Florida Senate - 2019 CS for SB 732
By the Committee on Health Policy; and Senator Flores
588-02904-19 2019732c1
1 A bill to be entitled
2 An act relating to clinics and office surgery;
3 amending s. 400.9905, F.S.; revising the definition of
4 the term “clinic”; amending s. 400.991, F.S.;
5 requiring a clinic to provide proof of its financial
6 responsibility to pay certain claims and costs along
7 with its application for licensure to the Agency for
8 Health Care Administration; amending s. 400.9935,
9 F.S.; requiring a medical director or a clinic
10 director to ensure that the clinic complies with
11 specified rules; amending s. 400.995, F.S.; requiring
12 the agency to impose a specified administrative fine
13 on an unregistered clinic that performs certain office
14 surgeries; amending s. 456.004, F.S.; requiring the
15 Department of Health to deny or revoke the
16 registration of or impose certain penalties against a
17 facility where certain office surgeries are performed
18 under certain circumstances; specifying provisions
19 that apply enforcement actions against such
20 facilities; authorizing the department to deny certain
21 persons associated with an office of which the
22 registration was revoked from registering a new office
23 to perform certain office surgery; amending s.
24 456.074, F.S.; authorizing the department to issue an
25 emergency order suspending or restricting the
26 registration of a certain office if it makes certain
27 findings; amending s. 458.305, F.S.; defining terms;
28 amending s. 458.309, F.S.; requiring a physician who
29 performs certain office surgery and the office in
30 which the surgery is performed to maintain specified
31 levels of financial responsibility; authorizing the
32 department to adopt rules to administer the
33 registration, inspection, and safety of offices that
34 perform certain office surgery; requiring the Board of
35 Medicine to adopt rules governing the standard of care
36 for physicians practicing in such offices; requiring
37 the board to impose a specified fine on physicians who
38 perform certain office surgeries in an unregistered
39 office; amending s. 458.331, F.S.; providing that a
40 physician performing certain office surgeries in an
41 unregistered office constitutes grounds for denial of
42 a license or disciplinary action; amending s. 459.003,
43 F.S.; defining terms; amending s. 459.005, F.S.;
44 requiring a physician who performs certain office
45 surgery and the office in which the surgery is
46 performed to maintain specified levels of financial
47 responsibility; authorizing the department to adopt
48 rules to administer the registration, inspection, and
49 safety of offices that perform certain office surgery;
50 requiring the Board of Osteopathic Medicine to adopt
51 rules governing the standard of care for physicians
52 practicing in such offices; requiring the board to
53 impose a specified fine on physicians who perform
54 certain office surgeries in an unregistered office;
55 amending s. 459.015, F.S.; providing that a physician
56 performing certain office surgeries in an unregistered
57 office constitutes grounds for denial of a license or
58 disciplinary action; amending s. 464.012, F.S.;
59 authorizing a certified registered nurse anesthetist
60 to provide specified services in a an office
61 registered to perform office surgery within the
62 framework of an established protocol with a licensed
63 anesthesiologist; amending s. 766.101, F.S.;
64 conforming a cross-reference; providing an effective
65 date.
66
67 Be It Enacted by the Legislature of the State of Florida:
68
69 Section 1. Subsection (4) of section 400.9905, Florida
70 Statutes, is amended to read:
71 400.9905 Definitions.—
72 (4) “Clinic” means an entity that provides where health
73 care services are provided to individuals and that receives
74 compensation and which tenders charges for reimbursement for
75 those such services, including a mobile clinic and a portable
76 equipment provider. As used in this part, the term does not
77 include and the licensure requirements of this part do not apply
78 to:
79 (a) Entities licensed or registered by the state under
80 chapter 395; entities licensed or registered by the state and
81 providing only health care services within the scope of services
82 authorized under their respective licenses under ss. 383.30
83 383.332, chapter 390, chapter 394, chapter 397, this chapter
84 except part X, chapter 429, chapter 463, chapter 465, chapter
85 466, chapter 478, chapter 484, or chapter 651; end-stage renal
86 disease providers authorized under 42 C.F.R. part 405, subpart
87 U; providers certified under 42 C.F.R. part 485, subpart B or
88 subpart H; or any entity that provides neonatal or pediatric
89 hospital-based health care services or other health care
90 services by licensed practitioners solely within a hospital
91 licensed under chapter 395.
