Case Title: Hoffman v. State Med. Bd. of Ohio

Citation: 2007-Ohio-2201

Docket Number: 20051754

State: ohio

Court: Ohio Supreme Court

Date: 2007-05-23T00:00:00Z

Document:
[Cite as Hoffman v. State Med. Bd. of Ohio, 113 Ohio St.3d 376, 2007-Ohio-2201.] 
 
 
HOFFMAN, APPELLANT, v. STATE MEDICAL BOARD OF OHIO, APPELLEE. 
[Cite as Hoffman v. State Med. Bd. of Ohio,  
113 Ohio St.3d 376, 2007-Ohio-2201.] 
Ohio Adm.Code 4731-24-04(A), which prohibits anesthesiologist assistants from 
performing epidural and spinal anesthetic procedures, is invalid because it 
conflicts with R.C. 4760.09. 
(No. 2005-1754 – Submitted January 10, 2007 – Decided May 23, 2007.) 
APPEAL from the Court of Appeals for Franklin County,  
No. 04AP-839, 2005-Ohio-3682. 
__________________ 
SYLLABUS OF THE COURT 
1. Ohio Adm.Code 4731-24-04(A), which prohibits anesthesiologist assistants 
from performing epidural and spinal anesthetic procedures, is invalid 
because it conflicts with R.C. 4760.09. 
2. The term “assist” as used in R.C. 4760.09 means “to carry out procedures as 
requested by the supervising anesthesiologist.” 
__________________ 
LANZINGER, J. 
{¶ 1} This discretionary appeal presents the question of whether Ohio 
Adm.Code 4731-24-04(A), which prohibits anesthesiologist assistants from 
performing epidural and spinal anesthetic procedures, conflicts with R.C. 
4760.09, which permits anesthesiologist assistants to assist supervising 
anesthesiologists with the performance of a variety of procedures. We hold that 
because there is a conflict, the Ohio Administrative Code regulation is invalid. 
Case Background 
SUPREME COURT OF OHIO 
2 
{¶ 2} In May 2000, the Ohio General Assembly enacted R.C. Chapter 
4760, which regulates the training, certification, and practice of anesthesiologist 
assistants in Ohio.  Am.Sub.S.B. No. 278, 148 Ohio Laws, Part V, 11484 (“S.B. 
278”).  Previously, anesthesiologist assistants had not been required by statute to 
undergo any specific training or certification. 
{¶ 3} The appellee, the State Medical Board of Ohio, determines which 
applicants satisfy certification requirements to become anesthesiologist assistants.  
R.C. 4760.04.  The board is also authorized by R.C. 4760.19 to adopt rules to 
implement R.C. Chapter 4760.  In May 2003, the board adopted Ohio Adm.Code 
4731-24-04(A), which prohibits anesthesiologist assistants from performing 
epidural and spinal anesthetic procedures. 
{¶ 4} Joseph Hoffman, the appellant, is a certified anesthesiologist 
assistant in Cleveland.  Since he began his career in 1982, he has performed 
epidural and spinal anesthetic procedures as part of his practice.  In 2003, he filed 
an action for declaratory and injunctive relief against the board, asserting that 
Ohio Adm.Code 4731-24-04(A) conflicts with R.C. 4760.09, the statute that lists 
the authorized activities of anesthesiologist assistants.  After considering cross-
motions for summary judgment, the trial court granted summary judgment in 
favor of Hoffman, finding the rule to be in clear conflict with the statute. 
{¶ 5} On appeal to the Tenth District Court of Appeals, the board argued 
that the administrative rule did not conflict with the statute.  Both parties focused 
their arguments on the word “assist,” a word found both in the administrative 
rules and in the statute.  The board asserted that the statute and rules should be 
read together and interpreted to mean that the anesthesiologist assistant may 
merely help the supervising anesthesiologist as the supervising anesthesiologist 
personally performs the specified procedure.  Hoffman, on the other hand, 
contended that the statutory language should be interpreted to mean that the 
anesthesiologist assistant, who is permitted to perform the procedure personally, 
January Term, 2007 
3 
thereby helps the supervising anesthesiologist in the overall treatment of the 
patient.  The court of appeals reversed the trial court’s judgment, agreeing with 
the board that the rule did not clearly conflict with the statute. 
The Statute and the Administrative Rule 
{¶ 6} R.C. 4760.09 governs the scope of practice of anesthesiologist 
assistants and provides:  
{¶ 7} “If the practice and supervision requirements of section 4760.08 of 
the Revised Code are being met, an anesthesiologist assistant may assist the 
supervising anesthesiologist in developing and implementing an anesthesia care 
plan for a patient. In providing assistance to the supervising anesthesiologist, an 
anesthesiologist assistant may do any of the following: 
