2009 - 2010 LEGISLATURE
February 11, 2010 - Introduced by Senators Taylor, Darling, Kapanke, Kedzie and
Plale, cosponsored by Representatives Shilling, Pasch, Petrowski, Smith,
Townsend, Vruwink, Zepnick
and A. Williams. Referred to Committee on
Health, Health Insurance, Privacy, Property Tax Relief, and Revenue.
SB535,1,6 1An Act to renumber 448.015 (1); to amend 448.02 (1), 448.03 (2) (c), 448.03 (2)
2(e), 448.03 (2) (k), 448.05 (1) (d) and 448.05 (6) (a); and to create 15.407 (9),
3448.015 (1b), 448.015 (1c), 448.03 (1) (d), 448.03 (3) (g), 448.03 (7), 448.04 (1) (g),
4448.05 (5w), 448.05 (6) (ar), 448.13 (3), 448.22 and 448.23 of the statutes;
5relating to: licensing anesthesiologist assistants and creating the Council on
6Anesthesiologist Assistants and granting rule-making authority.
Analysis by the Legislative Reference Bureau
This bill creates licensure requirements and practice standards for
anesthesiologist assistants.
The bill prohibits a person from practicing as an anesthesiologist assistant or
representing or implying that the person is an anesthesiologist assistant unless the
person holds a license to practice as an anesthesiologist assistant granted by the
Medical Examining Board (board). The bill requires the board to issue a license to
a person who has: 1) obtained a bachelor's degree; 2) completed an accredited
anesthesiologist assistant program; and 3) passed a certifying examination. The
board may also issue a license to a person who is licensed as an anesthesiologist
assistant in another state, if that state authorizes a licensed anesthesiologist
assistant to practice in the same manner and to the same extent as this state.
Under the bill, an anesthesiologist assistant may assist an anesthesiologist in
the delivery of medical care only under the supervision of an anesthesiologist who

is immediately available and able to intervene if needed. The scope of an
anesthesiologist assistant's practice is limited to assisting only the supervising
anesthesiologist and performing only certain medical care tasks assigned by the
supervising anesthesiologist. The medical care tasks are specified in the bill and
include the following: 1) developing and implementing an anesthesia care plan; 2)
implementing monitoring techniques; 3) pretesting and calibrating anesthesia
delivery systems; 4) administering vasoactive drugs and starting and adjusting
vasoactive infusions; 5) administering intermittent anesthetic, adjuvant, and
accessory drugs; 6) implementing spinal, epidural, and regional anesthetic
procedures; and 7) administering blood, blood products, and supportive fluids.
The bill requires an anesthesiologist assistant to be employed by one of certain
health care providers specified in the bill and to enter into a supervision agreement
with an anesthesiologist who represents the anesthesiologist assistant's employer.
The supervision agreement must identify the anesthesiologist assistant's
supervising anesthesiologist and define the scope of the anesthesiologist assistant's
practice, and may limit the anesthesiologist assistant's practice to less than the full
scope of anesthesiologist assistant practice authorized by the bill.
The bill authorizes a student anesthesiologist assistant to perform only medical
care tasks assigned by an anesthesiologist, who may delegate the supervision of a
student to a qualified anesthesiology provider. The bill also creates a five-member
Council on Anesthesiologist Assistants to advise and make recommendations to the
board and requires a study of the feasibility of establishing an anesthesiologist
assistant school in the University of Wisconsin System.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB535, s. 1 1Section 1. 15.407 (9) of the statutes is created to read:
SB535,3,22 15.407 (9) Council on anesthesiologist assistants; duties. There is created
3a council on anesthesiologist assistants in the department of regulation and
4licensing and serving the medical examining board in an advisory capacity. The
5council's membership shall consist of the following members, who shall be selected
6from a list of recommended appointees submitted by the president of the Wisconsin
7Society of Anesthesiologists, Inc., after the president of the Wisconsin Society of
8Anesthesiologists, Inc., has considered the recommendation of the Wisconsin

1Academy of Anesthesiologist Assistants for the appointee under par. (b), and who
2shall be appointed by the medical examining board for 3-year terms:
SB535,3,33 (a) One member of the medical examining board.
SB535,3,44 (b) One anesthesiologist assistant licensed under s. 448.04 (1) (g).