92 (b) Entities that own, directly or indirectly, entities
93 licensed or registered by the state pursuant to chapter 395;
94 entities that own, directly or indirectly, entities licensed or
95 registered by the state and providing only health care services
96 within the scope of services authorized pursuant to their
97 respective licenses under ss. 383.30-383.332, chapter 390,
98 chapter 394, chapter 397, this chapter except part X, chapter
99 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
100 484, or chapter 651; end-stage renal disease providers
101 authorized under 42 C.F.R. part 405, subpart U; providers
102 certified under 42 C.F.R. part 485, subpart B or subpart H; or
103 any entity that provides neonatal or pediatric hospital-based
104 health care services by licensed practitioners solely within a
105 hospital licensed under chapter 395.
106 (c) Entities that are owned, directly or indirectly, by an
107 entity licensed or registered by the state pursuant to chapter
108 395; entities that are owned, directly or indirectly, by an
109 entity licensed or registered by the state and providing only
110 health care services within the scope of services authorized
111 pursuant to their respective licenses under ss. 383.30-383.332,
112 chapter 390, chapter 394, chapter 397, this chapter except part
113 X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
114 478, chapter 484, or chapter 651; end-stage renal disease
115 providers authorized under 42 C.F.R. part 405, subpart U;
116 providers certified under 42 C.F.R. part 485, subpart B or
117 subpart H; or any entity that provides neonatal or pediatric
118 hospital-based health care services by licensed practitioners
119 solely within a hospital under chapter 395.
120 (d) Entities that are under common ownership, directly or
121 indirectly, with an entity licensed or registered by the state
122 pursuant to chapter 395; entities that are under common
123 ownership, directly or indirectly, with an entity licensed or
124 registered by the state and providing only health care services
125 within the scope of services authorized pursuant to their
126 respective licenses under ss. 383.30-383.332, chapter 390,
127 chapter 394, chapter 397, this chapter except part X, chapter
128 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
129 484, or chapter 651; end-stage renal disease providers
130 authorized under 42 C.F.R. part 405, subpart U; providers
131 certified under 42 C.F.R. part 485, subpart B or subpart H; or
132 any entity that provides neonatal or pediatric hospital-based
133 health care services by licensed practitioners solely within a
134 hospital licensed under chapter 395.
135 (e) An entity that is exempt from federal taxation under 26
136 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
137 under 26 U.S.C. s. 409 that has a board of trustees at least
138 two-thirds of which are Florida-licensed health care
139 practitioners and provides only physical therapy services under
140 physician orders, any community college or university clinic,
141 and any entity owned or operated by the federal or state
142 government, including agencies, subdivisions, or municipalities
143 thereof.
144 (f) A sole proprietorship, group practice, partnership, or
145 corporation that provides health care services by physicians
146 covered by s. 627.419, that is directly supervised by one or
147 more of such physicians, and that is wholly owned by one or more
148 of those physicians or by a physician and the spouse, parent,
149 child, or sibling of that physician.
150 (g) A sole proprietorship, group practice, partnership, or
151 corporation that provides health care services by licensed
152 health care practitioners under chapter 457, chapter 458,
153 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
154 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
155 chapter 490, chapter 491, or part I, part III, part X, part
156 XIII, or part XIV of chapter 468, or s. 464.012, and that is
157 wholly owned by one or more licensed health care practitioners,
158 or the licensed health care practitioners set forth in this
159 paragraph and the spouse, parent, child, or sibling of a
160 licensed health care practitioner if one of the owners who is a
161 licensed health care practitioner is supervising the business
162 activities and is legally responsible for the entity’s
163 compliance with all federal and state laws. However, a health
164 care practitioner may not supervise services beyond the scope of
165 the practitioner’s license, except that, for the purposes of
166 this part, a clinic owned by a licensee in s. 456.053(3)(b)
167 which provides only services authorized pursuant to s.
168 456.053(3)(b) may be supervised by a licensee specified in s.
169 456.053(3)(b).
170 (h) Clinical facilities affiliated with an accredited
171 medical school at which training is provided for medical
172 students, residents, or fellows.
