HB 427

1
A bill to be entitled
2An act relating to surgical first assistance; creating s.
3458.3465, F.S.; providing definitions; providing
4requirements for the performance of supervising
5physicians; providing the duties and scope and location of
6practice for certified surgical first assistants;
7providing contracting and employment guidelines for
8physicians, hospitals, clinics, or ambulatory surgical
9centers employing certified surgical first assistants;
10providing licensure criteria for certified surgical first
11assistants; providing for application fees and licensure
12renewal fees; providing for licensure renewal; providing
13continuing education requirements; authorizing the Board
14of Medicine to impose penalties; providing scope of a
15certified surgical first assistant's license; providing
16for reciprocity of licenses among states; providing for
17inactive and delinquent status; providing that an
18unlicensed person who holds himself or herself out as, or
19indicates or implies that he or she is, licensed commits a
20third degree felony and is subject to applicable
21penalties; providing for denial, suspension, or revocation
22of licensure; authorizing the board to adopt rules;
23providing that supervising physicians may be liable for
24certain acts or omissions of certified surgical first
25assistants; providing guidelines for the use of fees
26collected by the board; amending s. 627.419, F.S.;
27providing for payments to a physician assistant under
28contracts providing for payment for surgical first
29assisting benefits or services; including certified
30surgical first assistants, as defined, within certain
31benefits or services payment provisions; limiting
32application; providing an effective date.
33
34Be It Enacted by the Legislature of the State of Florida:
35
36     Section 1.  Section 458.3465, Florida Statutes, is created
37to read:
38     458.3465  Certified surgical first assistants.--
39     (1)  DEFINITIONS.--As used in this section:
40     (a)  "Board" means the Board of Medicine.
41     (b)  "Certified surgical first assistant" means a person
42who provides primary surgical assistance to the primary surgeon
43during a surgical procedure, is listed on the operative record
44as the first assistant, and meets the qualifications for
45licensure under this section.
46     (c)  "Continuing medical education" means courses
47recognized and approved by the board, the Liaison Council on
48Certification for the Surgical Technologist, the National
49Surgical Assistant Association, the American Board of Surgical
50Assistants, the American Medical Association, the American
51Osteopathic Association, or the Accreditation Council on
52Continuing Medical Education.
53     (d)  "Direct supervision" means supervision by a delegating
54physician who is physically present and who personally directs
55delegated acts and remains immediately available to personally
56respond to any emergency until the patient is released from the
57operating room or the physician's care and has been transferred
58to the care and responsibility of another physician.
59     (e)  "Surgical assisting" means providing aid under direct
60supervision in exposure, hemostasis, closures, and other
61intraoperative technical functions that assist a physician in
62performing a safe operation with optimal results for the
63patient.
64     (2)  PERFORMANCE OF SUPERVISING PHYSICIAN.--Each physician
65or group of physicians supervising a certified surgical first
66assistant shall be qualified in the medical areas in which the
67certified surgical first assistant is to perform and may be
68individually or collectively responsible and liable for the
69performance and the acts and omissions of the certified surgical
70first assistant.
71     (3)  PERFORMANCE OF CERTIFIED SURGICAL FIRST ASSISTANTS.--
72     (a)  A certified surgical first assistant may perform
73duties limited to the scope of certification in surgical
74assisting functions while under the direct supervision of a
75physician.
76     (b)  The scope of practice of a certified surgical first
77assistant is limited to surgical assisting and tasks delegated
78by the supervising physician.
79     (c)  A certified surgical first assistant may only perform
80his or her duties in a medical clinic, hospital, ambulatory
81surgical center, or similar medical institution.
82     (4)  EMPLOYMENT OF CERTIFIED SURGICAL FIRST ASSISTANTS.--
83     (a)  A physician or hospital is not required to contract
84with a certified surgical first assistant.
85     (b)  A health maintenance organization, preferred provider
86organization, or health benefit plan shall not require a
87physician, hospital, clinic, or ambulatory surgery center to
88contract with a certified surgical first assistant as a
89condition of payment to a certified surgical first assistant.
90     (c)  The employment arrangement of a certified surgical
91first assistant shall not be limited in any way by rule of the
92board or by statute.
93     (5)  CERTIFIED SURGICAL FIRST ASSISTANT LICENSURE.--
94     (a)  A person desiring to be licensed as a certified
95surgical first assistant shall apply to the board. The board
96shall issue a license to any person determined by the board as
97having met the following requirements:
98     1.  Is at least 18 years of age.
99     2.  Holds and maintains certification from one of the
100following recognized certifying agencies:
101     a.  The Liaison Council on Certification for the Surgical
102Technologist.
103     b.  The National Surgical Assistant Association.
104     c.  The American Board of Surgical Assistants.
