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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 office surgeries; amending ss. 2
458.320 and 459.0085, F.S.; establishing financial 3
responsibility requirements for physicians performing 4
gluteal fat grafting procedures in office surgery 5
settings; amending ss. 458.328 and 459.0138, F.S.; 6
revising standards of practice for office surgeries 7
and procedures; deleting obsolete language; making 8
technical and clarifying revisions; amending s. 9
458.3145, F.S.; conforming a cross -reference to 10
changes made by the act; providing an effective date. 11
12
Be It Enacted by the Legislature of the State of Florida: 13
14
Section 1. Subsections (3) through (9) of section 458.320, 15
Florida Statutes, are renumbere d as subsections (4) through 16
(10), respectively, paragraph (b) of present subsection (4) and 17
present subsection (5) are amended, and a new subsection (3) is 18
added to that section, to read: 19
458.320 Financial responsibility. — 20
(3) A physician performing a gluteal fat grafting 21
procedure in an office surgery setting registered under s. 22
458.328 must also establish financial responsibility by either 23
of the following methods: 24
(a) Obtaining and maintaining professional liability 25
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coverage in an amount not less than $250,000 per claim, with a 26
minimum annual aggregate of not less than $750,000, from an 27
authorized insurer as defined in s. 624.09, from an eligible 28
surplus lines insurer as defined in s. 626.914(2), from a risk 29
retention group as defined in s. 627.942 , from the Joint 30
Underwriting Association established under s. 627.351(4), 31
through a plan of self -insurance as provided in s. 627.357, or 32
through a plan of self -insurance which meets the conditions 33
specified for satisfying financial responsibility in s. 76 6.110. 34
The required coverage amount set forth in this subsection may 35
not be used for litigation costs or attorney fees for the 36
defense of any medical malpractice claim; or 37
(b) Obtaining and maintaining an unexpired irrevocable 38
letter of credit, establish ed pursuant to chapter 675, in an 39
amount not less than $250,000 per claim, with a minimum 40
aggregate availability of credit of not less than $750,000. The 41
letter of credit must be payable to the physician as beneficiary 42
upon presentment of a final judgment indicating liability and 43
awarding damages to be paid by the physician or upon presentment 44
of a settlement agreement signed by all parties to such 45
agreement when such final judgment or settlement is a result of 46
a claim arising out of the rendering of, or th e failure to 47
render, medical care and services. The letter of credit may not 48
be used for litigation costs or attorney fees for the defense of 49
any medical malpractice claim. The letter of credit must be 50
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nonassignable and nontransferable. The letter of credi t must be 51
issued by any bank or savings association organized and existing 52
under the laws of this state or any bank or savings association 53
organized under the laws of the United States which has its 54
principal place of business in this state or has a branch office 55
that is authorized under the laws of this state or of the United 56
States to receive deposits in this state. 57
58
The exemption under paragraph (6)(f) does not apply to this 59
subsection. This subsection shall be inclusive of the coverage 60
in subsection (1). 61
(5)(4) 62
(b) If financial responsibility requirements are met by 63
maintaining an escrow account or letter of credit as provided in 64
this section, upon the entry of an adverse final judgment 65
arising from a medical malpractice arbitration award, from a 66
claim of medical malpractice either in contract or tort, or from 67
noncompliance with the terms of a settlement agreement arising 68
from a claim of medical malpractice either in contract or tort, 69
the licensee shall pay the entire amount of the judgment 70
together with all accrued interest, or the amount maintained in 71
the escrow account or provided in the letter of credit as 72
required by this section, whichever is less, within 60 days 73
after the date such judgment became final and subject to 74
execution, unless otherwise mutually agreed to in writing by the 75
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parties. If timely payment is not made by the physician, the 76
department shall suspend the license of the physician pursuant 77
to procedures set forth in subparagraphs (6)(g)3., 4., and 5. 78
subparagraphs (5)(g)3., 4., and 5. Nothing in This paragraph 79
does not shall abrogate a judgment debtor's obligation to 80
satisfy the entire amount of any judgment. 81
(6)(5) The requirements of subsections (1), (2), and (3), 82
and (4) do not apply to: 83
(a) Any person licensed under this chap ter who practices 84
medicine exclusively as an officer, employee, or agent of the 85
Federal Government or of the state or its agencies or its 86
subdivisions. For the purposes of this subsection, an agent of 87
the state, its agencies, or its subdivisions is a perso n who is 88
eligible for coverage under any self -insurance or insurance 89
program authorized by the provisions of s. 768.28(16). 90
(b) Any person whose license has become inactive under 91
