CERTIFICATION OF ENROLLMENT
SENATE BILL 5184
Chapter 362, Laws of 2024
68th Legislature
2024 Regular Session
ANESTHESIOLOGIST ASSISTANTS
EFFECTIVE DATE: June 6, 2024
Passed by the Senate March 4, 2024 CERTIFICATE
Yeas 40 Nays 9
I, Sarah Bannister, Secretary of
the Senate of the State of
DENNY HECK Washington, do hereby certify that
President of the Senate the attached is SENATE BILL 5184 as
passed by the Senate and the House
of Representatives on the dates
hereon set forth.
Passed by the House February 29, 2024
Yeas 82 Nays 14
SARAH BANNISTER
LAURIE JINKINS Secretary
Speaker of the House of
Representatives
Approved March 29, 2024 11:02 AM FILED
April 1, 2024
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 SENATE BILL 5184
AS AMENDED BY THE HOUSE
Passed Legislature - 2024 Regular Session
State of Washington 68th Legislature 2023 Regular Session
By Senators Rivers, Cleveland, Braun, Dhingra, Mullet, Muzzall, and
Rolfes
Prefiled 01/06/23. Read first time 01/09/23. Referred to Committee
on Health & Long Term Care.
1 AN ACT Relating to licensure of anesthesiologist assistants;
2 reenacting and amending RCW 18.130.040 and 18.120.020; and adding a
3 new chapter to Title 18 RCW.
4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
5 NEW SECTION. Sec. 1. The definitions in this section apply
6 throughout this chapter unless the context clearly requires
7 otherwise.
8 (1) "Anesthesiologist" means an actively practicing, board-
9 eligible physician licensed under chapter 18.71, 18.71B, or 18.57 RCW
10 who has completed a residency or equivalent training in
11 anesthesiology.
12 (2) "Anesthesiologist assistant" means a person who is licensed
13 by the commission to assist in developing and implementing anesthesia
14 care plans for patients under the supervision of an anesthesiologist
15 or group of anesthesiologists approved by the commission to supervise
16 such assistant.
17 (3) "Assists" means the anesthesiologist assistant personally
18 performs those duties and responsibilities delegated by the
19 anesthesiologist. Delegated services must be consistent with the
20 delegating anesthesiologist's education, training, experience, and
21 active practice. Delegated services must be of the type that a
p. 1 SB 5184.SL
 1 reasonable and prudent anesthesiologist would find within the scope
2 of sound medical judgment to delegate.
3 (4) "Commission" means the Washington medical commission.
4 (5) "Practice medicine" has the meaning defined in RCW 18.71.011.
5 (6) "Secretary" means the secretary of health or the secretary's
6 designee.
7 (7) "Supervision" means the immediate availability of the
8 medically directing anesthesiologist for consultation and direction
9 of the activities of the anesthesiologist assistant. A medically
10 directing anesthesiologist is immediately available if they are in
11 physical proximity that allows the anesthesiologist to reestablish
12 direct contact with the patient to meet medical needs and any urgent
13 or emergent clinical problems, and personally participating in the
14 most demanding procedures of the anesthesia plan including, if
15 applicable, induction and emergence. These responsibilities may also
16 be met through coordination among anesthesiologists of the same group
17 or department.
18 NEW SECTION. Sec. 2. (1) The commission shall adopt rules
19 fixing the qualifications and the educational and training
20 requirements for licensure as an anesthesiologist assistant. The
21 requirements shall include completion of an anesthesiologist
22 assistant program accredited by the commission on accreditation of
23 allied health education programs, or successor organization, and
24 within one year successfully taking and passing an examination
25 administered by the national commission for the certification of
26 anesthesiologist assistants or other examination approved by the
27 commission.
28 (2) Applicants for licensure shall file an application with the
29 commission on a form prepared by the secretary with the approval of
30 the commission, detailing the education, training, and experience of
31 the applicant and such other information as the commission may
32 require. The application shall be accompanied by a fee determined by
33 the secretary as provided in RCW 43.70.250 and 43.70.280. Each
34 applicant shall furnish proof satisfactory to the commission of the
35 following:
36 (a) That the applicant has completed an accredited
37 anesthesiologist assistant program approved by the commission and is
38 eligible to take the examination approved by the commission; and
p. 2 SB 5184.SL
 1 (b) That the applicant is physically and mentally capable of
2 practicing as an anesthesiologist assistant with reasonable skill and
3 safety. The commission may require an applicant to submit to such
4 examination or examinations as it deems necessary to determine an
5 applicant's physical or mental capability, or both, to safely
6 practice as an anesthesiologist assistant.
7 (3)(a) The commission may approve, deny, or take other
8 disciplinary action upon the application for a license as provided in
9 the uniform disciplinary act, chapter 18.130 RCW.
10 (b) The license shall be renewed as determined under RCW
11 43.70.250 and 43.70.280. The commission shall request licensees to
12 submit information about their current professional practice at the
13 time of license renewal and licensees must provide the information
14 requested.
