FL
Florida House Bill H1471

Florida 2023 Regular Session

Florida House Bill H1471 Compare Versions

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1010 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
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14- 1
14+A bill to be entitled 1
1515 An act relating to health care provider 2
1616 accountability; amending s. 400.022, F.S.; revising 3
1717 the rights of licensed nursing home facility 4
1818 residents; providing definitions; amending s. 408.812, 5
1919 F.S.; creating a cause of action for an ex parte 6
2020 temporary injunction against continued unlicensed 7
2121 activity; providing requirements for such injunction; 8
2222 providing construction; authorizing the Agency for 9
2323 Health Care Administration to provide certain records 10
2424 to local law enforcement and state attorneys' offices 11
2525 under certain circumstances; amending ss. 458.328 and 12
2626 459.0138, F.S.; requiring the Department of Health to 13
2727 complete an inspection of any physician′s office 14
2828 seeking registration to perform office surgeries 15
2929 before the office may be registered; requiring 16
3030 immediate suspension of a registration under specified 17
3131 circumstances; requiring such offices to remain closed 18
3232 for the duration of any suspensions; requiring a 19
3333 suspension to remain in effect for a specified 20
3434 timeframe; requiring physicians performing gluteal fat 21
3535 grafting procedures in an office surgery setting to 22
3636 adhere to specified standards of practice; specifying 23
3737 surgeries that may not be performed in an office 24
3838 surgery setting; requiring physicians performing 25
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4747 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
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5151 gluteal fat grafting procedures to conduct in -person 26
5252 examinations of the patients; requiring the reporting 27
5353 of specified adverse incidents; providing requirements 28
5454 for the performance of gluteal fat grafting 29
5555 procedures; providing an effective date. 30
5656 31
5757 Be It Enacted by the Legislature of the State of Florida: 32
5858 33
5959 Section 1. Paragraph (o) of subsection (1) of section 34
6060 400.022, Florida Statutes, is amended to read: 35
6161 400.022 Residents' rights. — 36
6262 (1) All licensees of nursing home facilities shall adopt 37
6363 and make public a statement of the rights and responsibilities 38
6464 of the residents of such facilities and shall treat such 39
6565 residents in accordance with the provisions of that statement. 40
6666 The statement shall assure each resident the following: 41
6767 (o) The right to be free from mental and physical abuse, 42
6868 sexual abuse, neglect, exploitation, corporal punishment, 43
6969 extended involuntary seclusion, and from physical and chemical 44
7070 restraints, except those restraints authorized in writing by a 45
7171 physician for a specified and limited period of time or as are 46
7272 necessitated by an emergency. In case of an emergency, restraint 47
7373 may be applied only by a qualified licensed nurse who shall set 48
7474 forth in writing the circumstances requiring the use of 49
7575 restraint, and, in the case of use of a chemical restraint, a 50
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8484 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
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8686
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8888 physician shall be consulted immediately thereafter. Restraints 51
8989 may not be used in lieu of staff supervision or merely for staff 52
9090 convenience, for punishment, or for reasons other than resident 53
9191 protection or safety. For purposes of this paragraph, the terms 54
9292 "sexual abuse," "neglect," and "exploita tion" have the same 55
9393 meanings as provided in 42 C.F.R. s. 483.5. 56
9494 Section 2. Subsection (6) of section 408.812, Florida 57
9595 Statutes, is amended to read: 58
9696 408.812 Unlicensed activity. — 59
9797 (6) In addition to granting injunctive relief pursuant to 60
9898 subsection (2), if the agency determines that a person or entity 61
9999 is operating or maintaining a provider without obtaining a 62
100100 license and determines that a condition exists that poses a 63
101101 threat to the health, safety, or welfare of a client of the 64
102102 provider, the person or entity is subject to the same actions 65
103103 and fines imposed against a licensee as specified in this part, 66
104104 authorizing statutes, and agency rules. 67
105105 (a) There is created a cause of action for an ex parte 68
106106 temporary injunction against continued unlicensed activit y by a 69
107107 person or entity violating subsection (1), not to exceed 30 70
108108 days. 71
109109 (b) A sworn petition seeking the issuance of an ex parte 72
110110 temporary injunction against continued unlicensed activity shall 73
111111 allege all of the following: 74
112112 1. The location of the unlic ensed activity. 75
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121121 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
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123123
