Bill Text: OH HB205 | 2009-2010 | 128th General Assembly | Introduced

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Bill Title: To require hospitals and ambulatory surgical facilities to assign a circulating nurse to each procedure performed in an operating room or invasive procedure room and to require surgical technologists to work under the direct supervision of circulating nurses.

Spectrum: Slight Partisan Bill (Democrat 6-2)

Status: (Introduced - Dead) 2009-06-02 - To Health [HB205 Detail]

Download: Ohio-2009-HB205-Introduced.html

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As Introduced

128th General Assembly Regular Session 2009-2010

H. B. No. 205

Representative Letson 

Cosponsors: Representatives Ujvagi, Hagan, Luckie, Murray, Mallory, Lehner, Winburn 

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A BILL

To amend sections 3702.30 and 3702.31 and to enact

1

sections 3702.40 and 3727.60 of the Revised Code

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to require hospitals and ambulatory surgical

3

facilities to assign a circulating nurse to each

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procedure performed in an operating room or

5

invasive procedure room and to require surgical

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technologists to work under the direct

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supervision of circulating nurses.

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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 3702.30 and 3702.31 be amended and	9
sections 3702.40 and 3727.60 of the Revised Code be enacted to	10
read as follows:	11

Sec. 3702.30.  (A) As used in this section:

12

(1) "Ambulatory surgical facility" means a facility, whether	13
or not part of the same organization as a hospital, that is	14
located in a building distinct from another in which inpatient	15
care is provided, and to which any of the following apply:	16

(a) Outpatient surgery is routinely performed in the	17
facility, and the facility functions separately from a hospital's	18
inpatient surgical service and from the offices of private	19
physicians, podiatrists, and dentists.	20

(b) Anesthesia is administered in the facility by an	21
anesthesiologist or certified registered nurse anesthetist, and	22
the facility functions separately from a hospital's inpatient	23
surgical service and from the offices of private physicians,	24
podiatrists, and dentists.	25

(c) The facility applies to be certified by the United States	26
centers for medicare and medicaid services as an ambulatory	27
surgical center for purposes of reimbursement under Part B of the	28
medicare program, Part B of Title XVIII of the "Social Security	29
Act," 79 Stat. 286 (1965), 42 U.S.C.A. 1395, as amended.	30

(d) The facility applies to be certified by a national	31
accrediting body approved by the centers for medicare and medicaid	32
services for purposes of deemed compliance with the conditions for	33
participating in the medicare program as an ambulatory surgical	34
center.	35

(e) The facility bills or receives from any third-party	36
payer, governmental health care program, or other person or	37
government entity any ambulatory surgical facility fee that is	38
billed or paid in addition to any fee for professional services.	39

(f) The facility is held out to any person or government	40
entity as an ambulatory surgical facility or similar facility by	41
means of signage, advertising, or other promotional efforts.	42

"Ambulatory surgical facility" does not include a hospital	43
emergency department.	44

(2) "Ambulatory surgical facility fee" means a fee for	45
certain overhead costs associated with providing surgical services	46
in an outpatient setting. A fee is an ambulatory surgical facility	47
fee only if it directly or indirectly pays for costs associated	48
with any of the following:	49

(a) Use of operating and recovery rooms, preparation areas,	50
and waiting rooms and lounges for patients and relatives;	51

(b) Administrative functions, record keeping, housekeeping,	52
utilities, and rent;	53

(c) Services provided by nurses, orderlies, technical	54
personnel, and others involved in patient care related to	55
providing surgery.	56

"Ambulatory surgical facility fee" does not include any	57
additional payment in excess of a professional fee that is	58
provided to encourage physicians, podiatrists, and dentists to	59
perform certain surgical procedures in their office or their group	60
practice's office rather than a health care facility, if the	61
purpose of the additional fee is to compensate for additional cost	62
incurred in performing office-based surgery.	63

(3) "Governmental health care program" has the same meaning	64
as in section 4731.65 of the Revised Code.	65

(4) "Health care facility" means any of the following:

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(a) An ambulatory surgical facility;

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(b) A freestanding dialysis center;

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(c) A freestanding inpatient rehabilitation facility;

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(d) A freestanding birthing center;

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(e) A freestanding radiation therapy center;

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(f) A freestanding or mobile diagnostic imaging center.