173 (i) Entities that provide only oncology or radiation
174 therapy services by physicians licensed under chapter 458 or
175 chapter 459 or entities that provide oncology or radiation
176 therapy services by physicians licensed under chapter 458 or
177 chapter 459 which are owned by a corporation whose shares are
178 publicly traded on a recognized stock exchange.
179 (j) Clinical facilities affiliated with a college of
180 chiropractic accredited by the Council on Chiropractic Education
181 at which training is provided for chiropractic students.
182 (k) Entities that provide licensed practitioners to staff
183 emergency departments or to deliver anesthesia services in
184 facilities licensed under chapter 395 and that derive at least
185 90 percent of their gross annual revenues from the provision of
186 such services. Entities claiming an exemption from licensure
187 under this paragraph must provide documentation demonstrating
188 compliance.
189 (l) Orthotic, prosthetic, pediatric cardiology, or
190 perinatology clinical facilities or anesthesia clinical
191 facilities that are not otherwise exempt under paragraph (a) or
192 paragraph (k) and that are a publicly traded corporation or are
193 wholly owned, directly or indirectly, by a publicly traded
194 corporation. As used in this paragraph, a publicly traded
195 corporation is a corporation that issues securities traded on an
196 exchange registered with the United States Securities and
197 Exchange Commission as a national securities exchange.
198 (m) Entities that are owned by a corporation that has $250
199 million or more in total annual sales of health care services
200 provided by licensed health care practitioners where one or more
201 of the persons responsible for the operations of the entity is a
202 health care practitioner who is licensed in this state and who
203 is responsible for supervising the business activities of the
204 entity and is responsible for the entity’s compliance with state
205 law for purposes of this part.
206 (n) Entities that employ 50 or more licensed health care
207 practitioners licensed under chapter 458 or chapter 459 where
208 the billing for medical services is under a single tax
209 identification number. The application for exemption under this
210 subsection shall contain information that includes: the name,
211 residence, and business address and phone number of the entity
212 that owns the practice; a complete list of the names and contact
213 information of all the officers and directors of the
214 corporation; the name, residence address, business address, and
215 medical license number of each licensed Florida health care
216 practitioner employed by the entity; the corporate tax
217 identification number of the entity seeking an exemption; a
218 listing of health care services to be provided by the entity at
219 the health care clinics owned or operated by the entity and a
220 certified statement prepared by an independent certified public
221 accountant which states that the entity and the health care
222 clinics owned or operated by the entity have not received
223 payment for health care services under personal injury
224 protection insurance coverage for the preceding year. If the
225 agency determines that an entity which is exempt under this
226 subsection has received payments for medical services under
227 personal injury protection insurance coverage, the agency may
228 deny or revoke the exemption from licensure under this
229 subsection.
230
231 Notwithstanding this subsection, an entity shall be deemed a
232 clinic and must be licensed under this part in order to receive
233 reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
234 627.730-627.7405, unless exempted under s. 627.736(5)(h).
235 Section 2. Subsection (4) of section 400.991, Florida
236 Statutes, is amended to read:
237 400.991 License requirements; background screenings;
238 prohibitions.—
239 (4) In addition to the requirements of part II of chapter
240 408, the applicant must file with the application satisfactory
241 proof that the clinic is in compliance with this part and
242 applicable rules, including:
243 (a) A listing of services to be provided either directly by
244 the applicant or through contractual arrangements with existing
245 providers;
246 (b) The number and discipline of each professional staff
247 member to be employed; and
248 (c) Proof of financial ability to operate as required under
249 s. 408.810(8). As an alternative to submitting proof of
250 financial ability to operate as required under s. 408.810(8),
251 the applicant may file a surety bond of at least $500,000 which
252 guarantees that the clinic will act in full conformity with all
253 legal requirements for operating a clinic, payable to the
254 agency. The agency may adopt rules to specify related
255 requirements for such surety bond; and
256 (d) Proof that the clinic maintains the financial
257 responsibility in the manner set forth in s. 458.320(2) or s.