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125125 2. The names of the owners and operators of the unlicensed 76
126126 provider. 77
127127 3. The type of services that require licensure. 78
128128 4. The specific facts supporting the conclusion that the 79
129129 unlicensed provider is engaged in unlicensed activity, including 80
130130 the date, time, and location at which the unlicensed provider 81
131131 was notified by the agency to discontinue such activity. 82
132132 5. That agency personnel have verified, through an onsite 83
133133 inspection, that the unlicensed provider is advertising, 84
134134 offering, or providing services that require licensure. 85
135135 6. Whether the unlicensed provider prohibited the agency 86
136136 from conducting a subsequent investigation to determine current 87
137137 compliance with applicable laws and rules. 88
138138 7. Any previous injunctive relief granted against the 89
139139 unlicensed provider. 90
140140 8. Any previous agency determination that the unlicensed 91
141141 provider has been identified as engaging in unlicensed activity. 92
142142 (c) A bond may not be required by the court for entry of 93
143143 an ex parte temporary injunction. 94
144144 (d) Except as provided in s. 90.204, in a hearing to 95
145145 obtain an ex parte temporary injunction, evidence other than 96
146146 verified pleadings or affidavits by agency personnel or others 97
147147 with firsthand knowledge of the alleged unlicensed activity may 98
148148 not be used as evidence, unless the unlicensed provider appears 99
149149 at the hearing. A denial of a petition for an ex parte temporary 100
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158158 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
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162162 injunction shall specify the grounds for denial in writing. 101
163163 (e) If the court determines that the unlicensed provider 102
164164 is engaged in continued unl icensed activity after agency 103
165165 notification to cease such unlicensed activity, the court may 104
166166 grant the ex parte temporary injunction restraining the 105
167167 unlicensed provider from advertising, offering, or providing 106
168168 services for which licensure is required. The c ourt may also 107
169169 order the unlicensed provider to provide to agency personnel 108
170170 access to facility personnel, records, and clients for future 109
171171 inspection of the unlicensed provider's premises. 110
172172 (f) The agency must inspect the unlicensed provider's 111
173173 premises within 20 days after entry of the ex parte temporary 112
174174 injunction to verify compliance with such injunction. If the 113
175175 unlicensed provider is in compliance, the agency shall dismiss 114
176176 the injunction. If unlicensed activity has continued, the agency 115
177177 may file a petition for permanent injunction within 10 days 116
178178 after identifying noncompliance. The agency may also petition to 117
179179 extend the ex parte temporary injunction until the permanent 118
180180 injunction is decided. 119
181181 (g) The agency may provide any inspection records to local 120
182182 law enforcement or a state attorney's office upon request and 121
183183 without redaction. 122
184184 Section 3. Present subsection (2) of section 458.328, 123
185185 Florida Statutes, is redesignated as subsection (3), a new 124
186186 subsection (2) is added to that section, and paragraphs (a) an d 125
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195195 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
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197197
198198
199199 (e) of subsection (1) of that section are amended, to read: 126
200200 458.328 Office surgeries. — 127
201201 (1) REGISTRATION.— 128
202202 (a)1. An office in which a physician performs a 129
203203 liposuction procedure in which more than 1,000 cubic centimeters 130
204204 of supernatant fat is removed , a Level II office surgery, or a 131
205205 Level III office surgery must register with the department 132
206206 unless the office is licensed as a facility under chapter 390 or 133
207207 chapter 395. 134
208208 2. The department must complete an inspection of any 135
209209 office seeking registration un der this section before the office 136
210210 may be registered. 137
211211 (e)1. The department shall inspect a registered office at 138
212212 least annually, including a review of patient records, to ensure 139
213213 that the office is in compliance with this section and rules 140
214214 adopted hereunder unless the office is accredited by a 141
215215 nationally recognized accrediting agency approved by the board. 142
216216 The inspection may be unannounced, except for the inspection of 143
217217 an office that meets the description of a clinic specified in s. 144
218218 458.3265(1)(a)3.h., and those wholly owned and operated 145
219219 physician offices described in s. 458.3265(1)(a)3.g. which 146
220220 perform procedures referenced in s. 458.3265(1)(a)3.h., which 147
221221 must be announced. 148
222222 2. The department must immediately suspend the 149
223223 registration of a registered office that refuses an inspection 150
