HB 1467

1	A bill to be entitled
2	An act relating to cardiopulmonary perfusionists; amending
3	s. 456.048, F.S.; requiring the Board of Medicine and the
4	Board of Osteopathic Medicine to require medical
5	malpractice insurance or proof of financial responsibility
6	as a condition of licensure or licensure renewal for
7	licensed cardiopulmonary perfusionists; amending ss.
8	458.331 and 459.015, F.S.; revising grounds for which a
9	physician or osteopathic physician may be disciplined for
10	failing to provide adequate supervision; providing
11	penalties; creating ss. 458.3476 and 459.024, F.S.;
12	providing definitions; providing performance standards for
13	cardiopulmonary perfusionists and supervising physicians
14	or osteopathic physicians; providing for the approval of
15	training programs and for services authorized to be
16	performed by trainees; providing licensing procedures;
17	providing for fees; providing for additional membership,
18	powers, and duties of the Board of Medicine and the Board
19	of Osteopathic Medicine; providing penalties; providing
20	for disciplinary actions; providing for the adoption of
21	rules; providing liability; providing for the allocation
22	of fees; providing an effective date.
23
24	Be It Enacted by the Legislature of the State of Florida:
25
26	Section 1.  Section 456.048, Florida Statutes, is amended
27	to read:
28	456.048  Financial responsibility requirements for certain
29	health care practitioners.--
30	(1)  As a prerequisite for licensure or license renewal,
31	the Board of Acupuncture, the Board of Chiropractic Medicine,
32	the Board of Podiatric Medicine, and the Board of Dentistry
33	shall, by rule, require that all health care practitioners
34	licensed under the respective board, and the Board of Medicine
35	and the Board of Osteopathic Medicine shall, by rule, require
36	that all anesthesiologist assistants licensed pursuant to s.
37	458.3475 or s. 459.023 and cardiopulmonary perfusionists
38	licensed pursuant to s. 458.3476 or s. 459.024, and the Board of
39	Nursing shall, by rule, require that advanced registered nurse
40	practitioners certified under s. 464.012, and the department
41	shall, by rule, require that midwives maintain medical
42	malpractice insurance or provide proof of financial
43	responsibility in an amount and in a manner determined by the
44	board or department to be sufficient to cover claims arising out
45	of the rendering of or failure to render professional care and
46	services in this state.
47	(2)  The board or department may grant exemptions upon
48	application by practitioners meeting any of the following
49	criteria:
50	(a)  Any person licensed under chapter 457, s. 458.3475, s.
51	459.023, s. 458.3476, s. 459.024, chapter 460, chapter 461, s.
52	464.012, chapter 466, or chapter 467 who practices exclusively
53	as an officer, employee, or agent of the Federal Government or
54	of the state or its agencies or its subdivisions. For the
55	purposes of this subsection, an agent of the state, its
56	agencies, or its subdivisions is a person who is eligible for
57	coverage under any self-insurance or insurance program
58	authorized by the provisions of s. 768.28(16) or who is a
59	volunteer under s. 110.501(1).
60	(b)  Any person whose license or certification has become
61	inactive under chapter 457, s. 458.3475, s. 459.023, s.
62	458.3476, s. 459.024, chapter 460, chapter 461, part I of
63	chapter 464, chapter 466, or chapter 467 and who is not
64	practicing in this state. Any person applying for reactivation
65	of a license must show either that such licensee maintained tail
66	insurance coverage which provided liability coverage for
67	incidents that occurred on or after October 1, 1993, or the
68	initial date of licensure in this state, whichever is later, and
69	incidents that occurred before the date on which the license
70	became inactive; or such licensee must submit an affidavit
71	stating that such licensee has no unsatisfied medical
72	malpractice judgments or settlements at the time of application
73	for reactivation.
74	(c)  Any person holding a limited license pursuant to s.
75	456.015, and practicing under the scope of such limited license.
76	(d)  Any person licensed or certified under chapter 457, s.
77	458.3475, s. 459.023, s. 458.3476, s. 459.024, chapter 460,
78	chapter 461, s. 464.012, chapter 466, or chapter 467 who
79	practices only in conjunction with his or her teaching duties at
80	an accredited school or in its main teaching hospitals. Such
81	person may engage in the practice of medicine to the extent that
82	such practice is incidental to and a necessary part of duties in
83	connection with the teaching position in the school.
84	(e)  Any person holding an active license or certification
85	under chapter 457, s. 458.3475, s. 459.023, s. 458.3476, s.
