Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. CS for SB 732
       
       
       
       
       
       
                                Ì359744EÎ359744                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: RS            .                                
                  04/10/2019           .                                
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       Appropriations Subcommittee on Health and Human Services
       (Flores) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 414 - 624
    4  and insert:
    5  must register the office with the department unless that office
    6  is licensed as a facility under chapter 395. The department
    7  shall inspect the physician’s office annually unless the office
    8  is accredited by a nationally recognized accrediting agency or
    9  an accrediting organization subsequently approved by the Board
   10  of Medicine. The actual costs for registration and inspection or
   11  accreditation shall be paid by the person seeking to register
   12  and operate the office setting in which office surgery is
   13  performed. As a condition of registration, a physician who
   14  performs such surgical procedures in an office setting, and the
   15  office itself if it is a separate legal entity from the
   16  physician, must maintain the same levels of financial
   17  responsibility required in s. 458.320.
   18         (4)(a) The board may adopt rules to administer the
   19  registration, inspection, and safety of offices in which a
   20  physician performs office surgery.
   21         (b)As a part of registration, such an office must
   22  designate a physician who is responsible for the office’s
   23  compliance with this section and the rules adopted hereunder.
   24  Within 10 days after termination of the designated physician,
   25  the office must notify the department of the identity of another
   26  designated physician for that office. The designated physician
   27  must have a full, active, and unencumbered license under this
   28  chapter or chapter 459 and shall practice at the office for
   29  which he or she has assumed responsibility. The department may
   30  suspend a registration certificate for an office without a
   31  designated physician who practices at the office.
   32         (c) The department shall inspect the office at least
   33  annually, including a review of patient records, to ensure that
   34  it complies with this section and rules adopted hereunder unless
   35  the office is accredited by a nationally recognized accrediting
   36  agency approved by the board. The inspection must be
   37  unannounced.
   38         (d) The board shall adopt by rule standards of practice for
   39  physicians who perform office surgery. The board shall impose a
   40  fine of $5,000 per day on a physician who performs a surgical
   41  procedure identified in subsection (3) in an office that is not
   42  registered with the department.
   43         Section 9. Paragraph (vv) is added to subsection (1) of
   44  section 458.331, Florida Statutes, to read:
   45         458.331 Grounds for disciplinary action; action by the
   46  board and department.—
   47         (1) The following acts constitute grounds for denial of a
   48  license or disciplinary action, as specified in s. 456.072(2):
   49         (vv) Performing a liposuction procedure in which more than
   50  1,000 cubic centimeters of supernatant fat is removed, a Level
   51  II office surgery, or a Level III office surgery in an office
   52  that is not registered with the department pursuant to s.
   53  458.309(3).
   54         Section 10. Section 459.003, Florida Statutes, is amended
   55  to read:
   56         459.003 Definitions.—As used in this chapter, the term:
   57         (1) “Board” means the Board of Osteopathic Medicine.
   58         (2)“Deep sedation and analgesia” means a drug-induced
   59  depression of consciousness during which all of the following
   60  apply:
   61         (a) The patient cannot be easily aroused but responds by
   62  purposefully following repeated or painful stimulation.
   63         (b) The patient’s ability to independently maintain
   64  ventilatory function may be impaired.
   65         (c) The patient may require assistance in maintaining a
   66  patent airway, and spontaneous ventilation may be inadequate.
   67         (d) The patient’s cardiovascular function is usually
   68  maintained.
   69         (e) The patient’s reflex withdrawal from painful stimulus
   70  is not considered a purposeful response.
   71         (3)(2) “Department” means the Department of Health.
   72         (5)“Epidural anesthesia” means anesthesia produced by the
   73  injection of an anesthetic agent into the space on or around the
   74  dura mater of the spinal cord.
   75         (6)“General anesthesia” means a drug-induced loss of
   76  consciousness administered by a qualified general anesthesia
   77  provider during which all of the following apply:
   78         (a) The patient is not able to be aroused, even by painful
   79  stimulation.
   80         (b) The patient’s ability to independently maintain
   81  ventilatory function is often impaired.
   82         (c) The patient has a level of depressed neuromuscular
   83  function.
