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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to health care provider 2
accountability; amending s. 400.022, F.S.; revising 3
the rights of licensed nursing home facility 4
residents; amending s. 408.812, F.S.; creating a cause 5
of action for an ex parte temporary injunction against 6
continued unlicensed activity; providing requirements 7
for such injunction; providing construction; 8
authorizing the Agency for Health Care Administration 9
to provide certain records to local law enforcement 10
and state attorneys' offices under certain 11
circumstances; amending ss. 458.328 and 459.0138, 12
F.S.; providing standard of practice requirements for 13
office surgeries; providing definitions; prohibiting 14
certain office surge ries; providing physician, office, 15
and procedure requirements; prohibiting specified 16
health care facilities from registering as an office; 17
providing an effective date. 18
19
Be It Enacted by the Legislature of the State of Florida: 20
21
Section 1. Paragraph (o) of subsection (1) of section 22
400.022, Florida Statutes, is amended to read: 23
400.022 Residents' rights. — 24
(1) All licensees of nursing home facilities shall adopt 25
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and make public a statement of the rights and responsibilities 26
of the residents of suc h facilities and shall treat such 27
residents in accordance with the provisions of that statement. 28
The statement shall assure each resident the following: 29
(o) The right to be free from mental and physical abuse, 30
sexual abuse, neglect, exploitation, corporal punishment, 31
extended involuntary seclusion, and from physical and chemical 32
restraints, except those restraints authorized in writing by a 33
physician for a specified and limited period of time or as are 34
necessitated by an emergency. In case of an emergency , restraint 35
may be applied only by a qualified licensed nurse who shall set 36
forth in writing the circumstances requiring the use of 37
restraint, and, in the case of use of a chemical restraint, a 38
physician shall be consulted immediately thereafter. Restraint s 39
may not be used in lieu of staff supervision or merely for staff 40
convenience, for punishment, or for reasons other than resident 41
protection or safety. 42
Section 2. Subsection (6) of section 408.812, Florida 43
Statutes, is amended to read: 44
408.812 Unlicensed activity.— 45
(6) In addition to granting injunctive relief pursuant to 46
subsection (2), if the agency determines that a person or entity 47
is operating or maintaining a provider without obtaining a 48
license and determines that a condition exists that pos es a 49
threat to the health, safety, or welfare of a client of the 50
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provider, the person or entity is subject to the same actions 51
and fines imposed against a licensee as specified in this part, 52
authorizing statutes, and agency rules. 53
(a) The agency may peti tion the circuit court for an ex 54
parte temporary injunction against continued unlicensed activity 55
when agency personnel have verified, through an onsite 56
inspection, that a person or entity is advertising, offering, or 57
providing services that require licens ure and has previously 58
received notification from the agency to discontinue such 59
activity. 60
(b) A sworn petition seeking the issuance of an ex parte 61
temporary injunction against continued unlicensed activity shall 62
allege the location of the unlicensed act ivity, the owners and 63
operators of the unlicensed provider, the type of services that 64
require licensure, and specific facts supporting the conclusion 65
that the respondent is engaged in unlicensed activity, including 66
the date, time, and location at which the respondent was 67
notified to discontinue such activity, whether the respondent 68
prohibited the agency from conducting a subsequent investigation 69
to determine current compliance or noncompliance, any previous 70
injunctive relief granted against the respondent, and any 71
previous agency determination that the respondent has previously 72
been identified as engaging in unlicensed activity. 73
(c) A bond may not be required by the court for the entry 74
of an ex parte temporary injunction. 75
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(d) Except as provided in s. 90.204, in a hearing ex parte 76
for the purpose of obtaining an ex parte temporary injunction, 77
evidence other than verified pleadings or affidavits by agency 78
personnel or others with firsthand knowledge of the alleged 79
unlicensed activity may not be used as e vidence, unless the 80
respondent appears at the hearing. A denial of a petition for an 81
ex parte temporary injunction shall be by written order noting 82
the legal grounds for denial. This paragraph does not affect the 83
agency's right to promptly amend any petiti on or otherwise be 84
heard in person on any petition in accordance with the Florida 85
Rules of Civil Procedure. 86
(e) If it appears to the court that the respondent is 87