15 (4) No person shall practice as an anesthesiologist assistant or
16 represent that they are a "certified anesthesiologist assistant" or
17 "anesthesiologist assistant" or "C.A.A." or "A.A." without a license
18 granted by the commission.
19 NEW SECTION. Sec. 3. (1) The commission shall adopt rules
20 establishing the requirements and limitations on the practice by and
21 supervision of anesthesiologist assistants, including the number of
22 anesthesiologist assistants an anesthesiologist may supervise
23 concurrently. Unless approved by the commission, an anesthesiologist
24 may not concurrently supervise more than four specific, individual
25 anesthesiologist assistants at any one time.
26 (2) The commission may adopt rules for the arrangement of other
27 anesthesiologists to serve as backup or on-call supervising
28 anesthesiologists for multiple anesthesiologist assistants.
29 NEW SECTION. Sec. 4. (1) An anesthesiologist assistant may not
30 exceed the scope of their supervising anesthesiologist's practice and
31 may assist with those duties and responsibilities delegated to them
32 by the supervising anesthesiologist, and for which they are competent
33 to assist with based on their education, training, and experience.
34 Duties which an anesthesiologist may delegate to an anesthesiologist
35 assistant include but are not limited to:
36 (a) Assisting with preoperative anesthetic evaluations,
37 postoperative anesthetic evaluations, and patient progress notes, all
38 to be cosigned by the supervising anesthesiologist within 24 hours;
p. 3 SB 5184.SL
 1 (b) Administering and assisting with preoperative consultations;
2 (c) Under the supervising anesthesiologist's consultation and
3 direction, order perioperative pharmaceutical agents, medications,
4 and fluids, to be used only at the facility where ordered, including
5 but not limited to controlled substances, which may be administered
6 prior to the cosignature of the supervising anesthesiologist. The
7 supervising anesthesiologist may review and if required by the
8 facility or institutional policy must cosign these orders in a timely
9 manner;
10 (d) Changing or discontinuing a medical treatment plan, after
11 consultation with the supervising anesthesiologist;
12 (e) Calibrating anesthesia delivery systems and obtaining and
13 interpreting information from the systems and monitors, in
14 consultation with an anesthesiologist;
15 (f) Assisting the supervising anesthesiologist with the
16 implementation of medically accepted monitoring techniques;
17 (g) Assisting with basic and advanced airway interventions,
18 including but not limited to endotracheal intubation, laryngeal mask
19 insertion, and other advanced airways techniques;
20 (h) Establishing peripheral intravenous lines, including
21 subcutaneous lidocaine use;
22 (i) Establishing radial and dorsalis pedis arterial lines;
23 (j) Assisting with general anesthesia, including induction,
24 maintenance, and emergence;
25 (k) Assisting with procedures associated with general anesthesia,
26 such as but not limited to gastric intubation;
27 (l) Administering intermittent vasoactive drugs and starting and
28 titrating vasoactive infusions for the treatment of patient responses
29 to anesthesia;
30 (m) Assisting with spinal and intravenous regional anesthesia;
31 (n) Maintaining and managing established neuraxial epidurals and
32 regional anesthesia;
33 (o) Assisting with monitored anesthesia care;
34 (p) Evaluating and managing patient controlled analgesia,
35 epidural catheters, and peripheral nerve catheters;
36 (q) Obtaining venous and arterial blood samples;
37 (r) Assisting with, ordering, and interpreting appropriate
38 preoperative, point of care, intraoperative, or postoperative
39 diagnostic tests or procedures as authorized by the supervising
40 anesthesiologist;
p. 4 SB 5184.SL
 1 (s) Obtaining and administering perioperative anesthesia and
2 related pharmaceutical agents including intravenous fluids and blood
3 products;
4 (t) Participating in management of the patient while in the
5 preoperative suite and recovery area;
6 (u) Providing assistance to a cardiopulmonary resuscitation team
7 in response to a life-threatening situation;
8 (v) Participating in administrative, research, and clinical
9 teaching activities as authorized by the supervising
10 anesthesiologist; and
11 (w) Assisting with such other tasks not prohibited by law under
12 the supervision of a licensed anesthesiologist that an
13 anesthesiologist assistant has been trained and is proficient to
14 assist with.
15 (2) Nothing in this section shall be construed to prevent an
16 anesthesiologist assistant from having access to and being able to
17 obtain drugs as directed by the supervising anesthesiologist. An
18 anesthesiologist assistant may not prescribe, order, compound, or
19 dispense drugs, medications, or devices of any kind.
20 NEW SECTION. Sec. 5. No anesthesiologist who supervises a
21 licensed anesthesiologist assistant in accordance with and within the
22 terms of any permission granted by the commission is considered as
23 aiding and abetting an unlicensed person to practice medicine. The
24 supervising anesthesiologist and anesthesiologist assistant shall
25 retain professional and personal responsibility for any act which
26 constitutes the practice of medicine as defined in RCW 18.71.011 when
27 performed by the anesthesiologist assistant.
