NEW JERSEY REGISTER
MONDAY, MAY 5, 2003
VOLUME 34, NUMBER 9
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF MEDICAL EXAMINERS
NOTICE OF ADMINISTRATIVE CORRECTIONS SURGERY,
SPECIAL PROCEDURES, AND ANESTHESIA SERVICES PERFORMED IN AN
OFFICE SETTING DEFINITION OF "REGIONAL ANESTHESIA";
STANDARDS FOR ADMINISTERING OR SUPERVISING THE ADMINISTRATION
OF ANESTHESIA SERVICES IN AN OFFICE;
ADMINISTRATION OF CONSCIOUS SEDATION--AUTHORIZED PERSONNEL
N.J.A.C. 13:35-4A.3, 4A.7 and 4A.10
Take notice that the Division of Consumer Affairs has discovered errors in the
text of N.J.A.C. 13:35-4A.3, 4A.7 and 4A.10, arising under the
proposal and adoption of amendments to N.J.A.C. 13:35-4A effective December
16, 2003. See 33 N.J.R. 3870(a) and 34 N.J.R. 4449(a).
In N.J.A.C. 13:35-4A.3, the definition of "minor conduction block" contains
the term "brachial plexus anesthesia." This term is a correction upon adoption
of the proposed term "brachial anesthesia." However, in making the term
correction upon adoption, the current use of "brachial anesthesia" in the
definition of "regional anesthesia" was overlooked. Through this notice of
administrative correction, the term "brachial anesthesia" in the definition of
"regional anesthesia" is corrected as "brachial plexus anesthesia."
In N.J.A.C. 13:35-4A.7(a), the word "physician" in the second sentence is
corrected as "practitioner" in order to correspond to "practitioner" in the
first clause of the sentence.
In N.J.A.C. 13:35-4A.10(a)1, the word "physician" in the phrase, "[a]
physician privileged by a hospital or the Board pursuant to N.J.A.C. 13:35-
4A.12 to provide conscious sedation," was intended by the Board of Medical
Examiners to be replaced with "practitioner," which is defined at N.J.A.C.
13:35-4A.3 to mean a physician or a podiatrist. In the section dealing
generally with the standards for administering or supervising the
administration of anesthesia services in an office, N.J.A.C. 13:35-4A.7,
references to "physician" were changed to "practitioner." As explained in the
proposal Summary, these changes were made because, "the Board has recognized
that in a number of instances, particularly at N.J.A.C. 13:35-4A.7 where it
has made reference to physician, the privileges described could be obtained by
a properly privileged podiatrist and, therefore, the term practitioner has been
substituted." See 33 N.J.R. at 3871. As indicated by this language, N.J.A.C.
13:35-4A.7 was one, but not the only, section where the change from physician
to practitioner was intended to be made; however, the change from physician to
practitioner intended to be made in N.J.A.C. 13:35-4A.10, concerning
administration of conscious sedation, were inadvertently omitted from the
That a change from "physician" to "practitioner" was intended for N.J.A.C.
13:35-4A.10, and not for N.J.A.C. 13:35-4A.8 (concerning administration of
general anesthesia) or N.J.A.C. 13:35-4A.9 (concerning administration of
regional anesthesia), is reflected in the three rules' common requirement in
paragraph (a)1 that only "[a] physician privileged by a hospital or the Board
pursuant to N.J.A.C. 13:35-4A.12 to provide [general anesthesia/regional
anesthesia/conscious sedation] and who . . . completes [specified continuing
medical education]" can administer general anesthesia/regional anesthesia/
conscious sedation in an office. Since hospital privileges to provide general
anesthesia or regional anesthesia are given only to physicians, and all of the
criteria to be privileged by the Board to provide or supervise the
administration of general anesthesia or regional anesthesia under N.J.A.C.
13:35-4A.12(a) can only be satisfied by physicians, it follows that physicians
are those who may be eligible to administer and monitor general anesthesia
under N.J.A.C. 13:35-4A.8(a)1 and regional anesthesia under N.J.A.C.
