BILL ANALYSIS Ó
AB 890
Page 1
Date of Hearing: May 13, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
890 (Ridley-Thomas) - As Amended May 5, 2015
-----------------------------------------------------------------
|Policy |Business and Professions |Vote:|9 - 2 |
|Committee: | | | |
| | | | |
| | | | |
|-------------+-------------------------------+-----+-------------|
| | | | |
| | | | |
| | | | |
|-------------+-------------------------------+-----+-------------|
| | | | |
| | | | |
| | | | |
-----------------------------------------------------------------
Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill establishes title protection for anesthesiologist
assistants with no licensure or oversight agency. Specifically,
this bill:
AB 890
Page 2
1)Defines anesthesiologist assistant (AA) as someone who has
graduated from an anesthesiologist assistant program
recognized by a specified commission or by its successor
agency, and holds a specified active national certification.
2)States it is an unfair business practice if a person who does
not meet the specified requirements uses the title.
3)Requires an AA to work under the direction and supervision of
an anesthesiologist, and allows the AA to assist the
supervising anesthesiologist in developing and implementing an
anesthesia care plan for a patient.
FISCAL EFFECT:
Since there is no direct regulatory defined in this bill, this
bill creates unknown cost pressure to the Medical Board of
California (MBC), likely in the hundreds of thousands to low
millions of dollars for regulation and oversight of a new
profession, similar in scope to advanced practice nurses.
Although the MBC is not provided direct regulatory authority in
the bill, in absence of state licensure for this professional
category it appears reasonable to assume by default that
regulatory responsibility lies with MBC, as they oversee the
physicians who would supervise AAs.
COMMENTS:
1)Purpose. This bill is sponsored by the California Society of
Anesthesiologists. The author believes AAs will promote
efficiency by extending the reach of physician
AB 890
Page 3
anesthesiologists, while protecting patient safety by
operating under the physician-led, patient-centered model of
care.
2)Anesthesiologists are responsible for determining the
appropriate type of anesthesia for procedures, providing pain
control and managing a patient's breathing during procedures.
After surgery, anesthesiologists provide pain management to
assist the patient in their recovery.
3)Anesthesiologist assistants (AA). According to the American
Society of Anesthesiologists (ASA), in other states, AAs work
under the direct supervision of an anesthesiologists to
implement anesthesia care plans. Specifically, an AA can
perform the following under physician anesthesiologist
supervision:
a) Obtain a patient history;
b) Pretest and calibrate anesthesia delivery systems, and
interpret information from the systems in consultation with
the physician anesthesiologist;
c) Establish basic and advanced airway interventions;
d) Administer specified drugs;
e) Administer blood products and fluids;
f) Perform epidural anesthetic procedures;
g) Provide assistance to a cardiopulmonary resuscitation
team;
AB 890
Page 4
h) Participate in research and teaching activities
authorized by the physician anesthesiologist; and,
i) Supervise student anesthesiologist assistants
Unlike medical assistants, AAs are health care professionals
that require significant training and are responsible for
wide-ranging and direct patient care duties. There are no AAs
working in California, except in California Veteran
Administration hospitals. It is estimated that there are
approximately 1,000 AAs nationwide.
1)Nurse anesthetists (NAs) are advanced practice registered
nurses with training in anesthesia, and are regulated by the
Board of Registered Nursing. There are approximately 36,000
NAs nationwide and 1,600 in California. As of 2009, NAs are
allowed to practice independently of physician supervision,
but not all healthcare facilities approve independent
practice.
2)NAs and AAs. The ASA notes both anesthesiologist assistants
and nurse anesthetists have identical patient care
responsibility and technical capabilities. The Centers for
Medicare and Medicaid Services (CMS) treats the professions
the same for purposes of billing, coverage and qualifications.
California has no regulatory structure for AAs, while NAs can
practice either under physician supervision or without
supervision in the state. This is the major distinction, and
appears to be the only meaningful distinction, between the two
professional categories.
AB 890
Page 5
3)Support. This bill is sponsored by the California Society of
Anesthesiologists and supported by anesthesiologist and other
physician groups. They believe AAs need specific statutory
practice recognition and title protection in order to
establish hospital privileges working under the direct
supervision of a physician anesthesiologist, and believe
establishing AAs would lower healthcare costs and increase
access for anesthesia care.
4)Opposition. This bill is opposed by California Association of
Nurse Anesthetists and other groups representing nurses and
nurse midwives. They contend there is no shortage of
anesthesia providers in California, and this bill does not
increase access in any case. They also note it does not
require an AA to be licensed in the state of California and
does not set up any agency oversight of AA functions. The
California Labor Federation also opposes this bill, stating
the AA classification would drive up the cost of health care,
rather than reducing it.
5)The MBC Analysis of this bill states "If an AA were to provide
substandard patient care, there is no license to take
disciplinary action against and there is no way to stop the AA
from practicing. Although the bill does charge the
supervising anesthesiologist with accepting responsibility for
the medical services being rendered by an AA, there is not a
clear pathway for regulatory oversight other than the normal
regulatory oversight provided by the board for physicians."
At their May 7, 2015, meeting, MBC staff suggested the MBC
take a "neutral" position, if the bill is amended to include a
framework to stop an AA that is providing substandard care
from practicing.
AB 890
Page 6
6)Staff Comments. This bill asserts it is a practice act, but it
is a title act. A practice act would more clearly define scope
of practice and would define a regulatory entity to regulate
the practice in order to protect patients. This bill proposes
to define a health care professional with a scope of practice
similar to an advanced practice nurse, in a high-risk area of
health care, with no oversight body.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081