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232232 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
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234234
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236236 under subparagraph 1. The office must close during such 151
237237 suspension. The suspension must remain in effect for at least 14 152
238238 consecutive days and may not terminate until the department 153
239239 issues a written declaration that the office ma y reopen 154
240240 following the department′s completion of an inspection of the 155
241241 office. 156
242242 (2) STANDARDS OF PRACTICE. — 157
243243 (a) A physician performing a gluteal fat grafting 158
244244 procedure in an office surgery setting shall adhere to standards 159
245245 of practice pursuant to this s ubsection and rules adopted by the 160
246246 board. 161
247247 (b) Office surgeries may not: 162
248248 1. Be a type of surgery that generally results in blood 163
249249 loss of more than 10 percent of estimated blood volume in a 164
250250 patient with a normal hemoglobin level; 165
251251 2. Require major or pr olonged intracranial, intrathoracic, 166
252252 abdominal, or joint replacement procedures, except for 167
253253 laparoscopic procedures; 168
254254 3. Involve major blood vessels and be performed with 169
255255 direct visualization by open exposure of the major blood vessel, 170
256256 except for percutaneous endovascular intervention; or 171
257257 4. Be emergent or life threatening. 172
258258 (c)1. A physician performing a gluteal fat grafting 173
259259 procedure must conduct an in -person examination of the patient 174
260260 while physically present in the same room as the patient no 175
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269269 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
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273273 later than the day before the procedure. 176
274274 2. Before a physician may delegate any duties during a 177
275275 gluteal fat grafting procedure, the patient must provide 178
276276 written, informed consent for such delegation. Any duty 179
277277 delegated by a physician during a gluteal fat graft ing procedure 180
278278 must be performed under the direct supervision of the physician 181
279279 performing such procedure. Fat extraction and gluteal fat 182
280280 injections must be performed by the physician and may not be 183
281281 delegated. 184
282282 3. Fat may only be injected into the subcutane ous space of 185
283283 the patient and may not cross the fascia overlying the gluteal 186
284284 muscle. Intramuscular or submuscular fat injections are 187
285285 prohibited. 188
286286 4. When the physician performing a gluteal fat grafting 189
287287 procedure injects fat into the subcutaneous space of t he 190
288288 patient, the physician must use ultrasound guidance, or guidance 191
289289 with other technology authorized under board rule which equals 192
290290 or exceeds the quality of ultrasound, during the placement and 193
291291 navigation of the cannula to ensure that the fat is injected 194
292292 into the subcutaneous space of the patient above the fascia 195
293293 overlying the gluteal muscle. Such guidance with the use of 196
294294 ultrasound or other technology is not required for other 197
295295 portions of such procedure. 198
296296 (d) If a procedure in an office surgery setting re sults in 199
297297 hospitalization, the incident must be reported as an adverse 200
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306306 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
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310310 incident pursuant to s. 458.351. 201
311311 (e) An office in which a physician performs gluteal fat 202
312312 grafting procedures must at all times maintain a ratio of one 203
313313 physician to one patient during all phases of the procedure, 204
314314 beginning with the administration of anesthesia to the patient 205
315315 and concluding with the extubation of the patient. After a 206
316316 physician has commenced, and while he or she is engaged in, a 207
317317 gluteal fat grafting procedure, the physici an may not commence 208
318318 or engage in another gluteal fat grafting procedure or any other 209
319319 procedure with another patient at the same time. 210
320320 Section 4. Present subsection (2) of section 459.0138, 211
321321 Florida Statutes, is redesignated as subsection (3), a new 212
322322 subsection (2) is added to that section, and paragraphs (a) and 213
323323 (e) of subsection (1) of that section are amended, to read: 214
324324 459.0138 Office surgeries. — 215
325325 (1) REGISTRATION.— 216
326326 (a)1. An office in which a physician performs a 217
327327 liposuction procedure in which more than 1,000 cubic centimeters 218
328328 of supernatant fat is removed, a Level II office surgery, or a 219
329329 Level III office surgery must register with the department 220
330330 unless the office is licensed as a facility under chapter 390 or 221
331331 chapter 395. 222
332332 2. The department mu st complete an inspection of any 223
333333 office seeking registration under this section before the office 224
334334 may be registered. 225
