BILL ANALYSIS Ó
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THIRD READING
Bill No: AB 2062
Author: Roger Hernández (D)
Amended: 8/21/14 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 7-0, 6/18/14
AYES: Hernandez, Beall, DeSaulnier, Evans, Monning, Nielsen,
Wolk
NO VOTE RECORDED: Morrell, De León
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 76-0, 5/19/14 - See last page for vote
SUBJECT : Health facilities: surgical technologists
SOURCE : SEIU California
DIGEST : This bill 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.
Senate Floor Amendments of 8/21/14 apply continuing education or
skills training requirements to non-certified individuals that
hospitals are allowed to hire when the hospital is unable to
find enough certified technologist to meet its needs.
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ANALYSIS :
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
(MBC), and registered nurses by the Board of Registered
Nursing.
2. Requires DPH 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 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
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Certifying Agencies (NCCA) or the American National
Standards Institute (ANSI).
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 a surgical technologist
or otherwise contract with an individual to practice surgical
technology at the facility who does not meet the requirements
set forth in this bill if all of the following requirements
are satisfied:
A. After a diligent and thorough effort has been made,
the health facility is unable to employ or contract
with a sufficient number of surgical technologists who
meet the requirements of this bill;
B. The health facility makes a written record of these
efforts and retain this record at the facility; and
C. Any individual employed or under contract completes
continuing education or skills training equivalent to
the continuing education or skills training necessary
to maintain a certification, as described.
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/her
license.
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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 DPH, 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 MBC 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:
(1) Passing supplies, equipment, or
instruments;
(2) Sponging or suctioning an operative site;
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(3) Preparing and cutting suture material;
(4) Transferring and pouring irrigation
fluids;
(5) Transferring, but not administering drugs
within the sterile field;
(6) Handling specimens;
(7) Holding retractors and other instruments;
(8) Connecting drains to suction apparatus;
(9) Applying dressings to closed wounds;
(10) Assisting in counting sponges, needles,
supplies, and instruments with the registered
nurse circulator;
(11) Cleaning and preparing instruments for
sterilization on completion of the surgery; and
(12) 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 vital role in the
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surgical settings.
Background
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 NCCA or the ANSI." 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 ANSI.
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.
Comments
According the author's office, 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 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.
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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 Governor Brown, 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."
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/22/14)
SEIU California (source)
Association of Surgical Technologists
California Black Health Network
California Dietetic Association
California Health Collaborative
California Labor Federation
Kaiser Permanente
Latino Coalition for a Healthy California
National Board of Surgical Technology and Surgical Assisting
SEIU Local 1000
ARGUMENTS IN SUPPORT : This bill is sponsored by SEIU
California, which states that currently there are no training or
education standards for surgical technologists in 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 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 health care
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
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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.
ASSEMBLY FLOOR : 76-0, 5/19/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon,
Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hernández,
Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,
Maienschein, Medina, Melendez, Mullin, Muratsuchi, Olsen, Pan,
Patterson, Perea, John A. Pérez, V. Manuel Pérez, Quirk,
Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas, Skinner,
Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, Atkins
NO VOTE RECORDED: Mansoor, Nazarian, Nestande, Vacancy
JL:RM:d 8/22/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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