   84         (d) The patient may require assistance in maintaining a
   85  patent airway, and positive pressure ventilation may be
   86  required.
   87         (e) The patient’s cardiovascular function may be impaired.
   88         (7)“Minimal sedation” means a drug-induced state during
   89  which patients respond normally to verbal commands. Although
   90  cognitive function and physical coordination may be impaired,
   91  airway reflexes, and respiratory and cardiovascular functions
   92  are unaffected.
   93         (8) “Moderate sedation and analgesia” or “conscious
   94  sedation” means drug-induced depression of consciousness and a
   95  state of consciousness during which all of the following apply:
   96         (a) The patient responds purposefully to verbal commands,
   97  either alone or accompanied by light tactile stimulation.
   98         (b) Interventions are not required to maintain a patent
   99  airway, and spontaneous ventilation is adequate.
  100         (c) Cardiovascular function is maintained.
  101         (d) Reflex withdrawal from a painful stimulus is not
  102  considered a purposeful response.
  103         (9)“Office surgery” means a surgery that is performed in a
  104  physician’s office or any facility that is not licensed under
  105  chapter 390 or chapter 395.
  106         (a)“Level I office surgery” includes any surgery that
  107  consists of only minor procedures and in which anesthesia is
  108  limited to minimal sedation.
  109         (b)“Level II office surgery” includes any surgery in which
  110  the patient’s level of sedation is that of moderate sedation and
  111  analgesia or conscious sedation.
  112         (c) ”Level III office surgery” includes any surgery in
  113  which the patient’s level of sedation is that of deep sedation
  114  and analgesia or general anesthesia. The term includes any
  115  surgery that includes the use of spinal anesthesia or epidural
  116  anesthesia.
  117         (11)(3) “Practice of osteopathic medicine” means the
  118  diagnosis, treatment, operation, or prescription for any human
  119  disease, pain, injury, deformity, or other physical or mental
  120  condition, which practice is based in part upon educational
  121  standards and requirements which emphasize the importance of the
  122  musculoskeletal structure and manipulative therapy in the
  123  maintenance and restoration of health.
  124         (12)“Spinal anesthesia” means anesthesia produced by the
  125  injection of an anesthetic agent into the subarachnoid space of
  126  the spinal cord.
  127         (13)“Surgeon” means a physician who performs surgery.
  128         (14)“Surgery” means any manual or operative procedure,
  129  including the use of lasers, performed upon the body of a living
  130  human being for the purposes of preserving health, diagnosing or
  131  curing disease, repairing injury, correcting deformity or
  132  defects, prolonging life, or relieving suffering or any elective
  133  procedure for aesthetic, reconstructive, or cosmetic purposes,
  134  including, but not limited to: incision or curettage of tissue
  135  or an organ; suture or other repair of tissue or organ,
  136  including a closed as well as an open reduction of a fracture;
  137  extraction of tissue including premature extraction of the
  138  products of conception from the uterus; insertion of natural or
  139  artificial implants; or an endoscopic procedure with use of
  140  local or general anesthetic.
  141         (10)(4) “Osteopathic physician” means a person who is
  142  licensed to practice osteopathic medicine in this state.
  143         (4)(5) “Doctor of Osteopathy” and “Doctor of Osteopathic
  144  Medicine,” when referring to degrees, shall be construed to be
  145  equivalent and equal degrees.
  146         Section 11. Subsection (2) of section 459.005, Florida
  147  Statutes, is amended and subsection (3) is added to that
  148  section, to read:
  149         459.005 Rulemaking authority.—
  150         (2) A physician who performs any liposuction procedure
  151  procedures in which more than 1,000 cubic centimeters of
  152  supernatant fat is removed, any Level II office surgery level 2
  153  procedures lasting more than 5 minutes, or any Level III office
  154  surgery and all level 3 surgical procedures in an office setting
  155  must register the office with the department unless that office
  156  is licensed as a facility under chapter 395. The department
  157  shall inspect the physician’s office annually unless the office
  158  is accredited by a nationally recognized accrediting agency or
  159  an accrediting organization subsequently approved by the Board
  160  of Osteopathic Medicine. The actual costs for registration and
  161  inspection or accreditation shall be paid by the person seeking
  162  to register and operate the office setting in which office
  163  surgery is performed. As a condition of registration, a
  164  physician who performs such surgical procedures in an office
  165  setting, and the office itself if it is a separate legal entity
  166  from the physician, must maintain the same levels of financial
  167  responsibility required in s. 459.0085.
