Hoffman v. State Medical BoardHoffman v. State Medical Board
{¶ 1} This discretionary appeal presents the question of whether
Case Background
{¶ 2} In May 2000, the Ohio General Assembly enacted R.C. Chapter 4760, which regulates the training, certification, and practice of anesthesiologist assistants in Ohio. Am.Sub.S.B. No. 278, 148 Ohio Laws, Part V, 11484 (“S.B. 278”). Previously, anesthesiologist assistants had not been required by statute to undergo any specific training or certification.
{¶ 3} The appellee, the State Medical Board of Ohio, determines which applicants satisfy certification requirements to become anesthesiologist assistants.
{¶ 4} Joseph Hoffman, the appellant, is a certified anesthesiologist assistant in Cleveland. Since he began his career in 1982, he has performed epidural and spinal anesthetic procedures as part of his practice. In 2003, he filed an action for declaratory and injunctive relief against the board, asserting that
{¶ 5} On appeal to the Tenth District Court of Appeals, the board argued that the administrative rule did not conflict with the statute. Both parties focused their arguments on the word “assist,” a word found both in the administrative rules and in the statute. The board asserted that the statute and rules should be read together and interpreted to mean that the anesthesiologist assistant may merely help the supervising anesthesiologist as the supervising anesthesiologist personally performs the specified procedure. Hoffman, on the other hand, contended that the statutory language should be interpreted to mean that the anesthesiologist assistant, who is permitted to perform the procedure personally, thereby helps the supervising anesthesiologist in the overall treatment of the patient. The court of appeals reversed the trial court’s judgment, agreeing with the board that the rule did not clearly conflict "with the statute.
The Statute and the Administrative Rule
{¶ 6}
{¶ 7} “If the practice and supervision requirements of section 4760.08 of the Revised Code are being met, an anesthesiologist assistant may assist the supervising anesthesiologist in developing and implementing an anesthesia care plan for a patient. In providing assistance to the supervising anesthesiologist, an anesthesiologist assistant may do any of the following:
{¶ 8} “(A) Obtain a comprehensive patient history and present the history to the supervising anesthesiologist;
{¶ 9} “(B) Pretest and calibrate anesthesia delivery systems and monitor and obtain and interpret information from the systems and monitors;
{¶ 10} “(C) Assist the supervising anesthesiologist with the implementation of medically accepted monitoring techniques;
{¶ 12} “(E) Administer intermittent vasoactive drugs and start and adjust vasoactive infusions;
{¶ 13} “(F) Administer anesthetic drugs, adjuvant drugs, and accessory drugs;
{¶ 14} “(G) Assist the supervising anesthesiologist with the performance of epidural anesthetic procedures and spinal anesthetic procedures;
{¶ 15} “(H) Administer blood, blood products, and supportive fluids.” (Emphasis added.)
{¶ 16} The board adopted
The Conflict Issue Between the Rule and the Statute
{¶ 17} Administrative rules are designed to accomplish the ends sought by the legislation enacted by the General Assembly. Carroll v. Dept of Adm. Servs. (1983),
{¶ 18} The board contends that the administrative rule does not conflict with the statute. Pointing to the legislative history, the board argues that the legislature did not intend to allow anesthesiologist assistants to perform epidural and spinal anesthetic procedures. It is the board’s position that by using the word “assist” in the statute, the legislature intended to preclude anesthesiologist
{¶ 19} Because the administrative rule expressly prohibits anesthesiologist assistants from performing epidural or spinal anesthetic procedures — procedures that
Meaning of “Assist”
{¶ 20} “Assist” is not defined in R.C. Chapter 4760, but is found in the Administrative Code’s definitional section that regulates anesthesiologist assistants.
{¶ 21} “ ‘Assist’ means to carry out procedures as requested by the supervising anesthesiologist, provided that the requested procedure is within the anesthesiologist assistant’s training and scope of practice, is authorized by the practice protocol adopted by the supervising anesthesiologist, and is not prohibited by Chapter 4731. or 4760. of the Revised Code, or by any provision of Chapter 4731. of the Administrative Code.”
{¶ 22} Parsing the definition, we observe that an anesthesiologist assistant may carry out a procedure as requested by a supervising physician, provided that the procedure satisfies three tests. First, the procedure must be within the assistant’s training and scope of practice.
{¶ 23} Second, the procedure must be authorized by the practice protocol adopted by the supervising anesthesiologist.
{¶ 24} Finally, the procedures requested of an assistant must not be prohibited by R.C. Chapter 4731 or 4760. R.C. Chapter 4760 sets forth the procedures and activities that an assistant may perform. The only prohibitions listed in the statutes are the supervision and location requirements set out in
{¶ 25} In summary, the definition promulgated by the board in
{¶ 26} In advancing its definition, the board argues that the legislature intended the word “assist” to have its dictionary meaning of “to help,” or “to aid.” It contrasts the legislature’s choice of verbs such as “administer,” “establish,” and “calibrate,” used in other subsections of
{¶ 27} Applying the technical definition of “assist” to
{¶ 28} “In providing assistance to the supervising anesthesiologist, an anesthesiologist assistant may do any of the following:
{¶ 29} “ * * *
{¶ 30} “(C) [Carry out] the implementation of medically accepted monitoring techniques [as requested by the supervising anesthesiologist].
{¶ 31} “ * * *
{¶ 32} “(G) [Carry out] the performance of epidural anesthetic procedures and spinal anesthetic procedures [as requested by the supervising anesthesiologist].”
{¶ 33} Therefore, the statute permits anesthesiologist assistants to perform epidural and spinal anesthetic procedures provided that, pursuant to
{¶ 34} In contrast to the statute,
{¶ 35} We emphasize that
Conclusion
{¶ 36} We hold that
Judgment reversed.
Notes
. When S.B. 278, which enacted R.C. Chapter 4760, was debated and passed, the legislature heard testimony from anesthesiologists and anesthesiologist assistants. Rotunda, Inc., Capitol Connection, Professional Edition, at http://han2.liannah.eom/htbin/f.com/ohJban-12S:SB278.notes (accessed Mar. 27, 2007).