258 459.0085(2), as applicable, to pay claims and costs ancillary
259 thereto arising out of the rendering of or the failure to render
260 medical care and services, for physicians and osteopathic
261 physicians who perform liposuction procedures in which more than
262 1,000 cubic centimeters of supernatant fat is removed, Level II
263 office surgery, or Level III office surgery as those terms are
264 defined in ss. 458.305(8) and 459.003(9), in an office setting.
265 Section 3. Paragraph (j) is added to subsection (1) of
266 section 400.9935, Florida Statutes, to read:
267 400.9935 Clinic responsibilities.—
268 (1) Each clinic shall appoint a medical director or clinic
269 director who shall agree in writing to accept legal
270 responsibility for the following activities on behalf of the
271 clinic. The medical director or the clinic director shall:
272 (j) If the clinic is registered with the department to
273 perform office surgery, ensure that the clinic complies with the
274 standards of practice for office surgery adopted by rule under
275 ss. 458.309(4) and 459.005(3).
276 Section 4. Subsection (4) of section 400.995, Florida
277 Statutes, is amended to read:
278 400.995 Agency administrative penalties.—
279 (4) Any licensed clinic whose owner, medical director, or
280 clinic director concurrently operates an unlicensed clinic or a
281 clinic that is not registered with the department where any
282 liposuction procedure in which more than 1,000 cubic centimeters
283 of supernatant fat is removed or where any Level II office
284 surgery or Level III office surgery, as those terms are defined
285 in ss. 458.305(8) and 459.003(9), is performed, is shall be
286 subject to an administrative fine of $5,000 per day.
287 Section 5. Subsection (12) is added to section 456.004,
288 Florida Statutes, to read:
289 456.004 Department; powers and duties.—The department, for
290 the professions under its jurisdiction, shall:
291 (12) Deny or revoke the registration of, or impose any
292 penalty set forth in s. 456.072(2) against, any facility where
293 office surgery, as defined in ss. 458.305(8) and 459.003(9), is
294 performed for failure of any of its physicians, owners, or
295 operators to comply with rules adopted under ss. 458.309(3) and
296 459.005(2). Section 456.073 applies to enforcement actions
297 brought against such facilities. If a facility’s registration is
298 revoked, the department may deny any person named in the
299 registration documents of the facility, including the persons
300 who own or operate the facility, individually or as part of a
301 group, from registering a facility to perform surgical
302 procedures pursuant to s. 458.309(3) or s. 459.005(2) for 5
303 years after the revocation date.
304 Section 6. Subsection (6) is added to section 456.074,
305 Florida Statutes, to read:
306 456.074 Certain health care practitioners; immediate
307 suspension of license.—
308 (6) The department may issue an emergency order suspending
309 or restricting the registration of a facility in which
310 liposuction procedures in which more than 1,000 cubic
311 centimeters of supernatant fat is removed, Level II office
312 surgery, or Level III office surgery as those terms are defined
313 in ss. 458.305(8) and 459.003(9), are performed upon a finding
314 of probable cause that the facility or its surgeons are not in
315 compliance with the standards of practice for office surgery
316 adopted by the boards pursuant to s. 458.309(4) or s.
317 459.005(3), as applicable, or are in violation of s.
318 458.331(1)(v) or s. 459.015(1)(z) and that such noncompliance
319 constitutes an immediate danger to the public.
320 Section 7. Section 458.305, Florida Statutes, is amended to
321 read:
322 458.305 Definitions.—As used in this chapter, the term:
323 (1) “Board” means the Board of Medicine.
324 (2) “Deep sedation and analgesia” means a drug-induced
325 depression of consciousness during which all of the following
326 apply:
327 (a) The patient cannot be easily aroused but responds by
328 purposefully following repeated or painful stimulation.
329 (b) The patient’s ability to independently maintain
330 ventilatory function may be impaired.
331 (c) The patient may require assistance in maintaining a
332 patent airway, and spontaneous ventilation may be inadequate.
333 (d) The patient’s cardiovascular function is usually
334 maintained.
335 (e) The patient’s reflex withdrawal from painful stimulus
336 is not considered a purposeful response.
337 (3)(2) “Department” means the Department of Health.
338 (4) “Epidural anesthesia” means anesthesia produced by the
339 injection of an anesthetic agent into the space on or around the
340 dura mater of the spinal cord.