  168         (3)(a) The board may adopt rules to administer the
  169  registration, inspection, and safety of offices in which a
  170  physician performs office surgery.
  171         (b)As a part of registration, such an office must
  172  designate a physician who is responsible for the office’s
  173  compliance with this section and the rules adopted hereunder.
  174  Within 10 days after termination of the designated physician,
  175  the office must notify the department of the identity of another
  176  designated physician for that office. The designated physician
  177  must have a full, active, and unencumbered license under this
  178  chapter or chapter 458 and shall practice at the office for
  179  which he or she has assumed responsibility. The department may
  180  suspend a registration certificate for an office without a
  181  designated physician who practices at the office.
  182         (c) The department shall inspect the office at least
  183  annually, including a review of patient records, to ensure that
  184  it complies with this section and rules adopted hereunder unless
  185  the office is accredited by a nationally recognized accrediting
  186  agency approved by the board. The inspection must be
  187  unannounced.
  188         (d) The board shall adopt by rule standards of practice for
  189  physicians who perform office surgery. The board shall impose a
  190  fine of $5,000 per day on a physician who performs a surgical
  191  procedure identified in subsection (2) in an office that is not
  192  registered with the department.
  193         Section 12. Paragraph (xx) is added to subsection (1) of
  194  section 459.015, Florida Statutes, to read:
  195         459.015 Grounds for disciplinary action; action by the
  196  board and department.—
  197         (1) The following acts constitute grounds for denial of a
  198  license or disciplinary action, as specified in s. 456.072(2):
  199         (xx) Performing a liposuction procedure in which more than
  200  1,000 cubic centimeters of supernatant fat is removed, a Level
  201  II office surgery, or a Level III office surgery in an office
  202  that is not registered with the department pursuant to s.
  203  459.005(2).
  204  
  205  ================= T I T L E  A M E N D M E N T ================
  206  And the title is amended as follows:
  207         Delete lines 32 - 63
  208  and insert:
  209         Board of Medicine to adopt rules to administer the
  210         registration, inspection, and safety of offices that
  211         perform certain office surgery; requiring such an
  212         office to designate a certain physician responsible
  213         for the office’s compliance with specified provisions;
  214         authorizing the department to suspend an office’s
  215         registration certificate under certain circumstances;
  216         requiring the department to conduct certain
  217         inspections; providing an exception; requiring the
  218         board to adopt rules governing the standard of care
  219         for physicians practicing in such offices; requiring
  220         the board to impose a specified fine on physicians who
  221         perform certain office surgeries in an unregistered
  222         office; amending s. 458.331, F.S.; providing that a
  223         physician performing certain office surgeries in an
  224         unregistered office constitutes grounds for denial of
  225         a license or disciplinary action; amending s. 459.003,
  226         F.S.; defining terms; amending s. 459.005, F.S.;
  227         requiring a physician who performs certain office
  228         surgery and the office in which the surgery is
  229         performed to maintain specified levels of financial
  230         responsibility; authorizing the Board of Osteopathic
  231         Medicine to adopt rules to administer the
  232         registration, inspection, and safety of offices that
  233         perform certain office surgery; requiring such an
  234         office to designate a certain physician responsible
  235         for the office’s compliance with specified provisions;
  236         authorizing the department to suspend an office’s
  237         registration certificate under certain circumstances;
  238         requiring the department to conduct certain
  239         inspections; providing an exception; requiring the
  240         board to adopt rules governing the standard of care
  241         for physicians practicing in such offices; requiring
  242         the board to impose a specified fine on physicians who
  243         perform certain office surgeries in an unregistered
  244         office; amending s. 459.015, F.S.; providing that a
  245         physician performing certain office surgeries in an
  246         unregistered office constitutes grounds for denial of
  247         a license or disciplinary action; amending s. 766.101,
  248         F.S.;