OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 318 Bill Analysis
134th General Assembly
Click here for H.B. 318’sFiscal Note
Version: As Reported by House Health
Primary Sponsors: Reps. Swearingen and Plummer
Effective Date:
Elizabeth Molnar, Attorney
SUMMARY
 Repeals the requirement that an anesthesiologist assistant practice only in a hospital or
ambulatory surgical facility and during the first four years of practice, with enhanced
anesthesiologist supervision.
 Retains the requirements that an anesthesiologist assistant practice under the direct
supervision and in the immediate presence of an anesthesiologist and in accordance
with a written practice protocol adopted by the assistant’s supervising anesthesiologist.
 Maintains anesthesiologist assistant authority to engage in many of the activities and
services provided for in existing law, while also authorizing an anesthesiologist assistant
to engage in other activities and services, including selecting, ordering, and
administering drugs for conditions related to the administration of anesthesia.
 Establishes conditions on an anesthesiologist assistant’s authority to engage in such
activities, including that the supervising anesthesiologist request that the assistant
engage in the activity.
 Permits an anesthesiologist assistant to direct nurses and respiratory therapists to
perform specified tasks, including drug administration.
 This analysis was prepared before the report of the House Health Committee appeared in the House
Journal. Note that the legislative history may be incomplete.
May 31, 2022
Office of Research and Drafting LSC Legislative Budget Office
DETAILED ANALYSIS
Anesthesiologist assistants
Supervision and practice location
The bill makes several changes to the law governing anesthesiologist assistants,
including by repealing the requirement that an anesthesiologist assistant practice only as
follows:
 In a hospital or ambulatory surgical facility;1 and
 During the first four years of practice, with enhanced anesthesiologist supervision.2
It retains, however, the requirements that an assistant practice (1) under the direct
supervision and in the immediate presence of an anesthesiologist and (2) in a manner
consistent with a written practice protocol adopted by the supervising anesthesiologist.3
Scope of practice
While the bill maintains anesthesiologist assistant authority to engage in many of the
activities and services provided for in existing law, it also authorizes an anesthesiologist
assistant to engage in other activities and services. 4 The table below briefly describes the
changes in these activities and services.
Activities and services
Current law The bill
Obtaining a comprehensive patient history and Same.
presenting the history to the supervising
anesthesiologist.
Pretesting and calibrating anesthesia delivery Instead, testing and calibrating anesthesia
systems and monitors. delivery systems.
Obtaining and interpreting information from Instead, obtaining and interpreting information
anesthesia delivery systems and monitors. from anesthesia delivery systems.
1 In light of this change, the bill generally refers to an anesthesiologist assistant and supervising
anesthesiologist practicing in a health care facility (R.C. 4760.09, with conforming changes in
R.C. 4760.16).
2 R.C. 4760.08.
3 R.C. 4760.08.
4 R.C. 4760.08 and 4760.09.
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Activities and services
Current law The bill
Assisting the supervising anesthesiologist with No provision.
the implementation of medically accepted
monitoring techniques.
Administering intermittent vasoactive drugs and Same.
starting and adjusting vasoactive infusions.
Establishing basic and advanced airway Similar, establishing basic and advanced airway
interventions, including intubation of the trachea interventions, including performing tracheal
and performing ventilatory support. intubations and ventilatory support.
Administering blood, blood products, and Same.
supportive fluids.
Administering anesthetic drugs, adjuvant drugs, Instead, performing anesthesia induction,
and accessory drugs. maintenance, and emergence, including by
administering anesthetic, adjuvant, and accessory
drugs.
Assisting the supervising anesthesiologist with Instead, performing epidural or spinal anesthetic
the performance of epidural anesthetic procedures.
procedures and spinal anesthetic procedures.
Assisting the supervising anesthesiologist in Same.
developing and implementing an anesthesia care
plan.
No provision. Obtaining informed consent for anesthesia care.
No provision. Performing preanesthetic preparation and
evaluation, postanesthetic preparation and
evaluation, postanesthesia care, clinical support
functions, and any other function described in the
written practice protocol.
No provision. Performing and documenting evaluations and
assessments, including ordering and evaluating
one or more diagnostic tests for conditions
related to the administration of anesthesia.
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Office of Research and Drafting LSC Legislative Budget Office
Activities and services
Current law The bill
No provision. As necessary for patient management and care,
selecting, ordering, and administering treatments,
drugs, and intravenous fluids for conditions
related to the administration of anesthesia.5
No provision. As necessary for patient management and care,
directing registered nurses, licensed practical
nurses, and respiratory therapists6 to do either or
both of the following if authorized by law to do
so:
 Provide supportive care, including by
monitoring vital signs, conducting
electrocardiograms, and administering
intravenous fluids;
 Administer treatments, drugs, and
intravenous fluids to treat conditions
related to the administration of
anesthesia.
With respect to the authority to order – as necessary for patient management and care
– drugs for conditions related to the administration of anesthesia, the bill specifies that it does
not authorize an anesthesiologist assistant to prescribe a drug for use outside of the health care
facility where the anesthesiologist assistant practices.7
Conditions on practice
Under the bill, before an anesthesiologist assistant may engage in any of the foregoing
activities, the supervising anesthesiologist must request the assistant to engage in the activity.
The following other conditions also must be satisfied:
 The requested activity is consistent with the anesthesiologist assistant’s education,
training, and licensure;
 The requested activity is among the activities in which the anesthesiologist assistant is
authorized to engage, as delineated in the written practice protocol adopted by the
supervising anesthesiologist;
5 R.C. 4729.01.
6 R.C. 4723.01 and 4761.17.
7 R.C. 4760.09.
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 Office of Research and Drafting LSC Legislative Budget Office
 The anesthesiologist assistant is not prohibited from engaging in the requested activity
by Ohio statutory law or State Medical Board rule.8
Background
Ohio law recognizes the practice of anesthesiologist assistants, which are defined as
individuals who assist anesthesiologists in developing and implementing anesthesia care plans
for patients.9 It prohibits an individual from practicing as an anesthesiologist assistant without
holding a State Medical Board-issued license10 and establishes limits on that practice, including
by requiring an anesthesiologist assistant to practice only in a hospital or ambulatory surgical
facility and under the direct supervision and in the immediate presence of an
anesthesiologist.11
Current law also directs each supervising anesthesiologist to adopt a written practice protocol
delineating (1) the services the assistant is authorized to provide, some of which are outlined in
statute, and (2) the manner in which the assistant will be supervised. Existing law requires
enhanced supervision of anesthesiologist assistants during their first four years of practice.12
HISTORY
Action Date
Introduced 05-19-21
Reported, H. Health --
ANHB0318RH-134/ts
8 R.C. 4760.09.
9 R.C. 4760.01.
10 R.C. 4760.02, not in the bill.
11 R.C. 4760.08.
12 R.C. 4760.08.
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Statutes affected:
As Introduced: 4723.01, 4729.01, 4760.08, 4760.09, 4761.17
As Reported By House Committee: 4723.01, 4729.01, 4760.01, 4760.08, 4760.09, 4760.16, 4761.17