BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2062
AUTHOR: Hernández
AMENDED: May 1, 2014
HEARING DATE: June 18, 2014
CONSULTANT: Marchand
SUBJECT : Health facilities: surgical technologists.
SUMMARY : Prohibits a health facility from employing a surgical
technologist unless the individual has completed an accredited
educational program and obtained certification as a surgical
technologist. Grandfathers in surgical technologists who were
employed in health facilities prior to January 1, 2015.
Existing law:
1.Provides for the licensure and regulation of various healing
arts professionals by boards and bureaus within the Department
of Consumer Affairs, including the licensing and regulation of
physicians by the Medical Board of California, and registered
nurses by the Board of Registered Nursing.
2.Requires the California Department of Public Health (CDPH) to
adopt regulations that establish nurse-to-patient ratios by
hospital unit for all hospitals. For the surgical service
operating room, these regulations require at least one
registered nurse assigned to the duties of the circulating
nurse, and a minimum of one additional person serving as scrub
assistant for each patient-occupied operating room. The scrub
assistant may be a licensed nurse, an operating room
technician (another term for a surgical technologist), or
other person who has demonstrated current competence to the
hospital as a scrub assistant.
This bill:
1.Prohibits a health facility from employing a surgical
technologist or otherwise contracting with an individual to
practice surgical technology at the facility, unless the
individual was employed to practice surgical technology in a
health facility at any time prior to January 1, 2015, or the
individual meets the following requirements:
a. The individual has successfully completed a
surgical technology educational program accredited by
Continued---
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the Commission on Accreditation of Allied Health
Education Programs or by an organization recognized by
the Council for Higher Education Accreditation or the
United States Department of Education, or a training
program for surgical technology provided by one of the
armed forces of the United States or the Public Health
Service; and,
b. The individual holds and maintains
certification as a surgical technologist by a
credentialing organization with a surgical
technologist certification program that is accredited
by either the National Commission for Certifying
Agencies or the American National Standards Institute.
2.Requires a health facility that employs or contracts with
surgical technologists, for purposes of the provision of this
bill permitting a surgical technologist employed prior to
January 1, 2015 to continue working as a surgical technologist
without having to meet the education and certification
requirements of this bill, to verify the dates of employment
of a surgical technologist upon the request of a health
facility or a surgical technologist.
3.Permits a health facility to employ or contract with a
surgical technologist without holding the required
certification for a 12-month period immediately following the
individual's successful completion of an education or training
program, but requires the employment or contract to cease at
the end of the 12-month period unless the individual obtains
the required certification.
4.Permits a health facility to employ or contract with a
surgical technologist who does not meet the requirements of
this bill if the health facility is unable to employ or
contract with a sufficient number of surgical technologists
who meet the requirements of this bill, after a diligent and
thorough effort has been made. Requires the health facility to
make a written record of these efforts and retain this record
at the facility.
5.Prohibits this bill from being construed to prohibit a
licensed health care practitioner from performing tasks that
fall within the practice of surgical technology if the
individual is acting within the scope of practice of his or
her license.
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3
6.Specifies that a violation of this bill is not subject to
misdemeanor penalties established under existing law for
violations of the laws applying to health facilities.
7.Defines "health facility" as any hospital, skilled nursing
facility, intermediate care facility or other facility
licensed by CDPH, including any primary care clinic or
specialty clinic, as defined, as well as any outpatient
setting that is accredited by an accrediting organization
approved by the Medical Board of California where anesthesia
is used in doses that have the probability of placing a
patient at risk for loss of the patient's life-preserving
protective reflexes.
