BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 2561
                                                                  Page  1

          Date of Hearing:   April 24, 2012

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER 
                                     PROTECTION
                                 Mary Hayashi, Chair
               AB 2561 (Roger Hernández) - As Amended:  March 29, 2012
                             (As Proposed to be Amended)

           SUBJECT  :   Certified surgical technologists.

           SUMMARY  :   Establishes a title act for certified surgical 
          technologists.  Specifically,  this bill  :  

          1)Establishes the Certified Surgical Technologist Act and makes 
            it unlawful for a person to use the title "certified surgical 
            technologist" in this state unless the person: 

             a)   Has successfully completed a nationally accredited 
               educational program for surgical technologists, or a 
               training program for surgical technology provided by the 
               United States (U.S.) Army, Navy, Air Force, Marine Corps, 
               Coast Guard or Public Health Service; and,

             b)   Holds and maintains certification as a surgical 
               technologist by the National Board of Surgical Technology 
               and Surgical Assisting (NBSTSA) or its successor, or 
               another nationally accredited surgical technologist 
               credentialing organization.

          2)Provides that violations of the above provision are not 
            subject to a misdemeanor or enforcement thereof.

          3)Defines "certified surgical technologist to mean a person who 
            practices surgical technology, and who has successfully 
            completed a nationally accredited educational program for 
            surgical technologists and holds and maintains certification 
            as a surgical technologist by any of the entities described 
            above.

          4)Defines "surgical technology" to mean surgical patient care as 
            follows:

             a)   Preparing the operating room for surgical procedures by 
               ensuring that surgical equipment is functioning properly 
               and safely;








                                                                  AB 2561
                                                                  Page  2


             b)   Preparing the operating room and the sterile field for 
               surgical procedures 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)   As directed in an operating room setting, performing the 
               following tasks 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 instruments;

               viii)  Applying electrocautery to clamps on bleeders.

               ix)    Connecting drains to suction apparatus.

               x)     Applying dressings to closed wounds.

               xi)    Assisting in counting sponges, needles, supplies, 
                 and instruments with the registered nurse circulator.

               xii)   Cleaning and preparing instruments for sterilization 
                 on completion of the surgery.

               xiii)  Assisting the surgical team with cleaning of the 
                 operating room on completion of the surgery.

          5)Specifies that this bill does not:









                                                                  AB 2561
                                                                  Page  3

             a)   Repeal, modify, or amend any existing law relating to 
               the supervision of surgical technologists, nor shall it be 
               construed to do so;

             b)   Prohibit or limit any healing arts licensee described in 
               this division from performing a task or function within the 
               scope of the healing art licensee's license, nor shall it 
               be construed as such; or,

             c)   Apply to licensed registered nurses, licensed vocational 
               nurses, or an individual employed by a health care facility 
               whose primary functions include the cleaning or 
               sterilization of supplies, instruments, equipment, or 
               operating rooms.

          6)States findings and declarations.

           FISCAL EFFECT  :   Unknown

           COMMENTS  :   

           Purpose of this bill  .  According to the author, "Presently, 
          surgical technologists are the only health care professional 
          engaged in surgical suite activity without recognition of their 
          profession and the attendant standards of care which their work 
          in such settings warrant?As surgical site infections (SSI) have 
          been found to be the second most common hospital-acquired 
          infections in the United States (U.S.), a key purpose of the 
          bill is to encourage the education, training and utilization of 
          certified surgical technologists in California, given their work 
          in surgical settings to prevent SSI."

           Background  .  Surgical technologists, also known as "scrub 
          techs," "surgical technicians," or "operating room technicians", 
          are allied health professionals who work under the supervision 
          of a surgeon.  They provide surgical care to patients ensuring 
          that invasive surgical procedures are being carried out safely 
          and effectively.  They make sure the operating room environment 
          is safe and that equipment is working properly.  They also make 
          sure that surgical procedures are performed under conditions 
          that maximize patient safety. 

          Surgical technologists must possess a high school diploma (or 
          equivalent) and complete an accredited surgical technology 
          training program.  In California, the Commission on 








                                                                  AB 2561
                                                                  Page  4

          Accreditation of Allied Health Education Programs and the 
          Accrediting Bureau of Health Education School accredits surgical 
          technology programs offered by community colleges, vocational 
          schools, universities, hospitals, and the military.  Training 
          programs typically last from 12 to 24 months and lead to a 
          certificate, diploma, or associate degree. 

          In California, the number of surgical technologists is expected 
          to grow much faster than average growth rate for all 
          occupations.  Jobs for surgical technologists are expected to 
          increase by 29.2%, or 2,600 jobs, between 2008 and 2018.

          The NBSTSA was established in 1974 as the certifying agency for 
          surgical technologists.  The purpose of NBSTSA is to determine, 
          through examination, if an individual has acquired both 
          theoretical and practical knowledge of surgical technology or 
          surgical first assisting.

          An SSI is an infection that occurs after surgery in the part of 
          the body where the surgery took place.  This type of infection 
          develops in about 1 to 3 out of every 100 patients who have 
          surgery.  SSIs initiated during invasive procedures can require 
          additional and/or extended treatment.  Despite the best efforts 
          of healthcare facilities to maintain safe surgical environments, 
          surgical site infections result in up to $10 billion in 
          treatment costs every year in the U.S., with about 780,000 out 
          of 30 million surgical procedures performed annually in the U.S. 
          resulting in SSI.

           Support  .  The California State Assembly - Association of 
          Surgical Technologists write, "California is home to an 
          estimated 5,000 of the nation's 90,000 surgical technologists 
          who work every day to safeguard patient care.  We would welcome 
          and greatly appreciate the recognition of Certified Surgical 
          Technologists proposed by AB 2561."

           Opposition  .  The American Nurses Association/California writes, 
          "Licensure is a process to protect the public.  Licensure 
          usually imposes delegated authority for an unlicensed person or 
          a licensed person to practice a delegated statutory act.  A 
          surgical technologist is not responsible for any delegated act 
          in the operating room.  A surgical technologist works under the 
          direct authority of the Registered Nurse practicing tasks that 
          do not require a license and are appropriately delegated.  









                                                                  AB 2561
                                                                  Page  5

          "The Registered Nurse is responsible for the environmental 
          disinfection, safety, and efficiency of the operating room.  
          Some of the tasks involved in this responsibility can be 
          delegated to an unlicensed person like a surgical technologist.  
          Some surgical technologists are trained by the operating room in 
          the hospital and doctor's office.  Some of the technicians go on 
          to get certified.  This certification is not required by many 
          hospitals.  A Registered Nurse seeks certification as a standard 
          acknowledging their expertise but it is not a requirement for 
          licensure."
           Amendments attached  .  Amendments remove a requirement that 
          certified surgical technicians register with the Medical Board 
          of California (MBC) and the establishment of an associated 
          committee within the MBC.  
           
           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          California State Assembly - Association of Surgical 
          Technologists (sponsor)

           Opposition 
           
          American Nurses Association/California
           
          Analysis Prepared by  :    Angela Mapp / B.,P. & C.P. / (916) 
          319-3301