86	459.024, chapter 460, chapter 461, s. 464.012, chapter 466, or
87	chapter 467 who is not practicing in this state. If such person
88	initiates or resumes practice in this state, he or she must
89	notify the department of such activity.
90	(f)  Any person who can demonstrate to the board or
91	department that he or she has no malpractice exposure in the
92	state.
93	(3)  Notwithstanding the provisions of this section, the
94	financial responsibility requirements of ss. 458.320 and
95	459.0085 shall continue to apply to practitioners licensed under
96	those chapters, except for cardiopulmonary perfusionists
97	licensed pursuant to s. 458.3476 or s. 459.024 and
98	anesthesiologist assistants licensed pursuant to s. 458.3475 or
99	s. 459.023 who must meet the requirements of this section.
100	Section 2.  Paragraph (dd) of subsection (1) of section
101	458.331, Florida Statutes, is amended to read:
102	458.331  Grounds for disciplinary action; action by the
103	board and department.--
104	(1)  The following acts constitute grounds for denial of a
105	license or disciplinary action, as specified in s. 456.072(2):
106	(dd)  Failing to supervise adequately the activities of
107	those physician assistants, paramedics, emergency medical
108	technicians, advanced registered nurse practitioners, or
109	anesthesiologist assistants, or cardiopulmonary perfusionists
110	acting under the supervision of the physician.
111	Section 3.  Section 458.3476, Florida Statutes, is created
112	to read:
113	458.3476  Cardiopulmonary perfusionists.--
114	(1)  DEFINITIONS.--As used in this section, the term:
115	(a)  "Approved program" means a program for the education
116	and training of cardiopulmonary perfusion which has been
117	approved by the boards as provided in subsection (5).
118	(b)  "Boards" means the Board of Medicine and the Board of
119	Osteopathic Medicine.
120	(c)  "Cardiopulmonary perfusionist" means a graduate of an
121	approved program who is licensed to perform medical services
122	delegated and directly supervised by a licensed physician.
123	(d)  "Cardiopulmonary perfusion" means the functions
124	necessary for the support, treatment, measurement, or
125	supplementation of the cardiovascular, circulatory, and
126	respiratory systems or other organs, or a combination of those
127	activities, and to ensure the safe management of physiologic
128	functions by monitoring and analyzing the parameters of the
129	systems under an order and the supervision of a licensed
130	physician, including:
131	1.  The use of extracorporeal circulation, long-term
132	cardiopulmonary support techniques including extracorporeal
133	carbon dioxide removal and extracorporeal membrane oxygenation
134	and associated therapeutic and diagnostic technologies.
135	2.  The use of counter pulsation, ventricular assistance,
136	auto transfusion, blood conservation techniques, myocardial and
137	organ preservation, extracorporeal life support, isolated limb
138	perfusion, therapeutic aphaeresis, and platelet rich plasma
139	sequestration.
140	3.  The use of techniques involving blood management,
141	advanced life support, and other related functions.
142	4.  The performance of the following acts described in this
143	subsection:
144	a.  The administration of:
145	(I)  Pharmacological and therapeutic agents.
146	(II)  Blood products or anesthetic agents through the
147	extracorporeal circuit or through an intravenous line as ordered
148	by a physician.
149	b.  The performance and use of:
150	(I)  Coagulation monitoring and analysis.
151	(II)  Physiologic monitoring and analysis.
152	(III)  Blood gas and chemistry monitoring and analysis.
153	(IV)  Hematologic monitoring and analysis.
154	(V)  Hypothermia.
155	(VI)  Hyperthermia.
156	(VII)  Hemoconcentration and hemodilution.
157	(VIII)  Hemodialysis.
158	c.  The observation of signs and symptoms related to
159	perfusion services, the determination of whether the signs and
160	symptoms exhibit abnormal characteristics and the implementation
161	of appropriate reporting, perfusion protocols, or changes in or
162	the initiation of emergency procedures.
163	(e)  "Cardiopulmonary perfusionists licensing committee"
164	means the cardiopulmonary perfusion licensing committee
165	appointed by the board.
166	(f)  "Continuing medical education" means courses
167	recognized and approved by the boards, the American Academy of
168	Physician Assistants, the American Medical Association, the
169	American Osteopathic Association, the American Board of
170	Cardiopulmonary Perfusion, or the Accreditation Council on
171	Continuing Medical Education.
172	(g)  "Direct supervision" means the on-site, personal
173	supervision by a physician who is present in the surgical suite
174	when the procedure is being performed in that surgical suite and
175	who is in all instances immediately available to provide
176	assistance and direction to the cardiovascular perfusionist
177	while cardiac perfusion services are being performed.
