A BILL TO BE ENTITLED
AN ACT to establish the "north carolina anesthesia patient safety and access act" to confirm and reiterate the statutory requirement of physician SUPERVISION of nurse anesthetists and to authorize the licensure and regulation of anesthesiologist assistants.
Whereas, recent litigation has sought to undermine the long‑standing legal requirement that a physician supervise a nurse anesthetist providing anesthesia care in North Carolina; and
Whereas, the General Assembly seeks to reiterate that North Carolina law requires physician supervision of nurse anesthetists; and
Whereas, there is a documented shortage of anesthesia providers in North Carolina; and
Whereas, anesthesiologist assistants are licensed by many states to provide anesthesia services under the supervision of an anesthesiologist; and
Whereas, licensure of anesthesiologist assistants in North Carolina would help alleviate the existing shortage of anesthesia providers in this State; and
Whereas, anesthesiologist assistants have excellent clinical safety records, are highly trained, and are authorized to provide anesthesia services under such federal programs as Medicare, Medicaid, TriCare, and the Veterans Administration; Now, therefore,
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 90‑11 is amended by adding a new subsection to read:
"(a1)	Every applicant for licensure as an anesthesiologist assistant in the State shall satisfy the North Carolina Medical Board that the applicant is of good moral character and meets the other qualifications for the issuance of a license before a license is granted by the Board to the applicant."
SECTION 2.  G.S. 90‑15 reads as rewritten:
"§ 90‑15.  License fee; salaries, fees, and expenses of Board.
Each applicant for a license by examination shall pay to the North Carolina Medical Board a fee which shall be prescribed by the Board in an amount not exceeding the sum of four hundred dollars ($400.00) plus the cost of test materials before being admitted to the examination. Whenever a license is granted without examination, as authorized in G.S. 90‑13, the applicant shall pay to the Board a fee in an amount to be prescribed by the Board not in excess of two hundred fifty dollars ($250.00). Whenever a limited license is granted as provided in G.S. 90‑12, the applicant shall pay to the Board a fee not to exceed one hundred fifty dollars ($150.00), except where a limited license to practice in a medical education and training program approved by the Board for the purpose of education or training is granted, the applicant shall pay a fee of twenty‑five dollars ($25.00), and where a limited license to practice medicine and surgery only at clinics that specialize in the treatment of indigent patients is granted, the applicant shall not pay a fee. A fee of twenty‑five dollars ($25.00) shall be paid for the issuance of a duplicate license. All fees shall be paid in advance to the North Carolina Medical Board, to be held in a fund for the use of the Board. The compensation and expenses of the members and officers of the Board and all expenses proper and necessary in the opinion of the Board to the discharge of its duties under and to enforce the laws regulating the practice of medicine or surgery shall be paid out of the fund, upon the warrant of the Board. The per diem compensation of Board members shall not exceed two hundred dollars ($200.00) per day per member for time spent in the performance and discharge of duties as a member. Any unexpended sum or sums of money remaining in the treasury of the Board at the expiration of the terms of office of the members of the Board shall be paid over to their successors in office.
For the initial and annual registration of an assistant to a physician, the Board may require the payment of a fee not to exceed a reasonable amount.
For the initial and annual registration of an anesthesiologist assistant, the Board may require the payment of a fee not to exceed a reasonable amount."
SECTION 3.  G.S. 90‑18(c)(14) reads as rewritten:
"(c)	The following shall not constitute practicing medicine or surgery as defined in subsection (b) of this section:
…
(14)	The practice of nursing by a registered nurse engaged in the practice of nursing, except as otherwise provided herein, and the performance of acts otherwise constituting medical practice by a registered nurse when performed in accordance with rules and regulations developed by a joint subcommittee of the North Carolina Medical Board and the Board of Nursing and adopted by both boards.
…."
SECTION 4.  G.S. 90‑18(c) is amended by adding the following new subdivisions to read:
"(c)	The following shall not constitute practicing medicine or surgery as defined in subsection (b) of this section:
…
(14a)	The provision of anesthesia services by a registered nurse or nurse anesthetist under the supervision of a licensed physician.
…
(20)	The provision of anesthesia services by a licensed anesthesiologist assistant under the supervision of an anesthesiologist licensed under Article 1 of this Chapter."
SECTION 5.  Article 1 of Chapter 90 of the General Statutes is amended by adding a new section to read:
"§ 90‑18.5.  Limitations on anesthesiologist assistants.
(a)	Any person who is licensed under the provisions of G.S. 90‑11 to perform medical acts, tasks, and functions as an assistant to an anesthesiologist licensed under Article 1 of this Chapter may use the title 'anesthesiologist assistant'. Any other person who uses the title in any form or holds himself or herself out to be an anesthesiologist assistant or to be so licensed shall be deemed to be in violation of this Article. A student in any anesthesiologist assistant training program shall be identified as a 'student anesthesiologist assistant' or an 'anesthesiologist assistant student', but under no circumstances shall the student use or permit to be used on the student's behalf, the terms 'intern', 'resident', or 'fellow'. This subsection shall not limit or prevent any physician from delegating to a physician assistant, as defined in G.S. 90‑18.1, or other qualified person, any acts, tasks, or functions that are otherwise permitted by law or established by custom.
(b)	Anesthesiologist assistants are authorized to provide anesthesia services under the supervision of an anesthesiologist licensed under Article 1 of this Chapter, including the development and implementation of an anesthesia care plan for a patient, under the following conditions:
(1)	The North Carolina Medical Board has adopted regulations governing the provision of anesthesia services by an anesthesiologist assistant under the supervision of an anesthesiologist licensed under Article 1 of this Chapter with such limitations as the Board may determine to be in the best interest of patient health and safety.
(2)	The anesthesiologist assistant holds a current license issued by the Board.
(c)	The North Carolina Medical Board shall adopt rules to implement this section."
SECTION 6.  This act is effective when it becomes law.