Office-Based Surgery Rules Administrative Rules, Chapter 540-X-10, Office-Based Surgery:   Requires, among other things, registration with the Board of every licensed physician who performs office-based surgery (as defined in the rules) within the state of Alabama (click here for the Physician Registration form) Provides standards for different levels of anesthesia used in office-based procedures Does not require facility accreditation, but it is encouraged for those settings where deep sedation and general anesthesia are provided Requires reporting of adverse events as defined in the rule (click here for the Adverse Event Reporting Form) IMPORTANT :  To determine if a physician should register with the Board, read the rules carefully, especially sections .04 to .08, standards for each level of sedation.  The Rules specify which physicians are required to register.  Board of Medical Examiners staff will not be able to instruct physicians as to whether they are required to register.  This is a decision to be made by the physician after having thoroughly read the rules.  If after careful consideration, a physician remains unclear as to registration, the physician should write the Board for an opinion. Office-Based Surgery FAQ 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: A reporting form will be mailed to all physicians who are registered for office-based surgery. 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 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).