178	(h)  "Extracorporeal circulation" means the diversion of a
179	patient's blood through a heart-lung machine or a similar device
180	that assumes the functions of the patient's heart, lungs,
181	kidney, liver, or other organs.
182	(i)  "Trainee" means a person who is currently enrolled in
183	an approved program.
184	(j)  "Perfusion protocols" means perfusion-related policies
185	and protocols developed or approved by a licensed health
186	facility or a physician through collaboration with
187	administrators, licensed cardiovascular perfusionists, and other
188	health care professionals.
189	(k)  "Proficiency examination" means an entry-level
190	examination approved by the boards, including examinations
191	administered by the American Board of Cardiovascular Perfusion
192	(ABCP).
193	(l)  "Provisional licensed perfusionist" means a person
194	granted a provisional license under this section.
195	(m)  "Supervising physician" means an allopathic physician
196	who holds an active and unrestricted license and who has
197	successfully completed a training program approved by the
198	Accreditation Council for Graduate Medical Education or its
199	equivalent.
200	(n)  "Temporary perfusionist licensee" means a person
201	granted a temporary license under this section.
202	(2)  PERFORMANCE OF SUPERVISING PHYSICIAN.--A physician who
203	directly supervises a cardiopulmonary perfusionist must be
204	qualified in the medical areas in which the cardiopulmonary
205	perfusionist performs and is liable for the performance of the
206	cardiopulmonary perfusionist. A physician may only supervise two
207	cardiopulmonary perfusionists at the same time.
208	(3)  PERFORMANCE OF CARDIOPULMONARY PERFUSIONISTS.--
209	(a)  A cardiopulmonary perfusionist may perform duties
210	established by rule by the board in any of the following
211	functions that are included in the cardiopulmonary
212	perfusionist's protocol while prescribed by a physician or under
213	the supervision of a physician:
214	1.  Perform extracorporeal circulation/cardiopulmonary
215	support.
216	2.  Perform or administer counter pulsation.
217	3.  Perform circulatory support and ventricular assistance.
218	4.  Perform extracorporeal membrane oxygenation (ECMO) and
219	extracorporeal life support (ECLS).
220	5.  Perform blood conservation techniques, auto
221	transfusion, and blood component sequestration.
222	6.  Perform myocardial preservation.
223	7.  Perform coagulation and hemotalogic
224	monitoring/analysis.
225	8 . Perform physiological analysis and monitoring.
226	9.  Perform blood gas and blood chemistry analysis and
227	monitoring.
228	10.  Perform induction of hypothermia or hyperthermia with
229	reversal.
230	11.  Perform hemodilution.
231	12.  Perform hemofiltration.
232	13.  Administer blood, blood products, supportive fluids,
233	and anesthetic agents via the extracorporeal circuit.
234	14.  Documentation associated with described duties.
235	15.  Perform isolated limb and organ perfusion.
236	16.  Provide surgical assistance.
237	17.  Perform organ preservation.
238	18.  Perform dialysis while on cardiopulmonary bypass.
239	19.  Perform therapeutic aphaeresis.
240	(b)  Nothing in this section or chapter prevents third-
241	party payors from reimbursing employers of cardiopulmonary
242	perfusionists for covered services rendered by such
243	cardiopulmonary perfusionists.
244	(c)  A cardiopulmonary perfusionist shall clearly convey to
245	the patient that he or she is a cardiopulmonary perfusionist.
246	(d)  A cardiopulmonary perfusionist may perform medical
247	tasks and services within the framework of a written practice
248	protocol developed between the supervising physician and the
249	cardiopulmonary perfusionist.
250	(e)  A cardiopulmonary perfusionist may not prescribe,
251	order, or compound any controlled substance, legend drug, or
252	medical device nor may a cardiopulmonary perfusionist dispense
253	sample drugs to patients. Nothing in this paragraph prohibits a
254	cardiopulmonary perfusionist from administering legend drugs or
255	controlled substances, intravenous drugs, fluids, or blood
256	products to patients which are ordered by the supervising
257	physician and administered while under the supervision of the
258	supervising physician.
259	(4)  PERFORMANCE BY TRAINEES.--The practice of a  trainee
260	is exempt from the requirements of this chapter while the
261	trainee is performing assigned tasks as a trainee in conjunction
262	with an approved program. Before providing cardiopulmonary
263	perfusion services in conjunction with the requirements of an
264	approved program, the trainee must clearly convey to the patient
265	that he or she is a trainee.