341 (5) “General anesthesia” means a drug-induced loss of
342 consciousness administered by a qualified general anesthesia
343 provider during which all of the following apply:
344 (a) The patient is not able to be aroused, even by painful
345 stimulation.
346 (b) The patient’s ability to independently maintain
347 ventilatory function is often impaired.
348 (c) The patient has a level of depressed neuromuscular
349 function.
350 (d) The patient may require assistance in maintaining a
351 patent airway, and positive pressure ventilation may be
352 required.
353 (e) The patient’s cardiovascular function may be impaired.
354 (6) “Minimal sedation” means a drug-induced state during
355 which patients respond normally to verbal commands. Although
356 cognitive function and physical coordination may be impaired,
357 airway reflexes and respiratory and cardiovascular functions are
358 unaffected.
359 (7) “Moderate sedation and analgesia” or “conscious
360 sedation” means drug-induced depression of consciousness and a
361 state of consciousness during which all of the following apply:
362 (a) The patient responds purposefully to verbal commands,
363 either alone or accompanied by light tactile stimulation.
364 (b) Interventions are not required to maintain a patent
365 airway, and spontaneous ventilation is adequate.
366 (c) Cardiovascular function is maintained.
367 (d) Reflex withdrawal from a painful stimulus is not
368 considered a purposeful response.
369 (8) “Office surgery” means a surgery that is performed in a
370 physician’s office or any facility that is not licensed under
371 chapter 390 or chapter 395.
372 (a) “Level I office surgery” includes any surgery that
373 consists of only minor procedures and in which anesthesia is
374 limited to minimal sedation.
375 (b) “Level II office surgery” includes any surgery in which
376 the patient’s level of sedation is that of moderate sedation and
377 analgesia or conscious sedation.
378 (c) ”Level III office surgery” includes any surgery in
379 which the patient’s level of sedation is that of deep sedation
380 and analgesia or general anesthesia. The term includes any
381 surgery that includes the use of spinal anesthesia or epidural
382 anesthesia.
383 (10)(3) “Practice of medicine” means the diagnosis,
384 treatment, operation, or prescription for any human disease,
385 pain, injury, deformity, or other physical or mental condition.
386 (11) “Spinal anesthesia” means anesthesia produced by the
387 injection of an anesthetic agent into the subarachnoid space of
388 the spinal cord.
389 (12) “Surgeon” means a physician who performs surgery.
390 (13) “Surgery” means any manual or operative procedure,
391 including the use of lasers, performed upon the body of a living
392 human being for the purposes of preserving health, diagnosing or
393 curing disease, repairing injury, correcting deformity or
394 defects, prolonging life, or relieving suffering or any elective
395 procedure for aesthetic, reconstructive, or cosmetic purposes,
396 including, but not limited to: incision or curettage of tissue
397 or an organ; suture or other repair of tissue or organ,
398 including a closed as well as an open reduction of a fracture;
399 extraction of tissue including premature extraction of the
400 products of conception from the uterus; insertion of natural or
401 artificial implants; or an endoscopic procedure with use of
402 local or general anesthetic.
403 (9)(4) “Physician” means a person who is licensed to
404 practice medicine in this state.
405 Section 8. Subsection (3) of section 458.309, Florida
406 Statutes, is amended and subsection (4) is added to that
407 section, to read:
408 458.309 Rulemaking authority.—
409 (3) A physician who performs any liposuction procedure
410 procedures in which more than 1,000 cubic centimeters of
411 supernatant fat is removed, any Level II office surgery level 2
412 procedures lasting more than 5 minutes, or any Level III office
413 surgery and all level 3 surgical procedures in an office setting
414 must register the office with the department unless that office
415 is licensed as a facility under chapter 395. The department
416 shall inspect the physician’s office annually unless the office
417 is accredited by a nationally recognized accrediting agency or
418 an accrediting organization subsequently approved by the Board
419 of Medicine. The actual costs for registration and inspection or
420 accreditation shall be paid by the person seeking to register
421 and operate the office setting in which office surgery is
422 performed. As a condition of registration, a physician who
423 performs such surgical procedures in an office setting, and the
424 office itself if it is a separate legal entity from the
425 physician, must maintain the same levels of financial
426 responsibility required in s. 458.320.