this chapter and who is not practicing medicine in this state. 92
Any person applying for reactivation of a license must show 93
either that such licensee maintained tail insurance coverage 94
which provided liability coverage for incidents that occurred on 95
or after January 1, 1987, or the initial date of licensure in 96
this state, whicheve r is later, and incidents that occurred 97
before the date on which the license became inactive; or such 98
licensee must submit an affidavit stating that such licensee has 99
no unsatisfied medical malpractice judgments or settlements at 100
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the time of application fo r reactivation. 101
(c) Any person holding a limited license pursuant to s. 102
458.317 and practicing under the scope of such limited license. 103
(d) Any person licensed or certified under this chapter 104
who practices only in conjunction with his or her teaching 105
duties at an accredited medical school or in its main teaching 106
hospitals. Such person may engage in the practice of medicine to 107
the extent that such practice is incidental to and a necessary 108
part of duties in connection with the teaching position in the 109
medical school. 110
(e) Any person holding an active license under this 111
chapter who is not practicing medicine in this state. If such 112
person initiates or resumes any practice of medicine in this 113
state, he or she must notify the department of such activity and 114
fulfill the financial responsibility requirements of this 115
section before resuming the practice of medicine in this state. 116
(f) Any person holding an active license under this 117
chapter who meets all of the following criteria: 118
1. The licensee has held an a ctive license to practice in 119
this state or another state or some combination thereof for more 120
than 15 years. 121
2. The licensee has either retired from the practice of 122
medicine or maintains a part -time practice of no more than 1,000 123
patient contact hours pe r year. 124
3. The licensee has had no more than two claims for 125
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medical malpractice resulting in an indemnity exceeding $25,000 126
within the previous 5 -year period. 127
4. The licensee has not been convicted of, or pled guilty 128
or nolo contendere to, any criminal violation specified in this 129
chapter or the medical practice act of any other state. 130
5. The licensee has not been subject within the last 10 131
years of practice to license revocation or suspension for any 132
period of time; probation for a period of 3 years o r longer; or 133
a fine of $500 or more for a violation of this chapter or the 134
medical practice act of another jurisdiction. The regulatory 135
agency's acceptance of a physician's relinquishment of a 136
license, stipulation, consent order, or other settlement, 137
offered in response to or in anticipation of the filing of 138
administrative charges against the physician's license, 139
constitutes action against the physician's license for the 140
purposes of this paragraph. 141
6. The licensee has submitted a form supplying necessary 142
information as required by the department and an affidavit 143
affirming compliance with this paragraph. 144
7. The licensee must submit biennially to the department 145
certification stating compliance with the provisions of this 146
paragraph. The licensee must, upon request, demonstrate to the 147
department information verifying compliance with this paragraph. 148
149
A licensee who meets the requirements of this paragraph must 150
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post notice in the form of a sign prominently displayed in the 151
reception area and clearly noticeable by all patients or provide 152
a written statement to any person to whom medical services are 153
being provided. The sign or statement must read as follows: 154
"Under Florida law, physicians are generally required to carry 155
medical malpractice insurance or otherwise demonstrate financial 156
responsibility to cover potential claims for medical 157
malpractice. However, certain part -time physicians who meet 158
state requirements are exempt from the financial responsibility 159
law. YOUR DOCTOR MEETS THESE REQUIREMENTS AND HAS DECIDED NOT TO 160
CARRY MEDICAL MALPRACTICE INSURANCE. This notice is provided 161
pursuant to Florida law." 162
(g) Any person holding an active license under this 163
chapter who agrees to meet all of the following criteria: 164
1. Upon the entry of an adverse final judgment arising 165
from a medical malpractice arbitration award, from a claim of 166
medical malpractice either in contract or tort, or from 167
noncompliance with the terms of a settlement agreement arising 168
from a claim of medical malpractice either in contract or tort, 169
the licensee shall pay the judgment creditor the lesser of the 170
entire amount of the judgment with all accrued interest or 171
either $100,000, if the physician is licensed pursuant to this 172
chapter but does not maintain hospital staff privileges, or 173
$250,000, if the physician is licensed pursuant to this chapter 174
and maintains hospital staff privileges, within 60 days after 175
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the date such judgment became final and subject to execution, 176
unless otherwise mutually agreed to in writing by the parties. 177