266	(5)  PROGRAM APPROVAL.--The boards shall approve programs
267	for the education and training of cardiopulmonary perfusionists
268	that meet standards established by board rules. The boards may
269	recommend only those cardiopulmonary perfusionist training
270	programs that hold full accreditation or provisional
271	accreditation from the Commission on Accreditation of Allied
272	Health Education Programs.
273	(6)  CARDIOPULMONARY PERFUSIONIST LICENSURE.--
274	(a)  Any person desiring to be licensed as a
275	cardiopulmonary perfusionist shall apply to the department. The
276	department shall issue a license to any person certified by the
277	board to:
278	1.  Be 18 years of age or older.
279	2.  Have satisfactorily passed proficiency examination with
280	a score established by the American Board of Cardiovascular
281	Perfusion (ABCP). The board, on receipt of an application and
282	application fee, shall waive the examination requirement for an
283	applicant who at the time of application:
284	a.  Is appropriately licensed or certified by another
285	state, territory, or possession of the United States if the
286	requirements of that state, territory, or possession for the
287	license or certificate are the substantial equivalent of the
288	requirements of this section as determined by the board; or
289	b.  Holds a current certificate as a certified clinical
290	perfusionist issued by the American Board of Cardiovascular
291	Perfusion (ABCP) or its successor prior to July 1, 2005.
292	3.  Be certified in basic cardiac life support.
293	4.  Have completed the application form and remitted an
294	application fee, not to exceed $1,000, as set by the boards. An
295	application must include:
296	a.  A certificate of completion of an approved program.
297	b.  A sworn statement of any prior felony convictions.
298	c.  A sworn statement of any prior discipline or denial of
299	licensure or certification in any state.
300	d.  One letter of recommendation from a physician and one
301	letter of recommendation from a cardiopulmonary perfusionist.
302	(b)  A license must be renewed biennially. Each renewal
303	must include:
304	1.  A renewal fee, not to exceed $1,000, as set by the
305	boards.
306	2.  A sworn statement of no felony convictions in the
307	immediately preceding 2 years.
308	(c)  Each licensed cardiopulmonary perfusionist must
309	biennially complete 40 hours of continuing medical education or
310	hold a current certificate issued by the American Board of
311	Cardiovascular Perfusion or its successor.
312	1.  A provisional license may be issued by the board to a
313	person who has successfully completed an approved perfusion
314	education program and the filing of an application, payment of
315	an application fee, and the submission of evidence satisfactory
316	to the board of the successful completion of the education
317	requirement set forth in this section. A provisional licensee
318	shall be under the supervision and direction of a licensed
319	perfusionist at all times during which the provisional licensee
320	performs perfusion. Rules adopted by the board governing such
321	supervision and direction may not require the immediate physical
322	presence of the supervising licensed perfusionist. A provisional
323	license is valid for 2 years from the date it is issued and may
324	be extended subject to rule by the board. The application for
325	extension must be signed by a supervising licensed perfusionist.
326	Upon notification by the approved testing service or the board
327	that any portion of the licensing examination has been failed
328	after the 2-year provisional license term, the provisional
329	license will be surrendered to the board.
330	2.  A temporary license may be issued by the department to
331	a person who has successfully completed the perfusion licensure
332	application.
333	(d)  The board may impose upon a cardiopulmonary
334	perfusionist any penalty specified in s. 456.072 or s.
335	458.331(2) if the cardiopulmonary perfusionist or the
336	supervising physician is found guilty of or is investigated for
337	an act that constitutes a violation of this chapter or chapter
338	456.
339	(7)  CARDIOVASCULAR SURGEON AND CARDIOPULMONARY
340	PERFUSIONIST TO ADVISE THE BOARD.--
341	(a)  The chairperson of the board may appoint a
342	cardiovascular surgeon and a cardiopulmonary perfusionist to
343	advise the board as to the adoption of rules for the licensure
344	of cardiopulmonary perfusionists. The board may use a committee
345	structure that is most practicable in order to receive any
346	recommendations to the board regarding rules and all matters
347	relating to cardiopulmonary perfusionists, including, but not
348	limited to, recommendations to improve safety in the clinical
349	practices of licensed cardiopulmonary perfusionists.