427 (4) The department may adopt rules to administer the
428 registration, inspection, and safety of offices in which a
429 physician performs office surgery. The board shall adopt by rule
430 standards of practice for physicians who perform office surgery.
431 The board shall impose a fine of $5,000 per day on a physician
432 who performs a surgical procedure identified in subsection (3)
433 in an office that is not registered with the department.
434 Section 9. Paragraph (vv) is added to subsection (1) of
435 section 458.331, Florida Statutes, to read:
436 458.331 Grounds for disciplinary action; action by the
437 board and department.—
438 (1) The following acts constitute grounds for denial of a
439 license or disciplinary action, as specified in s. 456.072(2):
440 (vv) Performing a liposuction procedure in which more than
441 1,000 cubic centimeters of supernatant fat is removed, a Level
442 II office surgery, or a Level III office surgery in an office
443 that is not registered with the department pursuant to s.
444 458.309(3).
445 Section 10. Section 459.003, Florida Statutes, is amended
446 to read:
447 459.003 Definitions.—As used in this chapter, the term:
448 (1) “Board” means the Board of Osteopathic Medicine.
449 (2) “Deep sedation and analgesia” means a drug-induced
450 depression of consciousness during which all of the following
451 apply:
452 (a) The patient cannot be easily aroused but responds by
453 purposefully following repeated or painful stimulation.
454 (b) The patient’s ability to independently maintain
455 ventilatory function may be impaired.
456 (c) The patient may require assistance in maintaining a
457 patent airway, and spontaneous ventilation may be inadequate.
458 (d) The patient’s cardiovascular function is usually
459 maintained.
460 (e) The patient’s reflex withdrawal from painful stimulus
461 is not considered a purposeful response.
462 (3)(2) “Department” means the Department of Health.
463 (5) “Epidural anesthesia” means anesthesia produced by the
464 injection of an anesthetic agent into the space on or around the
465 dura mater of the spinal cord.
466 (6) “General anesthesia” means a drug-induced loss of
467 consciousness administered by a qualified general anesthesia
468 provider during which all of the following apply:
469 (a) The patient is not able to be aroused, even by painful
470 stimulation.
471 (b) The patient’s ability to independently maintain
472 ventilatory function is often impaired.
473 (c) The patient has a level of depressed neuromuscular
474 function.
475 (d) The patient may require assistance in maintaining a
476 patent airway, and positive pressure ventilation may be
477 required.
478 (e) The patient’s cardiovascular function may be impaired.
479 (7) “Minimal sedation” means a drug-induced state during
480 which patients respond normally to verbal commands. Although
481 cognitive function and physical coordination may be impaired,
482 airway reflexes, and respiratory and cardiovascular functions
483 are unaffected.
484 (8) “Moderate sedation and analgesia” or “conscious
485 sedation” means drug-induced depression of consciousness and a
486 state of consciousness during which all of the following apply:
487 (a) The patient responds purposefully to verbal commands,
488 either alone or accompanied by light tactile stimulation.
489 (b) Interventions are not required to maintain a patent
490 airway, and spontaneous ventilation is adequate.
491 (c) Cardiovascular function is maintained.
492 (d) Reflex withdrawal from a painful stimulus is not
493 considered a purposeful response.
494 (9) “Office surgery” means a surgery that is performed in a
495 physician’s office or any facility that is not licensed under
496 chapter 390 or chapter 395.
497 (a) “Level I office surgery” includes any surgery that
498 consists of only minor procedures and in which anesthesia is
499 limited to minimal sedation.
500 (b) “Level II office surgery” includes any surgery in which
501 the patient’s level of sedation is that of moderate sedation and
502 analgesia or conscious sedation.
503 (c) ”Level III office surgery” includes any surgery in
504 which the patient’s level of sedation is that of deep sedation
505 and analgesia or general anesthesia. The term includes any
506 surgery that includes the use of spinal anesthesia or epidural
507 anesthesia.
508 (11)(3) “Practice of osteopathic medicine” means the
509 diagnosis, treatment, operation, or prescription for any human
510 disease, pain, injury, deformity, or other physical or mental
511 condition, which practice is based in part upon educational
512 standards and requirements which emphasize the importance of the
513 musculoskeletal structure and manipulative therapy in the
514 maintenance and restoration of health.
