Office of House Bill AnalysisC.S.H.B. 1183
By: Capelo
Public Health
Committee Report (Substituted)


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.
Currently, there is not a surgical assistant educational program or license
in Texas; instead surgical assistants are 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 would benefit patients by helping to ensure that the person
assisting a physician during a surgical procedure is qualified and meets
certain educational and training standards.  C.S.H.B. 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 206.101, 206.153, 206.210, and 206.351,
Occupations Code) and SECTION 5 of this bill.   


C.S.H.B. 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 (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. 206.103); 

_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 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 and criminal penalties for violations of
these provisions equivalent to existing provisions established for
physicians assistants (Secs. 206.351 and 206.352). 

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 (Sec. 206.101 and SECTION 5).  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 Code to add licensed surgical assistant to
provisions relating to accident and sickness insurance coverage and the
selection of practitioners by a consumer (SECTIONS 2, 3, and 4). 


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. 


C.S.H.B. 1183 differs from the original bill by creating an advisory
committee rather than an  advisory board and transferring the powers and
duties originally granted to the advisory board to the Texas State Board of
Medical Examiners (TSBME) or the advisory committee (Secs. 206.001,
206.101-206.104, 206.151-206.158, 206.206, 206.209, 206.211, and 206.214).
The substitute provides that the advisory committee has no independent
rulemaking authority (Sec. 206.101).  The substitute provides that a
registered nurse or licensed physician assistant is not required to hold a
license as a surgical assistant (Sec. 206.002) The substitute modifies the
requirements for a license (Secs. 206.203-206.205 and 206.209). 

The substitute includes a provision authorizing TSBME to receive and accept
gifts, grants, and donations (Sec. 206.104).  The substitute expands the
list of entities subject to reporting requirements and immunity provisions
(Sec. 206.103).  The substitute includes provisions related to service
contracts (Sec. 206.252). The substitute requires, rather than authorizes,
TSBME to take disciplinary action against a license holder or applicant
that has taken part in certain inappropriate conduct (Sec. 206.301).  The
substitute authorizes TSBME to impose an administrative penalty on, rather
than establishes a civil penalty for, a person who violates certain
provisions and  modifies provisions for a criminal penalty (Secs. 206.351
and 206.352). The substitute modifies provisions related to the scope of
practice of a surgical assistant (Sec. 206.251). 

The substitute requires the surgical assistant and the surgical assistant's
delegating physician to establish the functions and standards of the
surgical assistant (Sec. 206.254).  The substitute includes provisions
relating to rehabilitation orders, subpoenas, suspension requirements for
an incarcerated surgical assistant, rules for disciplinary proceedings, and
temporary suspension (Secs. 206.305-206.312).  The substitute modifies
provisions regarding a health care entity's request for information (Sec.

The substitute removes provisions relating to TSBME's authority to adopt by
rule a broad schedule of sanctions, requirements for the State Office of
Administrative Hearings to use the schedule for a sanction imposed as the
result of a hearing, and provisions relating to seeking an injunction
against a person in violation of this bill.