| 1 | The Health Care Regulation Committee recommends the following: |
| 2 |
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| 3 | Council/Committee Substitute |
| 4 | Remove the entire bill and insert: |
| 5 | A bill to be entitled |
| 6 | An act relating to surgical first assistance; creating s. |
| 7 | 458.3465, F.S.; providing definitions; providing |
| 8 | requirements for the performance of supervising |
| 9 | physicians; providing the duties and scope and location of |
| 10 | practice for certified surgical first assistants; |
| 11 | providing contracting and employment guidelines for |
| 12 | physicians, hospitals, clinics, or ambulatory surgical |
| 13 | centers employing certified surgical first assistants; |
| 14 | providing licensure criteria for certified surgical first |
| 15 | assistants; providing for application fees and licensure |
| 16 | renewal fees; providing for licensure renewal; providing |
| 17 | continuing education requirements; authorizing the Board |
| 18 | of Medicine to impose penalties; providing scope of a |
| 19 | certified surgical first assistant's license; providing |
| 20 | for inactive and delinquent status; providing that an |
| 21 | unlicensed person who holds himself or herself out as, or |
| 22 | indicates or implies that he or she is, licensed commits a |
| 23 | third degree felony and is subject to applicable |
| 24 | penalties; providing for denial, suspension, or revocation |
| 25 | of licensure; authorizing the board to adopt rules; |
| 26 | providing that supervising physicians may be liable for |
| 27 | certain acts or omissions of certified surgical first |
| 28 | assistants; providing guidelines for the use of fees |
| 29 | collected by the board; amending s. 627.419, F.S.; |
| 30 | providing for payments to a physician assistant under |
| 31 | contracts providing for payment for surgical first |
| 32 | assisting benefits or services; including certified |
| 33 | surgical first assistants, as defined, within certain |
| 34 | benefits or services payment provisions; limiting |
| 35 | application; providing an effective date. |
| 36 |
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| 37 | Be It Enacted by the Legislature of the State of Florida: |
| 38 |
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| 39 | Section 1. Section 458.3465, Florida Statutes, is created |
| 40 | to read: |
| 41 | 458.3465 Certified surgical first assistants.-- |
| 42 | (1) DEFINITIONS.--As used in this section: |
| 43 | (a) "Board" means the Board of Medicine. |
| 44 | (b) "Certified surgical first assistant" means a person |
| 45 | who provides primary surgical assistance to the primary surgeon |
| 46 | during a surgical procedure, is listed on the operative record |
| 47 | as the first assistant, and meets the qualifications for |
| 48 | licensure under this section. |
| 49 | (c) "Continuing medical education" means courses |
| 50 | recognized and approved by the board, the Liaison Council on |
| 51 | Certification for the Surgical Technologist, the National |
| 52 | Surgical Assistant Association, the American Board of Surgical |
| 53 | Assistants, the American Medical Association, the American |
| 54 | Osteopathic Association, or the Accreditation Council on |
| 55 | Continuing Medical Education. |
| 56 | (d) "Department" means the Department of Health. |
| 57 | (e) "Direct supervision" means supervision by a delegating |
| 58 | physician who is physically present and who personally directs |
| 59 | delegated acts and remains immediately available to personally |
| 60 | respond to any emergency until the patient is released from the |
| 61 | operating room or the physician's care and has been transferred |
| 62 | to the care and responsibility of another physician. |
| 63 | (f) "Surgical assisting" means providing aid under direct |
| 64 | supervision in exposure, hemostasis, closures, and other |
| 65 | intraoperative technical functions that assist a physician in |
| 66 | performing a safe operation with optimal results for the |
| 67 | patient. |
| 68 | (2) PERFORMANCE OF SUPERVISING PHYSICIAN.--Each physician |
| 69 | or group of physicians supervising a certified surgical first |
| 70 | assistant shall be qualified in the medical areas in which the |