SB535,3,55 (c) Two anesthesiologists.
SB535,3,66 (d) One lay member.
SB535, s. 2 7Section 2. 448.015 (1) of the statutes is renumbered 448.015 (1d).
SB535, s. 3 8Section 3. 448.015 (1b) of the statutes is created to read:
SB535,3,129 448.015 (1b) "Anesthesiologist" means a physician who has completed a
10residency in anesthesiology approved by the American Board of Anesthesiology or
11the American Osteopathic Board of Anesthesiology, holds an unrestricted license,
12and is actively engaged in clinical practice.
SB535, s. 4 13Section 4. 448.015 (1c) of the statutes is created to read:
SB535,3,1614 448.015 (1c) "Anesthesiologist assistant" means an individual licensed by the
15board to assist an anesthesiologist in the delivery of certain medical care with
16anesthesiologist supervision.
SB535, s. 5 17Section 5. 448.02 (1) of the statutes is amended to read:
SB535,3,2018 448.02 (1) License. The board may grant licenses, including various classes
19of temporary licenses, to practice medicine and surgery, to practice perfusion, to
20practice as an anesthesiologist assistant,
and to practice as a physician assistant.
SB535, s. 6 21Section 6. 448.03 (1) (d) of the statutes is created to read:
SB535,3,2322 448.03 (1) (d) No person may practice as an anesthesiologist assistant unless
23he or she is licensed by the board as an anesthesiologist assistant.
SB535, s. 7 24Section 7. 448.03 (2) (c) of the statutes is amended to read:
SB535,4,4
1448.03 (2) (c) The activities of a medical student, respiratory care student,
2perfusion student, anesthesiologist assistant student, or physician assistant student
3required for such student's education and training, or the activities of a medical
4school graduate required for training as required in s. 448.05 (2).
SB535, s. 8 5Section 8. 448.03 (2) (e) of the statutes is amended to read:
SB535,4,96 448.03 (2) (e) Any person other than a physician assistant or an
7anesthesiologist assistant
who is providing patient services as directed, supervised
8and inspected by a physician who has the power to direct, decide and oversee the
9implementation of the patient services rendered.
SB535, s. 9 10Section 9. 448.03 (2) (k) of the statutes is amended to read:
SB535,4,1211 448.03 (2) (k) Any persons, other than physician assistants, anesthesiologist
12assistants,
or perfusionists, who assist physicians.
SB535, s. 10 13Section 10. 448.03 (3) (g) of the statutes is created to read:
SB535,4,2014 448.03 (3) (g) No person may designate himself or herself as an
15"anesthesiologist assistant" or use or assume the title "anesthesiologist assistant" or
16append to the person's name the words or letters "anesthesiologist assistant" or
17"A.A." or any other titles, letters, or designation that represents or may tend to
18represent the person as an anesthesiologist assistant unless he or she is licensed as
19an anesthesiologist assistant by the board. An anesthesiologist assistant shall be
20clearly identified as an anesthesiologist assistant.
SB535, s. 11 21Section 11. 448.03 (7) of the statutes is created to read:
SB535,4,2522 448.03 (7) Supervision of anesthesiologist assistants. An anesthesiologist
23may not supervise more than the number of anesthesiologist assistants permitted
24by reimbursement standards for Part A or Part B of the federal Medicare program
25under Title XVIII of the federal Social Security Act, 42 USC 1395 to 1395hhh.
SB535, s. 12
1Section 12. 448.04 (1) (g) of the statutes is created to read:
SB535,5,142 448.04 (1) (g) Anesthesiologist assistant license. The board shall license as an
3anesthesiologist assistant an individual who meets the requirements for licensure
4under s. 448.05 (5w). The board may, by rule, provide for a temporary license to
5practice as an anesthesiologist assistant. The board may issue a temporary license
6to a person who meets the requirements under s. 448.05 (5w) and who is eligible to
7take, but has not passed, the examination under s. 448.05 (6). A temporary license
8expires on the date on which the board grants or denies an applicant permanent
9licensure or on the date of the next regularly scheduled examination required under
10s. 448.05 (6) if the applicant is required to take, but has failed to apply for, the
11examination. An applicant who continues to meet the requirements for a temporary
12license may request that the board renew the temporary license, but an
13anesthesiologist assistant may not practice under a temporary license for a period
14of more than 3 years.
