim counseling, batterer counseling, or child
protection services, and which is approved by any state or federal government agency, or
nationally affiliated professional association, or any provider of Category I or II American
Medical Association Continuing Medical Education or American Osteopathic Association
approved Category I-A continuing education related to the practice of osteopathic medicine or
under osteopathic auspices. Home study courses approved by the above agencies will be
acceptable.
(e) For all licensees one hour of Category I American Medical Association Continuing Medical
Education or American Osteopathic Association approved Category I-A continuing education
related to the practice of osteopathic medicine or under osteopathic auspices, which includes
the topics of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome; the
modes of transmission, including transmission from healthcare worker to patient and patient to
healthcare worker; infection control procedures, including universal precautions; epidemiology
of the disease; related infections including TB; clinical management; prevention; and current
Florida law on AIDS and its impact on testing, confidentiality of test results, and treatment of
patients. Any hours of said CME may also be counted toward the CME license renewal
requirement. In order for a course to count as meeting this requirement, licensees practicing
in Florida must clearly demonstrate that the course includes Florida law on HIV/AIDS and its
impact on testing, confidentiality of test results, and treatment of patients. Only Category I
hours shall be accepted.
(f) Not withstanding the provisions of paragraphs (d) and (e), above, an anesthesiologist
assistant may complete continuing education on end-of-life care and palliative health care in
lieu of continuing education in HIV/AIDS or domestic violence, if that anesthesiologist assistant
has completed the HIV/AIDS or domestic violence continuing education in the immediately
preceding biennium. This allows for end-of-life care and palliative health care continuing
education to substitute for HIV/AIDS or domestic violence continuing education in alternate
biennia.
(g) Completion of two hours of continuing medical education relating to prevention of medical
errors which includes a study of root cause analysis, error reduction and prevention, and
patient safety, and which is approved by any state or federal government agency, or
nationally affiliated professional association, or any provider of Category I or II American
Medical Association Continuing Medical Education or American Osteopathic Association
approved Category I-A continuing education related to the practice of osteopathic medicine or
under osteopathic auspices. One hour of a two hour course which is provided by a facility
licensed pursuant to Chapter 395, F.S., for its employees may be used to partially meet this
requirement.
(3) Reactivation of Inactive License. To reactivate an inactive license, the licensee
must:
(a) Submit to the Department the original inactive license;
(b) Provide the Department with licensure verification from each state in which the licensee is
licensed to practice as an anesthesiologist assistant, or a statement that the licensee is
licensed only in Florida;
(c) Provide to the Department a statement of medical activities from the date the licensee
became inactive to the present; or, if the licensee has not practiced as an anesthesiologist
assistant for at least 2 of the 4 years preceding application for reactivation, the licensee must
either:
1. Demonstrate completion of the University of South Florida (USF) Anesthesia Competency
Assessment or an equivalent anesthesia assessment program approved by the Board; or
2. Re-take the NCCAA certification examination.
(d) Submit to the Department a statement of any criminal or disciplinary actions pending in any
jurisdiction;
(e) Submit proof of completion of the continuing medical education requirements in
compliance with paragraphs 64B8-31.007(2)(c), (d), (e), (f) and (g), or 64B15-7.007(2)(c), (d),
(e), (f) and (g) F.A.C., for each biennium in which the license was inactive;
(f) Submit the protocol as set forth in Rule 64B8-31.005 or 64B15-7.005, F.A.C.;
(g) Demonstrate financial responsibility as set forth in Rule 64B8-31.006 or 64B15-7.006; and
(h) Pay the appropriate fees.
(4) Licensure Renewal or Reactivation Applications.
(a) Application for renewal as a licensed anesthesiologist assistant or for reactivation must be
made upon forms supplied by the Board, and incorporated in Rule 64B8-1.007, F.A.C.
(b) Renewal or reactivation application forms submitted to the Board must be complete in
every detail and must be typed or legibly printed in black ink.
(5) The renewal or reactivation fees are found in Rule 64B8-31.012 or 64B15157.012,
F.A.C.
(6) The failure of any license holder to either renew the license or elect inactive
status before the license expires shall cause the license to become delinquent.
(a) The delinquent status licensee must affirmatively apply for active or inactive status during
the licensure cycle in which the license becomes delinquent. The failure by the delinquent
status licensee to cause the license to be reactivated or made inactive before the expiration of
the licensure cycle in which the license became delinquent shall render the license null and
void without further action by the Board or the Department.