105     3.  Has completed the application form and remitted an
106application fee not to exceed $750 as set by the board. An
107application for licensure made by a certified surgical first
108assistant shall include:
109     a.  A certificate from one of the recognized certifying
110agencies specified in subparagraph 2.
111     b.  A sworn statement of any prior felony convictions.
112     c.  A sworn statement of any previous revocation or denial
113of licensure or certification.
114     (b)  A license shall be renewed biennially. Each renewal
115shall include:
116     1.  A renewal fee not to exceed $1,000 as set by the board.
117     2.  A sworn statement of no felony convictions in the
118previous 2 years.
119     (c)  Each licensed certified surgical first assistant shall
120biennially complete 40 hours of continuing medical education or
121shall hold a current certificate issued by a recognized
122certifying agency listed in subparagraph (a)2.
123     (d)  The board may impose any of the penalties authorized
124under ss. 456.072 and 458.331(2) upon a certified surgical first
125assistant if the certified surgical first assistant or the
126supervising physician has been found guilty of or is being
127investigated for any act that constitutes a violation of this
128chapter or chapter 456.
129     (e)  A certified surgical first assistant's license:
130     1.  Does not authorize the licensee to engage in the
131practice of medicine or professional nursing.
132     2.  Is not required of a registered nurse, an advanced
133registered nurse practitioner, a registered nurse first
134assistant, or a physician assistant as a condition of
135employment.
136     (6)  RECIPROCITY.--The department shall allow reciprocity
137to certified surgical first assistants who are determined by the
138board to:
139     (a)  Be licensed in other states and who are in good
140standing with their state of licensure and their certifying
141agency.
142     (b)  Have paid appropriate licensure fees.
143     (c)  Have complied with all other requirements of the
144board.
145     (7)  INACTIVE AND DELINQUENT STATUS.--A license on inactive
146or delinquent status may be reactivated only as provided in s.
147456.036.
148     (8)  PENALTY.--A person who has not been licensed by the
149board and approved by the department and who holds himself or
150herself out as a licensed certified surgical first assistant or
151who uses any other term in indicating or implying that he or she
152is a licensed certified surgical first assistant commits a
153felony of the third degree, punishable as provided in s.
154775.082, s. 775.083, or s. 775.084.
155     (9)  DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The
156board may deny, suspend, or revoke a certified surgical first
157assistant license if the board determines that the certified
158surgical first assistant has violated this chapter.
159     (10)  RULES.--The board may adopt rules to administer this
160section.
161     (11)  LIABILITY.--Each supervising physician using a
162certified surgical first assistant may be liable for acts or
163omissions of the certified surgical first assistant acting under
164the physician's supervision and control.
165     (12)  FEES.--The fees collected by the board under this
166section shall be used for the licensure and regulation of
167certified surgical first assistants in accordance with this
168section.
169     Section 2.  Subsection (6) of section 627.419, Florida
170Statutes, is amended to read:
171     627.419  Construction of policies.--
172     (6)(a)  Notwithstanding any other provision of law, when
173any health insurance policy, health care services plan, or other
174contract provides for payment for surgical first assisting
175benefits or services, the policy, plan, or contract is to be
176construed as providing for payment to a physician assistant or
177registered nurse first assistant or employers of a physician
178assistant or registered nurse first assistant who performs such
179services that are within the scope of a physician assistant's or
180a registered nurse first assistant's professional license. The
181provisions of This paragraph applies subsection apply only if
182reimbursement for an assisting physician, licensed under chapter
183458 or chapter 459, would be covered and a physician assistant
184or a registered nurse first assistant who performs such services
185is used as a substitute.
186     (b)1.  Notwithstanding any other provision of law, when any
187health insurance policy, health care services plan, or other
188contract provides for payment for surgical first assisting
189benefits or services, the policy, plan, or contract is to be
190construed as providing for payment to a certified surgical first
191assistant or to the employer of a certified surgical first
192assistant who performs such services that are assigned by the
193supervising physician or osteopathic physician. This paragraph
194applies only if reimbursement for an assisting physician,
195licensed under chapter 458 or chapter 459, would be covered and
196the certified surgical first assistant who performs such
197services is used as a substitute. As used in this paragraph, the
198term "certified surgical first assistant" means a person who is
199a licensed health care provider who is directly accountable to a
200physician licensed under chapter 458 or an osteopathic physician
201licensed under chapter 459 and who is certified by the National
202Surgical Assistant Association, the Liaison Council on
203Certification for the Surgical Technologist, or the American
204Board of Surgical Assistants.
205     2.  This paragraph does not require an insurer to directly
206reimburse a certified surgical first assistant if the certified
207surgical first assistant is paid or will be paid for a surgical
208procedure by the health care facility at which the surgical
209procedure is performed.
210     Section 3.  This act shall take effect July 1, 2006.


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