Florida Senate - 2012 SB 1594 By Senator Garcia 40-01074-12 20121594__ 1 A bill to be entitled 2 An act relating to surgical first assistants; 3 providing definitions; providing requirements for the 4 performance of supervising physicians; providing the 5 duties and scope and location of practice for 6 certified surgical first assistants; providing 7 contracting and employment guidelines for physicians, 8 hospitals, clinics, or ambulatory surgical centers 9 employing certified surgical first assistants; 10 providing licensure criteria for certified surgical 11 first assistants; providing for application fees and 12 licensure renewal fees; providing for licensure 13 renewal; providing continuing education requirements; 14 authorizing the Board of Medicine to impose penalties; 15 providing the scope of a certified surgical first 16 assistant’s license; providing for reciprocity of 17 licenses among states; providing for inactive and 18 delinquent status; providing that an unlicensed person 19 who holds himself or herself out as, or indicates or 20 implies that he or she is, licensed commits a third 21 degree felony and is subject to applicable penalties; 22 providing for denial, suspension, or revocation of 23 licensure; authorizing the board to adopt rules; 24 providing that supervising physicians may be liable 25 for certain acts or omissions of certified surgical 26 first assistants; providing guidelines for the use of 27 fees collected by the board; amending s. 627.419, 28 F.S.; providing for payments to a physician assistant 29 under contracts providing for payment for surgical 30 first assisting benefits or services; including 31 certified surgical first assistants, as defined, 32 within certain benefits or services payment 33 provisions; limiting such application; providing an 34 effective date. 35 36 Be It Enacted by the Legislature of the State of Florida: 37 38 Section 1. (1) DEFINITIONS.—As used in this section, the term: 39 (a) “Board” means the Board of Medicine. 40 (b) “Certified surgical first assistant” means a person who 41 provides primary surgical assistance to the primary surgeon 42 during a surgical procedure, is listed on the operative record 43 as the first assistant, and meets the qualifications for 44 licensure under this section. 45 (c) “Continuing medical education” means courses recognized 46 and approved by the board, the Liaison Council on Certification 47 for the Surgical Technologist, the National Surgical Assistant 48 Association, the American Board of Surgical Assistants, the 49 American Medical Association, the American Osteopathic 50 Association, or the Accreditation Council on Continuing Medical 51 Education. 52 (d) “Direct supervision” means supervision by a delegating 53 physician who is physically present and who personally directs 54 delegated acts and remains immediately available to personally 55 respond to any emergency until the patient is released from the 56 operating room or the physician’s care and has been transferred 57 to the care and responsibility of another physician. 58 (e) “Surgical assisting” means providing aid under direct 59 supervision in exposure, hemostasis, closures, and other 60 intraoperative technical functions that assist a physician in 61 performing a safe operation with optimal results for the 62 patient. 63 (2) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or 64 group of physicians supervising a certified surgical first 65 assistant must be qualified in the medical areas in which the 66 certified surgical first assistant is to perform and may be 67 individually or collectively responsible and liable for the 68 performance and the acts and omissions of the certified surgical 69 first assistant. 70 (3) PERFORMANCE OF CERTIFIED SURGICAL FIRST ASSISTANTS.— 71 (a) A certified surgical first assistant may perform duties 72 limited to the scope of certification in surgical assisting 73 functions while under the direct supervision of a physician. 74 (b) The scope of practice of a certified surgical first 75 assistant is limited to surgical assisting and tasks delegated 76 by the supervising physician. 77 (c) A certified surgical first assistant may perform his or 78 her duties only in a medical clinic, hospital, ambulatory 79 surgical center, or similar medical institution. 80 (4) EMPLOYMENT OF CERTIFIED SURGICAL FIRST ASSISTANTS.— 81 (a) A physician or hospital is not required to contract 82 with a certified surgical first assistant. 83 (b) A health maintenance organization, preferred provider 84 organization, or health benefit plan may not require a 85 physician, hospital, clinic, or ambulatory surgery center to 86 contract with a certified surgical first assistant as a 87 condition of payment to a certified surgical first assistant. 88 (c) The board may not limit in any way by rule the 89 employment arrangement of a certified surgical first assistant. 90 (5) CERTIFIED SURGICAL FIRST ASSISTANT LICENSURE.— 91 (a) A person desiring to be licensed as a certified 92 surgical first assistant shall apply to the board. The board 93 shall issue a license to any person determined by the board as 94 having met the following requirements: 95 1. Is at least 18 years of age. 96 2. Holds and maintains certification from one of the 97 following recognized certifying agencies: 98 a. The Liaison Council on Certification for the Surgical 99 Technologist. 100 b. The National Surgical Assistant Association. 101 c. The American Board of Surgical Assistants. 102 3. Has completed the application form and remitted an 103 application fee not to exceed $750 as set by the board. An 104 application for licensure made by a certified surgical first 105 assistant must include: 106 a. A certificate from one of the recognized certifying 107 agencies specified in subparagraph 2. 