(b) The delinquent status licensee who applies for license reactivation or inactive status shall:
1. File with the Department the completed application for either license reactivation as
required by Section 458.3475, or 459.023 F.S., or inactive status as required by Section
456.036, F.S.;
2. Pay to the Board either the license reactivation fee or the inactive status fee, the
delinquency fee, and if applicable, the processing fee; and
3. If reactivation is elected, demonstrate compliance with the continuing education
requirements found in Rule 64B8-31.007 and 64B15-7.007, F.A.C. Specific Authority 456.013,
456.031(1)(a), 456.033(1), 458.309, 458.3475 , 459.005, 459.023 FS. Law Implemented
456.013, 456.031(1), 456.033, 458.3475, 459.023 FS. History--New .
*64B8-31.008 and 64B15-7.008 Notice of Noncompliance.
(1) Pursuant to Section 456.073(3), F.S., the department is authorized to provide a notice of
noncompliance for an initial offense of a minor violation if the board establishes by rule a list of
minor violations. A minor violation is one which does not endanger the public health, safety,
and welfare and which does not demonstrate a serious inability to practice the profession. A
notice of noncompliance in lieu of other action is authorized only if the violation is not a repeat
violation and only if there is only one violation. If there are multiple violations, then the
Department may not issue a notice of noncompliance, but must prosecute the violations under
the other provisions of Section 456.073, F.S. A notice of noncompliance may be issued to a
licensee for a first time violation of one or both of the violations listed in paragraph (3)(b).
Failure of a licensee to take action in correcting the violation within 15 days after notice shall
result in the institution of regular disciplinary proceedings.
(2) The department shall submit to the board a monthly report detailing the number of notices
given, the number of cases completed through receipt of a notarized statement of compliance
from the licensee, and the types of violations for which notices of noncompliance have been
issued. Notices of noncompliance shall be considered by the probable cause panels when
reviewing a licensee's subsequent violations of a same or similar offense.
(3) The following violations are those for which the board authorizes the Department to issue a
notice of noncompliance:
(a) Failing to include the specific disclosure statement required by Section 456.062, F.S., in
any advertisement for a free, discounted fee, or reduced fee service, examination or treatment.
(b) Violating any of the following provisions of Chapter 458, F.S., as prohibited by Sections
458.3475 and 458.331(1)(x), F.S.:
1. Section 458.3475, F.S., which provides for criminal penalties for the practice as an
anesthsiologist assistant without an active license. A notice of noncompliance would be issued
for this violation only if the subject of the investigation met the following criteria: the subject
was the holder of a license to practice as an anesthesiologist assistant at all time material to
the matter; that license was otherwise in good standing; and that license was or will be
renewed and placed in an active status within 90 days of the date it reverted to delinquent
status based on failure to renew the license. If the license was in a delinquent status for more
than 90 days and the individual continued to practice, then the matter would proceed under
the other provisions of Sections 456.073 and 456.035(1), F.S.
2. Failing to notify the board of a change of practice location, contrary to Sections 458.319(3)
and 456.035(1), F.S. Specific Authority 456.073(3), 458.309, 458.3475, 459.005, 459.023 FS.
Law Implemented 456.073(3), 458.331, 458.3475, 459.015, 459.023 FS. History--New .
*64B8-31.009 and 64B15-7.009. Citation Authority
(1) Pursuant to Section 456.077, F.S., the Board sets forth below those violations for which
there is no substantial threat to the public health, safety, and welfare; or, if there is a
substantial threat to the public health, safety, and welfare, such potential for harm has been
removed prior to the issuance of the citation. Next to each violation is the penalty to be
imposed. In addition to any administrative fine imposed, the Respondent may be required by
the department to pay the costs of investigation.
(2) If the violation constituted a substantial threat to the public health, safety, and welfare,
such potential for harm must have been removed prior to issuance of the citation.
(3) The following violations with accompanying penalty may be disposed of by citation with the
specified penalty: VIOLATIONS PENALTY
(a) CME violations. Within twelve months of the date the citation (Section 458.3475, F.S.) is
issued, Respondent must submit certified (Section 458.331(1)(g), (x), F.S.) documentation of
completion of all CME (Section 456.072(1)(e), (s), F.S.) requirements for the period for which
the citation was issued; prior to renewing the license for the next biennium, Respondent must
document compliance with the CME requirements for the relevant period; AND pay a $250 fine.