8.Defines "surgical technology" as intraoperative surgical
patient care as follows:
a. Preparing the operating room for surgical
procedures, at the direction of, or subject to
supervision by, a physician or a registered nurse, by
ensuring that surgical equipment is functioning
properly and safely;
b. Preparing the operating room and the sterile
field for surgical procedures, at the direction of, or
subject to supervision by, a physician or registered
nurse, by preparing sterile supplies, instruments, and
equipment using sterile technique;
c. Anticipating the needs of the surgical team
based on knowledge of human anatomy and
pathophysiology and how they relate to the surgical
patient and the patient's surgical procedure; and,
d. Performing the following tasks, as directed in
an operating room setting, at the sterile field:
i. Passing supplies, equipment, or
instruments;
ii. Sponging or suctioning an operative
site;
iii. Preparing and cutting suture
material;
iv. Transferring and pouring irrigation
fluids;
v. Transferring, but not administering
drugs within the sterile field;
vi. Handling specimens;
vii. Holding retractors and other
AB 2062 | Page 4
instruments;
viii. Connecting drains to suction
apparatus;
ix. Applying dressings to closed
wounds;
x. Assisting in counting sponges,
needles, supplies, and instruments with the
registered nurse circulator;
xi. Cleaning and preparing instruments
for sterilization on completion of the surgery;
and,
xii. Assisting the surgical team with
cleaning of the operating room on completion of
the surgery.
9.Makes various legislative findings and declarations, including
that the surgical technology profession has grown to meet the
continuing demand for well-educated, highly skilled, and
versatile individuals to work with physicians and other
skilled professionals to deliver the highest possible level of
patient care, and that a key purpose of this act is to
encourage the education and training of surgical
technologists, given their role in surgical settings, in order
to take specific steps to prevent surgical site infections.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, minor and absorbable costs to CDPH's Licensing and
Certification division to verify facilities are complying with
the new requirement with respect to surgical technologists they
employ (Licensing and Certification Special Fund).
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 76- 0
COMMENTS :
1.Author's statement. According the author, surgical
technologists are a key member of the surgical team in any
operating room responsible for environmental disinfection,
safety, and efficiency. Skillful surgical technique protects
patients from life-threatening surgical site infections,
malfunctioning equipment and unneeded delays during the
procedure. Currently, California is home to an estimated
9,250 of the nation's approximate 98,000 surgical
technologists -- all of whom go unregulated for minimum
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education and training standards. In fact, surgical
technologists are the only member of the surgical team with no
minimum education or training requirements. The unregulated
practice of surgical technology creates a risk of patient
harm. The purpose of this bill is to improve patient care
safety while lowering health care costs by raising the
education and training standards for surgical technologists.
2.Background. According to the United States Bureau of Labor
Statistics, surgical technologists, also called operating room
technicians, assist in surgical operations by preparing
operating rooms, arranging equipment, and helping physicians
during surgery. As of 2012, there were 98,500 surgical
technologists in the United States, with growth of 30 percent
expected through 2022, much higher than average. The median
pay is $20.09 per hour, or $41,790 per year. According to the
Bureau of Labor Statistics, surgical technologists typically
need postsecondary education, and that many community colleges
and vocational schools, as well as some universities and
hospitals, have accredited programs in surgical technology.
Programs range in length from several months to 2 years. In
2012, about 500 surgical technologist training programs were
accredited by the Commission on Accreditation of Allied Health
Education Programs and the Accrediting Bureau of Health
Education Schools. According to the author, eight states
currently have minimum education and certification
requirements: Idaho, Indiana, Massachusetts, New Jersey, New
York, South Carolina, Tennessee and Texas.
3.Prior legislation. AB 2561 (Hernández), of 2012, would have
established a title act for certified surgical technologists,
making it unlawful for a person to use the title "certified
surgical technologist" unless the person had completed an
accredited training program and obtain certification as a
surgical technologists. AB 2561 was vetoed by the Governor,
who stated that "I don't agree, however, that we need to
establish 'title protection' for certified technologists in
law. For those who have taken the time to become certified,
let the marketplace reward their higher skills and education.
Recognition by the state is not needed."