Such adverse final judgment shall include any cross -claim, 178
counterclaim, or claim for indemnity or contribution arising 179
from the claim of medical malpractice. Upon notification of the 180
existence of an unsatisfied judgment or payment pursuant to this 181
subparagraph, the departme nt shall notify the licensee by 182
certified mail that he or she shall be subject to disciplinary 183
action unless, within 30 days from the date of mailing, he or 184
she either: 185
a. Shows proof that the unsatisfied judgment has been paid 186
in the amount specified in this subparagraph; or 187
b. Furnishes the department with a copy of a timely filed 188
notice of appeal and either: 189
(I) A copy of a supersedeas bond properly posted in the 190
amount required by law; or 191
(II) An order from a court of competent jurisdiction 192
staying execution on the final judgment pending disposition of 193
the appeal. 194
2. The Department of Health shall issue an emergency order 195
suspending the license of any licensee who, after 30 days 196
following receipt of a notice from the Department of Health, has 197
failed to: satisfy a medical malpractice claim against him or 198
her; furnish the Department of Health a copy of a timely filed 199
notice of appeal; furnish the Department of Health a copy of a 200
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supersedeas bond properly posted in the amount required by law; 201
or furnish the Department of Health an order from a court of 202
competent jurisdiction staying execution on the final judgment 203
pending disposition of the appeal. 204
3. Upon the next meeting of the probable cause panel of 205
the board following 30 days after the date o f mailing the notice 206
of disciplinary action to the licensee, the panel shall make a 207
determination of whether probable cause exists to take 208
disciplinary action against the licensee pursuant to 209
subparagraph 1. 210
4. If the board determines that the factual re quirements 211
of subparagraph 1. are met, it shall take disciplinary action as 212
it deems appropriate against the licensee. Such disciplinary 213
action shall include, at a minimum, probation of the license 214
with the restriction that the licensee must make payments to the 215
judgment creditor on a schedule determined by the board to be 216
reasonable and within the financial capability of the physician. 217
Notwithstanding any other disciplinary penalty imposed, the 218
disciplinary penalty may include suspension of the license for a 219
period not to exceed 5 years. In the event that an agreement to 220
satisfy a judgment has been met, the board shall remove any 221
restriction on the license. 222
5. The licensee has completed a form supplying necessary 223
information as required by the department. 224
225
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A licensee who meets the requirements of this paragraph shall be 226
required either to post notice in the form of a sign prominently 227
displayed in the reception area and clearly noticeable by all 228
patients or to provide a written statement to any person to wh om 229
medical services are being provided. Such sign or statement 230
shall state: "Under Florida law, physicians are generally 231
required to carry medical malpractice insurance or otherwise 232
demonstrate financial responsibility to cover potential claims 233
for medical malpractice. YOUR DOCTOR HAS DECIDED NOT TO CARRY 234
MEDICAL MALPRACTICE INSURANCE. This is permitted under Florida 235
law subject to certain conditions. Florida law imposes penalties 236
against noninsured physicians who fail to satisfy adverse 237
judgments arising from claims of medical malpractice. This 238
notice is provided pursuant to Florida law." 239
Section 2. Paragraph (i) of subsection (1) of section 240
458.328, Florida Statutes, is redesignated as paragraph (h), and 241
present paragraphs (a), (b), and (h) of subsecti on (1) and 242
subsection (2) of that section are amended to read: 243
458.328 Office surgeries. — 244
(1) REGISTRATION.— 245
(a)1. An office in which a physician performs a 246
liposuction procedure in which more than 1,000 cubic centimeters 247
of supernatant fat is temporarily or permanently removed, a 248
Level II office surgery, or a Level III office surgery must 249
register with the department . unless the office is licensed as A 250
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facility licensed under chapter 390 or chapter 395 may not be 251
registered under this section . 252
2. The department must complete an inspection of any 253
office seeking registration under this section before the office 254
may be registered. 255
(b) By January 1, 2020, Each office registered under this 256
section or s. 459.0138 must designate a physician who is 257
responsible for the office's compliance with the office health 258
and safety requirements of this section and rules adopted 259
hereunder. A designated physician must have a full, active, and 260
unencumbered license under this chapter or chapter 459 and shall 261
practice at the office for which he or she has assumed 262
responsibility. Within 10 calendar days after the termination of 263
a designated physician relationship, the office must notify the 264
department of the designation of another physician to serve as 265
the designated physi cian. The department may suspend the 266
registration of an office if the office fails to comply with the 267