72

(5) "Third-party payer" has the same meaning as in section	73
3901.38 of the Revised Code.	74

(B) By rule adopted in accordance with sections 3702.12 and	75
3702.13 of the Revised Code, the director of health shall	76
establish quality standards for health care facilities. The	77
standards may incorporate accreditation standards or other quality	78
standards established by any entity recognized by the director.	79

(C) Every ambulatory surgical facility shall require that	80
each physician who practices at the facility comply with all	81
relevant provisions in the Revised Code that relate to the	82
obtaining of informed consent from a patient.	83

(D) The director shall issue a license to each health care	84
facility that makes application for a license and demonstrates to	85
the director that it meets the quality standards established by	86
the rules adopted under division (B) of this section and satisfies	87
the informed consent compliance requirements specified in division	88
(C) of this section.	89

(E)(1) Except as provided in section 3702.301 of the Revised	90
Code, no health care facility shall operate without a license	91
issued under this section.	92

(2) If the department of health finds that a physician who	93
practices at a health care facility is not complying with any	94
provision of the Revised Code related to the obtaining of informed	95
consent from a patient, the department shall report its finding to	96
the state medical board, the physician, and the health care	97
facility.	98

(3) This division does not create, and shall not be construed	99
as creating, a new cause of action or substantive legal right	100
against a health care facility and in favor of a patient who	101
allegedly sustains harm as a result of the failure of the	102
patient's physician to obtain informed consent from the patient	103
prior to performing a procedure on or otherwise caring for the	104
patient in the health care facility.	105

(F) The rules adopted under division (B) of this section	106
shall include all of the following:	107

(1) Provisions governing application for, renewal,	108
suspension, and revocation of a license under this section;	109

(2) Provisions governing orders issued pursuant to section	110
3702.32 of the Revised Code for a health care facility to cease	111
its operations or to prohibit certain types of services provided	112
by a health care facility;	113

(3) Provisions governing the orders issued pursuant to	114
section 3702.40 of the Revised Code for an ambulatory surgical	115
facility to cease its operations or to prohibit specified types of	116
services provided by an ambulatory surgical facility;	117

(4) Provisions governing the imposition under section	118
sections 3702.32 and 3702.40 of the Revised Code of civil	119
penalties for violations of this section or the rules adopted	120
under this section, including a scale for determining the amount	121
of the penalties;	122

(5) The tasks that are intraoperative tasks for purposes of	123
division (B)(4) of section 3702.40 of the Revised Code.	124

(G) An ambulatory surgical facility that performs or induces	125
abortions shall comply with section 3701.791 of the Revised Code.	126

Sec. 3702.31.  (A) The quality monitoring and inspection fund	127
is hereby created in the state treasury. The director of health	128
shall use the fund to administer and enforce this section and	129
sections 3702.11 to 3702.20, 3702.30, 3702.301, and 3702.32, and	130
3702.40 of the Revised Code and rules adopted pursuant to those	131
sections. The director shall deposit in the fund any moneys	132
collected pursuant to this section or section 3702.32 or 3702.40	133
of the Revised Code. All investment earnings of the fund shall be	134
credited to the fund.	135

(B) The director of health shall adopt rules pursuant to	136
Chapter 119. of the Revised Code establishing fees for both of the	137
following:	138

(1) Initial and renewal license applications submitted under	139
section 3702.30 of the Revised Code. The fees established under	140
division (B)(1) of this section shall not exceed the actual and	141
necessary costs of performing the activities described in division	142
(A) of this section.	143

(2) Inspections conducted under section 3702.15 or 3702.30 of	144
the Revised Code. The fees established under division (B)(2) of	145
this section shall not exceed the actual and necessary costs	146
incurred during an inspection, including any indirect costs	147
incurred by the department for staff, salary, or other	148
administrative costs. The director of health shall provide to	149
each health care facility or provider inspected pursuant to	150
section 3702.15 or 3702.30 of the Revised Code a written statement	151
of the fee. The statement shall itemize and total the costs	152
incurred. Within fifteen days after receiving a statement from	153
the director, the facility or provider shall forward the total	154
amount of the fee to the director.	155

(3) The fees described in divisions (B)(1) and (2) of this	156
section shall meet both of the following requirements:	157

(a) For each service described in section 3702.11 of the	158
Revised Code, the fee shall not exceed one thousand seven hundred	159
fifty dollars annually, except that the total fees charged to a	160
health care provider under this section shall not exceed five	161
thousand dollars annually.	162

(b) The fee shall exclude any costs reimbursable by the	163
United States centers for medicare and medicaid services as part	164
of the certification process for the medicare program established	165
under Title XVIII of the "Social Security Act," 79 Stat. 286	166
(1935), 42 U.S.C.A. 1395, as amended, and the medicaid program	167
established under Title XIX of the "Social Security Act," 79 Stat.	168
286 (1965), 42 U.S.C. 1396.	169

(4) The director shall not establish a fee for any service	170
for which a licensure or inspection fee is paid by the health care	171
provider to a state agency for the same or similar licensure or	172
inspection.	173

Sec. 3702.40.  (A) As used in this section:

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(1) "Circulating nurse" means a registered nurse who is	175
educated, trained, or experienced in perioperative nursing and who	176
is responsible for coordinating the nursing care and safety needs	177
of a patient in an operating room or invasive procedure room.	178

(2) "Physician" means a person who holds a valid certificate	179
issued under Chapter 4731. of the Revised Code authorizing the	180
person to practice medicine and surgery, osteopathic medicine and	181
surgery, or podiatric medicine and surgery.	182

(3) "Registered nurse" means a person who is licensed as a	183
registered nurse under Chapter 4723. of the Revised Code.	184