{¶ 8} “(A) Obtain a comprehensive patient history and present the 
history to the supervising anesthesiologist; 
{¶ 9} “(B) Pretest and calibrate anesthesia delivery systems and monitor 
and obtain and interpret information from the systems and monitors; 
{¶ 10} “(C) 
Assist 
the 
supervising 
anesthesiologist 
with 
the 
implementation of medically accepted monitoring techniques; 
{¶ 11} “(D) Establish basic and advanced airway interventions, including 
intubation of the trachea and performing ventilatory support; 
{¶ 12} “(E) Administer intermittent vasoactive drugs and start and adjust 
vasoactive infusions; 
{¶ 13} “(F) Administer anesthetic drugs, adjuvant drugs, and accessory 
drugs; 
{¶ 14} “(G) Assist the supervising anesthesiologist with the performance 
of epidural anesthetic procedures and spinal anesthetic procedures; 
{¶ 15} “(H) Administer blood, blood products, and supportive fluids.”  
(Emphasis added.) 
SUPREME COURT OF OHIO 
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{¶ 16} The board adopted Ohio Adm.Code 4731-24-04(A) after R.C. 
4760.09 was enacted.  This rule expressly prohibits anesthesiologist assistants 
from performing epidural and spinal anesthetic procedures: “(A) Nothing in this 
chapter of the Administration Code or Chapter 4760. of the Revised Code shall 
permit an anesthesiologist assistant to perform any anesthetic procedure not 
specifically authorized by Chapter 4760. of the Revised Code, including epidural 
and spinal anesthetic procedures and invasive medically accepted monitoring 
techniques. For purposes of this chapter of the Administrative Code, ‘invasive 
medically 
accepted 
monitoring 
techniques’ 
means 
pulmonary 
artery 
catheterization, central venous catheterization, and all forms of arterial 
catheterization with the exception of brachial, radial and dorsalis pedis 
cannulation.” 
The Conflict Issue Between the Rule and the Statute 
{¶ 17} Administrative rules are designed to accomplish the ends sought 
by the legislation enacted by the General Assembly.  Carroll v. Dept. of Adm. 
Servs. (1983), 10 Ohio App.3d 108, 110, 10 OBR 132, 460 N.E.2d 704.  
Therefore, “[r]ules promulgated by administrative agencies are valid and 
enforceable unless unreasonable or in conflict with statutory enactments covering 
the same subject matter.”  State ex rel. Curry v. Indus. Comm. (1979), 58 Ohio 
St.2d 268, 269, 12 O.O.3d 271, 389 N.E.2d 1126.  The board derives its power to 
adopt administrative rules from R.C. 4760.19, which authorizes the board to adopt 
rules to implement R.C. Chapter 4760.  However, an administrative rule may not 
add to or subtract from a legislative enactment.  Cent. Ohio Joint Vocational 
School Dist. Bd. of Edn. v. Ohio Bur. of Emp. Servs. (1986), 21 Ohio St.3d 5, 10, 
21 OBR 269, 487 N.E.2d 288.  If it does, it creates a clear conflict with the 
statute, and the rule is invalid.  Id. 
{¶ 18} The board contends that the administrative rule does not conflict 
with the statute.  Pointing to the legislative history, the board argues that the 
January Term, 2007 
5 
legislature did not intend to allow anesthesiologist assistants to perform epidural 
and spinal anesthetic procedures.  It is the board’s position that by using the word 
“assist” in the statute, the legislature intended to preclude anesthesiologist 
assistants from actually inserting the needle during epidural or spinal anesthetic 
procedures.  On the other hand, Hoffman argues that the legislature used the word 
“assist” in its technical sense, which he argues is “to perform procedures as 
requested by a supervising physician.”  To support his assertion that this is the 
technical meaning of the word “assist” within the field of anesthesiology, 
Hoffman submitted an affidavit from Joel Zivot, M.D., a board-certified 
anesthesiologist and the director of the anesthesiologist-assistant program at Case 
Western Reserve University, who stated that, as used in the medical field, the 
word “assist” has a technical meaning, which is “to perform the help that is 
needed by a physician, and includes the actual performance of procedures under 
appropriate circumstances.”  Hoffman also notes that the board had used this 
same meaning for “assist” in its administrative rules relating to R.C. Chapter 
4760.  Under Hoffman’s interpretation, an anesthesiologist assistant is allowed to 
insert the needle under the direct supervision of the anesthesiologist during 
epidural or spinal anesthetic procedures. Thus, he argues, the rule prohibiting that 