engaged in unlicensed activity and has not discontinued that 88
activity after notification by the agency, the court may grant 89
an ex parte temporary injunction, pending a full hearing, and 90
may grant such relief as the court deems proper, including an ex 91
parte temporary injunction restraining the respondent from 92
advertising, offering, or providing se rvices for which licensure 93
is required under this chapter and authorizing statutes, and 94
requiring the respondent to provide agency personnel with full 95
access to facility personnel, records, and clients for a future 96
inspection of the premises. 97
(f) Any such ex parte temporary injunction shall be 98
effective for a fixed period not to exceed 30 days. 99
(g) The agency must conduct an inspection of the 100
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identified premises within 20 days after issuance of the ex 101
parte temporary injunction to verify the respondent' s compliance 102
or noncompliance with the ex parte temporary injunction. If the 103
respondent is found to have complied with the ex parte temporary 104
injunction, the agency shall voluntarily dismiss the ex parte 105
temporary injunction. If the agency identifies that unlicensed 106
activity has continued in violation of the ex parte temporary 107
injunction, the agency may file a petition for permanent 108
injunction within 10 days after identifying the continued 109
noncompliance at which time a full hearing shall be set as soon 110
as practicable. The agency may, along with the filing of a 111
petition for permanent injunction, move for an extension of the 112
ex parte temporary injunction until disposition of the permanent 113
injunction proceedings. 114
(h) An ex parte temporary injunction against c ontinued 115
unlicensed activity shall be served by the sheriff of the county 116
in which the respondent's activities are conducted. 117
(i) Remedies in this subsection are not exclusive but are 118
in addition to any other administrative or criminal remedies for 119
unlicensed activity. 120
(j) The agency is not required to exhaust its 121
administrative remedies before seeking the relief provided under 122
this subsection. 123
(k) The agency is authorized to provide any and all 124
records of agency inspections to local law enforcement o r state 125
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attorneys' offices upon request and without redaction. 126
Section 3. Subsection (2) of section 458.328, Florida 127
Statutes, renumbered as subsection (3), and a new subsection (2) 128
is added to that section to read: 129
458.328 Office surgeries. — 130
(2) STANDARD OF PRACTICE. — 131
(a) For purposes of this section, the term: 132
1. "Office surgery" means a surgery performed at an office 133
that primarily serves as a physician's office at which a 134
physician regularly performs consultations with surgical 135
patients, presurgical examinations, and postoperative monitoring 136
and care related to office surgeries and at which patient 137
records are readily maintained and available. 138
2. "Physician" means a physician or surgeon licensed to 139
practice under this chapter. 140
(b) A physician performing a gluteal fat grafting 141
procedure in an office surgery setting shall adhere to standards 142
of practice pursuant to this subsection and rules adopted by the 143
board. The board may not adopt by rule standards of practice 144
that conflict with this su bsection. 145
(c) Office surgeries may not: 146
1. Result in blood loss of more than 10 percent of 147
estimated blood volume in a patient with a normal hemoglobin 148
level; 149
2. Require major or prolonged intracranial, intrathoracic, 150
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abdominal, or joint replacement procedures, except for 151
laparoscopic procedures; 152
3. Involve major blood vessels performed with direct 153
visualization by open exposure of the major blood vessel, except 154
for percutaneous endovascular intervention; or 155
4. Be emergent or life threatening. 156
(d)1. A physician performing a gluteal fat grafting 157
procedure must be a cosmetic surgeon certified by the American 158
Board of Cosmetic Surgery. 159
2. Any duty delegated by a physician, with a patient's 160
informed consent, to be performed during a gluteal fat gra fting 161
procedure must be performed under the direct supervision of the 162
physician performing such procedure. Gluteal fat injections must 163
be performed by the physician and may not be delegated. 164
3. Gluteal fat may only be injected into the subcutaneous 165
space of the patient and may not cross the fascia overlying the 166
gluteal muscle. Intramuscular or submuscular fat injections are 167
prohibited. 168
4. When the physician performing a gluteal fat grafting 169
procedure injects fat into the subcutaneous space of the 170
patient, the physician must use ultrasound guidance during the 171
placement and navigation of the canula to ensure that the fat is 172
injected into the subcutaneous space of the patient above the 173
fascia overlying the gluteal muscle. Ultrasound guidance is not 174
required for other portions of such procedure. 175