requirements of this paragraph. 268
(h) A physician may only perform a procedure or surgery 269
identified in paragraph (a) in an office that is registered with 270
the department. The board shall impose a fine of $5,000 per day 271
on a physician who performs a procedure or surgery in an office 272
that is not registered with the department. 273
(2) STANDARDS OF PRACTICE. — 274
(a) A physician may not perform any surgery or proc edure 275
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identified in paragraph (1)(a) in a setting other than an office 276
surgery setting registered under this section or a facility 277
licensed under chapter 390 or chapter 395, as applicable. The 278
board shall impose a fine of $5,000 per incident on a physician 279
who violates this paragraph performing a gluteal fat grafting 280
procedure in an office surgery setting shall adhere to standards 281
of practice pursuant to this subsection and rules adopted by the 282
board. 283
(b) Office surgeries may not: 284
1. Be a type of surger y that generally results in blood 285
loss of more than 10 percent of estimated blood volume in a 286
patient with a normal hemoglobin level; 287
2. Require major or prolonged intracranial, intrathoracic, 288
abdominal, or joint replacement procedures, except for 289
laparoscopic procedures; 290
3. Involve major blood vessels and be performed with 291
direct visualization by open exposure of the major blood vessel, 292
except for percutaneous endovascular intervention; or 293
4. Be emergent or life threatening. 294
(c) A physician performing a gluteal fat grafting 295
procedure in an office surgery setting shall adhere to standards 296
of practice under this subsection and rules adopted by the board 297
which include, but are not limited to, all of the following: 298
1. A physician performing a gluteal fat grafting procedure 299
must conduct an in-person examination of the patient while 300
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physically present in the same room as the patient no later than 301
the day before the procedure. 302
2. Before a physician may delegate any duties during a 303
gluteal fat grafting p rocedure, the patient must provide 304
written, informed consent for such delegation. Any duty 305
delegated by a physician during a gluteal fat grafting procedure 306
must be performed under the direct supervision of the physician 307
performing such procedure. Fat extra ction and gluteal fat 308
injections must be performed by the physician and may not be 309
delegated. 310
3. Fat may only be injected into the subcutaneous space of 311
the patient and may not cross the fascia overlying the gluteal 312
muscle. Intramuscular or submuscular f at injections are 313
prohibited. 314
4. When the physician performing a gluteal fat grafting 315
procedure injects fat into the subcutaneous space of the 316
patient, the physician must use ultrasound guidance, or guidance 317
with other technology authorized under board r ule which equals 318
or exceeds the quality of ultrasound, during the placement and 319
navigation of the cannula to ensure that the fat is injected 320
into the subcutaneous space of the patient above the fascia 321
overlying the gluteal muscle. Such guidance with the us e of 322
ultrasound or other technology is not required for other 323
portions of such procedure. 324
5. An office in which a physician performs gluteal fat 325
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grafting procedures must at all times maintain a ratio of one 326
physician to one patient during all phases of t he procedure, 327
beginning with the administration of anesthesia to the patient 328
and concluding with the extubation of the patient. After a 329
physician has commenced, and while he or she is engaged in, a 330
gluteal fat grafting procedure, the physician may not comm ence 331
or engage in another gluteal fat grafting procedure or any other 332
procedure with another patient at the same time. 333
(d) If a procedure in an office surgery setting results in 334
hospitalization, the incident must be reported as an adverse 335
incident pursuant to s. 458.351. 336
(e) An office in which a physician performs gluteal fat 337
grafting procedures must at all times maintain a ratio of one 338
physician to one patient during all phases of the procedure, 339
beginning with the administration of anesthesia to the pa tient 340
and concluding with the extubation of the patient. After a 341
physician has commenced, and while he or she is engaged in, a 342
gluteal fat grafting procedure, the physician may not commence 343
or engage in another gluteal fat grafting procedure or any other 344
procedure with another patient at the same time. 345
Section 3. Subsections (3) through (10) of section 346
459.0085, Florida Statutes, are renumbered as subsections (4) 347
through (11), respectively, paragraph (b) of present subsection 348
(4) and present subsection (5) are amended, and a new subsection 349
(3) is added to that section, to read: 350
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459.0085 Financial responsibility. — 351
(3) A physician performing a gluteal fat grafting 352
procedure in an office surgery setting registered under s. 353
459.0138 must also establish f inancial responsibility by either 354
of the following methods: 355
(a) Obtaining and maintaining professional liability 356