4.Support. This bill is sponsored by the California State
Council of the Service Employees International Union (SEIU
California), which states that currently there are no training
or education standards for surgical technologists in
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California, and that in fact they are the only members of the
surgical team in the operating room with no minimum education
or certification or licensing standards. SEIU California
states that this bill requires a newly hired surgical
technologist to attend an accredited training program and
obtain a certification from a nationally accredited
organization, and it would also grandfather the current
workforce and allow new graduates up to a year to achieve
certification. SEIU California states that accredited training
programs and certification, along with the experience of the
current workforce, will contribute to lower the rates of
surgical site infections and adverse surgical events,
improving public safety. According to SEIU California, the
goal of setting these standards is to improve the quality of
healthcare delivered in the surgical setting, and the at
providing surgical technologists with basic training and
education standards can help to ensure a level playing field
of competency in the operating room. SEIU California states
that it represents surgical technologists throughout
California, and that some have gone through the certification
process, but many more have not, and they understand the
benefits of standardizing professional competency in line with
other members of the surgical care team.
Kaiser Permanente also supports this bill, stating that surgical
technologists assist the physician during surgical procedures
and this bill is an important measure to ensure patient safety
and quality of care for Kaiser Permanente.
5.Opposition. This bill is opposed by the Northern California
Chapter of the American College of Surgeons (ACS), which
states that it does not believe there is sufficient scientific
evidence to support the assertion that the requirement of
employers to hire certified surgical technologists will result
in a reduction in the incidence of wound infections.
6.Oppose unless amended. The California Society of Plastic
Surgeons (CSPS) has taken an oppose unless amended position,
requesting that this bill be clarified to ensure that
registered nurses (RNs) and licensed vocational nurses (LVNs)
are not affected by this bill. CSPS states that in many of its
outpatient surgery settings, its member will have RNs and LVNs
providing "surgical technology" duties, and they are concerned
that the language in this bill may preclude an RN or LVN from
providing duties identified under surgical technology. CSPS is
proposing the following amendment:
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On page 4, line 3-6:
(d) This section shall not be construed to prohibit a licensed
health care practitioner , including but not limited to
registered nurses and licensed vocational nurses, from
performing tasks that fall within the practice of surgical
technology or be subject to the requirements of this section
if the individual is acting within the scope of practice of
his or her license.
7.Certifying agencies. This bill requires prospective surgical
technologists to be certified by a "credentialing organization
with a surgical technologist certification program that is
accredited by either the National Commission for Certifying
Agencies (NCCA) or the American National Standards Institute."
It appears that the only certifying entity that meets this
requirement is the National Board of Surgical Technology and
Surgical Assisting (NBSTSA), which offers a certification
program for "Certified Surgical Technologists," and is
accredited by the NCCA. However, an organization called the
National Center for Competency Testing also offers a
certification program for "Tech in Surgery-Certified." Both
require an exam, and both require continuing education in
order for surgical technologists to maintain their
certification. However, the "Tech in Surgery-Certified" does
not appear to be accredited by NCCA or by the American
National Standards Institute.
The examination fees for the NBSTSA Certified Surgical
Technologist exam are $190 for members and $290 for
nonmembers. Renewal is required every four years, and
requires either 60 continuing education units, or the retaking
of the examination for an additional fee.
8.Should all surgical technologists be grandfathered in? This
bill grandfathers in every individual who was ever employed as
a surgical technologist prior to the effective date of this
bill. This means that someone who was hired in December of
this year, who may have never gone to an approved surgical
technologist school, will never be required to obtain
certification as a surgical technologist, nor will he or she
have to complete continuing education to maintain a
certification. But all persons hired on January 1st or later
will first have to prove they have completed an accredited
training program, which commonly takes about a year, and pay
fees to obtain a certification, and then likely have to pay
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additional fees to take continuing education courses to
maintain certification. This has the potential to create a
long-lasting double-standard, and makes no distinction with
regard to the grandfathered surgical technologists in terms of
how long they may have been practicing and what education and
training they may have received. The author may wish to
consider whether the grandfathered surgical technologists
should be required to have spent a minimum length of time
practicing as a surgical technologist in order to qualify for
being grandfathered, and whether they should be required to
comply with some form of continuing education requirements.
SUPPORT AND OPPOSITION :
Support: California State Council of the Service Employees
International Union (sponsor)
Kaiser Permanente
Oppose: California Society of Plastic Surgeons (unless
amended)
Northern California Chapter of American College of
Surgeons
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