(1) Physician
Registration Requirement: The Alabama Board of Medical Examiners requires each
physician who offers office-based surgery that requires moderate sedation, deep
sedation or general anesthesia, as defined in these rules to register with the
State Board of Medical Examiners as an office-based surgery
physician.7
(2) Equipment and
supplies: Emergency resuscitation equipment, emergency life-saving medications,
suction, and a reliable source of oxygen with a backup tank must be readily
available. When medication for sedation and/or analgesia is administered
intravenously (IV), monitoring equipment should include: blood pressure
apparatus, stethoscope, pulse oximetry, continuous EKG, and temperature
monitoring for procedures lasting longer than thirty (30) minutes. Patient's
vital signs, oxygen saturation, and level of consciousness should be documented
prior to the procedure, during regular intervals throughout the procedure, and
prior to discharge. Facility, in terms of general preparation, should have
adequate equipment and supplies, provisions for proper record keeping, and the
ability to recover patients after anesthesia.
(3) Training required: The physician must be
able to document satisfactory completion of training such as being Board
certified or being an active candidate for certification by a Board approved by
the American Board of Medical Specialties or comparable formal training.
Alternative credentialing for procedures outside the physician's core
curriculum must be applied for through the Alabama Board of Medical Examiners
and must be approved by the Board. The physician and at least one assistant
must be currently trained in Advanced Cardiac Life Support (ACLS).
(4) Assistance of other personnel: Anesthesia
should be administered only by licensed, qualified and competent practitioners.
Practitioners must have documented competence and training to administer
moderate sedation/analgesia and to assist in any support or resuscitation
measures as required. The individual administering moderate sedation/analgesia
and/or monitoring the patient cannot assist the physician in performing the
surgical procedure. Scrub or Circulating nurse(s) and/or assistant(s) must be
trained in their specific job skills as determined by the supervising
physician. At least one physician currently trained in ACLS must be immediately
and physically available until the last patient is past the first stage of
recovery. At least one practitioner currently trained in ACLS must be
immediately and physically available until the last patient is discharged from
the facility.
Authors: Alabama Board of Medical Examiners
ad hoc Committee: Arthur F. Toole, III, M.D.; Jorge A. Alsip,
M.D.; James G. Chambers, III, M.D.; Craig H. Christopher, M.D.; Alcus Ray
Hudson, M.D.; Pamela D. Varner, M.D.; James E. West, M.D.; and Task Force
Sub-Committee: Jeff Plagenhoef, M.D.; Eric Crum, M.D.; Dan J. Coyle, Jr., M.D.;
Gary Monheit, M.D.; Robert Hurlbutt, IV, M.D.; C. Paul Perry, M.D.; W. Guinn
Paulk, M.D.; Mark McIlwain, D.M.D., M.D.; Jerald Clanton, D.M.D., M.D.; Patrick
J. Budny, M.D.; James W. Northington, M.D.; David Franco, M.D.; Thomas E.
Moody, M.D.