350	(b)  In addition to its other duties and responsibilities
351	as prescribed by law, the board shall:
352	1.  Recommend to the department the licensure of
353	cardiopulmonary perfusionists.
354	2. Develop all rules regulating the use of cardiopulmonary
355	perfusionists under this chapter and chapter 459, except for
356	rules relating to the formulary developed under s.
357	458.347(4)(f). The board shall also develop rules to ensure that
358	the continuity of supervision is maintained in each practice
359	setting. The boards shall consider adopting a proposed rule at
360	the regularly scheduled meeting immediately following the
361	submission of the proposed rule. A proposed rule may not be
362	adopted by either board unless both boards have accepted and
363	approved the identical language contained in the proposed rule.
364	The language of all proposed rules must be approved by both
365	boards pursuant to each respective board's guidelines and
366	standards regarding the adoption of proposed rules.
367	3.  Address concerns and problems of practicing
368	cardiopulmonary perfusionists to improve safety in the clinical
369	practices of licensed cardiopulmonary perfusionists.
370	(c)  When the board finds that an applicant for licensure
371	has failed to meet, to the board's satisfaction, each of the
372	requirements for licensure set forth in this section, the board
373	may enter an order to:
374	1.  Refuse to certify the applicant for licensure;
375	2.  Approve the applicant for licensure with restrictions
376	on the scope of practice or license; or
377	3.  Approve the applicant for conditional licensure. Such
378	conditions may include placement of the licensee on probation
379	for a period of time and subject to such conditions as the board
380	specifies, including, but not limited to, requiring the licensee
381	to undergo treatment, to attend continuing education courses, or
382	to take corrective action.
383	(8)  PENALTY.--A person who falsely holds himself or
384	herself out as a cardiopulmonary perfusionist commits a felony
385	of the third degree, punishable as provided in s. 775.082, s.
386	775.083, or s. 775.084.
387	(9)  DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
388	boards may deny, suspend, or revoke the license of a
389	cardiopulmonary perfusionist who the board determines has
390	violated any provision of this section or chapter or any rule
391	adopted pursuant thereto.
392	(10)  RULES.--The boards shall adopt rules to administer
393	this section.
394	(11)  LIABILITY.--A supervising physician is liable for any
395	act or omission of a cardiopulmonary perfusionist acting under
396	the physician's supervision and control and shall comply with
397	the financial responsibility requirements of this chapter and
398	chapter 456, as applicable.
399	(12)  FEES.--The department shall allocate the fees
400	collected under this section to the board.
401	Section 4.  Paragraph (hh) of subsection (1) of section
402	459.015, Florida Statutes, is amended to read:
403	459.015  Grounds for disciplinary action; action by the
404	board and department.--
405	(1)  The following acts constitute grounds for denial of a
406	license or disciplinary action, as specified in s. 456.072(2):
407	(hh)  Failing to supervise adequately the activities of
408	those physician assistants, paramedics, emergency medical
409	technicians, advanced registered nurse practitioners,
410	anesthesiologist assistants, cardiopulmonary perfusionists, or
411	other persons acting under the supervision of the osteopathic
412	physician.
413	Section 5.  Section 459.025, Florida Statutes, is created
414	to read:
415	459.025  Cardiopulmonary perfusionists.--
416	(1)  DEFINITIONS.--As used in this section, the term:
417	(a)  "Approved program" means a program for the education
418	and training of cardiopulmonary perfusion which has been
419	approved by the boards as provided in subsection (5).
420	(b)  "Boards" means the Board of Medicine and the Board of
421	Osteopathic Medicine.
422	(c)  "Cardiopulmonary perfusionist" means a graduate of an
423	approved program who is licensed to perform medical services
424	delegated and directly supervised by a licensed osteopathic
425	physician.
426	(d)  "Cardiopulmonary perfusion" means the functions
427	necessary for the support, treatment, measurement, or
428	supplementation of the cardiovascular, circulatory, and
429	respiratory systems or other organs, or a combination of those
430	activities, and to ensure the safe management of physiologic
431	functions by monitoring and analyzing the parameters of the
432	systems under an order and the supervision of a licensed
433	osteopathic physician, including:
434	1.  The use of extracorporeal circulation, long-term
435	cardiopulmonary support techniques including extracorporeal
436	carbon dioxide removal and extracorporeal membrane oxygenation,
437	and associated therapeutic and diagnostic technologies.
438	2.  The use of counter pulsation, ventricular assistance,
439	auto transfusion, blood conservation techniques, myocardial and
440	organ preservation, extracorporeal life support, isolated limb
441	perfusion, therapeutic aphaeresis, and platelet rich plasma
442	sequestration.
