OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 362 Bill Analysis
135th General Assembly
Click here for H.B. 362’s Fiscal Note
Version: As Introduced
Primary Sponsors: Reps. Baker and Robb Blasdel
Effective date:
Elizabeth Molnar, Attorney
SUMMARY
Eliminates the current law requirement that a certified registered nurse anesthetist
(CRNA) practice with a physician’s, podiatrist’s, or dentist’s supervision, defined under
existing law to mean that the CRNA is under the physician’s, podiatrist’s, or dentist’s
direction.
Instead requires a CRNA to practice in consultation with a provider, defined by the bill to
mean that the provider has requested the CRNA to perform certain tasks for a patient.
Also eliminates the requirement that a CRNA be in the immediate presence of a
physician, podiatrist, or dentist when administering anesthesia or performing its
induction, maintenance, or emergence.
Removes current law provisions establishing a timeline during which a CRNA may
engage in specified activities, including selecting, ordering, and administering certain
treatments, drugs, and intravenous fluids, while still maintaining CRNA authority to
engage in many of those activities.
Prohibits the State Dental and Medical Boards, when adopting rules, from prohibiting a
dentist or podiatrist from consulting with a CRNA.
Makes other changes to the law governing the practice of CRNAs, including by
consolidating provisions of existing law.
DETAILED ANALYSIS
Provider consultation
H.B. 362 eliminates the current law requirement that a certified registered nurse
anesthetist (CRNA) practice under the supervision of a physician, podiatrist, or dentist, instead
May 6, 2024
Office of Research and Drafting LSC Legislative Budget Office
requiring a CRNA to practice in consultation with a provider.1 Under the bill, “consultation” is
defined to mean that a provider, in accordance with policies established by the setting where
the provider and CRNA practice, has requested the CRNA to perform certain activities for a
patient (see “CRNA scope of practice” below).2 Such a request may be made either
verbally or in writing.
Note that the bill neither describes a consulting provider nor requires that such a
provider act within the provider’s scope of practice when consulting with the CRNA.
Physician, podiatrist, or dentist supervision
At present, Ohio law requires a CRNA to practice with the supervision of a physician,
podiatrist, or dentist, defining “supervision” to mean that the CRNA is under the physician’s,
podiatrist’s, or dentist’s direction.3 In the case of a podiatrist or dentist, current law also
requires the podiatrist or dentist to be acting within that professional’s scope of practice when
directing the CRNA.4
Immediate presence
In addition to replacing physician, podiatrist, or dentist supervision with provider
collaboration, the bill eliminates the existing law requirement that a CRNA be in the immediate
presence of a physician, podiatrist, or dentist when administering anesthesia or performing its
induction, maintenance, or emergence.5
CRNA scope of practice
The bill consolidates several existing law statutory sections governing a CRNA’s scope of
practice and also revises in part that scope of practice, by eliminating certain activities and
authorizing others.6 The following table highlights the revisions. As noted above, under current
law, each activity must be performed with physician, podiatrist, or dentist supervision, while
under the bill, a CRNA may engage in the activities in collaboration with a provider.
Activity Current law H.B. 362
Administering anesthesia. Permitted under current law in Maintained by the bill, without
the immediate presence of a requiring a physician’s,
physician, podiatrist, or dentist. podiatrist’s, or dentist’s
immediate presence.
1 R.C. 4723.01 and 4723.43.
2 R.C. 4723.01(M).
3 R.C. 4723.01(M) and 4723.43(B).
4 R.C. 4723.01(M).
5 R.C. 4723.01(M) and 4723.43.
6 R.C. 4723.43(D), 4723.433, repealed and reenacted, 4723.434, repealed, and 4723.435, repealed. See
also R.C. 4761.17.
P a g e |2 H.B. 362
As Introduced
Office of Research and Drafting LSC Legislative Budget Office
Activity Current law H.B. 362
Performing anesthesia induction, Permitted under current law in Maintained by the bill, without
maintenance, and emergence. the immediate presence of a requiring a physician’s,
physician, podiatrist, or dentist. podiatrist’s, or dentist’s
immediate presence.
Performing epidural or spinal No provision. Specifically authorized by the
anesthetic procedures. bill.
Obtaining informed consent for Permitted under current law. Maintained by the bill.
anesthesia care.
Performing and documenting Permitted under current law, but No provision.
evaluations and assessments, only when performed as follows:
which may include ordering and
During the time period
evaluating one or more
that begins on a
diagnostic tests for conditions
patient’s admission for a
related to the administration of
surgery or procedure
anesthesia.
and ends with the
patient’s discharge from
recovery;
While the CRNA is
physically present at the
health care facility;
While the CRNA’s
supervising physician,
podiatrist, or dentist is
also physically present at
the health care facility;
and
Under a written policy
adopted by the health
care facility’s medical,
nursing, and pharmacy
directors.
Performing pre-anesthetic Permitted under current law. Maintained by the bill, but also
preparation and evaluation, specifies that clinical support
post-anesthetic preparation and functions include selecting,
evaluation, post-anesthesia care, ordering, and administering
and clinical support functions. treatments, drugs, and
intravenous (IV) fluids.