(B) An ambulatory surgical facility shall do all of the	185
following:	186

(1) Assign a circulating nurse to each procedure performed	187
in an operating room or invasive procedure room of the facility;	188

(2) Ensure that the circulating nurse assigned to a procedure	189
described in division (B)(1) of this section is present in the	190
operating room or invasive procedure room for the entire duration	191
of the procedure unless it becomes necessary for the nurse to	192
leave the room as required by the procedure or the nurse is	193
relieved by another circulating nurse;	194

(3) Ensure that a circulating nurse assigned to a procedure	195
described in division (B)(1) of this section is not assigned to	196
another procedure that is scheduled to occur concurrently or that	197
may overlap in time with the procedure to which the nurse was	198
originally assigned;	199

(4) Ensure that any person the ambulatory surgical facility	200
has employed or contracted with to work as a surgical technologist	201
for a procedure, or has assigned to assist with the performance	202
of one or more intraoperative tasks as specified by the director	203
of health in rules adopted under divisions (B) and (F)(5) of	204
section 3702.30 of the Revised Code for a procedure, works under	205
the direct supervision of the circulating nurse assigned to the	206
same procedure or the circulating nurse who relieves the	207
circulating nurse assigned to the procedure as described in	208
division (B)(2) of this section.	209

(C) If the director of health determines that an ambulatory	210
surgical facility has violated this section, the director may do	211
one or both of the following:	212

(1) Provide an opportunity for the ambulatory surgical	213
facility to correct the violation within a period of time	214
specified by the director;	215

(2) Prior to or during the pendency of an administrative	216
hearing under Chapter 119. of the Revised Code, issue an order	217
that requires the ambulatory surgical facility to cease operation	218
or prohibits the facility from performing the types of services	219
specified by the director.	220

(D) If an ambulatory surgical facility subject to an order	221
issued under division (C)(2) of this section continues to operate	222
or to perform the types of services prohibited by the order, the	223
director of health may file a petition in the court of common	224
pleas of the county in which the facility is located for an order	225
enjoining the facility from continuing to operate or continuing to	226
perform those types of services. The court shall grant the	227
injunction on a showing that the respondent named in the petition	228
is continuing to operate or perform the types of services	229
prohibited by the director's order.	230

Sec. 3727.60.  (A) As used in this section:

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(1) "Circulating nurse" means a registered nurse who is	232
educated, trained, or experienced in perioperative nursing and who	233
is responsible for coordinating the nursing care and safety needs	234
of a patient in an operating room or invasive procedure room.	235

(2) "Physician" means a person who holds a valid certificate	236
issued under Chapter 4731. of the Revised Code authorizing the	237
person to practice medicine and surgery, osteopathic medicine and	238
surgery, or podiatric medicine and surgery.	239

(3) "Registered nurse" means a person who is licensed as a	240
registered nurse under Chapter 4723. of the Revised Code.	241

(B) A hospital shall do all of the following:

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(1) Assign a circulating nurse to each procedure performed	243
in an operating room or invasive procedure room or invasive	244
procedure room of the hospital;	245

(2) Ensure that the circulating nurse assigned to a procedure	246
described in division (B)(1) of this section is present in the	247
operating room or invasive procedure room for the entire duration	248
of the procedure unless it becomes necessary for the nurse to	249
leave the room as required by the procedure or the nurse is	250
relieved by another circulating nurse;	251

(3) Ensure that a circulating nurse assigned to a procedure	252
described in division (B)(1) of this section is not assigned to	253
another procedure that is scheduled to occur concurrently or that	254
may overlap in time with the procedure to which the nurse was	255
originally assigned;	256

(4) Ensure that any person the hospital has employed or	257
contracted with to work as a surgical technologist for a surgical	258
procedure, or has assigned to assist with the performance of one	259
or more intraoperative tasks as specified by the director of	260
health in rules adopted under division (E) of this section for a	261
procedure, works under the direct supervision of the circulating	262
nurse assigned to the same procedure or the circulating nurse who	263
relieves the circulating nurse assigned to the procedure as	264
described in division (B)(2) of this section.	265

(C) If the director of health determines that a hospital has	266
violated this section, the director may provide an opportunity for	267
the hospital to correct the violation within a period of time	268
specified by the director.	269

(D) If a hospital fails to correct a violation determined by	270
the director under division (C) of this section within the amount	271
of time specified by the director, the director may file a	272
petition in the court of common pleas of the county in which the	273
hospital is located for an order enjoining the hospital from	274
continuing to operate or continuing to perform the types of	275
services that are associated with the violation. The court shall	276
grant the injunction on a showing that the respondent named in	277
the petition is continuing to operate or perform the types of	278
services associated with the violation.	279

(E) The director of health shall adopt rules to specify the	280
tasks that are intraoperative tasks for purposes of division	281
(B)(4) of this section.	282

Section 2.  That existing sections 3702.30 and 3702.31 of the	283
Revised Code are hereby repealed.	284