443	3.  The use of techniques involving blood management,
444	advanced life support, and other related functions.
445	4.  The performance of the following acts described in this
446	subsection:
447	a.  The administration of:
448	(I)  Pharmacological and therapeutic agents.
449	(II)  Blood products or anesthetic agents through the
450	extracorporeal circuit or through an intravenous line as ordered
451	by an osteopathic physician.
452	b.  The performance and use of:
453	(I)  Coagulation monitoring and analysis.
454	(II)  Physiologic monitoring and analysis.
455	(III)  Blood gas and chemistry monitoring and analysis.
456	(IV)  Hematologic monitoring and analysis.
457	(V)  Hypothermia.
458	(VI)  Hyperthermia.
459	(VII)  Hemoconcentration and hemodilution.
460	(VIII)  Hemodialysis.
461	c.  The observation of signs and symptoms related to
462	perfusion services, the determination of whether the signs and
463	symptoms exhibit abnormal characteristics, and the
464	implementation of appropriate reporting, perfusion protocols, or
465	changes in or the initiation of emergency procedures.
466	(e)  "Cardiopulmonary perfusionists licensing committee"
467	means the cardiopulmonary perfusion licensing committee
468	appointed by the board.
469	(f)  "Continuing medical education" means courses
470	recognized and approved by the boards, the American Academy of
471	Physician Assistants, the American Medical Association, the
472	American Osteopathic Association, the American Board of
473	Cardiopulmonary Perfusion, or the Accreditation Council on
474	Continuing Medical Education.
475	(g)  "Direct supervision" means the on-site, personal
476	supervision by an osteopathic physician who is present in the
477	surgical suite when the procedure is being performed in that
478	surgical suite and who is in all instances immediately available
479	to provide assistance and direction to the cardiovascular
480	perfusionist while cardiac perfusion services are being
481	performed.
482	(h)  "Extracorporeal circulation" means the diversion of a
483	patient's blood through a heart-lung machine or a similar device
484	that assumes the functions of the patient's heart, lungs,
485	kidney, liver, or other organs.
486	(i)  "Trainee" means a person who is currently enrolled in
487	an approved program.
488	(j)  "Perfusion protocols" means perfusion-related policies
489	and protocols developed or approved by a licensed health
490	facility or an osteopathic physician through collaboration with
491	administrators, licensed cardiovascular perfusionists, and other
492	health care professionals.
493	(k)  "Proficiency examination" means an entry-level
494	examination approved by the boards, including examinations
495	administered by the American Board of Cardiovascular Perfusion
496	(ABCP).
497	(l)  "Provisional licensed perfusionist" means a person
498	granted a provisional license under this section.
499	(m)  "Supervising osteopathic physician" means an
500	osteopathic physician who holds an active and unrestricted
501	license and who has successfully completed a training program
502	approved by the Accreditation Council for Graduate Medical
503	Education or its equivalent.
504	(n)  "Temporary perfusionist licensee" means a person
505	granted a temporary license under this section.
506	(2)  PERFORMANCE OF SUPERVISING OSTEOPATHIC PHYSICIAN.--An
507	osteopathic physician who directly supervises a cardiopulmonary
508	perfusionist must be qualified in the medical areas in which the
509	cardiopulmonary perfusionist performs and is liable for the
510	performance of the cardiopulmonary perfusionist. An osteopathic
511	physician may only supervise two cardiopulmonary perfusionists
512	at the same time.
513	(3)  PERFORMANCE OF CARDIOPULMONARY PERFUSIONISTS.--
514	(a)  A cardiopulmonary perfusionist may perform duties
515	established by rule by the board in any of the following
516	functions that are included in the cardiopulmonary
517	perfusionist's protocol while prescribed by an osteopathic
518	physician or under the supervision of an osteopathic physician:
519	1.  Perform extracorporeal circulation/cardiopulmonary
520	support.
521	2.  Perform or administer counter pulsation.
522	3.  Perform circulatory support and ventricular assistance.
523	4.  Perform extracorporeal membrane oxygenation (ECMO) and
524	extracorporeal life support (ECLS).
525	5.  Perform blood conservation techniques, auto
526	transfusion, and blood component sequestration.
527	6.  Perform myocardial preservation.
528	7.  Perform anticoagulation and hemotalogic
529	monitoring/analysis.
530	8.  Perform physiological analysis and monitoring.
