**Effective Jan. 2012, annual registration will be required for certain procedures**
- Surgery performed outside a hospital or outpatient facility licensed by the Alabama Department of Public Health.
- Definition of "surgery" -- the revision, destruction, incision or structural alteration of human tissue performed using a variety of methods and instruments.
- Can include non-surgical procedures if moderate sedation, deep sedation or general anesthesia is used.
- Includes surgery using local anesthesia, minimal sedation, moderate sedation/analgesia, deep sedation/analgesia, and general and regional anesthesia.
- Includes procedures in which Propofol is administered, given or used
- Includes liposuction when infiltration methods such as the tumescent technique are used
- Licensed physicians who maintain a practice location in Alabama and perform or offer to perform any office-based surgery/procedure which requires moderate sedation, deep sedation or general anesthesia (click here for definitions of these levels of anesthesia).
- Effective October 17, 2011: licensed physicians who maintain a practice location in Alabama and perform or offer to perform any office-based surgery/procedure in which Propofol is administered, given or used
- Effective October 17, 2011: licensed physicians who maintain a practice location in Alabama and perform or offer to perform liposuction when infiltration methods such as the tumescent technique are used
- Beginning in Jan. 2012, annual registration will be required for office based surgery/procedures physicians
- - In Jan. 2012, every licensed physician will be mailed a notification of the registration requirement
- - Registration is due by March 1 of each year
- Beginning in January 2012, registration will be online only using the web submission form. Those physicians already registered will have to re-register and complete the new form.
- If your address or status as an office-based procedures physician changes, you should notify the Board in writing.
- Board Rules, Chapter 540-X-10, set forth the requirements for office based surgery at each level of anesthesia. See sections .04 through .08.
- Physicians performing office-based surgery should carefully consider the expected level of anesthesia to be used and register with the Board where appropriate.
- Events required to be reported to the Board: all surgical related deaths and all events related to procedure that resulted in an emergency transfer of the surgical patient to the hospital, anesthetic or surgical events requiring CPR, unscheduled hospitalization related to the surgery, and surgical site deep wound infection (click here for adverse event reporting form)
- See section .10 of Board Rules, Chapter 540-X-10 for the written documents and policies and procedures encouraged by the Board.
Questions concerning the operation of the Rules and interpretations of the Rules which are not addressed here should be directed to the Board in writing.
Q: What is the Board's position regarding the use of oral medications prior
to an office-based surgical procedure?
A: The Board considers oral medications (anxiolytics) as level two anesthesia. The Board further states that responses to medications may vary from patient to patient; therefore, the physician should be prepared for a complication and/or additional anesthesia.
Q: Should a physician register as an Office-Based Surgery physician if only minimal
sedation is used? Sometimes the physician intends to use only minimal sedation but
circumstances occur which require a higher level of sedation.
A: If there is a question concerning level of sedation being given, the physician should register even though only minimal sedation was intended to be administered. Virtually any sedation administered intravenously can move from minimal to moderate or deep; consequently, the physician should always be prepared. Reasonable concern for patient safety rather than strict adherence to a specific rule should be the goal of the physician.
Q: What is the process for reporting an adverse event? What happens when an
adverse event is reported?
A: Significant adverse events (events which alter the planned post-operative management) subsequent to office-based surgery, even when minimal sedation was administered, should be reported on the Board's Adverse Event Reporting form in order for the Board to gather data for future physician education concerning patient safety. All reports are protected by Alabama law. They are not public records, nor are they available for court subpoena or for discovery proceedings. If a complication develops which results in a review by the Board, each case will be reviewed on an individual basis and on its own merits.
Q: Are physicians performing epidural pain management procedures required
to register as office-based surgery physicians?
A: An office-based procedure involving the injection of intravenous drugs having an analgesic, anesthetic or sedative effect falls, at a minimum, in the moderate sedation category. Major regional blocks including, but not limited to, spinal, epidural or caudal injection of any drug which has analgesic, anesthetic or sedative effects are in the same category as general anesthesia. Injection of drugs such as steroids or chemotherapy which do not have anesthetic, analgesic or sedative properties would usually be in the minimal category. A physician is expected to be prepared for possible reactions or untoward events relative to injection of drugs.
Q: What is meant by the requirement for Board approval of
"alternative credentialing for procedures outside the physician's core curriculum?"
A: Alternative credentialing applies when a physician performs a procedure for which he or she has trained, but the procedure was not included in the core curriculum of the physician's residency training program. A physician who seeks Board approval for alternative credentialing should submit a request to the Board with supporting documentation of training in the procedure(s).
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