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343343 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
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345345
346346
347347 (e)1. The department shall inspect a registered office at 226
348348 least annually, including a review of patient records, to ensure 227
349349 that the office is in compliance with this section and rules 228
350350 adopted hereunder unless the office is accredited by a 229
351351 nationally recognized accrediting agency approved by the board. 230
352352 The inspection may be unannounced, except for the inspection of 231
353353 an office that meets the d escription of clinic specified in s. 232
354354 459.0137(1)(a)3.h., and those wholly owned and operated 233
355355 physician offices described in s. 459.0137(1)(a)3.g. which 234
356356 perform procedures referenced in s. 459.0137(1)(a)3.h., which 235
357357 must be announced. 236
358358 2. The department mus t immediately suspend the 237
359359 registration of a registered office that refuses an inspection 238
360360 under subparagraph 1. The office must close during such 239
361361 suspension. The suspension must remain in effect for at least 14 240
362362 consecutive days and may not terminate until t he department 241
363363 issues a written declaration that the office may reopen 242
364364 following the department′s completion of an inspection of the 243
365365 office. 244
366366 (2) STANDARDS OF PRACTICE. — 245
367367 (a) A physician performing a gluteal fat grafting 246
368368 procedure in an office surgery set ting shall adhere to standards 247
369369 of practice pursuant to this subsection and rules adopted by the 248
370370 board. 249
371371 (b) Office surgeries may not: 250
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380380 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
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382382
383383
384384 1. Be a type of surgery that generally results in blood 251
385385 loss of more than 10 percent of estimated blood volume in a 252
386386 patient with a normal hemoglobin level; 253
387387 2. Require major or prolonged intracranial, intrathoracic, 254
388388 abdominal, or joint replacement procedures, except for 255
389389 laparoscopic procedures; 256
390390 3. Involve major blood vessels and be performed with 257
391391 direct visualization by open exposure of the major blood vessel, 258
392392 except for percutaneous endovascular intervention; or 259
393393 4. Be emergent or life threatening. 260
394394 (c)1. A physician performing a gluteal fat grafting 261
395395 procedure must conduct an in -person examination of the patient 262
396396 while physically present in the same room as the patient no 263
397397 later than the day before the procedure. 264
398398 2. Before a physician may delegate any duties during a 265
399399 gluteal fat grafting procedure, the patient must provide 266
400400 written, informed consent for such delegation. Any duty 267
401401 delegated by a physician during a gluteal fat grafting procedure 268
402402 must be performed under the direct supervision of the physician 269
403403 performing such procedure. Fat extraction and gluteal fat 270
404404 injections must be performed by the physician and may not b e 271
405405 delegated. 272
406406 3. Fat may only be injected into the subcutaneous space of 273
407407 the patient and may not cross the fascia overlying the gluteal 274
408408 muscle. Intramuscular or submuscular fat injections are 275
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417417 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
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419419
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421421 prohibited. 276
422422 4. When the physician performing a gluteal fat gr afting 277
423423 procedure injects fat into the subcutaneous space of the 278
424424 patient, the physician must use ultrasound guidance, or guidance 279
425425 with other technology authorized under board rule which equals 280
426426 or exceeds the quality of ultrasound, during the placement and 281
427427 navigation of the cannula to ensure that the fat is injected 282
428428 into the subcutaneous space of the patient above the fascia 283
429429 overlying the gluteal muscle. Such guidance with the use of 284
430430 ultrasound or other technology is not required for other 285
431431 portions of such procedure. 286
432432 (d) If a procedure in an office surgery setting results in 287
433433 hospitalization, the incident must be reported as an adverse 288
434434 incident pursuant to s. 458.351. 289
435435 (e) An office in which a physician performs gluteal fat 290
436436 grafting procedures must at all ti mes maintain a ratio of one 291
437437 physician to one patient during all phases of the procedure, 292
438438 beginning with the administration of anesthesia to the patient 293
439439 and concluding with the extubation of the patient. After a 294
440440 physician has commenced, and while he or she is engaged in, a 295
441441 gluteal fat grafting procedure, the physician may not commence 296
442442 or engage in another gluteal fat grafting procedure or any other 297
443443 procedure with another patient at the same time. 298
444444 Section 5. This act shall take effect July 1, 2023. 299