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(e) An office at which office surgeries will be performed 176
must be inspected by the department before registration. If the 177
office refuses the preregistration inspection, the office may 178
not be registered by the depart ment until completion of an 179
inspection. If a registered office refuses any subsequent 180
inspection, the registration of such office shall be immediately 181
suspended until completion of an inspection by the department. 182
(f) If a procedure in an office surgery setting results in 183
hospitalization, the type of procedure performed and the 184
location at which the procedure was performed, if known, must be 185
included in the hospital intake information for the purpose of 186
adverse incident reporting. 187
(g) A health care facility that meets the definition of an 188
ambulatory surgical center as defined in s. 395.002 or a 189
hospital or an abortion clinic as defined in s. 390.011, 190
respectively, may not register as an office under this section 191
or rules adopted by the board. 192
Section 4. Subsection (2) of section 459.0138, Florida 193
Statutes, is renumbered as subsection (3), and a new subsection 194
(2) is added to that section to read: 195
459.0138 Office surgeries. — 196
(2) STANDARD OF PRACTICE. — 197
(a) For purposes of this section, the ter m: 198
1. "Office surgery" means a surgery performed at an office 199
that primarily serves as a physician's office at which a 200
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physician performs surgeries as permitted under this section. 201
The physician's office must be an office at which such physician 202
regularly performs consultations with surgical patients, 203
presurgical examinations, and postoperative monitoring and care 204
related to office surgeries and at which patient records are 205
readily maintained and available. 206
2. "Physician" means a physician or surgeon li censed to 207
practice under this chapter. 208
(b) A physician performing a gluteal fat grafting 209
procedure in an office surgery setting shall adhere to standards 210
of practice pursuant to this subsection and rules adopted by the 211
board. The board may not adopt by r ule standards of practice 212
that conflict with this subsection. 213
(c) Office surgeries may not: 214
1. Result in blood loss of more than 10 percent of 215
estimated blood volume in a patient with a normal hemoglobin 216
level; 217
2. Require major or prolonged intracranial, intrathoracic, 218
abdominal, or joint replacement procedures, except for 219
laparoscopic procedures; 220
3. Involve major blood vessels performed with direct 221
visualization by open exposure of the major blood vessel, except 222
for percutaneous endovascul ar intervention; or 223
4. Be emergent or life threatening. 224
(d)1. A physician performing a gluteal fat grafting 225
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procedure must be a cosmetic surgeon certified by the American 226
Board of Cosmetic Surgery. 227
2. Any duty delegated by a physician, with a patient 's 228
informed consent, to be performed during a gluteal fat grafting 229
procedure must be performed under the direct supervision of the 230
physician performing such procedure. Gluteal fat injections must 231
be performed by the physician and may not be delegated. 232
3. Gluteal fat may only be injected into the subcutaneous 233
space of the patient and may not cross the fascia overlying the 234
gluteal muscle. Intramuscular or submuscular fat injections are 235
prohibited. 236
4. When the physician performing a gluteal fat grafting 237
procedure injects fat into the subcutaneous space of the 238
patient, the physician must use ultrasound guidance during the 239
placement and navigation of the canula to ensure that the fat is 240
injected into the subcutaneous space of the patient above the 241
fascia overlying the gluteal muscle. Ultrasound guidance is not 242
required for other portions of such procedure. 243
(e) An office at which office surgeries will be performed 244
must be inspected by the department before registration. If the 245
office refuses the preregistrati on inspection, the office may 246
not be registered by the department until completion of an 247
inspection. If a registered office refuses any subsequent 248
inspection, the registration of such office shall be immediately 249
suspended until completion of an inspection by the department. 250
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(f) If a procedure in an office surgery setting results in 251
hospitalization, the type of procedure performed and the 252
location at which the procedure was performed, if known, must be 253
included in the hospital intake information for the pu rpose of 254
adverse incident reporting. 255
(g) A health care facility that meets the definition of an 256
ambulatory surgical center in s. 395.002 or a hospital or an 257
abortion clinic as defined in s. 390.011, respectively, may not 258
register as an office under this section or rules adopted by the 259
board. 260
Section 5. This act shall take effect July 1, 2023. 261