531	9.  Perform blood gas and blood chemistry analysis and
532	monitoring.
533	10.  Perform induction of hypothermia or hyperthermia with
534	reversal.
535	11.  Perform hemodilution.
536	12.  Perform hemofiltration.
537	13.  Administer blood, blood products, supportive fluids,
538	and anesthetic agents via the extracorporeal circuit.
539	14.  Documentation associated with described duties.
540	15.  Perform isolated limb and organ perfusion.
541	16.  Provide surgical assistance.
542	17.  Perform organ preservation.
543	18.  Perform dialysis while on cardiopulmonary bypass.
544	19.  Perform therapeutic aphaeresis.
545	(b)  Nothing in this section or chapter prevents third-
546	party payors from reimbursing employers of cardiopulmonary
547	perfusionists for covered services rendered by such
548	cardiopulmonary perfusionists.
549	(c)  A cardiopulmonary perfusionist shall clearly convey to
550	the patient that he or she is a cardiopulmonary perfusionist.
551	(d)  A cardiopulmonary perfusionist may perform medical
552	tasks and services within the framework of a written practice
553	protocol developed between the supervising osteopathic physician
554	and the cardiopulmonary perfusionist.
555	(e)  A cardiopulmonary perfusionist may not prescribe,
556	order, or compound any controlled substance, legend drug, or
557	medical device, nor may a cardiopulmonary perfusionist dispense
558	sample drugs to patients. Nothing in this paragraph prohibits a
559	cardiopulmonary perfusionist from administering legend drugs or
560	controlled substances, intravenous drugs, fluids, or blood
561	products to patients which are ordered by the supervising
562	osteopathic physician and administered while under the
563	supervision of the supervising osteopathic physician.
564	(4)  PERFORMANCE BY TRAINEES.--The practice of a trainee is
565	exempt from the requirements of this chapter while the trainee
566	is performing assigned tasks as a trainee in conjunction with an
567	approved program. Before providing cardiopulmonary perfusion
568	services in conjunction with the requirements of an approved
569	program, the trainee must clearly convey to the patient that he
570	or she is a trainee.
571	(5)  PROGRAM APPROVAL.--The boards shall approve programs
572	for the education and training of cardiopulmonary perfusionists,
573	which meet standards established by board rules. The boards may
574	recommend only those cardiopulmonary perfusionist training
575	programs that hold full accreditation or provisional
576	accreditation from the Commission on Accreditation of Allied
577	Health Education Programs.
578	(6)  CARDIOPULMONARY PERFUSIONIST LICENSURE.--
579	(a)  Any person desiring to be licensed as a
580	cardiopulmonary perfusionist shall apply to the department. The
581	department shall issue a license to any person certified by the
582	board to:
583	1.  Be 18 years of age or older.
584	2.  Have satisfactorily passed proficiency examination with
585	a score established by the American Board of Cardiovascular
586	Perfusion (ABCP). The board, on receipt of an application and
587	application fee, shall waive the examination requirement for an
588	applicant who at the time of application:
589	a.  Is appropriately licensed or certified by another
590	state, territory, or possession of the United States if the
591	requirements of that state, territory, or possession for the
592	license or certificate are the substantial equivalent of the
593	requirements of this section as determined by the board; or
594	b.  Holds a current certificate as a certified clinical
595	perfusionist issued by the American Board of Cardiovascular
596	Perfusion (ABCP) or its successor prior to July 1, 2005.
597	3.  Be certified in basic cardiac life support.
598	4.  Have completed the application form and remitted an
599	application fee, not to exceed $1,000, as set by the boards. An
600	application must include:
601	a.  A certificate of completion of an approved program.
602	b.  A sworn statement of any prior felony convictions.
603	c.  A sworn statement of any prior discipline or denial of
604	licensure or certification in any state.
605	d.  One letter of recommendation from an osteopathic
606	physician and one letter of recommendation from a
607	cardiopulmonary perfusionist.
608	(b)  A license must be renewed biennially. Each renewal
609	must include:
610	1.  A renewal fee, not to exceed $1,000, as set by the
611	boards.
612	2.  A sworn statement of no felony convictions in the
613	immediately preceding 2 years.
