November 2, 2012

Effective November 1, 2012, Wisconsin Act 160 (Act 160) establishes a licensure requirement for anesthesiologist assistants (AAs).  Prior to Act 160, AAs practiced under delegated authority.  Act 160 also established the requirements for obtaining AA licensure, AA’s scope of practice, anesthesiologist supervision requirements as well as a Council on Anesthesiologist Assistants.  This announcement summarizes some of the key aspects of the new law that Wisconsin anesthesiology providers need to know.

AA Scope of Practice

Act 160 provides that an AA may assist an anesthesiologist in the delivery of medical care.  The medical care tasks that may be assigned by the supervising anesthesiologist, falling within the AA’s scope of practice, are the following:

• Developing and implementing an anesthesia care plan for the patient;
• Obtaining a comprehensive patient history and performing relevant elements of a physical exam;
• Pretesting and calibrating anesthesia delivery systems and obtaining and interpreting information from the systems and from monitors;
• Implementing medically accepted monitoring techniques;
• Establishing basic and advanced airway interventions, including intubation of the trachea and performing ventilator support;
• Administering intermittent vasoactive drugs and starting and adjusting vasoactive infusions;
• Administering anesthetic drugs, adjuvant drugs, and accessory drugs;
• Implementing spinal, epidural, and regional anesthetic procedures;
• Administering blood, blood products, and supportive fluids;
• Assisting a cardiopulmonary resuscitation team in response to a life threatening situation;
• Participating in administrative, research, and clinical teaching activities specified in the supervision agreement; and
• Supervising student anesthesiologist assistants.

Notably, the AA may assist in the delivery of medical care under the anesthesiologist’s supervision, not another licensed non-anesthesiologist physician (e.g., surgeon) or a certified registered nurse anesthetist (CRNA).  Moreover, tasks assigned by the supervising anesthesiologist to the AA may not be delegated by the AA to someone else.  In other words, AAs do not have delegation authority.

Anesthesiologist Supervision of AAs

Anesthesiologists may not supervise more than 4 AAs at a given time, consistent with Medicare requirements. For purposes of this statute, “supervision” means “the use of the powers of direction and decision to coordinate, direct, and inspect the accomplishments of another, and to oversee the implementation of the anesthesiologist’s intentions.”  Supervising anesthesiologists must be immediately available in the same physical location or facility as the AA that is assisting in the delivery of medical care.  While the definition of “physical location” or “facility” could vary in different settings, the supervising anesthesiologist must be supervising in such a way that s/he would be able to intervene, if necessary.

The supervision relationship between the AA and the anesthesiologist is set forth in a supervision agreement (Supervision Agreement).  Even though the Supervision Agreement describes the AA’s practice, it may not permit the AA to perform services that exceed the AA’s education, training or scope of practice.

Anesthesiologist Supervision of Student AAs

A student AA may only assist an anesthesiologist in the delivery of medical care and may only be assigned tasks by the anesthesiologist.  Importantly, however, supervision of the student AA may be delegated to a qualified anesthesiologist, an anesthesiology fellow, an anesthesiology resident who has completed his/her first year of residency or an AA.  Notably, an anesthesiologist may not concurrently supervise, either directly or as delegated, more than 2 student AAs.

Next Steps

To comply with the requirements of Act 160, Wisconsin anesthesiologists should ensure, when working with AAs, that they are familiar with the AA’s scope of practice and their supervisory obligations.  Moreover, anesthesiologists should also ensure that they have Supervision Agreements with their AAs and that the Supervision Agreements are reviewed on a regular basis.