Office of House Bill AnalysisH.B. 1183
By: Capelo
Public Health


A surgical assistant stands across from a surgeon at the operating table
and assists the surgeon in performing a surgical procedure.  In the past,
most surgical assistance was performed by another licensed surgeon, but
because of the cost and other factors, in recent years surgeons have begun
to choose nonphysician surgical assistants to assist during surgery. Prior
to the 77th Legislature, there was not a surgical assistant educational
program or license in Texas.  Instead, surgical assistants were
credentialed at hospitals.  Physician assistants, nurses, and other
licensed professionals often serve as surgical assistants, but sometimes
other health care professionals who do not hold a license perform these
duties.  A surgical assistant license in Texas benefits patients by helping
to ensure that the person assisting a physician during a surgical procedure
is qualified and meets certain educational and training standards.  House
Bill 1183 sets forth provisions relating to the practice, education, and
training of a surgical assistant and creates an advisory committee to
advise the Texas State Board of Medical Examiners concerning the regulation
of surgical assistants. 


It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated  to the Texas State Board of Medical
Examiners in SECTION 1 (Sections 206.001, 206.153, 206.210, and 206.351,
Occupations Code) and SECTION 7 of this bill.   


House Bill 1183 amends the Occupations Code to prohibit a person from
practicing as a surgical assistant unless the person is licensed by the
Texas State Board of Medical Examiners (TSBME) as a surgical assistant
(Sec. 206.201).  The bill sets forth exceptions to the licensing
requirements (Sec. 206.002).  The bill creates an informal advisory
committee that is not subject to provisions regarding state agency advisory
committees to advise TSBME and provides for the appointment, membership,
administration, and operation of the advisory committee (Secs.
206.051-206.058).  The bill requires TSBME to establish qualifications,
examination requirements , education  and training requirements,
application forms, and continuing education requirements for surgical
assistants (Sec. 206.101).  The bill sets forth provisions relating to: 

_reporting information to the advisory committee regarding the actions of a
surgical assistant and immunity from civil liability for such reporting
(Sec. 206.159); 

_the development and implementation of policies to provide the public
access to TSBME for purposes of public participation and access to its
programs and services and the availability of information regarding TSBME
(Secs. 206.151 and 206.152); 

_procedures by which complaints are filed, resolved, recorded, and accessed
and by which information is provided (Secs. 206.153-206.156); 

_the confidentiality and permitted disclosure of investigative information
(Secs. 206.157 and  206.158); 

_licensing requirements including, application, eligibility, examination,
issuance, fees, renewal, and license holder information (Secs.
206.201-206.206, and 206.208-206.214); and  

_assistance from TSBME to administer licensing requirements (Sec. 206.207).

Scope of Practice

The bill provides that the practice of a surgical assistant is limited to
surgical assisting performed under the direct supervision of a physician
who delegated the acts.  The bill authorizes the practice of a surgical
assistant to be performed in any place authorized by a delegating licensed
physician (Sec. 206.251).  The bill sets forth provisions regarding service
contracts and prohibits a licensed surgical assistant from engaging in
certain medical practices (Secs. 206.252 and 206.253).  The bill prohibits
health insurance organizations and health care facilities from requiring a
registered nurse or physician assistant to be licensed as a surgical
assistant (Sec. 206.253).  The bill requires a surgical assistant and the
surgical assistant's delegating physician to establish functions and
standards for a surgical assistant (Sec. 206.254). 

Disciplinary Proceedings

The bill requires TSBME to take action against  an applicant or license
holder if TSBME determines that the applicant or license holder has taken
part in certain inappropriate conduct  (Sec. 206.301).  The bill authorizes
TSBME to take disciplinary action against an applicant or license holder

_commits certain fraudulent, deceptive, or unlawful acts;

_commits a violation of state law relating to surgical assistants or a rule
or law of these provisions; or  

_conducts themselves in a manner that is unprofessional or lacks fitness to
safely perform the duties of a surgical assistant. 

The bill provides that proof that an act which violates state law was
committed while practicing as a surgical assistant or under the guise of
practice as a surgical assistant is sufficient for TSBME to take
disciplinary action, and that a complaint, indictment, or conviction for a
violation of law is not necessary (Sec. 206.303).  The bill authorizes
TSBME, through an agreed order or after a contested case proceeding, to
impose a rehabilitation order on an applicant as a prerequisite for issuing
a license or on a license holder based on the persons behavior or actions
(Sec. 206.305).  The bill sets forth provisions for a  rehabilitation
order, subpoena, and protection of patient identity equivalent to existing
provisions established for a physician assistant  (Sec. 206.305-206.309).
The bill sets forth rules for disciplinary proceedings and provisions
related to the suspension of a license, including the appointment of a
disciplinary panel (Secs. 206.310-206.312) 

Penalties and Enforcement

The bill sets forth administrative penalties for violations of these
provisions equivalent to existing provisions established for physicians
assistants (Sec. 206.351). 

The bill requires TSBME to adopt rules for the administration and
enforcement of these provisions not later than January 1, 2002, and
provides that the advisory committee has no independent rulemaking
authority (SECTION 7).  The bill requires TSBME to adopt rules that provide
for the annual renewal of a surgical assistant license and authorizes TSBME
by rule to adopt a system under which a license expires on various dates
during the year (Sec. 206.210).  The bill requires TSBME by rule to
establish methods by which consumers and service recipients are notified of
the name, mailing address, and telephone number of  TSBME for the purpose
of directing complaints about licensed surgical assistants to TSBME (Sec.
206. 153).  The bill requires TSBME to prepare annually a report accounting
for all funds received and disbursed under this bill (Sec. 206.102). 

Miscellaneous Provisions

The bill amends the Insurance and Humans Resources codes to provide for the
selection of a licensed surgical assistant by a consumer (SECTIONS 2-6). 


September 1, 2001; however, a person is not required to obtain a surgical
assistant license until September 1, 2002.  The modification to the
Insurance Code in the Act applies only to an insurance policy, contract, or
evidence of coverage delivered, issued for delivery, or renewed on or after
January 1, 2003.