coverage in an amount not less than $250,000 per claim, with a 357
minimum annual aggregate of not less than $750,000, from an 358
authorized insurer as defined in s. 624.09, from an eligible 359
surplus lines insurer as defined in s. 626.914(2), from a risk 360
retention group as defined in s. 627.942, from the Joint 361
Underwriting Association established under s. 627.351(4), 362
through a plan of self -insurance as provided in s. 627.357, or 363
through a plan of self -insurance which meets the conditions 364
specified for satisfying financial responsibility in s. 766.110. 365
The required coverage amount set forth in this subsection may 366
not be used for litigation costs or attor ney fees for the 367
defense of any medical malpractice claim; or 368
(b) Obtaining and maintaining an unexpired irrevocable 369
letter of credit, established pursuant to chapter 675, in an 370
amount not less than $250,000 per claim, with a minimum 371
aggregate availabili ty of credit of not less than $750,000. The 372
letter of credit must be payable to the physician as beneficiary 373
upon presentment of a final judgment indicating liability and 374
awarding damages to be paid by the physician or upon presentment 375
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of a settlement agre ement signed by all parties to such 376
agreement when such final judgment or settlement is a result of 377
a claim arising out of the rendering of, or the failure to 378
render, medical care and services. The letter of credit may not 379
be used for litigation costs or a ttorney fees for the defense of 380
any medical malpractice claim. The letter of credit must be 381
nonassignable and nontransferable. The letter of credit must be 382
issued by any bank or savings association organized and existing 383
under the laws of this state or any bank or savings association 384
organized under the laws of the United States which has its 385
principal place of business in this state or has a branch office 386
that is authorized under the laws of this state or of the United 387
States to receive deposits in this st ate. 388
389
The exemption under paragraph (6)(f) does not apply to this 390
subsection. This subsection shall be inclusive of the coverage 391
in subsection (1). 392
(5)(4) 393
(b) If financial responsibility requirements are met by 394
maintaining an escrow account or letter of credit as provided in 395
this section, upon the entry of an adverse final judgment 396
arising from a medical malpractice arbitration award, from a 397
claim of medical malpractice either in contract or tort, or from 398
noncompliance with the terms of a settlement agre ement arising 399
from a claim of medical malpractice either in contract or tort, 400
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the licensee shall pay the entire amount of the judgment 401
together with all accrued interest or the amount maintained in 402
the escrow account or provided in the letter of credit as 403
required by this section, whichever is less, within 60 days 404
after the date such judgment became final and subject to 405
execution, unless otherwise mutually agreed to in writing by the 406
parties. If timely payment is not made by the osteopathic 407
physician, the department shall suspend the license of the 408
osteopathic physician pursuant to procedures set forth in 409
subparagraphs (6)(g)3., 4., and 5. subparagraphs (5)(g)3., 4., 410
and 5. Nothing in This paragraph does not shall abrogate a 411
judgment debtor's obligation to s atisfy the entire amount of any 412
judgment. 413
(6)(5) The requirements of subsections (1), (2), and (3), 414
and (4) do not apply to: 415
(a) Any person licensed under this chapter who practices 416
medicine exclusively as an officer, employee, or agent of the 417
Federal Government or of the state or its agencies or its 418
subdivisions. For the purposes of this subsection, an agent of 419
the state, its agencies, or its subdivisions is a person who is 420
eligible for coverage under any self -insurance or insurance 421
program authorized by the provisions of s. 768.28(16). 422
(b) Any person whose license has become inactive under 423
this chapter and who is not practicing medicine in this state. 424
Any person applying for reactivation of a license must show 425
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either that such licensee maintained tail insurance coverage 426
that provided liability coverage for incidents that occurred on 427
or after January 1, 1987, or the initial date of licensure in 428
this state, whichever is later, and incidents that occurred 429
before the date on which the license became in active; or such 430
licensee must submit an affidavit stating that such licensee has 431
no unsatisfied medical malpractice judgments or settlements at 432
the time of application for reactivation. 433
(c) Any person holding a limited license pursuant to s. 434
459.0075 and practicing under the scope of such limited license. 435
(d) Any person licensed or certified under this chapter 436
who practices only in conjunction with his or her teaching 437
duties at a college of osteopathic medicine. Such person may 438
engage in the practice of osteopathic medicine to the extent 439
that such practice is incidental to and a necessary part of 440
duties in connection with the teaching position in the college 441
of osteopathic medicine. 442
