(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.9
(2) Equipment and
supplies: Emergency resuscitation equipment, suction and a reliable source of
oxygen with a backup tank must be readily available. When triggering agents are
in the office, at least 12 ampules of dantrolene sodium must be readily
available within 10 minutes with additional ampules available from another
source. Monitoring equipment should include: blood pressure apparatus,
stethoscope, pulse oximetry, continuous EKG, capnography, and temperature
monitoring for procedures lasting longer than thirty (30) minutes. Monitoring
equipment and supplies should be in compliance with currently adopted ASA
standards 10. Facility, in terms of general preparation, must 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
general and regional anesthesia and to assist in any support or resuscitation
measures as required. The individual administering general and regional
anesthesia 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. Direction of the sedation/analgesia component of the
medical procedure should be provided by a physician who is immediately and
physically present, who is licensed to practice medicine in the state of
Alabama, and who is responsible for the direction of administration of the
anesthetic. The physician providing direction should assure that an appropriate
pre-anesthetic examination is performed, assure that qualified practitioners
participate, be available for diagnosis treatment and management of anesthesia
related complications or emergencies, and assure the provision of indicated
post anesthesia care. 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 11.
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.