SB535, s. 13 15Section 13. 448.05 (1) (d) of the statutes is amended to read:
SB535,5,1816 448.05 (1) (d) Be found qualified by three-fourths of the members of the board,
17except that an applicant for a temporary license under s. 448.04 (1) (b) 1. and 3. and,
18(e), and (g) must be found qualified by 2 members of the board.
SB535, s. 14 19Section 14. 448.05 (5w) of the statutes is created to read:
SB535,5,2220 448.05 (5w) Anesthesiologist assistant license. An applicant for a license
21to practice as an anesthesiologist assistant shall submit evidence satisfactory to
22board that the applicant has done all of the following:
SB535,5,2323 (a) Obtained a bachelor's degree.
SB535,6,3
1(b) Satisfactorily completed an anesthesiologist assistant program that is
2accredited by the Commission on Accreditation of Allied Health Education
3Programs, or by a predecessor or successor entity.
SB535,6,64 (c) Passed the certifying examination administered by, or obtained active
5certification from, the National Commission on Certification of Anesthesiologist
6Assistants or a successor entity.
SB535, s. 15 7Section 15. 448.05 (6) (a) of the statutes is amended to read:
SB535,6,168 448.05 (6) (a) Except as provided in par. pars. (am) and (ar), the board shall
9examine each applicant it finds eligible under this section in such subject matters as
10the board deems applicable to the class of license or certificate which the applicant
11seeks to have granted. Examinations may be both written and oral. In lieu of its own
12examinations, in whole or in part, the board may make such use as it deems
13appropriate of examinations prepared, administered, and scored by national
14examining agencies, or by other licensing jurisdictions of the United States or
15Canada. The board shall specify passing grades for any and all examinations
16required.
SB535, s. 16 17Section 16. 448.05 (6) (ar) of the statutes is created to read:
SB535,6,2518 448.05 (6) (ar) When examining an applicant for a license to practice as an
19anesthesiologist assistant under par. (a), the board shall use the certification
20examination administered by the National Commission on Certification of
21Anesthesiologist Assistants or a successor entity. The board may license without
22additional examination any qualified applicant who is licensed in any state or
23territory of the United States or the District of Columbia and whose license
24authorizes the applicant to practice in the same manner and to the same extent as
25an anesthesiologist assistant is authorized to practice under s. 448.22 (2).
SB535, s. 17
1Section 17. 448.13 (3) of the statutes is created to read:
SB535,7,62 448.13 (3) Each person licensed as an anesthesiologist assistant shall, in each
32nd year at the time of application for a certificate of registration under s. 448.07,
4submit proof of meeting the criteria for recertification by the National Commission
5on Certification of Anesthesiologist Assistants or by a successor entity, including any
6continuing education requirements.
SB535, s. 18 7Section 18. 448.22 of the statutes is created to read:
SB535,7,11 8448.22 Anesthesiologist assistants. (1) In this section, "supervision" means
9the use of the powers of direction and decision to coordinate, direct, and inspect the
10accomplishments of another, and to oversee the implementation of the
11anesthesiologist's intentions.
SB535,7,18 12(2) An anesthesiologist assistant may assist an anesthesiologist in the
13delivery of medical care only under the supervision of an anesthesiologist and only
14as described in a supervision agreement between the anesthesiologist assistant and
15an anesthesiologist who represents the anesthesiologist assistant's employer. The
16supervising anesthesiologist shall be immediately available in the same physical
17location or facility in which the anesthesiologist assistant assists in the delivery of
18medical care such that the supervising anesthesiologist is able to intervene if needed.
SB535,7,19 19(3) A supervision agreement under sub. (2) shall do all of the following:
SB535,7,2020 (a) Describe the supervising anesthesiologist.
SB535,7,2221 (b) Define the practice of the anesthesiologist assistant consistent with subs.
22(2), (4) and (5).
SB535,8,2 23(4) An anesthesiologist assistant's practice may not exceed his or her education
24and training, the scope of practice of the supervising anesthesiologist, and the
25practice outlined in the anesthesiologist assistant supervision agreement. A medical

1care task assigned by the supervising anesthesiologist to the anesthesiologist
2assistant may not be delegated by the anesthesiologist assistant to another person.