(e) Any person holding an active license under this 443
chapter who is not practicing osteopathic medicine in this 444
state. If such person initiates or resumes any practice of 445
osteopathic medicine in this state, he or she must notify the 446
department of such activity and fulfill the financial 447
responsibility requirements of this sect ion before resuming the 448
practice of osteopathic medicine in this state. 449
(f) Any person holding an active license under this 450
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chapter who meets all of the following criteria: 451
1. The licensee has held an active license to practice in 452
this state or another state or some combination thereof for more 453
than 15 years. 454
2. The licensee has either retired from the practice of 455
osteopathic medicine or maintains a part -time practice of 456
osteopathic medicine of no more than 1,000 patient contact hours 457
per year. 458
3. The licensee has had no more than two claims for 459
medical malpractice resulting in an indemnity exceeding $25,000 460
within the previous 5 -year period. 461
4. The licensee has not been convicted of, or pled guilty 462
or nolo contendere to, any criminal violation spe cified in this 463
chapter or the practice act of any other state. 464
5. The licensee has not been subject within the last 10 465
years of practice to license revocation or suspension for any 466
period of time, probation for a period of 3 years or longer, or 467
a fine of $500 or more for a violation of this chapter or the 468
medical practice act of another jurisdiction. The regulatory 469
agency's acceptance of an osteopathic physician's relinquishment 470
of a license, stipulation, consent order, or other settlement, 471
offered in response to or in anticipation of the filing of 472
administrative charges against the osteopathic physician's 473
license, constitutes action against the physician's license for 474
the purposes of this paragraph. 475
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6. The licensee has submitted a form supplying necessa ry 476
information as required by the department and an affidavit 477
affirming compliance with this paragraph. 478
7. The licensee must submit biennially to the department a 479
certification stating compliance with this paragraph. The 480
licensee must, upon request, demo nstrate to the department 481
information verifying compliance with this paragraph. 482
483
A licensee who meets the requirements of this paragraph must 484
post notice in the form of a sign prominently displayed in the 485
reception area and clearly noticeable by all patien ts or provide 486
a written statement to any person to whom medical services are 487
being provided. The sign or statement must read as follows: 488
"Under Florida law, osteopathic physicians are generally 489
required to carry medical malpractice insurance or otherwise 490
demonstrate financial responsibility to cover potential claims 491
for medical malpractice. However, certain part -time osteopathic 492
physicians who meet state requirements are exempt from the 493
financial responsibility law. YOUR OSTEOPATHIC PHYSICIAN MEETS 494
THESE REQUIREMENTS AND HAS DECIDED NOT TO CARRY MEDICAL 495
MALPRACTICE INSURANCE. This notice is provided pursuant to 496
Florida law." 497
(g) Any person holding an active license under this 498
chapter who agrees to meet all of the following criteria. 499
1. Upon the entry of an adverse final judgment arising 500
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from a medical malpractice arbitration award, from a claim of 501
medical malpractice either in contract or tort, or from 502
noncompliance with the terms of a settlement agreement arising 503
from a claim of medical malpractice eithe r in contract or tort, 504
the licensee shall pay the judgment creditor the lesser of the 505
entire amount of the judgment with all accrued interest or 506
either $100,000, if the osteopathic physician is licensed 507
pursuant to this chapter but does not maintain hospit al staff 508
privileges, or $250,000, if the osteopathic physician is 509
licensed pursuant to this chapter and maintains hospital staff 510
privileges, within 60 days after the date such judgment became 511
final and subject to execution, unless otherwise mutually agreed 512
to in writing by the parties. Such adverse final judgment shall 513
include any cross-claim, counterclaim, or claim for indemnity or 514
contribution arising from the claim of medical malpractice. Upon 515
notification of the existence of an unsatisfied judgment or 516
payment pursuant to this subparagraph, the department shall 517
notify the licensee by certified mail that he or she shall be 518
subject to disciplinary action unless, within 30 days from the 519
date of mailing, the licensee either: 520
a. Shows proof that the unsatisf ied judgment has been paid 521
in the amount specified in this subparagraph; or 522
b. Furnishes the department with a copy of a timely filed 523
notice of appeal and either: 524
(I) A copy of a supersedeas bond properly posted in the 525
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amount required by law; or 526
(II) An order from a court of competent jurisdiction 527
staying execution on the final judgment, pending disposition of 528
the appeal. 529
2. The Department of Health shall issue an emergency order 530
suspending the license of any licensee who, after 30 days 531