practice conflicts with the statute. 
{¶ 19} Because 
the 
administrative 
rule 
expressly 
prohibits 
anesthesiologist assistants from performing epidural or spinal anesthetic 
procedures—procedures that R.C. 4760.09(G) allows an anesthesiologist assistant 
to “assist” in, the outcome of this case depends upon the meaning of the word 
“assist.” 
Meaning of “Assist” 
{¶ 20} “Assist” is not defined in R.C. Chapter 4760, but is found in the 
Administrative Code’s definitional section that regulates anesthesiologist 
assistants. Ohio Adm.Code 4731-24-01.  Hoffman claims that the Administrative 
SUPREME COURT OF OHIO 
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Code definition is consistent with the technical meaning of “assist” that is 
generally accepted in the field of anesthesiology.  Ohio Adm.Code 4731-24-01(B) 
states: 
{¶ 21} “ ‘Assist’ means to carry out procedures as requested by the 
supervising anesthesiologist, provided that the requested procedure is within the 
anesthesiologist assistant’s training and scope of practice, is authorized by the 
practice protocol adopted by the supervising anesthesiologist, and is not 
prohibited by Chapter 4731. or 4760. of the Revised Code, or by any provision of 
Chapter 4731. of the Administrative Code.” 
{¶ 22} Parsing the definition, we observe that an anesthesiologist assistant 
may carry out a procedure as requested by a supervising physician, provided that 
the procedure satisfies three tests.  First, the procedure must be within the 
assistant’s training and scope of practice.  R.C. 4760.031 sets forth the training 
requirements for certification as an anesthesiologist assistant.  Those requirements 
include clinical experience consisting of at least 2,000 hours of direct patient 
contact, including instruction on indwelling vascular catheter placement, 
including intravenous and arterial catheters; administration and maintenance of 
volatile anesthetics, anesthetic agents, narcotics, hypnotics, and muscle relaxants; 
patient monitoring; and regional anesthesia techniques.  These statutory 
requirements ensure that the anesthesiologist assistant has the skills to perform the 
procedures that a supervising anesthesiologist may request.  It appears that 
epidural and spinal anesthetic procedures are subjects covered within an 
assistant’s training and scope of practice. 
{¶ 23} Second, the procedure must be authorized by the practice protocol 
adopted by the supervising anesthesiologist.  R.C. 4760.08 requires that the 
supervising anesthesiologist adopt written practice protocol that delineates the 
services that the assistant is authorized to provide and the manner in which the 
anesthesiologist will supervise the assistant.  Significantly, the anesthesiologist 
January Term, 2007 
7 
assistant is prohibited from practicing unless he or she is “under the direct 
supervision and in the immediate presence” of an anesthesiologist “who is 
actively and directly engaged in the clinical practice of medicine.”  R.C. 4760.08.  
Furthermore, the assistant may practice only in a hospital or ambulatory surgical 
facility.  Id. 
{¶ 24} Finally, the procedures requested of an assistant must not be 
prohibited by R.C. Chapter 4731 or 4760.  R.C. Chapter 4760 sets forth the 
procedures and activities that an assistant may perform.  The only prohibitions 
listed in the statutes are the supervision and location requirements set out in R.C. 
4760.08 just discussed. 
{¶ 25} In summary, the definition promulgated by the board in Ohio 
Adm.Code 4731-24-01(B) explains that for the practice of anesthesiology, the 
term “assist” means “[t]o carry out procedures as requested by the supervising 
anesthesiologist.” 
{¶ 26} In advancing its definition, the board argues that the legislature 
intended the word “assist” to have its dictionary meaning of “to help,” or “to aid.”  
It contrasts the legislature’s choice of verbs such as “administer,” “establish,” and 
“calibrate,” used in other subsections of R.C. 4760.09, with its use of the word 
“assist” in subsections (C) and (G).  However, because the word “assist” has a 
technical meaning in the field of anesthesiology, as demonstrated by Hoffman 
through his expert’s affidavit and by the definition set forth in the Ohio 
Administrative Code, we believe that the General Assembly intended that 
technical meaning to apply.1  “It is established law in Ohio that [in construing 
statutes], where a word has a technical definition differing from its dictionary 
                                                 
