1. (1) If the REH provides outpatient surgical services, surgical procedures must be performed in a safe manner by qualified and credentialed practitioners who have been granted clinical privileges by the REH's governing authority in accordance with the REH's approved policies and procedures and the state scope of practice laws. Each provider of the surgical services offered by the REH shall be individually credentialed by the REH's governing authority and shall be governed by the applicable rules for that provider's licensing authority while providing the service and by the applicable provisions of the Board's Rules for Ambulatory Surgical Treatment Facilities, Chapter 420-5-2, Ala. Admin. Code. Surgery shall be performed only by a physician; a doctor of dental surgery or dental medicine; or a doctor of podiatric medicine.
2. (2) A qualified practitioner, as specified in paragraph (1) above, must examine the patient immediately before surgery to evaluate the risk of the procedure to be performed. A qualified practitioner, as specified in paragraph (3) below, must examine each patient before surgery to evaluate the risk of anesthesia. Before discharge from the REH, each patient must be evaluated for proper anesthesia recovery by a qualified practitioner, as specified in paragraph (3) below.
   
   
3. (3) Anesthesia shall be administered in accordance with the REH's approved policies and procedures and within state scope of practice laws. Anesthesia shall be administered to patients only by an anesthesiologist, anesthesiologist assistant, doctor of dental surgery or dental medicine, doctor of podiatric medicine, CRNA, or a physician deemed qualified by the facility's medical director. CRNAs must administer anesthesia under the direct physical supervision of a licensed physician, dentist or podiatrist, or in coordination with a licensed physician, dentist or podiatrist who is immediately available. Anesthesiologist assistants must administer anesthesia under the direct supervision of an anesthesiologist. After the administration of anesthesia, patients shall remain under the physical observation of a physician, RN, or LPN (the LPN must be directly supervised by an RN) until the patient is sufficiently alert and able to summon aid.

Author: Dana H. Billingsley

Statutory Authority: Code of Ala. 1975, §§22-21-20, et seq.

History: New Rule: Published August 31, 2023; effective October 15, 2023.