108 b. A sworn statement of any prior felony convictions. 109 c. A sworn statement of any previous revocation or denial 110 of licensure or certification. 111 (b) A license must be renewed biennially. Each renewal must 112 include: 113 1. A renewal fee not to exceed $1,000 as set by the board. 114 2. A sworn statement of no felony convictions in the 115 previous 2 years. 116 (c) Each licensed certified surgical first assistant shall 117 biennially complete 40 hours of continuing medical education or 118 hold a current certificate issued by a recognized certifying 119 agency listed in subparagraph (a)2. 120 (d) The board may impose any of the penalties authorized 121 under ss. 456.072 and 458.331(2), Florida Statutes, upon a 122 certified surgical first assistant if the certified surgical 123 first assistant or the supervising physician has been found 124 guilty of or is being investigated for any act that constitutes 125 a violation of chapter 456 or chapter 458, Florida Statutes. 126 (e) A certified surgical first assistant’s license: 127 1. Does not authorize the licensee to engage in the 128 practice of medicine or professional nursing. 129 2. Is not required of a registered nurse, an advanced 130 registered nurse practitioner, a registered nurse first 131 assistant, or a physician assistant as a condition of 132 employment. 133 (6) RECIPROCITY.—The Department of Health shall allow 134 reciprocity to certified surgical first assistants who are 135 determined by the board to: 136 (a) Be licensed in other states and who are in good 137 standing with their state of licensure and their certifying 138 agency. 139 (b) Have paid appropriate licensure fees. 140 (c) Have complied with all other requirements of the board. 141 (7) INACTIVE AND DELINQUENT STATUS.—A license on inactive 142 or delinquent status may be reactivated only as provided in s. 143 456.036, Florida Statutes. 144 (8) PENALTY.—A person who has not been licensed by the 145 board and approved by the Department of Health and who holds 146 himself or herself out as a licensed certified surgical first 147 assistant or who uses any other term in indicating or implying 148 that he or she is a licensed certified surgical first assistant 149 commits a felony of the third degree, punishable as provided in 150 s. 775.082, s. 775.083, or s. 775.084, Florida Statutes. 151 (9) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.—The 152 board may deny, suspend, or revoke a certified surgical first 153 assistant license if the board determines that the certified 154 surgical first assistant has violated chapter 456 or chapter 155 458, Florida Statutes. 156 (10) RULES.—The board may adopt rules to administer this 157 section. 158 (11) LIABILITY.—Each supervising physician using a 159 certified surgical first assistant may be liable for acts or 160 omissions of the certified surgical first assistant acting under 161 the physician’s supervision and control. 162 (12) FEES.—The fees collected by the board under this 163 section shall be used for the licensure and regulation of 164 certified surgical first assistants in accordance with this 165 section. 166 Section 2. Subsection (6) of section 627.419, Florida 167 Statutes, is amended to read: 168 627.419 Construction of policies.— 169 (6)(a) Notwithstanding any other provision of law, if a 170
when anyhealth insurance policy, health care services plan, or 171 other contract provides for payment for surgical first assisting 172 benefits or services, the policy, plan, or contract shall is to173 be construed as providing for payment to a physician assistant 174 or a registered nurse first assistant or employers of a 175 physician assistant or registered nurse first assistant who 176 performs such services that are within the scope of a physician 177 assistant’s or a registered nurse first assistant’s professional 178 license. This paragraph applies The provisions of this179 subsection applyonly if reimbursement for an assisting 180 physician, licensed under chapter 458 or chapter 459, would be 181 covered and a physician assistant or a registered nurse first 182 assistant who performs such services is used as a substitute. 183 (b)1. Notwithstanding any other provision of law, if a 184 health insurance policy, health care services plan, or other 185 contract provides for payment for surgical first assisting 186 benefits or services, the policy, plan, or contract shall be 187 construed as providing for payment to a certified surgical first 188 assistant or to the employer of a certified surgical first 189 assistant who performs such services that are assigned by the 190 supervising physician or osteopathic physician. This paragraph 191 applies only if reimbursement for an assisting physician 192 licensed under chapter 458 or chapter 459 would be covered and 193 the certified surgical first assistant who performs such 194 services is used as a substitute. As used in this paragraph, the 195 term “certified surgical first assistant” means a person who is 196 a licensed health care provider who is directly accountable to a 197 physician licensed under chapter 458 or an osteopathic physician 198 licensed under chapter 459 and who is certified by the National 199 Surgical Assistant Association, the Liaison Council on 200 Certification for the Surgical Technologist, or the American 201 Board of Surgical Assistants. 202 2. This paragraph does not require an insurer to directly 203 reimburse a certified surgical first assistant if the certified 204 surgical first assistant is paid or will be paid for a surgical 205 procedure by the health care facility at which the surgical 206 procedure is performed. 207 Section 3. This act shall take effect July 1, 2012.