following receipt of a notice from the Department of Health, has 532
failed to: satisfy a medical malpractice claim against him or 533
her; furnish the Department of Health a copy of a timely filed 534
notice of appeal; furnish the Department of Health a copy of a 535
supersedeas bond properly posted in the amount required by law; 536
or furnish the Department of Health an order from a court of 537
competent jurisdiction staying execution on the final judgment 538
pending disposition of the appeal. 539
3. Upon the next meeting of the probable cause panel of 540
the board following 30 days after the date of mailing the notice 541
of disciplinary action to the licensee, the panel shall make a 542
determination of whether probable cause exists to take 543
disciplinary action against the licensee pursuant to 544
subparagraph 1. 545
4. If the board determines that the factual requirements 546
of subparagraph 1. are met, it shall take disciplinary action as 547
it deems appropriate against the licensee. Such disciplinary 548
action shall include, at a minimum, probation of the license 549
with the restriction that the licensee must make payments to the 550
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judgment creditor on a schedule determined by the board to be 551
reasonable and within the financial capability of the 552
osteopathic physician. Notwithstanding any other disciplinary 553
penalty imposed, the disciplinary penalty may include suspension 554
of the license for a period not to exceed 5 years. In the event 555
that an agreement to satisfy a judgment has been met, the board 556
shall remove any restriction on the license. 557
5. The licensee has completed a f orm supplying necessary 558
information as required by the department. 559
560
A licensee who meets the requirements of this paragraph shall be 561
required either to post notice in the form of a sign prominently 562
displayed in the reception area and clearly noticeable by all 563
patients or to provide a written statement to any person to whom 564
medical services are being provided. Such sign or statement 565
shall state: "Under Florida law, osteopathic physicians are 566
generally required to carry medical malpractice insurance or 567
otherwise demonstrate financial responsibility to cover 568
potential claims for medical malpractice. YOUR OSTEOPATHIC 569
PHYSICIAN HAS DECIDED NOT TO CARRY MEDICAL MALPRACTICE 570
INSURANCE. This is permitted under Florida law subject to 571
certain conditions. Florida law im poses strict penalties against 572
noninsured osteopathic physicians who fail to satisfy adverse 573
judgments arising from claims of medical malpractice. This 574
notice is provided pursuant to Florida law." 575
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Section 4. Paragraph (i) of subsection (1) of section 576
459.0138, Florida Statutes, is redesignated as paragraph (h), 577
and present paragraphs (a), (b), and (h) of subsection (1) and 578
subsection (2) of that section are amended to read: 579
459.0138 Office surgeries. — 580
(1) REGISTRATION.— 581
(a)1. An office in which a physician performs a 582
liposuction procedure in which more than 1,000 cubic centimeters 583
of supernatant fat is temporarily or permanently removed, a 584
Level II office surgery, or a Level III office surgery must 585
register with the depa rtment. unless the office is licensed as A 586
facility licensed under chapter 390 or chapter 395 may not be 587
registered under this section . 588
2. The department must complete an inspection of any 589
office seeking registration under this section before the office 590
may be registered. 591
(b) By January 1, 2020, Each office registered under this 592
section or s. 458.328 must designate a physician who is 593
responsible for the office's compliance with the office health 594
and safety requirements of this section and rules adopted 595
hereunder. A designated physician must have a full, active, and 596
unencumbered license under this chapter or chapter 458 and shall 597
practice at the office for which he or she has assumed 598
responsibility. Within 10 calendar days after the termination of 599
a designated physician relationship, the office must notify the 600
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department of the designation of another physician to serve as 601
the designated physician. The department may suspend a 602
registration for an office if the office fails to comply with 603
the requirements of this paragraph. 604
(h) A physician may only perform a procedure or surgery 605
identified in paragraph (a) in an office that is registered with 606
the department. The board shall impose a fine of $5,000 per day 607
on a physician who performs a procedure or surgery i n an office 608
that is not registered with the department. 609
(2) STANDARDS OF PRACTICE. — 610
(a) A physician may not perform any surgery or procedure 611
identified in paragraph (1)(a) in a setting other than an office 612
surgery setting registered under this section or a facility 613
licensed under chapter 390 or chapter 395, as applicable. The 614
board shall impose a fine of $5,000 per incident on a physician 615
who violates this paragraph performing a gluteal fat grafting 616
procedure in an office surgery setting shall adhere to standards 617
of practice pursuant to this subsection and rules adopted by the 618
board. 619
(b) Office surgeries may not: 620