SB535,8,5 3(5) An anesthesiologist assistant may assist only the supervising
4anesthesiologist in the delivery of medical care and may perform only the following
5medical care tasks as assigned by the supervising anesthesiologist:
SB535,8,66 (a) Developing and implementing an anesthesia care plan for a patient.
SB535,8,87 (b) Obtaining a comprehensive patient history and performing relevant
8elements of a physical exam.
SB535,8,109 (c) Pretesting and calibrating anesthesia delivery systems and obtaining and
10interpreting information from the systems and from monitors.
SB535,8,1111 (d) Implementing medically accepted monitoring techniques.
SB535,8,1312 (e) Establishing basic and advanced airway interventions, including
13intubation of the trachea and performing ventilatory support.
SB535,8,1514 (f) Administering intermittent vasoactive drugs and starting and adjusting
15vasoactive infusions.
SB535,8,1616 (g) Administering anesthetic drugs, adjuvant drugs, and accessory drugs.
SB535,8,1717 (h) Implementing spinal, epidural, and regional anesthetic procedures.
SB535,8,1818 (i) Administering blood, blood products, and supportive fluids.
SB535,8,2019 (j) Assisting a cardiopulmonary resuscitation team in response to a life
20threatening situation.
SB535,8,2221 (k) Participating in administrative, research, and clinical teaching activities
22specified in the supervision agreement.
SB535,8,2323 (L) Supervising student anesthesiologist assistants.
SB535,9,4 24(6) An anesthesiologist who represents an anesthesiologist assistant's
25employer shall review a supervision agreement with the anesthesiologist assistant

1at least annually. The supervision agreement shall be available for inspection at the
2location where the anesthesiologist assistant practices. The supervision agreement
3may limit the practice of an anesthesiologist assistant to less than the full scope of
4practice authorized under sub. (5).
SB535,9,10 5(7) An anesthesiologist assistant shall be employed by a health care provider,
6as defined in s. 655.001 (8), that is operated in this state for the primary purpose of
7providing the medical services of physicians or that is an entity described in s.
8655.002 (1) (g), (h), or (i). If an anesthesiologist assistant's employer is not an
9anesthesiologist, the employer shall provide for, and not interfere with, an
10anesthesiologist's supervision of the anesthesiologist assistant.
SB535,9,23 11(8) A student in an anesthesiologist assistant training program may assist only
12an anesthesiologist in the delivery of medical care and may perform only medical
13care tasks assigned by the anesthesiologist. An anesthesiologist may delegate the
14supervision of a student in an anesthesiologist assistant training program to a
15qualified anesthesia provider. For purposes of this subsection, a "qualified
16anesthesia provider" is an anesthesiologist, an anesthesiology fellow, an
17anesthesiology resident who has completed his or her first year of anesthesiology
18residency, a certified registered nurse anesthetist or an anesthesiologist assistant.
19This section shall not be interpreted to limit the number of other qualified anesthesia
20providers an anesthesiologist may supervise. A student in an anesthesiologist
21assistant training program shall be identified as a student anesthesiologist assistant
22or an anesthesiologist assistant student and may not be identified as an "intern,"
23"resident," or "fellow."
SB535, s. 19 24Section 19. 448.23 of the statutes is created to read:
SB535,10,4
1448.23 Council on anesthesiologist assistants. The council on
2anesthesiologist assistants shall guide, advise, and make recommendations to the
3board regarding the scope of anesthesiologist assistant practice and the promotion
4of the role of anesthesiologist assistants in the delivery of health care services.
SB535, s. 20 5Section 20. Nonstatutory provisions.
SB535,10,116 (1) Notwithstanding section 15.407 (9) (b) of the statutes, as created by this act,
7the initial member of the council on anesthesiologist assistants appointed under
8section 15.407 (9) (b) of the statutes, as created by this act, is not required to be a
9licensed anesthesiologist assistant under section 448.04 (1) (g) of the statutes, as
10created by this act, but shall be an individual who meets the criteria specified under
11section 448.05 (5w) of the statutes, as created by this act.
SB535,10,1512 (2) Notwithstanding section 15.407 (9) of the statutes, as created by this act,
13one of the initial members of the council on anesthesiologist assistants appointed
14under section 15.407 (9) (c) of the statutes, as created by this act, shall be appointed
15for a 2-year term.
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