515 (12) “Spinal anesthesia” means anesthesia produced by the
516 injection of an anesthetic agent into the subarachnoid space of
517 the spinal cord.
518 (13) “Surgeon” means a physician who performs surgery.
519 (14) “Surgery” means any manual or operative procedure,
520 including the use of lasers, performed upon the body of a living
521 human being for the purposes of preserving health, diagnosing or
522 curing disease, repairing injury, correcting deformity or
523 defects, prolonging life, or relieving suffering or any elective
524 procedure for aesthetic, reconstructive, or cosmetic purposes,
525 including, but not limited to: incision or curettage of tissue
526 or an organ; suture or other repair of tissue or organ,
527 including a closed as well as an open reduction of a fracture;
528 extraction of tissue including premature extraction of the
529 products of conception from the uterus; insertion of natural or
530 artificial implants; or an endoscopic procedure with use of
531 local or general anesthetic.
532 (10)(4) “Osteopathic physician” means a person who is
533 licensed to practice osteopathic medicine in this state.
534 (4)(5) “Doctor of Osteopathy” and “Doctor of Osteopathic
535 Medicine,” when referring to degrees, shall be construed to be
536 equivalent and equal degrees.
537 Section 11. Subsection (2) of section 459.005, Florida
538 Statutes, is amended and subsection (3) is added to that
539 section, to read:
540 459.005 Rulemaking authority.—
541 (2) A physician who performs any liposuction procedure
542 procedures in which more than 1,000 cubic centimeters of
543 supernatant fat is removed, any Level II office surgery level 2
544 procedures lasting more than 5 minutes, or any Level III office
545 surgery and all level 3 surgical procedures in an office setting
546 must register the office with the department unless that office
547 is licensed as a facility under chapter 395. The department
548 shall inspect the physician’s office annually unless the office
549 is accredited by a nationally recognized accrediting agency or
550 an accrediting organization subsequently approved by the Board
551 of Osteopathic Medicine. The actual costs for registration and
552 inspection or accreditation shall be paid by the person seeking
553 to register and operate the office setting in which office
554 surgery is performed. As a condition of registration, a
555 physician who performs such surgical procedures in an office
556 setting, and the office itself if it is a separate legal entity
557 from the physician, must maintain the same levels of financial
558 responsibility required in s. 459.0085.
559 (3) The department may adopt rules to administer the
560 registration, inspection, and safety of offices in which a
561 physician performs office surgery. The board shall adopt by rule
562 standards of practice for physicians who perform office surgery.
563 The board shall impose a fine of $5,000 per day on a physician
564 who performs a surgical procedure identified in subsection (2)
565 in an office that is not registered with the department.
566 Section 12. Paragraph (xx) is added to subsection (1) of
567 section 459.015, Florida Statutes, to read:
568 459.015 Grounds for disciplinary action; action by the
569 board and department.—
570 (1) The following acts constitute grounds for denial of a
571 license or disciplinary action, as specified in s. 456.072(2):
572 (xx) Performing a liposuction procedure in which more than
573 1,000 cubic centimeters of supernatant fat is removed, a Level
574 II office surgery, or a Level III office surgery in an office
575 that is not registered with the department pursuant to s.
576 459.005(2).
577 Section 13. Paragraph (b) of subsection (4) of section
578 464.012, Florida Statutes, is amended to read:
579 464.012 Licensure of advanced practice registered nurses;
580 fees; controlled substance prescribing.—
581 (4) In addition to the general functions specified in
582 subsection (3), an advanced practice registered nurse may
583 perform the following acts within his or her specialty:
584 (b) The certified registered nurse anesthetist may, to the
585 extent authorized by established protocol approved by the
586 medical staff of the facility in which the anesthetic service is
587 performed, perform any or all of the following:
588 1. Determine the health status of the patient as it relates
589 to the risk factors and to the anesthetic management of the
590 patient through the performance of the general functions.
591 2. Based on history, physical assessment, and supplemental
592 laboratory results, determine, with the consent of the
593 responsible physician, the appropriate type of anesthesia within
594 the framework of the protocol.
595 3. Order under the protocol preanesthetic medication.