13:35-4A.9(a)1. However, the Board may privilege a practitioner (either a
physician or podiatrist) to administer or supervise the administration of
conscious sedation under N.J.A.C. 13:35-4A.12(b), as a podiatrist would be
able to satisfy the criteria in N.J.A.C. 13:35-4A.12(b)1, 2iii and
3. Therefore, the use of "practitioner" rather than "physician" in
N.J.A.C. 13:35-4A.10(a)1 concerning administration of conscious sedation
in an office is correct.
Another error in N.J.A.C. 13:35-4A.10(a)1 is the date July 1, 2001 as
the beginning of the first three-year period during which specified continuing
medical education must be completed in order for a practitioner (as corrected
by this notice) to be able to administer conscious sedation in an office. As
originally adopted effective June 15, 1998 (see 29 N.J.R. 2238(a) and 30 N.J.R.
2236(b)), this paragraph and similar requirements in N.J.A.C. 13:35-4A.8(a)
1 and 4A.9(a)1 set the start of the first three-year period at July 1,
1998. However, implementation of these requirements was not enforced pending
the promulgation of the Board privileging rule, N.J.A.C. 13:35-4A.12, which
was effective December 16, 2002 (see 30 N.J.R. 4485(b)). While the year 1998 in
that date in N.J.A.C. 13:35-4A.8(a)1 and 4A.9(a)1 was proposed to
be replaced with a "yet unspecified date one year after the adoption," with the
date becoming July 1, 2004 upon adoption, in N.J.A.C. 13:35-4A.10(a)1,
July 1, "2001" was inadvertently proposed and adopted to replace July 1,
"1998." That this date was not that intended by the Board is indicated by the
use of identical dates in the original adoption of N.J.A.C. 13:35-4A.8(a)
1, 4A.9(a)1 and 4A.10(a)1, the revised dates proposed and
adopted in N.J.A.C. 13:35-4A.8(a)1 and 4A.9(a)1, and the fact that
the effect of "July 1, 2001" would be to render the first three-year continuing
medical education requirement under N.J.A.C. 13:35-4A.10(a)1
inappropriately retroactive, as its duration would commence almost 1 1/2 years
prior to the effectiveness of the requirement. On this basis, "July 1, 2001"
in N.J.A.C. 13:35-4A.10(a)1 is being corrected to "July 1, 2004."
This notice of administrative corrections is published pursuant to N.J.A.C.
Full text of the corrected rules follows:
<< NJ ADC 13:35-4A.3 >>
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Regional anesthesia" means the administration of anesthetic agents to a patient to interrupt nerve impulses without loss of consciousness and includes epidural, caudal, spinal and brachial <<+plexus+>> anesthesia. Regional anesthesia does not include minor conduction blocks as defined in this section.
<< NJ ADC 13:35-4A.7 >>
13:35-4A.7 Standards for administering or supervising the administration of anesthesia services in an office; pre-anesthesia counseling; patient monitoring; recovery; patient record; discharge of patient
(a) A practitioner who administers or supervises the administration and monitoring of anesthesia services in an office shall be privileged by a hospital to provide the particular anesthesia service. If a practitioner is not privileged but wishes to administer or supervise the administration of anesthesia services, the <<-physician->> <<+practitioner+>> shall apply to the Board pursuant to N.J.A.C. 13:35-4A.12 to seek Board-approved privileging.
(b)-(i) (No change.)
<< NJ ADC 13:35-4A.10 >>
13:35-4A.10 Administration of conscious sedation; authorized personnel
(a) Conscious sedation shall be administered in an office only by the followingindividuals:
1. A <<-physician->> <<+practitioner+>> privileged by a hospital or the Board pursuant to N.J.A.C. 13:35-4A.12 to provide conscious sedation and who, during every consecutive three-year period beginning July 1, <<- 2001->> <<+2004+>>, completes at least eight Category I or II hours of continuing medical education in any anesthesia services, including conscious sedation exclusively, or in anesthesia as it relates to the physician's field of practice, which either meet the criteria for credit towards the Physician's Recognition Award of the American Medical Association or have been approved by the American Osteopathic Association;
2.-3. (No change.)
(b)-(e) (No change.)