SENATE BILL No. 268
DIGEST OF INTRODUCED BILL
Citations Affected: IC 25-22.5-1-2; IC 25-23-1.
Synopsis: Certified registered nurse anesthetists. Includes a registered
certified nurse anesthetist in the definition of an "advanced practice
nurse". Allows a registered certified nurse anesthetist to administer
anesthesia under the direction of and in the immediate presence of a
podiatrist or a dentist if the podiatrist or dentist is certified to
administer anesthesia. (Current law allows a registered certified nurse
anesthetist to administer anesthesia under the direction of and in the
immediate presence of a physician.)
Effective: July 1, 2013.
January 8, 2013, read first time and referred to Committee on Health and Provider
First Regular Session 118th General Assembly (2013)
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between statutes enacted by the 2012 Regular Session of the General Assembly.
SENATE BILL No. 268
A BILL FOR AN ACT to amend the Indiana Code concerning
professions and occupations.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 25-22.5-1-2; (13)IN0268.1.1. -->
SECTION 1. IC 25-22.5-1-2, AS AMENDED BY P.L.77-2012,
SECTION 52, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 2. (a) This article, as it relates to the unlawful or
unauthorized practice of medicine or osteopathic medicine, does not
apply to any of the following:
(1) A student in training in a medical school approved by the
board, or while performing duties as an intern or a resident in a
hospital under the supervision of the hospital's staff or in a
program approved by the medical school.
(2) A person who renders service in case of emergency where no
fee or other consideration is contemplated, charged, or received.
(3) A paramedic (as defined in IC 16-18-2-266), an advanced
emergency medical technician (as defined in IC 16-18-2-6.5), an
emergency medical technician (as defined in IC 16-18-2-112), or
a person with equivalent certification from another state who
renders advanced life support (as defined in IC 16-18-2-7), or
basic life support (as defined in IC 16-18-2-33.5):
(A) during a disaster emergency declared by the governor
under IC 10-14-3-12 in response to an act that the governor in
good faith believes to be an act of terrorism (as defined in
IC 35-31.5-2-329); and
(B) in accordance with the rules adopted by the Indiana
emergency medical services commission or the disaster
emergency declaration of the governor.
(4) Commissioned medical officers or medical service officers of
the armed forces of the United States, the United States Public
Health Service, and medical officers of the United States
Department of Veterans Affairs in the discharge of their official
duties in Indiana.
(5) An individual who is not a licensee who resides in another
state or country and is authorized to practice medicine or
osteopathic medicine there, who is called in for consultation by an
individual licensed to practice medicine or osteopathic medicine
(6) A person administering a domestic or family remedy to a
member of the person's family.
(7) A member of a church practicing the religious tenets of the
church if the member does not make a medical diagnosis,
prescribe or administer drugs or medicines, perform surgical or
physical operations, or assume the title of or profess to be a
(8) A school corporation and a school employee who acts under
IC 34-30-14 (or IC 34-4-16.5-3.5 before its repeal).
(9) A chiropractor practicing the chiropractor's profession under
IC 25-10 or to an employee of a chiropractor acting under the
direction and supervision of the chiropractor under IC 25-10-1-13.
(10) A dental hygienist practicing the dental hygienist's profession
under IC 25-13.
(11) A dentist practicing the dentist's profession under IC 25-14.
(12) A hearing aid dealer practicing the hearing aid dealer's
profession under IC 25-20.
(13) A nurse practicing the nurse's profession under IC 25-23.
However, a certified registered nurse anesthetist (as defined in
IC 25-23-1-1.4) may administer anesthesia if the certified
registered nurse anesthetist acts under the direction of and in the
immediate presence of a physician, podiatrist, or dentist under
the requirements set forth in IC 25-23-1-30.
(14) An optometrist practicing the optometrist's profession under
(15) A pharmacist practicing the pharmacist's profession under
(16) A physical therapist practicing the physical therapist's
profession under IC 25-27.
(17) A podiatrist practicing the podiatrist's profession under
(18) A psychologist practicing the psychologist's profession under
(19) A speech-language pathologist or audiologist practicing the
pathologist's or audiologist's profession under IC 25-35.6.