1. Be a type of surgery that generally results in blood 621
loss of more than 10 percent of estimated blood volume in a 622
patient with a normal h emoglobin level; 623
2. Require major or prolonged intracranial, intrathoracic, 624
abdominal, or joint replacement procedures, except for 625
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laparoscopic procedures; 626
3. Involve major blood vessels and be performed with 627
direct visualization by open exposure of th e major blood vessel, 628
except for percutaneous endovascular intervention; or 629
4. Be emergent or life threatening. 630
(c) A physician performing a gluteal fat grafting 631
procedure in an office surgery setting shall adhere to standards 632
of practice under this su bsection and rules adopted by the board 633
which include, but are not limited to, all of the following: 634
1. A physician performing a gluteal fat grafting procedure 635
must conduct an in-person examination of the patient while 636
physically present in the same room as the patient no later than 637
the day before the procedure. 638
2. Before a physician may delegate any duties during a 639
gluteal fat grafting procedure, the patient must provide 640
written, informed consent for such delegation. Any duty 641
delegated by a physician d uring a gluteal fat grafting procedure 642
must be performed under the direct supervision of the physician 643
performing such procedure. Fat extraction and gluteal fat 644
injections must be performed by the physician and may not be 645
delegated. 646
3. Fat may only be in jected into the subcutaneous space of 647
the patient and may not cross the fascia overlying the gluteal 648
muscle. Intramuscular or submuscular fat injections are 649
prohibited. 650
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4. When the physician performing a gluteal fat grafting 651
procedure injects fat into th e subcutaneous space of the 652
patient, the physician must use ultrasound guidance, or guidance 653
with other technology authorized under board rule which equals 654
or exceeds the quality of ultrasound, during the placement and 655
navigation of the cannula to ensure t hat the fat is injected 656
into the subcutaneous space of the patient above the fascia 657
overlying the gluteal muscle. Such guidance with the use of 658
ultrasound or other technology is not required for other 659
portions of such procedure. 660
5. An office in which a p hysician performs gluteal fat 661
grafting procedures must at all times maintain a ratio of one 662
physician to one patient during all phases of the procedure, 663
beginning with the administration of anesthesia to the patient 664
and concluding with the extubation of th e patient. After a 665
physician has commenced, and while he or she is engaged in, a 666
gluteal fat grafting procedure, the physician may not commence 667
or engage in another gluteal fat grafting procedure or any other 668
procedure with another patient at the same time . 669
(d) If a procedure in an office surgery setting results in 670
hospitalization, the incident must be reported as an adverse 671
incident pursuant to s. 458.351. 672
(e) An office in which a physician performs gluteal fat 673
grafting procedures must at all times mai ntain a ratio of one 674
physician to one patient during all phases of the procedure, 675
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beginning with the administration of anesthesia to the patient 676
and concluding with the extubation of the patient. After a 677
physician has commenced, and while he or she is enga ged in, a 678
gluteal fat grafting procedure, the physician may not commence 679
or engage in another gluteal fat grafting procedure or any other 680
procedure with another patient at the same time. 681
Section 5. Subsection (6) of section 458.3145, Florida 682
Statutes, is amended to read: 683
458.3145 Medical faculty certificate. — 684
(6) Notwithstanding subsection (1), any physician, when 685
providing medical care or treatment in connection with the 686
education of students, residents, or faculty at the request of 687
the dean of an accredited medical school within this state or at 688
the request of the medical director of a statutory teaching 689
hospital as defined in s. 408.07 or a specialty -licensed 690
children's hospital licensed under chapter 395 that is 691
affiliated with an accredited medi cal school and its affiliated 692
clinics, may do so upon registration with the board and 693
demonstration of financial responsibility pursuant to s. 694
458.320(1) or (2) unless such physician is exempt under s. 695
458.320(6)(a) s. 458.320(5)(a). The performance of suc h medical 696
care or treatment must be limited to a single period of time, 697
which may not exceed 180 consecutive days, and must be rendered 698
within a facility registered under subsection (2) or within a 699
statutory teaching hospital as defined in s. 408.07. A 700
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registration fee not to exceed $300, as set by the board, is 701
required of each physician registered under this subsection. 702
However, no more than three physicians per year per institution 703
may be registered under this subsection, and an exemption under 704
this subsection may not be granted to a physician more than once 705
in any given 5-year period. 706
Section 6. This act shall take effect upon becoming a law. 707