614	(c)  Each licensed cardiopulmonary perfusionist must
615	biennially complete 40 hours of continuing medical education or
616	hold a current certificate issued by the American Board of
617	Cardiovascular Perfusion or its successor.
618	1.  A provisional license may be issued by the board to a
619	person who has successfully completed an approved perfusion
620	education program and the filing of an application, payment of
621	an application fee, and the submission of evidence satisfactory
622	to the board of the successful completion of the education
623	requirement set forth in this section. A provisional licensee
624	shall be under the supervision and direction of a licensed
625	perfusionist at all times during which the provisional licensee
626	performs perfusion. Rules adopted by the board governing such
627	supervision and direction may not require the immediate physical
628	presence of the supervising licensed perfusionist. A provisional
629	license is valid for 2 years from the date it is issued and may
630	be extended subject to rule by the board. The application for
631	extension must be signed by a supervising licensed perfusionist.
632	Upon notification by the approved testing service or the board
633	that any portion of the licensing examination has been failed
634	after the 2-year provisional license term, the provisional
635	license will be surrendered to the board.
636	2.  A temporary license may be issued by the department to
637	a person who has successfully completed the perfusion licensure
638	application.
639	(d)  The board may impose upon a cardiopulmonary
640	perfusionist any penalty specified in s. 456.072 or s.
641	459.015(2) if the cardiopulmonary perfusionist or the
642	supervising osteopathic physician is found guilty of or is
643	investigated for an act that constitutes a violation of this
644	chapter or chapter 456.
645	(7)  CARDIOVASCULAR SURGEON AND CARDIOPULMONARY
646	PERFUSIONIST TO ADVISE THE BOARD.--
647	(a)  The chairperson of the board may appoint a
648	cardiovascular surgeon and a cardiopulmonary perfusionist to
649	advise the board as to the adoption of rules for the licensure
650	of cardiopulmonary perfusionists. The board may use a committee
651	structure that is most practicable in order to receive any
652	recommendations to the board regarding rules and all matters
653	relating to cardiopulmonary perfusionists, including, but not
654	limited to, recommendations to improve safety in the clinical
655	practices of licensed cardiopulmonary perfusionists.
656	(b)  In addition to its other duties and responsibilities
657	as prescribed by law, the board shall:
658	1.  Recommend to the department the licensure of
659	cardiopulmonary perfusionists.
660	2.  Develop all rules regulating the use of cardiopulmonary
661	perfusionists under this chapter and chapter 458, except for
662	rules relating to the formulary developed under s.
663	458.347(4)(f). The board shall also develop rules to ensure that
664	the continuity of supervision is maintained in each practice
665	setting. The boards shall consider adopting a proposed rule at
666	the regularly scheduled meeting immediately following the
667	submission of the proposed rule. A proposed rule may not be
668	adopted by either board unless both boards have accepted and
669	approved the identical language contained in the proposed rule.
670	The language of all proposed rules must be approved by both
671	boards pursuant to each respective board's guidelines and
672	standards regarding the adoption of proposed rules.
673	3.  Address concerns and problems of practicing
674	cardiopulmonary perfusionists to improve safety in the clinical
675	practices of licensed cardiopulmonary perfusionists.
676	(c)  When the board finds that an applicant for licensure
677	has failed to meet, to the board's satisfaction, each of the
678	requirements for licensure set forth in this section, the board
679	may enter an order to:
680	1.  Refuse to certify the applicant for licensure;
681	2.  Approve the applicant for licensure with restrictions
682	on the scope of practice or license; or
683	3.  Approve the applicant for conditional licensure. Such
684	conditions may include placement of the licensee on probation
685	for a period of time and subject to such conditions as the board
686	specifies, including, but not limited to, requiring the licensee
687	to undergo treatment, to attend continuing education courses, or
688	to take corrective action.
689	(8)  PENALTY.--A person who falsely holds himself or
690	herself out as a cardiopulmonary perfusionist commits a felony
691	of the third degree, punishable as provided in s. 775.082, s.
692	775.083, or s. 775.084.
693	(9)  DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
694	boards may deny, suspend, or revoke the license of a
695	cardiopulmonary perfusionist who the board determines has
696	violated any provision of this section or chapter or any rule
697	adopted pursuant thereto.
698	(10)  RULES.--The boards shall adopt rules to administer
699	this section.
700	(11)  LIABILITY.--A supervising osteopathic physician is
701	liable for any act or omission of a cardiopulmonary perfusionist
702	acting under the physician's supervision and control and shall
703	comply with the financial responsibility requirements of this
704	chapter and chapter 456, as applicable.
705	(12)  FEES.--The department shall allocate the fees
706	collected under this section to the board.
707	Section 6.  This act shall take effect July 1, 2005.

CODING: Words stricken are deletions; words underlined are additions.