Analysis

Topic: Physician Delegation of Anesthesia Administration
Sponsor: Representative Hart
Committee: Health Policy
Date Introduced: April 17, 2001
Date of Analysis: December 14, 2001

Position: The Michigan Department of Consumer and Industry Services supports the bill.

Background: The Public Health Code permits a licensee who holds a license other than a health profession subfield license to delegate to a licensed or unlicensed individual who otherwise is qualified by education, training, or experience the performance of selected acts, tasks, or functions where they fall within the scope of practice of the licensee's profession and will be performed under the licensee's supervision.

"Delegation" means an authorization granted by a licensee to a licensed or unlicensed individual to perform selected acts, tasks, or functions that fall within the scope of practice of the delegator and that are not within the scope of practice of the delegatee and that, in the absence of the authorization, would constitute illegal practice of a licensed profession. "Supervision", except as otherwise provided, means the overseeing of or participation in the work of another individual by a health professional licensed under Article 15 in circumstances where at least all of the following conditions exist:

• The continuous availability of direct communication in person or by radio, telephone, or telecommunication between the supervised individual and a licensed health professional.
• The availability of a licensed health professional on a regularly scheduled basis to review the practice of the supervised individual, to provide consultation to the supervised individual, to review records, and to further educate the supervised individual in the performance of the individual's functions.
• The provision by the licensed supervising health professional of predetermined procedures and drug protocol.

A licensee cannot delegate an act, task, or function if, under standards of acceptable and prevailing practice, the act, task, or function requires the level of education, skill, and judgment required of the licensee under the Code.

Licensed medical physicians or osteopathic physicians and surgeons may delegate an act, task, or function that involves performing a procedure that uses surgical instruments only to a person who is licensed under Article 15. A physician or surgeon may delegate certain surgical functions to a person who is not licensed if he or she were a student enrolled in an approved medical or osteopathic school or in an approved physician's assistant training program and the procedure was directly supervised by a licensed physician or surgeon who was present physically during the procedure. A medical or osteopathic physician or surgeon may delegate a surgical function to a person who is not licensed under Article 15 and who is performing acupuncture, or surgically removing bone, skin, or other specified tissues from a deceased person for transplantation, implantation, injection, or other medical or scientific purpose.

Description of Bill: The bill would amend the Public Health Code to permit a licensed medical physician or osteopathic physician and surgeon to delegate an act, task, or function that involved the administration of surgical anesthesia only under one of the following conditions:

• The delegating physician or surgeon had anesthesia privileges at the health facility at which the surgery was being performed and was physically available in the health facility during the time the surgery was being performed.
• The delegating physician or surgeon was performing the surgery, at the time the surgery was being performed.

The bill would define "general anesthesia" to mean the elimination of all sensations accompanied by a state of unconsciousness and loss of reflexes necessary to maintain a patient airway. "Surgical anesthesia" would mean general anesthesia that entailed drug-induced loss of consciousness and impairment of ventilatory reflexes, or major conductive regional anesthesia if administered for facilitating surgery. "Surgery" would mean a procedure that required the use of surgical instrumentation.

Arguments For: The purpose of the bill is to give anesthesiologists more control over the delegation and administration of anesthesia.

Arguments Against: By requiring the physicians to be present in the health facility, the bill may make it more difficult for rural hospitals to schedule surgeries.

Supporters: Many anesthesiologists have voiced support for the bill as they feel it gives them more control.

Opponents: Although no formal opposition has been registered to date, there may be opposition from nurse anesthetists (CRNAs) because the proposed bill would require the physician to be present in the health facility. Similarly, rural hospitals may oppose the bill because requiring the physician to be present in the facility may make it difficult to schedule surgeries.

Fiscal Information: None available at this time.

Administrative Rules Impact: The rules for the Boards of Medicine, Osteopathy, and Nursing may require revision to address issues concerning standards of acceptable and prevailing practice as well as administration of anesthesia.