1. When S.B. 278, which enacted R.C. Chapter 4760, was debated and passed, the legislature 
heard testimony from anesthesiologists and anesthesiologist assistants. Rotunda, Inc., Capitol 
Connection, Professional Edition, at http://han2.hannah.com/htbin/f.com/oh_ban_123:SB278. 
notes (accessed Mar. 27, 2007). 
 
SUPREME COURT OF OHIO 
8 
definition, it shall be construed according to the former.”  Youngstown Sheet & 
Tube Co. v. Lindley (1978), 56 Ohio St.2d 303, 309, 10 O.O.3d 423, 383 N.E.2d 
903.  An axiom of statutory construction is that “[w]ords * * * that have acquired 
a technical or particular meaning, whether by legislative definition or otherwise, 
shall be construed accordingly.”  R.C. 1.42; see also State v. Rentex, Inc. (1977), 
51 Ohio App.2d 57, 5 O.O.3d 173, 365 N.E.2d 1274, paragraph one of the 
syllabus (terms in a statute regulating a specialized industry that uses terms that 
have acquired technical meanings in the industry require a technical 
interpretation). 
{¶ 27} Applying the technical definition of “assist” to R.C. 4760.09 and 
specifically to subsections (C) and (G), the statute reads:  
{¶ 28} “In providing assistance to the supervising anesthesiologist, an 
anesthesiologist assistant may do any of the following: 
{¶ 29} “* * * 
{¶ 30} “(C) [Carry out] the implementation of medically accepted 
monitoring techniques [as requested by the supervising anesthesiologist]. 
{¶ 31} “* * * 
{¶ 32} “(G) [Carry out] the performance of epidural anesthetic procedures 
and 
spinal 
anesthetic 
procedures 
[as 
requested 
by 
the 
supervising 
anesthesiologist].” 
{¶ 33} Therefore, the statute permits anesthesiologist assistants to perform 
epidural and spinal anesthetic procedures provided that, pursuant to R.C. 4760.08, 
the assistants are directly supervised by an anesthesiologist.  The term “assist” as 
used in R.C. 4760.09 means “to carry out procedures as requested by the 
supervising anesthesiologist.” 
{¶ 34} In contrast to the statute, Ohio Adm.Code 4731-24-04(A) states 
that anesthesiologist assistants are not permitted to perform “any anesthetic 
procedure not specifically authorized by Chapter 4760. of the Revised Code, 
January Term, 2007 
9 
including epidural and spinal anesthetic procedures.”  Because the administrative 
rule prohibits anesthesiologist assistants from performing procedures that the 
statute permits, the rule clearly conflicts with the statute. 
{¶ 35} We emphasize that R.C. 4760.08 permits an anesthesiologist 
assistant to carry out epidural and spinal anesthetic procedures as requested by 
and performed under the direction of a supervising anesthesiologist who is 
physically present in the room.  Without such direct supervision, performance of 
these procedures by an anesthesiologist assistant would violate the statute. 
Conclusion 
{¶ 36} We hold that Ohio Adm.Code 4731-24-04(A), which prohibits 
anesthesiologist assistants from performing epidural and spinal anesthetic 
procedures, is invalid because it conflicts with R.C. 4760.09.  We therefore 
reverse the judgment of the court of appeals. 
Judgment reversed. 
 
MOYER, C.J., PFEIFER, LUNDBERG STRATTON, O’CONNOR, O’DONNELL 
and CUPP, JJ., concur. 
__________________ 
Benesch, Friedlander, Coplan, Aronoff, L.L.P., N. Victor Goodman, C. 
David Paragas, Marc S. Blubaugh, and Jennifer M. Turk, for appellant. 
Marc Dann, Attorney General, Brian Laliberte, Deputy First Assistant 
Attorney General, Elise Porter, Acting State Solicitor, Stephen P. Carney, Deputy 
Solicitor, Lawrence D. Pratt, and Rebecca J. Albers, Assistant Attorneys General, 
for appellee. 
Colleen Treml; Janet L. Miller; Taft, Stettinius & Hollister, L.L.P., and 
Robert E. Rich; Elayne R. Biddlestone; Lagos & Lagos, P.L.L., and James H. 
Lagos; Eastman & Smith, Ltd., and Kevin Devaney, urging reversal on behalf of 
amici curiae Case Western Reserve University, University Hospitals of 
Cleveland, the Anesthesia Associates of Cincinnati, the Academy of Medicine of 
SUPREME COURT OF OHIO 
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Cleveland/Northern Ohio Medical Association, McCallum Robinson Hoyt, M.D., 
M.B.A., Mercy Anesthesiologists, Inc., and Medical College of Ohio Physicians, 
L.L.C. 
Samuel B. Weiner Co., L.P.A., and Samuel B. Weiner, urging reversal for 
amici curiae the American Academy of Anesthesiologist Assistants and the Ohio 
Academy of Anesthesiologist Assistants. 
Chester, Willcox & Saxbe, L.L.P., Sarah D. Morrison, and Charles R. 
Saxbe, urging affirmance for amicus curiae Ohio Society of Anesthesiologists. 
______________________