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New Jersey Association of Nurse Anesthetists, Inc. v. New Jersey State Board of Medical Examiners

June 29, 2005

NEW JERSEY ASSOCIATION OF NURSE ANESTHETISTS, INC., APPELLANT-APPELLANT,
v.
NEW JERSEY STATE BOARD OF MEDICAL EXAMINERS, RESPONDENT-RESPONDENT.
NEW JERSEY STATE SOCIETY OF ANESTHESIOLOGISTS, RESPONDENT-INTERVENOR.



On certification to the Superior Court, Appellate Division, whose opinion is reported at 372 N.J. Super. 554 (2004).

SYLLABUS BY THE COURT

(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the interests of brevity, portions of any opinion may not have been summarized).

(NOTE: This Court wrote no full opinion in this case. Rather, the Court's affirmance of the judgment of the Appellate Division is based substantially on the reasons expressed in the written opinion below.)

In 1997, the State Board of Medical Examiners (BME) proposed regulations, later codified at N.J.A.C. 13:35-4A.1 to -4A.18, setting forth standards for the administration of anesthesia during surgery performed in a physician's office (as opposed to anesthesia administered in a hospital or in ambulatory care settings). The proposal established that anesthesia could be administered only by physicians meeting certain standards or by Certified Registered Nurse Anesthetists (CRNAs) under the supervision of a physician meeting those standards. The physician administering or supervising the administration of anesthesia was required, depending on the type of anesthesia, to meet additional educational or certification requirements.

On June 15, 1998, the BME adopted the proposed regulations. Further proceedings regarding privilege followed, resulting in the adoption of alternative privileging procedures on November 13, 2002. The BME withheld implementation of the supervision requirements during the pendency of the privileging issues.

The New Jersey State Association of Nurse Anesthetists (NJANA) appealed, and the Appellate Division stayed implementation of the regulations pending the outcome of the case. On appeal, NJANA argued that the promulgation of the regulations was an unauthorized incursion on the nursing profession and that the regulations lacked any factual support, thus rendering them arbitrary.

The Appellate Division rejected NJANA's arguments and upheld the regulations. The appellate panel based its conclusion, among other things, on the scope of the BME's authority over the practice of medicine, the presumption of validity of administrative regulations, the deference granted to an administrative agency decision, and the legitimate distinctions between the training of physicians and CRNAs.

The Supreme Court granted certification.

HELD: Judgment of the Appellate Division is AFFIRMED substantially for the reasons expressed in Judge Alley's written opinion. The rules promulgated by the New Jersey Board of Medical Examiners and challenged by the New Jersey State Association of Nurse Anesthetists, Inc. were within the BME's delegated authority and were enacted in accordance with applicable legal principles.

1. When a matter comes before a court on appeal from the promulgation of a rule by an administrative agency, the court's function is not to assess the wisdom of the agency's decision. Rather, the court's narrow function, as fully understood by the Appellate Division in this case, is to rule on whether the subject matter falls within the substantive authority delegated to the agency and whether the rule was enacted in accordance with applicable legal principles. (Pp. 6-7)

2. The Appellate Division properly noted that the administration of anesthesia is the practice of medicine and that the regulations fall squarely within the BME's core jurisdiction, the licensing and qualifications of physicians and how they perform their professional services. (Pp.7-8)

3. NJANA's claim that the BME's action was arbitrary is unavailing. Furthermore, it is fundamentally reasonable that additional education and training would enable anesthesiologists administering or overseeing anesthesia to better protect patients and to respond when complications occur. Thus, NJANA failed to overcome the presumption of validity of the regulations. (P.8)

CHIEF JUSTICE PORITZ and JUSTICES LONG, ZAZZALI, ALBIN, WALLACE and RIVERA-SOTO join in this opinion. JUSTICE ...


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