1. Failure to document required HIV/AIDS $250 fine CME. (Section 456.033, F.S.)
2. Failure to document required domestic $250 fine violence or end-of-life and palliative health
care CME. (Section 456.031, F.S.)
3. Failure to document required prevention of $250 fine medical errors CME. (Section 456.013
(7), F.S.)
4. Failure to document both the required $500 fine HIV/AIDS and domestic violence, or end-of-
life and palliative health care CME.
5. Documentation of some, but not all, 40 $25 fine for each hour not documented hours of
required CME for license renewal.
(b) Obtaining license renewal by negligent $2500 fine misrepresentation. (Section 458.3475,
F.S.) (Section 458.331(1)(a), F.S.)
(c) Failure to document any of the 40 hours $2500 fine of required CME for license renewal.
(Section 458.3475, F.S.) (Section 458.331(1)(x), F.S.)
(d) Practice on an inactive or delinquent license. (Section 456.036(1), F.S.) (Section 458.327
(1)(a), F.S.) (Section 458.3475, F.S.) (Section 458.331(1)(x), F.S.)
1. For a period of up to nine months. $100 for each month or part thereof.
2. For a period of nine months to twelve $150 for each month or part thereof. months.
(e) Failure to notify Department of change of $125 fine practice and/or mailing address.
(Section 456.035, F.S.) (Section 458.319(3), F.S.) (Section 458.331(1)(g), F.S.) (Section
458.3475, F.S.)
(f) Failure of the anesthesiologist assistant to $250 fine clearly identify that he/she is an
anesthesiologist assistant. (Section 458.3475, F.S.)(Section 458.3475, F.S.)(Section 458.331
(1)
(g), F.S.)
(g) Failure to report to the Department of $125 fine addition/deletion/change of supervising
physician(s).(Section 456.035, F.S.)(Section 458.331(1)(g), F.S.)(Section 458.3475, F.S.)
(4) Citations shall be issued to licensees by the Bureau of Investigative Services only after
review by the legal staff of the Department of Health, Division of Regulation. Such review may
be by telephone, in writing, or by facsimile machine.
(5) The procedures described herein apply only for an initial offense of the alleged violation.
Subsequent violation(s) of the same rule or statute shall require the procedures of Section
456.073, F.S., to be followed. In addition, should an initial offense for which a citation could be
issued occur in conjunction with other violations, then the procedures of Section 456.073, F.
S., shall apply.
(6) The subject has 30 days from the date the citation becomes a final order to pay any fine
imposed and costs. All fines and costs are to be made payable to the "Department of Health"
and sent to the Department of Health in Tallahassee. A copy of the citation shall accompany
the payment of the fine.
(7) The Department of Health shall, at the end of each calendar quarter, submit a report to the
Board of the citations issued, which report shall contain the name of the subject, the violation,
fine imposed, and the number of subjects who dispute the citation and chose to follow the
procedures of Section 456.073, F.S. Specific Authority 456.077, 458.309, 458.3475, 459.005,
459.023 FS. Law Implemented
456.077, 458.331, 458.3475, 459.023 FS. History--New .
*64B8-31.012 and 64B15-7.012 Fees Regarding Anesthesiologist Assistants.
The following fees are prescribed by the Board:
(1) The application fee for a person applying to be licensed as an anesthesiologist assistant
shall be
$300.
(2) The initial licensure fee for an anesthesiologist assistant shall be $500.
(3) The biennial renewal fee for an active or inactive anesthesiologist assistant licensed
pursuant to Section 458.3475 or 459.023, F.S., shall be $500. Licenses not renewed at the
end of a biennial period shall automatically become delinquent.
(4) The reactivation fee for an inactive anesthesiologist assistant licensure pursuant to
Section 458.3475 or 459.023, F.S., shall be $100. Reactivation shall require payment of all
the applicable renewal fees and the reactivation fee.
(5) The duplicate licensure fee shall be $25.00.
(6) Any licensed anesthesiologist assistant who fails to renew his/her licensure by the end of
the biennium shall pay a delinquent fee of $100 upon application for either active or inactive
status.
(7) The unlicensed activity fee for initial licensure and licensure renewal shall be $5.00.
Specific Authority 456.036(5), (7), 458.309, 458.3475, 459.005, 459.023 FS. Law
Implemented 456.036(5), (7), 458.3475, 459.023 FS. History--New
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