By Craddick H.B. No. 3265
75R3990 JMM-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of surgical technologists and surgical
1-3 first assistants; providing a penalty.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. DEFINITIONS. In this Act:
1-6 (1) "Advisory board" means the Surgical Technologist
1-7 and Surgical First Assistant Advisory Board.
1-8 (2) "Board" means the Texas State Board of Medical
1-9 Examiners.
1-10 (3) "Surgical first assistant" means a person who has
1-11 passed the certifying examination for first assisting (CST/CFA)
1-12 administered by the Liaison Council on Certification for Surgical
1-13 Technologists and who is registered as a surgical first assistant
1-14 by the board.
1-15 (4) "Surgical technologist" means a person who has
1-16 graduated from a surgical technologist training program accredited
1-17 by the Commission on Accreditation of Allied Health Education
1-18 Programs and who has passed the certifying examination for surgical
1-19 technology (CST) administered by the Liaison Council on
1-20 Certification for Surgical Technologists and who is registered as a
1-21 surgical technologist by the board.
1-22 (5) "Supervising physician" means a physician licensed
1-23 by the board either as a doctor of medicine or doctor of
1-24 osteopathic medicine who is assuming responsibility and legal
2-1 liability for the services rendered by a surgical technologist or
2-2 surgical first assistant and who has received approval from the
2-3 board to supervise a specific surgical technologist or surgical
2-4 first assistant.
2-5 (6) "Supervision" means overseeing the activities of,
2-6 and accepting responsibility for, the medical services rendered by
2-7 a surgical technologist or surgical first assistant. Supervision
2-8 does not require the constant physical presence of a supervising
2-9 physician.
2-10 (7) "State" means any state, territory, or possession
2-11 of the United States and the District of Columbia.
2-12 SECTION 2. REGISTRATION REQUIRED. A person may not practice
2-13 as a surgical technologist or surgical first assistant unless the
2-14 person holds a certificate of registration issued under this Act.
2-15 SECTION 3. SURGICAL TECHNOLOGIST AND SURGICAL FIRST
2-16 ASSISTANT ADVISORY BOARD. (a) The Surgical Technologist and
2-17 Surgical First Assistant Advisory Board is created as an advisory
2-18 board to the Texas State Board of Medical Examiners.
2-19 (b) The advisory board consists of 12 members appointed by
2-20 the governor as follows:
2-21 (1) three members who are practicing surgical first
2-22 assistants and who have at least five years of clinical experience
2-23 as practicing surgical first assistants;
2-24 (2) three members who are practicing surgical
2-25 technologists and who have at least five years of clinical
2-26 experience as a practicing surgical technologist;
2-27 (3) three members who are physicians licensed in this
3-1 state and who supervise surgical technologists and surgical first
3-2 assistants; and
3-3 (4) three members who are members of the general
3-4 public who are not licensed or registered as physicians, surgical
3-5 technologists, or surgical first assistants.
3-6 (c) A person is not eligible for appointment as a public
3-7 member of the advisory board if the person or the person's spouse:
3-8 (1) is licensed by an occupational regulatory agency
3-9 in the field of health care; or
3-10 (2) is employed by or participates in the management
3-11 of a business entity or other organization that provides health
3-12 care services or that sells, manufactures, or distributes health
3-13 care supplies or equipment.
3-14 (d) Each member of the advisory board is entitled to a per
3-15 diem as set by legislative appropriation for each day that the
3-16 member engages in the business of the advisory board.
3-17 (e) It is a ground for removal from the advisory board if a
3-18 member:
3-19 (1) does not have at the time of appointment the
3-20 qualifications required by this section for appointment to the
3-21 advisory board;
3-22 (2) does not maintain during the service on the
3-23 advisory board the qualifications required by this section for
3-24 appointment to the advisory board; or
3-25 (3) fails to attend at least one-half of the regularly
3-26 scheduled advisory board meetings held in a calendar year,
3-27 excluding meetings held while the person was not an advisory board
4-1 member.
4-2 (f) A person who is required to register as a lobbyist under
4-3 Chapter 305, Government Code, may not serve as a member of the
4-4 advisory board.
4-5 (g) The validity of an action of the advisory board is not
4-6 affected by the fact that it is taken when a ground for removal of
4-7 a member of the advisory board exists.
4-8 (h) The advisory board is subject to Chapter 551, Government
4-9 Code, and Chapter 2001, Government Code.
4-10 (i) Members of the advisory board hold office for staggered
4-11 terms of six years expiring February 1 of each odd-numbered year.
4-12 A member is ineligible to serve more than two consecutive full
4-13 terms and may not serve more than a total of three full terms.
4-14 (j) In the case of a vacancy on the advisory board, the
4-15 governor shall appoint a new member to complete an unexpired term.