596 4. Perform under the protocol procedures commonly used to
597 render the patient insensible to pain during the performance of
598 surgical, obstetrical, therapeutic, or diagnostic clinical
599 procedures. These procedures include ordering and administering
600 regional, spinal, and general anesthesia; inhalation agents and
601 techniques; intravenous agents and techniques; and techniques of
602 hypnosis.
603 5. Order or perform monitoring procedures indicated as
604 pertinent to the anesthetic health care management of the
605 patient.
606 6. Support life functions during anesthesia health care,
607 including induction and intubation procedures, the use of
608 appropriate mechanical supportive devices, and the management of
609 fluid, electrolyte, and blood component balances.
610 7. Recognize and take appropriate corrective action for
611 abnormal patient responses to anesthesia, adjunctive medication,
612 or other forms of therapy.
613 8. Recognize and treat a cardiac arrhythmia while the
614 patient is under anesthetic care.
615 9. Participate in management of the patient while in the
616 postanesthesia recovery area, including ordering the
617 administration of fluids and drugs.
618 10. Place special peripheral and central venous and
619 arterial lines for blood sampling and monitoring as appropriate.
620 11. Provide the services identified in subsections 1.-10.
621 in an office registered to perform office surgery pursuant to s.
622 458.309(3) or s. 459.005(2) within the framework of an
623 established protocol with an anesthesiologist licensed under
624 chapter 458 or chapter 459.
625 Section 14. Paragraph (a) of subsection (1) of section
626 766.101, Florida Statutes, is amended to read:
627 766.101 Medical review committee, immunity from liability.—
628 (1) As used in this section:
629 (a) The term “medical review committee” or “committee”
630 means:
631 1.a. A committee of a hospital or ambulatory surgical
632 center licensed under chapter 395 or a health maintenance
633 organization certificated under part I of chapter 641;
634 b. A committee of a physician-hospital organization, a
635 provider-sponsored organization, or an integrated delivery
636 system;
637 c. A committee of a state or local professional society of
638 health care providers;
639 d. A committee of a medical staff of a licensed hospital or
640 nursing home, provided the medical staff operates pursuant to
641 written bylaws that have been approved by the governing board of
642 the hospital or nursing home;
643 e. A committee of the Department of Corrections or the
644 Correctional Medical Authority as created under s. 945.602, or
645 employees, agents, or consultants of either the department or
646 the authority or both;
647 f. A committee of a professional service corporation formed
648 under chapter 621 or a corporation organized under part I of
649 chapter 607 or chapter 617, which is formed and operated for the
650 practice of medicine as defined in s. 458.305 s. 458.305(3), and
651 which has at least 25 health care providers who routinely
652 provide health care services directly to patients;
653 g. A committee of the Department of Children and Families
654 which includes employees, agents, or consultants to the
655 department as deemed necessary to provide peer review,
656 utilization review, and mortality review of treatment services
657 provided pursuant to chapters 394, 397, and 916;
658 h. A committee of a mental health treatment facility
659 licensed under chapter 394 or a community mental health center
660 as defined in s. 394.907, provided the quality assurance program
661 operates pursuant to the guidelines that have been approved by
662 the governing board of the agency;
663 i. A committee of a substance abuse treatment and education
664 prevention program licensed under chapter 397 provided the
665 quality assurance program operates pursuant to the guidelines
666 that have been approved by the governing board of the agency;
667 j. A peer review or utilization review committee organized
668 under chapter 440;
669 k. A committee of the Department of Health, a county health
670 department, healthy start coalition, or certified rural health
671 network, when reviewing quality of care, or employees of these
672 entities when reviewing mortality records; or
673 l. A continuous quality improvement committee of a pharmacy
674 licensed pursuant to chapter 465,
675
676 which committee is formed to evaluate and improve the quality of
677 health care rendered by providers of health service, to
678 determine that health services rendered were professionally
679 indicated or were performed in compliance with the applicable
680 standard of care, or that the cost of health care rendered was
681 considered reasonable by the providers of professional health
682 services in the area; or
683 2. A committee of an insurer, self-insurer, or joint
684 underwriting association of medical malpractice insurance, or
685 other persons conducting review under s. 766.106.
686 Section 15. This act shall take effect upon becoming a law.