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MONDAY, MAY 5, 2003

N.J.A.C. 13:35-4A.3, 4A.7 and 4A.10

Take notice that the Division of Consumer Affairs has discovered errors in the text of N.J.A.C. 13:35-4A.3, 4A.7 and 4A.10, arising under the proposal and adoption of amendments to N.J.A.C. 13:35-4A effective December 16, 2003. See 33 N.J.R. 3870(a) and 34 N.J.R. 4449(a).

In N.J.A.C. 13:35-4A.3, the definition of "minor conduction block" contains the term "brachial plexus anesthesia." This term is a correction upon adoption of the proposed term "brachial anesthesia." However, in making the term correction upon adoption, the current use of "brachial anesthesia" in the definition of "regional anesthesia" was overlooked. Through this notice of administrative correction, the term "brachial anesthesia" in the definition of "regional anesthesia" is corrected as "brachial plexus anesthesia."

In N.J.A.C. 13:35-4A.7(a), the word "physician" in the second sentence is corrected as "practitioner" in order to correspond to "practitioner" in the first clause of the sentence.

In N.J.A.C. 13:35-4A.10(a)1, the word "physician" in the phrase, "[a] physician privileged by a hospital or the Board pursuant to N.J.A.C. 13:35- 4A.12 to provide conscious sedation," was intended by the Board of Medical Examiners to be replaced with "practitioner," which is defined at N.J.A.C. 13:35-4A.3 to mean a physician or a podiatrist. In the section dealing generally with the standards for administering or supervising the administration of anesthesia services in an office, N.J.A.C. 13:35-4A.7, references to "physician" were changed to "practitioner." As explained in the proposal Summary, these changes were made because, "the Board has recognized that in a number of instances, particularly at N.J.A.C. 13:35-4A.7 where it has made reference to physician, the privileges described could be obtained by a properly privileged podiatrist and, therefore, the term practitioner has been substituted." See 33 N.J.R. at 3871. As indicated by this language, N.J.A.C. 13:35-4A.7 was one, but not the only, section where the change from physician to practitioner was intended to be made; however, the change from physician to practitioner intended to be made in N.J.A.C. 13:35-4A.10, concerning administration of conscious sedation, were inadvertently omitted from the rulemaking.

That a change from "physician" to "practitioner" was intended for N.J.A.C. 13:35-4A.10, and not for N.J.A.C. 13:35-4A.8 (concerning administration of general anesthesia) or N.J.A.C. 13:35-4A.9 (concerning administration of regional anesthesia), is reflected in the three rules' common requirement in paragraph (a)1 that only "[a] physician privileged by a hospital or the Board pursuant to N.J.A.C. 13:35-4A.12 to provide [general anesthesia/regional anesthesia/conscious sedation] and who . . . completes [specified continuing medical education]" can administer general anesthesia/regional anesthesia/ conscious sedation in an office. Since hospital privileges to provide general anesthesia or regional anesthesia are given only to physicians, and all of the criteria to be privileged by the Board to provide or supervise the administration of general anesthesia or regional anesthesia under N.J.A.C. 13:35-4A.12(a) can only be satisfied by physicians, it follows that physicians are those who may be eligible to administer and monitor general anesthesia under N.J.A.C. 13:35-4A.8(a)1 and regional anesthesia under N.J.A.C. 13:35-4A.9(a)1. However, the Board may privilege a practitioner (either a physician or podiatrist) to administer or supervise the administration of conscious sedation under N.J.A.C. 13:35-4A.12(b), as a podiatrist would be able to satisfy the criteria in N.J.A.C. 13:35-4A.12(b)1, 2iii and 3. Therefore, the use of "practitioner" rather than "physician" in N.J.A.C. 13:35-4A.10(a)1 concerning administration of conscious sedation in an office is correct.

Another error in N.J.A.C. 13:35-4A.10(a)1 is the date July 1, 2001 as the beginning of the first three-year period during which specified continuing medical education must be completed in order for a practitioner (as corrected by this notice) to be able to administer conscious sedation in an office. As originally adopted effective June 15, 1998 (see 29 N.J.R. 2238(a) and 30 N.J.R. 2236(b)), this paragraph and similar requirements in N.J.A.C. 13:35-4A.8(a) 1 and 4A.9(a)1 set the start of the first three-year period at July 1, 1998. However, implementation of these requirements was not enforced pending the promulgation of the Board privileging rule, N.J.A.C. 13:35-4A.12, which was effective December 16, 2002 (see 30 N.J.R. 4485(b)). While the year 1998 in that date in N.J.A.C. 13:35-4A.8(a)1 and 4A.9(a)1 was proposed to be replaced with a "yet unspecified date one year after the adoption," with the date becoming July 1, 2004 upon adoption, in N.J.A.C. 13:35-4A.10(a)1, July 1, "2001" was inadvertently proposed and adopted to replace July 1, "1998." That this date was not that intended by the Board is indicated by the use of identical dates in the original adoption of N.J.A.C. 13:35-4A.8(a) 1, 4A.9(a)1 and 4A.10(a)1, the revised dates proposed and adopted in N.J.A.C. 13:35-4A.8(a)1 and 4A.9(a)1, and the fact that the effect of "July 1, 2001" would be to render the first three-year continuing medical education requirement under N.J.A.C. 13:35-4A.10(a)1 inappropriately retroactive, as its duration would commence almost 1 1/2 years prior to the effectiveness of the requirement. On this basis, "July 1, 2001" in N.J.A.C. 13:35-4A.10(a)1 is being corrected to "July 1, 2004."

This notice of administrative corrections is published pursuant to N.J.A.C. 1:30-2.7.

Full text of the corrected rules follows:

<< NJ ADC 13:35-4A.3 >>

13:35-4A.3 Definitions

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

"Regional anesthesia" means the administration of anesthetic agents to a patient to interrupt nerve impulses without loss of consciousness and includes epidural, caudal, spinal and brachial <<+plexus+>> anesthesia. Regional anesthesia does not include minor conduction blocks as defined in this section.


<< NJ ADC 13:35-4A.7 >>

13:35-4A.7 Standards for administering or supervising the administration of anesthesia services in an office; pre-anesthesia counseling; patient monitoring; recovery; patient record; discharge of patient

(a) A practitioner who administers or supervises the administration and monitoring of anesthesia services in an office shall be privileged by a hospital to provide the particular anesthesia service. If a practitioner is not privileged but wishes to administer or supervise the administration of anesthesia services, the <<-physician->> <<+practitioner+>> shall apply to the Board pursuant to N.J.A.C. 13:35-4A.12 to seek Board-approved privileging.

(b)-(i) (No change.)

<< NJ ADC 13:35-4A.10 >>

13:35-4A.10 Administration of conscious sedation; authorized personnel

(a) Conscious sedation shall be administered in an office only by the followingindividuals:

1. A <<-physician->> <<+practitioner+>> privileged by a hospital or the Board pursuant to N.J.A.C. 13:35-4A.12 to provide conscious sedation and who, during every consecutive three-year period beginning July 1, <<- 2001->> <<+2004+>>, completes at least eight Category I or II hours of continuing medical education in any anesthesia services, including conscious sedation exclusively, or in anesthesia as it relates to the physician's field of practice, which either meet the criteria for credit towards the Physician's Recognition Award of the American Medical Association or have been approved by the American Osteopathic Association;

2.-3. (No change.)

(b)-(e) (No change.)

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