4-16 (k) The advisory board is subject to Chapter 325, Government
4-17 Code (Texas Sunset Act). Unless continued in existence as provided
4-18 by that chapter, the advisory board is abolished and this Act
4-19 expires September 1, 2009.
4-20 (l) The advisory board shall select from its membership a
4-21 presiding officer and a secretary to serve for one-year terms.
4-22 (m) A majority of the members of the advisory board
4-23 constitute a quorum for the transaction of the business of the
4-24 advisory board.
4-25 SECTION 4. POWERS AND DUTIES OF BOARD. The board shall:
4-26 (1) review and approve or reject applications for
4-27 registration;
5-1 (2) review and approve or reject applications for
5-2 renewal of registration;
5-3 (3) issue all certificates of registration;
5-4 (4) deny, suspend, or revoke a certificate of
5-5 registration or otherwise discipline a certificate holder;
5-6 (5) prescribe and collect fees authorized under this
5-7 Act; and
5-8 (6) take any action necessary to carry out the
5-9 functions and duties of the board under this Act.
5-10 SECTION 5. FEES. (a) The board shall establish fees that
5-11 are reasonable and necessary to defray the cost of administering
5-12 this Act.
5-13 (b) The board may not maintain unnecessary fund balances,
5-14 and fee amounts shall be set in accordance with this requirement.
5-15 SECTION 6. REGISTRATION QUALIFICATIONS. The board shall
5-16 issue a certificate of registration under this Act to an applicant
5-17 who:
5-18 (1) submits an application on a form prescribed by the
5-19 board;
5-20 (2) pays the application fee as prescribed by the
5-21 board;
5-22 (3) has successfully completed an educational program
5-23 for surgical technologists accredited by the Commission on
5-24 Accreditation of Allied Health Education Programs or by that
5-25 committee's predecessor or successor entities and has passed the
5-26 national certifying examination administered by the Liaison Council
5-27 on Certification for Surgical Technologists;
6-1 (4) certifies that the applicant is mentally and
6-2 physically able to function safely as a surgical technologist or
6-3 surgical first assistant;
6-4 (5) does not have a license, certification, or
6-5 registration as a surgical technologist or surgical first
6-6 assistant in this state or from any other licensing authority that
6-7 is currently revoked or suspended or the applicant is not subject
6-8 to probation or other disciplinary action for cause resulting from
6-9 the applicant's acts as a surgical technologist or surgical first
6-10 assistant, unless the board takes that fact into consideration in
6-11 determining whether to issue the certificate of registration;
6-12 (6) is of good moral character;
6-13 (7) submits to the board any other information the
6-14 board considers necessary to evaluate the applicant's
6-15 qualifications; and
6-16 (8) meets any other requirement established by rules
6-17 adopted by the board.
6-18 SECTION 7. RENEWAL OF REGISTRATION. A person who holds a
6-19 certificate of registration under this Act may, on notification
6-20 from the board, renew the registration by:
6-21 (1) paying the renewal fee prescribed by the board;
6-22 (2) submitting the appropriate form; and
6-23 (3) meeting any other requirement established by rules
6-24 adopted by the board.
6-25 SECTION 8. EXEMPTION FROM REGISTRATION. This Act does not
6-26 require a certificate of registration for:
6-27 (1) a surgical technologist or surgical first
7-1 assistant student enrolled in a surgical technologist or surgical
7-2 first assistant educational program accredited by the Commission on
7-3 Accreditation of Allied Health Education Programs or, if that
7-4 entity goes out of existence, successor entities as approved and
7-5 designated by board rule;
7-6 (2) a surgical technologist or surgical first
7-7 assistant employed in the service of the federal government while
7-8 performing duties related to that employment;
7-9 (3) a technician, assistant, or employee of a
7-10 physician who performs delegated tasks in the office of a physician
7-11 or elsewhere but who does not act as a surgical technologist or
7-12 surgical first assistant or represent that the person is a surgical
7-13 technologist or surgical first assistant; or
7-14 (4) any other licensed health care worker acting
7-15 within the scope of that person's license if the person does not
7-16 use the titles "surgical technologist" or "surgical first
7-17 assistant," the initials "S.T." or "S.F.A.," or is not represented
7-18 or designated as a surgical technologist or surgical first
7-19 assistant.
7-20 SECTION 9. SCOPE OF PRACTICE. (a) The practice of a
7-21 surgical technologist or surgical first assistant includes medical
7-22 services within the education, training, and experience of the
7-23 surgical technologist or surgical first assistant that are
7-24 delegated by the supervising physician.
7-25 (b) The board shall adopt rules prescribing the types of
7-26 medical services that are included in the scope and practice of a
7-27 surgical technologist and surgical first assistant.
