Anesthesiologist Assistant Supervision Agreements

PURPOSE: This rule defines the terms used throughout this rule as applicable to anesthesiologist assistants, specifies the requirements for supervision agreements and practice of an anesthesiologist assistant pursuant to a supervision agreement. (1) As used in this rule, unless specifically provided otherwise, the term— (A) Anesthesiologist assistant supervision agreements shall mean written agreements, jointly agreed upon protocols, or standing orders between a supervising anesthesiologist and a licensed anesthesiologist assistant which provide for the delegation of health care services from a supervising anesthesiologist to a licensed anesthesiologist assistant and the review of such services; (B) Assistance shall mean participation by a supervising anesthesiologist in patient care; (C) Consultation shall mean the process of seeking a supervising anesthesiologist’s input and guidance regarding patient care including, but not limited to, the methods specified in the anesthesiologist assistant supervision agreement; (D) Intervention shall mean the direct management of a patient’s care by a supervising anesthesiologist; and (E) Supervising anesthesiologist shall mean a physician so designated in the anesthesiologist assistant supervision agreement who: 1. Has completed an anesthesiology residency approved by the American Board of Anesthesiology or the American Osteopathic Association: 2. Holds a permanent license to practice medicine in the state of Missouri; and 3. Is actively engaged in the practice of medicine, except that this shall not include physicians who hold a limited license pursuant to section 334.112, RSMo, or a temporary license pursuant to section 334.045 or 334.046, RSMo, or physicians who have retired from the practice of medicine. (2) No anesthesiologist assistant shall practice pursuant to the provisions of sections 334.400 through 334.430, RSMo or to the provisions of this rule unless licensed and pursuant to a written anesthesiologist assistant supervision agreement. (3) A licensed anesthesiologist assistant practicing pursuant to an anesthesiologist assistant supervision agreement shall work in the same facility as the supervising anesthesiologist. (4) A supervising anesthesiologist as designated in the anesthesiologist assistant supervision agreement shall at all times be immediately available to the licensed anesthesiologist assistant for consultation, assistance, and intervention within the same facility. No anesthesiologist assistant shall practice without an anesthesiologist’s supervision or in any location where a supervising anesthesiologist is not immediately available for consultation, assistance and intervention, except as otherwise defined by law. (5) Upon entering into an anesthesiologist assistant supervision agreement, the supervising anesthesiologist shall be familiar with the level of skill, training and the competence of the licensed anesthesiologist assistant whom the anesthesiologist will be supervising. The provisions contained in the anesthesiologist assistant supervision agreement between the licensed anesthesiologist assistant and the supervising anesthesiologist shall be within the scope of practice of the licensed anesthesiologist assistant and consistent with the licensed anesthesiologist assistant’s skill, training and competence. (6) The delegated health care services provided for in the anesthesiologist assistant supervision agreement shall be consistent with the scopes of practice of both the supervising anesthesiologist and licensed anesthesiologist assistant including, but not limited to, any restrictions placed upon the supervising anesthesiologist’s practice or license. (7) The anesthesiologist assistant supervision agreement between a supervising anesthesiologist and a licensed anesthesiologist assistant shall— (A) Include the method and frequency of review of the licensed anesthesiologist assistant’s practice activities; (B) Be reviewed at least annually and revised as the supervising anesthesiologist deems necessary; (C) Be maintained by the supervising anesthesiologist and licensed anesthesiologist assistant for a minimum of eight (8) years after the termination of the agreement; (D) Be signed and dated by the supervising anesthesiologist and licensed anesthesiologist assistant prior to its implementation; (E) Contain the mechanisms for evaluation of serious or significant adverse outcomes to a patient or patients, and/or deviations from standard of care, as established by the practice or community based standards; and (F) Anesthesiologist assistant supervisory agreements must be consistent with the statutory requirements of section 334.424.2, RSMo. (8) The board may require any supervising anesthesiologist to appear before the board to answer questions regarding supervision agreements and/or annual reviews of an anesthesiologist assistant. AUTHORITY: sections 334.125, RSMo 2000 and 334.400, 334.402, and 334.414, RSMo Supp. 2005.* This rule originally filed as 4 CSR 150-9.040. Original rule filed Jan. 17, 2006, effective Aug. 30, 2006. Moved to 20 CSR 2150-9.040, effective Aug. 28, 2006. *Original authority: 334.125, RSMo 1959, amended 1993, 1995; 334.400, RSMo 2003; 334.402, RSMo 2003 and 334.414, RSMo 2003.