28 NEW SECTION. Sec. 6. An anesthesiologist assistant may sign and
29 attest to any certificates, cards, forms, or other required
30 documentation that the anesthesiologist assistant's supervising
31 anesthesiologist may sign, provided that it is within the
32 anesthesiologist assistant's scope of practice.
33 NEW SECTION. Sec. 7. (1) The uniform disciplinary act, chapter
34 18.130 RCW, governs the issuance and denial of licenses and the
35 discipline of licensees under this chapter.
36 (2) The commission shall consult with the board of osteopathic
37 medicine and surgery when investigating allegations of unprofessional
p. 5 SB 5184.SL
 1 conduct against a licensee who has a supervising anesthesiologist
2 license under chapter 18.57 RCW.
3 Sec. 8. RCW 18.130.040 and 2023 c 469 s 18, 2023 c 460 s 15,
4 2023 c 425 s 27, 2023 c 270 s 14, 2023 c 175 s 11, and 2023 c 123 s
5 21 are each reenacted and amended to read as follows:
6 (1) This chapter applies only to the secretary and the boards and
7 commissions having jurisdiction in relation to the professions
8 licensed under the chapters specified in this section. This chapter
9 does not apply to any business or profession not licensed under the
10 chapters specified in this section.
11 (2)(a) The secretary has authority under this chapter in relation
12 to the following professions:
13 (i) Dispensing opticians licensed and designated apprentices
14 under chapter 18.34 RCW;
15 (ii) Midwives licensed under chapter 18.50 RCW;
16 (iii) Ocularists licensed under chapter 18.55 RCW;
17 (iv) Massage therapists and businesses licensed under chapter
18 18.108 RCW;
19 (v) Dental hygienists licensed under chapter 18.29 RCW;
20 (vi) Acupuncturists or acupuncture and Eastern medicine
21 practitioners licensed under chapter 18.06 RCW;
22 (vii) Radiologic technologists certified and X-ray technicians
23 registered under chapter 18.84 RCW;
24 (viii) Respiratory care practitioners licensed under chapter
25 18.89 RCW;
26 (ix) Hypnotherapists registered, agency affiliated counselors
27 registered, certified, or licensed, and advisors and counselors
28 certified under chapter 18.19 RCW;
29 (x) Persons licensed as mental health counselors, mental health
30 counselor associates, marriage and family therapists, marriage and
31 family therapist associates, social workers, social work associates—
32 advanced, and social work associates—independent clinical under
33 chapter 18.225 RCW;
34 (xi) Persons registered as nursing pool operators under chapter
35 18.52C RCW;
36 (xii) Nursing assistants registered or certified or medication
37 assistants endorsed under chapter 18.88A RCW;
38 (xiii) Dietitians and nutritionists certified under chapter
39 18.138 RCW;
p. 6 SB 5184.SL
 1 (xiv) Substance use disorder professionals, substance use
2 disorder professional trainees, or co-occurring disorder specialists
3 certified under chapter 18.205 RCW;
4 (xv) Sex offender treatment providers and certified affiliate sex
5 offender treatment providers certified under chapter 18.155 RCW;
6 (xvi) Persons licensed and certified under chapter 18.73 RCW or
7 RCW 18.71.205;
8 (xvii) Orthotists and prosthetists licensed under chapter 18.200
9 RCW;
10 (xviii) Surgical technologists registered under chapter 18.215
11 RCW;
12 (xix) Recreational therapists under chapter 18.230 RCW;
13 (xx) Animal massage therapists certified under chapter 18.240
14 RCW;
15 (xxi) Athletic trainers licensed under chapter 18.250 RCW;
16 (xxii) Home care aides certified under chapter 18.88B RCW;
17 (xxiii) Genetic counselors licensed under chapter 18.290 RCW;
18 (xxiv) Reflexologists certified under chapter 18.108 RCW;
19 (xxv) Medical assistants-certified, medical assistants-
20 hemodialysis technician, medical assistants-phlebotomist, forensic
21 phlebotomist, and medical assistants-registered certified and
22 registered under chapter 18.360 RCW;
23 (xxvi) Behavior analysts, assistant behavior analysts, and
24 behavior technicians under chapter 18.380 RCW;
25 (xxvii) Birth doulas certified under chapter 18.47 RCW;
26 (xxviii) Music therapists licensed under chapter 18.233 RCW;
27 (xxix) Behavioral health support specialists certified under
28 chapter 18.227 RCW; and
29 (xxx) Certified peer specialists and certified peer specialist
30 trainees under chapter 18.420 RCW.
31 (b) The boards and commissions having authority under this
32 chapter are as follows:
33 (i) The podiatric medical board as established in chapter 18.22
34 RCW;
35 (ii) The chiropractic quality assurance commission as established
36 in chapter 18.25 RCW;
37 (iii) The dental quality assurance commission as established in
38 chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW,
39 licenses and registrations issued under chapter 18.260 RCW, licenses
p. 7 SB 5184.SL
 1 issued under chapter 18.265 RCW, and certific