8-1 (c) The activities prescribed by rule under Subsection (b)
8-2 of this section may be performed in any place authorized by a
8-3 supervising physician, including a clinic, hospital, ambulatory
8-4 surgical center, patient home, nursing home, or other institutional
8-5 setting.
8-6 SECTION 10. SUPERVISION REQUIREMENTS. (a) Supervision by a
8-7 supervising physician must be continuous but does not require the
8-8 physical presence of the supervising physician at the place where
8-9 surgical technologist or surgical first assistant services are
8-10 performed while the services are performed.
8-11 (b) Each team of a physician and surgical technologist or
8-12 surgical first assistant must ensure that:
8-13 (1) the surgical technologist's or surgical first
8-14 assistant's scope of function is identified;
8-15 (2) delegation of medical tasks is appropriate to the
8-16 surgical technologist's or surgical first assistant's level of
8-17 competence;
8-18 (3) the relationship between the members of the team
8-19 and the access of the surgical technologist or surgical first
8-20 assistant to the supervising physician is defined; and
8-21 (4) a process for evaluating the surgical
8-22 technologist's or surgical first assistant's performance is
8-23 established.
8-24 (c) A surgical technologist or surgical first assistant may
8-25 have more than one supervising physician.
8-26 SECTION 11. SUPERVISING PHYSICIAN. A supervising physician
8-27 must:
9-1 (1) be licensed as a physician in this state by the
9-2 board with a license that is unrestricted and active;
9-3 (2) notify the board of the physician's intent to
9-4 supervise a surgical technologist or surgical first assistant; and
9-5 (3) submit a statement to the board that the physician
9-6 will:
9-7 (A) supervise the surgical technologist or
9-8 surgical first assistant according to rules adopted by the board;
9-9 and
9-10 (B) retain professional and legal responsibility
9-11 for the care rendered by the surgical technologist or surgical
9-12 first assistant.
9-13 SECTION 12. ASSUMPTION OF PROFESSIONAL RESPONSIBILITY. (a)
9-14 A surgical technologist or surgical first assistant employed by a
9-15 physician must be supervised by and is the legal responsibility of
9-16 the supervising physician. The legal responsibility for the
9-17 surgical technologist's or surgical first assistant's patient care
9-18 activities remains the responsibility of the supervising physician
9-19 regardless of where the activities are performed, including when
9-20 the surgical technologist or surgical first assistant provides care
9-21 and treatment for a patient in a health care facility.
9-22 (b) A surgical technologist or surgical first assistant
9-23 employed by a health care facility or other entity shall be
9-24 supervised by a licensed physician. The employing health care
9-25 facility or other entity shares the legal responsibility for the
9-26 surgical technologist's or surgical first assistant's acts or
9-27 omissions with the supervising physician.
10-1 SECTION 13. DISCIPLINARY PROCEEDINGS. (a) The board may
10-2 refuse to issue a certificate of registration, publicly or
10-3 privately reprimand a certificate holder, or suspend, revoke, or
10-4 place other restrictions on a certificate of registration if the
10-5 applicant or certificate holder:
10-6 (1) fraudulently or deceptively obtains or attempts to
10-7 obtain a certificate of registration;
10-8 (2) fraudulently or deceptively uses a certificate of
10-9 registration;
10-10 (3) violates this Act or any rule adopted under this
10-11 Act;
10-12 (4) is convicted of a felony;
10-13 (5) is a habitual user of intoxicants or
10-14 nontherapeutic drugs to the extent that the person cannot safely
10-15 perform as a surgical technologist or surgical first assistant;
10-16 (6) has been adjudicated as mentally incompetent or
10-17 has a mental or physical condition that renders the person unable
10-18 to safely perform as a surgical technologist or surgical first
10-19 assistant;
10-20 (7) has committed an act of moral turpitude;
10-21 (8) represents that the person is a physician;
10-22 (9) has acted in an unprofessional or dishonorable
10-23 manner that is likely to deceive, defraud, or injure any member of
10-24 the public;
10-25 (10) has failed to practice as a surgical technologist
10-26 or surgical first assistant in an acceptable manner consistent with
10-27 public health and welfare;
11-1 (11) has committed any act that is in violation of the
11-2 laws of the state if the act is connected with practice as a
11-3 surgical technologist or surgical first assistant; or
11-4 (12) has had the person's certificate of registration
11-5 suspended, revoked, or restricted or has had other disciplinary
11-6 action taken by another state or the uniformed services of the
11-7 United States regarding practice as a surgical technologist or
11-8 surgical first assistant, based on acts by the person similar to
11-9 acts described in this subsection.