| 71 | certified surgical first assistant is to perform and may be |
| 72 | individually or collectively responsible and liable for the |
| 73 | performance and the acts and omissions of the certified surgical |
| 74 | first assistant. |
| 75 | (3) PERFORMANCE OF CERTIFIED SURGICAL FIRST ASSISTANTS.-- |
| 76 | (a) A certified surgical first assistant may perform |
| 77 | duties limited to the scope of certification in surgical |
| 78 | assisting functions while under the direct supervision of a |
| 79 | physician. |
| 80 | (b) The scope of practice of a certified surgical first |
| 81 | assistant is limited to surgical assisting and tasks delegated |
| 82 | by the supervising physician. |
| 83 | (c) A certified surgical first assistant may only perform |
| 84 | his or her duties in a medical clinic, hospital, ambulatory |
| 85 | surgical center, or similar medical institution. |
| 86 | (d) Nothing in this section shall be construed as |
| 87 | requiring licensure as a certified surgical first assistant in |
| 88 | order to provide surgical assisting services. |
| 89 | (4) EMPLOYMENT OF CERTIFIED SURGICAL FIRST ASSISTANTS.-- |
| 90 | (a) A physician or hospital is not required to contract |
| 91 | with a certified surgical first assistant. |
| 92 | (b) A health maintenance organization, preferred provider |
| 93 | organization, or health benefit plan shall not require a |
| 94 | physician, hospital, clinic, or ambulatory surgery center to |
| 95 | contract with a certified surgical first assistant as a |
| 96 | condition of payment to a certified surgical first assistant. |
| 97 | (c) The employment arrangement of a certified surgical |
| 98 | first assistant shall not be limited in any way by rule of the |
| 99 | board or by statute. |
| 100 | (5) CERTIFIED SURGICAL FIRST ASSISTANT LICENSURE.-- |
| 101 | (a) A person desiring to be licensed as a certified |
| 102 | surgical first assistant shall apply to the department. The |
| 103 | department shall issue a license to any person certified by the |
| 104 | board as having met the following requirements: |
| 105 | 1. Is at least 18 years of age. |
| 106 | 2. Holds and maintains certification from one of the |
| 107 | following recognized certifying agencies: |
| 108 | a. The Liaison Council on Certification for the Surgical |
| 109 | Technologist. |
| 110 | b. The National Surgical Assistant Association. |
| 111 | 3. Has completed the application form and remitted an |
| 112 | application fee not to exceed $750 as set by the board. An |
| 113 | application for licensure made by a certified surgical first |
| 114 | assistant shall include: |
| 115 | a. A certificate from one of the recognized certifying |
| 116 | agencies specified in subparagraph 2. |
| 117 | b. A sworn statement of any prior felony convictions. |
| 118 | c. A sworn statement of any previous revocation or denial |
| 119 | of licensure or certification. |
| 120 | (b) A license shall be renewed biennially. Each renewal |
| 121 | shall include: |
| 122 | 1. A renewal fee not to exceed $1,000 as set by the board. |
| 123 | 2. A sworn statement of no felony convictions in the |
| 124 | previous 2 years. |
| 125 | (c) Each licensed certified surgical first assistant shall |
| 126 | biennially complete 40 hours of continuing medical education and |
| 127 | shall hold a current certificate issued by a recognized |
| 128 | certifying agency listed in subparagraph (a)2. |
| 129 | (d) The board may impose any of the penalties authorized |
| 130 | under ss. 456.072 and 458.331(2) upon a certified surgical first |
| 131 | assistant if the certified surgical first assistant or the |
| 132 | supervising physician has been found guilty of or is being |
| 133 | investigated for any act that constitutes a violation of this |
| 134 | chapter or chapter 456. |
| 135 | (e) A certified surgical first assistant's license: |
| 136 | 1. Does not authorize the licensee to engage in the |
| 137 | practice of medicine or professional nursing. |
| 138 | 2. Is not required of a registered nurse, an advanced |
| 139 | registered nurse practitioner, a registered nurse first |
| 140 | assistant, a physician assistant, or hospital employee as a |
| 141 | condition of employment to perform duties as a surgical |
| 142 | assistant. |