P a g e |3 H.B. 362
As Introduced
Office of Research and Drafting LSC Legislative Budget Office
Activity Current law H.B. 362
Selecting, ordering, and Permitted under current law, but Maintains CRNA authority to
administering treatments, drugs, only when performed as follows: perform the activities, but
and IV fluids. eliminates all the current law
During the time period
conditions except for the
that begins on a
following: as necessary for
patient’s admission for a
patient management and care
surgery or procedure
AND for conditions related to the
and ends with the
administration of anesthesia.
patient’s discharge from
recovery;
As necessary for patient
management and care
AND for conditions
related to the
administration of
anesthesia;
While the CRNA is
physically present at the
health care facility;
While the CRNA’s
supervising physician,
podiatrist, or dentist is
physically present at the
health care facility; and
Under a written policy
adopted by the health
care facility’s medical,
nursing, and pharmacy
directors.
Directing a registered nurse Permitted under current law Maintained by the bill, but
(RN), licensed practical nurse when performing clinical support eliminates the condition that the
(LPN), or respiratory therapist to functions if the following treatment, drugs, and IV fluids
do the following: conditions are met: be ordered by a physician,
podiatrist, or dentist.
Provide supportive care, The RN, LPN, or therapist
including monitoring is authorized by law to
vital signs, conducting provide such care;
electrocardiograms, and
With respect to the
administering IV fluids;
administration of
Administer treatments, treatments, drugs, and IV
drugs, and IV fluids for fluids for anesthesia-
conditions related to the related conditions, a
administration of physician, podiatrist, or
anesthesia. dentist has ordered them.
P a g e |4 H.B. 362
As Introduced
Office of Research and Drafting LSC Legislative Budget Office
Activity Current law H.B. 362
Directing an RN, LPN, or Also permitted under current Maintained by the bill, but
respiratory therapist to do the law separate from clinical without any of the current law
following: support functions if the direction conditions.
occurs as follows:
Provide supportive care,
including monitoring During the time period
vital signs, conducting that begins on a
electrocardiograms, and patient’s admission for a
administering IV fluids; surgery or procedure
and ends with the
Administer treatments,
patient’s discharge from
drugs, and IV fluids for
recovery;
conditions related to the
administration of As necessary for patient
anesthesia. management and care;
While the CRNA is
physically present at the
health care facility;
While the CRNA’s
supervising physician,
podiatrist, or dentist is
physically present at the
health care facility;
Under a written policy
adopted by the health
care facility’s medical,
nursing, and pharmacy
directors.
Prescribing a drug for use Specifies that such prescribing is Same as current law.
outside the health care facility not authorized.
where the CRNA practices.
Note on verbal orders
The bill maintains an existing law provision specifying that a CRNA is not prohibited from
implementing a verbal order of a supervising physician, podiatrist, or dentist, except that the
bill instead refers to a consulting provider’s verbal order.7
Limits on CRNA practice
The bill eliminates the following current law limits on a CRNA’s practice:
7 R.C. 4723.433 and 4723.434, repealed.
P a g e |5 H.B. 362
As Introduced
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That a CRNA’s scope of practice, when supervised by a podiatrist, is limited to the
anesthesia procedures that the podiatrist is authorized to perform;
That a CRNA may not administer general anesthesia under the supervision of a
podiatrist in a podiatrist’s office;
That a CRNA’s scope of practice, when supervised by a dentist, is limited to the
anesthesia procedures that the dentist is authorized to perform.8
The bill also revises an existing law provision prohibiting a CRNA from engaging in
certain activities if the supervising physician, podiatrist, or dentist or the health care facility
where the nurse practices determines that it is not in a patient’s best interest for the nurse to
perform the one or more activities. Under current law, this prohibition applies only to certain
tasks and only when performed during the period beginning on a patient’s admission to a
facility for a surgery or procedure and ending with the patient’s discharge from recovery.9 But,
under the bill, the foregoing prohibition applies to any CRNA activity and at any time.10 Note
also that the bill refers to a consulting provider rather than a supervising physician, podiatrist,
or dentist.
Board rules governing dentists and podiatrists
Under the bill, the State Dental Board, when adopting rules and administering and
enforcing the law governing dentists, must not prohibit a dentist from consulting with a CRNA,
including a dentist who is not authorized to employ or use conscious sedation or general
anesthesia.11 Under existing law unchanged by the bill, a dentist must hold a conscious sedation
permit or general anesthesia permit issued by the Dental Board in order to be eligible to
employ or use conscious sedation or general anesthesia.12
Similarly, the bill prohibits the State Medical Board, when adopting rules and
administering and enforcing the law governing podiatrists, from prohibiting a podiatrist from
consulting with a CRNA, including a podiatrist who practices in a setting other than a hospital or
college of podiatric medicine and surgery.13 Under existing law unchanged by the bill, a
podiatrist may use general anesthetics only in those settings.14
8 R.C. 4