11-10 (b) For the purposes of a disciplinary action under
11-11 Subsection (a)(11) of this section, a complaint, indictment, or
11-12 conviction of a law violation is not necessary for enforcement of
11-13 that provision. Proof of the commission of a proscribed act while
11-14 in practice as a surgical technologist or surgical first assistant
11-15 or under the guise of practice as a surgical technologist or
11-16 surgical first assistant is sufficient for action by the board
11-17 under that subdivision.
11-18 (c) For the purposes of a disciplinary action under
11-19 Subsection (a)(12) of this section, a certified copy of the record
11-20 of the state or uniformed services of the United States taking the
11-21 action is conclusive evidence of the action.
11-22 SECTION 14. ADDITIONAL DISCIPLINARY AUTHORITY. In addition
11-23 to the authority under Section 13 of this Act, the board may, on
11-24 finding that a surgical technologist or surgical first assistant
11-25 has committed an offense described by Section 15 of this Act:
11-26 (1) require a surgical technologist or surgical first
11-27 assistant to submit to the care, counseling, or treatment of a
12-1 health care practitioner designated by the board;
12-2 (2) stay enforcement of an order and place the
12-3 surgical technologist or surgical first assistant on probation with
12-4 the board retaining the right to vacate the probationary stay and
12-5 enforce the original order for noncompliance with the terms of
12-6 probation or impose any other remedial measures or sanctions
12-7 authorized by this section;
12-8 (3) restore or reissue a certificate of registration
12-9 or remove any disciplinary or corrective measure that the board may
12-10 have imposed;
12-11 (4) order the surgical technologist or surgical first
12-12 assistant to perform public service; or
12-13 (5) require the surgical technologist or surgical
12-14 first assistant to complete additional training.
12-15 SECTION 15. OFFENSE. (a) A person commits an offense if,
12-16 without holding a certificate of registration under this Act, the
12-17 person:
12-18 (1) holds the person out as a surgical technologist or
12-19 surgical first assistant;
12-20 (2) uses any combination or abbreviation of the term
12-21 "surgical technologist or surgical first assistant" to indicate or
12-22 imply that the person is a surgical technologist or surgical first
12-23 assistant; or
12-24 (3) acts as a surgical technologist or surgical first
12-25 assistant.
12-26 (b) An offense under this section is a felony of the third
12-27 degree.
13-1 SECTION 16. IDENTIFICATION REQUIREMENTS. A surgical
13-2 technologist or surgical first assistant registered under this Act
13-3 shall:
13-4 (1) keep the person's certificate of registration
13-5 available for inspection at the person's primary place of business;
13-6 and
13-7 (2) when engaged in the surgical technologist's or
13-8 surgical first assistant's professional activities, wear a name tag
13-9 identifying the person as a surgical technologist or surgical first
13-10 assistant.
13-11 SECTION 17. RULES. With the advice of the advisory board,
13-12 the board shall adopt rules that are reasonable and necessary for
13-13 the performance of the board's duties under this Act, as provided
13-14 by Chapter 2001, Government Code, including rules:
13-15 (1) setting registration and other fees;
13-16 (2) establishing renewal dates for registration; and
13-17 (3) establishing rules and procedures for disciplinary
13-18 actions.
13-19 SECTION 18. COMPLAINTS. (a) The board shall keep an
13-20 information file about each complaint filed with the board,
13-21 consistent with this Act.
13-22 (b) If a written complaint is filed with the board relating
13-23 to a person registered under this Act, the board, at least as often
13-24 as quarterly and until final determination of the action to be
13-25 taken relative to the complaint, shall notify, in a manner
13-26 consistent with this Act, the parties to the complaint of the
13-27 status of the complaint unless the notice would jeopardize an
14-1 active investigation.
14-2 SECTION 19. TRANSITION. (a) A person is not required to
14-3 obtain a certificate of registration under this Act until September
14-4 1, 1998.
14-5 (b) The Texas State Board of Medical Examiners shall adopt
14-6 rules under this Act not later than January 1, 1998.
14-7 (c) In making the initial appointments to the advisory
14-8 board, the governor shall designate four members for terms expiring
14-9 February 1, 1999, four members for terms expiring February 1, 2001,
14-10 and four members for terms expiring February 1, 2003.
14-11 SECTION 20. EFFECTIVE DATE. This Act takes effect September
14-12 1, 1997, except that Sections 2 and 15 of this Act take effect
14-13 September 1, 1998.
14-14 SECTION 21. EMERGENCY. The importance of this legislation
14-15 and the crowded condition of the calendars in both houses create an
14-16 emergency and an imperative public necessity that the
14-17 constitutional rule requiring bills to be read on three several
14-18 days in each house be suspended, and this rule is hereby suspended.