| 143 | (6) INACTIVE AND DELINQUENT STATUS.--A license on inactive |
| 144 | or delinquent status may be reactivated only as provided in s. |
| 145 | 456.036. |
| 146 | (7) PENALTY.--A person who has not been licensed by the |
| 147 | board and approved by the department and who holds himself or |
| 148 | herself out as a licensed certified surgical first assistant or |
| 149 | who uses any other term in indicating or implying that he or she |
| 150 | is a licensed certified surgical first assistant commits a |
| 151 | felony of the third degree, punishable as provided in s. |
| 152 | 775.082, s. 775.083, or s. 775.084. |
| 153 | (8) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.--The |
| 154 | board may deny, suspend, or revoke a certified surgical first |
| 155 | assistant license if the board determines that the certified |
| 156 | surgical first assistant has violated this chapter. |
| 157 | (9) RULES.--The board may adopt rules to administer this |
| 158 | section. |
| 159 | (10) LIABILITY.--Each supervising physician using a |
| 160 | certified surgical first assistant may be liable for acts or |
| 161 | omissions of the certified surgical first assistant acting under |
| 162 | the physician's direct supervision and control. |
| 163 | (11) FEES.--The fees collected by the board under this |
| 164 | section shall be used for the licensure and regulation of |
| 165 | certified surgical first assistants in accordance with this |
| 166 | section. |
| 167 | Section 2. Subsection (6) of section 627.419, Florida |
| 168 | Statutes, is amended to read: |
| 169 | 627.419 Construction of policies.-- |
| 170 | (6)(a) Notwithstanding any other provision of law, when |
| 171 | any health insurance policy, health care services plan, or other |
| 172 | contract provides for payment for surgical first assisting |
| 173 | benefits or services, the policy, plan, or contract is to be |
| 174 | construed as providing for payment to a physician assistant or |
| 175 | registered nurse first assistant or employers of a physician |
| 176 | assistant or registered nurse first assistant who performs such |
| 177 | services that are within the scope of a physician assistant's or |
| 178 | a registered nurse first assistant's professional license. The |
| 179 | provisions of This paragraph applies subsection apply only if |
| 180 | reimbursement for an assisting physician, licensed under chapter |
| 181 | 458 or chapter 459, would be covered and a physician assistant |
| 182 | or a registered nurse first assistant who performs such services |
| 183 | is used as a substitute. |
| 184 | (b)1. Notwithstanding any other provision of law, when any |
| 185 | health insurance policy, health care services plan, or other |
| 186 | contract provides for payment for surgical first assisting |
| 187 | benefits or services, the policy, plan, or contract is to be |
| 188 | construed as providing for payment to a certified surgical first |
| 189 | assistant or to the employer of a certified surgical first |
| 190 | assistant who performs such services that are assigned by the |
| 191 | supervising physician or osteopathic physician. This paragraph |
| 192 | applies only if reimbursement for an assisting physician, |
| 193 | licensed under chapter 458 or chapter 459, would be covered and |
| 194 | the certified surgical first assistant who performs such |
| 195 | services is used as a substitute. As used in this paragraph, the |
| 196 | term "certified surgical first assistant" means a person who is |
| 197 | a licensed health care provider who is directly accountable to a |
| 198 | physician licensed under chapter 458 or an osteopathic physician |
| 199 | licensed under chapter 459 and who is certified by the National |
| 200 | Surgical Assistant Association, the Liaison Council on |
| 201 | Certification for the Surgical Technologist, or the American |
| 202 | Board of Surgical Assistants. |
| 203 | 2. This paragraph does not require an insurer to directly |
| 204 | reimburse a certified surgical first assistant if the certified |
| 205 | surgical first assistant is paid or will be paid for a surgical |
| 206 | procedure by the health care facility at which the surgical |
| 207 | procedure is performed. |
| 208 | Section 3. This act shall take effect October 1, 2006. |