(20) An employee of a physician or group of physicians who
performs an act, a duty, or a function that is customarily within
the specific area of practice of the employing physician or group
of physicians, if the act, duty, or function is performed under the
direction and supervision of the employing physician or a
physician of the employing group within whose area of practice
the act, duty, or function falls. An employee may not make a
diagnosis or prescribe a treatment and must report the results of
an examination of a patient conducted by the employee to the
employing physician or the physician of the employing group
under whose supervision the employee is working. An employee
may not administer medication without the specific order of the
employing physician or a physician of the employing group.
Unless an employee is licensed or registered to independently
practice in a profession described in subdivisions (9) through
(18), nothing in this subsection grants the employee independent
practitioner status or the authority to perform patient services in
an independent practice in a profession.
(21) A hospital licensed under IC 16-21 or IC 12-25.
(22) A health care organization whose members, shareholders, or
partners are individuals, partnerships, corporations, facilities, or
institutions licensed or legally authorized by this state to provide
health care or professional services as:
(A) a physician;
(B) a psychiatric hospital;
(C) a hospital;
(D) a health maintenance organization or limited service
health maintenance organization;
(E) a health facility;
(F) a dentist;
(G) a registered or licensed practical nurse;
(H) a midwife;
(I) an optometrist;
(J) a podiatrist;
(K) a chiropractor;
(L) a physical therapist; or
(M) a psychologist.
(23) A physician assistant practicing the physician assistant
profession under IC 25-27.5.
(24) A physician providing medical treatment under section 2.1
of this chapter.
(25) An attendant who provides attendant care services (as
defined in IC 16-18-2-28.5).
(26) A personal services attendant providing authorized attendant
care services under IC 12-10-17.1.
(27) A respiratory care practitioner practicing the practitioner's
profession under IC 25-34.5.
(b) A person described in subsection (a)(9) through (a)(18) is not
excluded from the application of this article if:
(1) the person performs an act that an Indiana statute does not
authorize the person to perform; and
(2) the act qualifies in whole or in part as the practice of medicine
or osteopathic medicine.
(c) An employment or other contractual relationship between an
entity described in subsection (a)(21) through (a)(22) and a licensed
physician does not constitute the unlawful practice of medicine under
this article if the entity does not direct or control independent medical
acts, decisions, or judgment of the licensed physician. However, if the
direction or control is done by the entity under IC 34-30-15 (or
IC 34-4-12.6 before its repeal), the entity is excluded from the
application of this article as it relates to the unlawful practice of
medicine or osteopathic medicine.
(d) This subsection does not apply to a prescription or drug order for
a legend drug that is filled or refilled in a pharmacy owned or operated
by a hospital licensed under IC 16-21. A physician licensed in Indiana
who permits or authorizes a person to fill or refill a prescription or drug
order for a legend drug except as authorized in IC 16-42-19-11 through
IC 16-42-19-19 is subject to disciplinary action under IC 25-1-9. A
person who violates this subsection commits the unlawful practice of
medicine under this chapter.
(e) A person described in subsection (a)(8) shall not be authorized
to dispense contraceptives or birth control devices.
SOURCE: IC 25-23-1-1; (13)IN0268.1.2. -->
SECTION 2. IC 25-23-1-1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 1. As used in this
(a) "Board" means the Indiana state board of nursing.
(b) "Advanced practice nurse" means:
(1) a nurse practitioner;
(2) a nurse midwife;
(3) a clinical nurse specialist; or
(4) a certified registered nurse anesthetist;
who is a registered nurse qualified to practice nursing in a specialty
role based upon the additional knowledge and skill gained through a
formal organized program of study and clinical experience, or the
equivalent as determined by the board, which does not limit but
extends or expands the function of the nurse which may be initiated by
the client or provider in settings that shall include hospital outpatient
clinics and health maintenance organizations.
(c) "Human response" means those signs, symptoms, behaviors, and
processes that denote the individual's interaction with the environment.
SOURCE: IC 25-23-1-30; (13)IN0268.1.3. -->
SECTION 3. IC 25-23-1-30, AS AMENDED BY P.L.177-2009,
SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 30. (a) A certified registered nurse anesthetist may
administer anesthesia if the certified registered nurse anesthetist acts
under the direction of and in the immediate presence of:
a physician; or
(2) a podiatrist licensed under IC 25-29 or a dentist licensed
under IC 25-14 if the podiatrist or dentist directing the
certified registered nurse anesthetist holds a certificate to
administer anesthesia to patients.
(b) Nothing in this chapter shall be construed as requiring a certified
registered nurse anesthetist to obtain prescriptive authority to
administer anesthesia under subsection (a).