The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Rules
BILL: CS/SB 172
INTRODUCER: Health Policy Committee; Senators Burton and Passidomo
SUBJECT: Health Care Practitioner Specialty Titles and Designations
DATE: March 31, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Smith Brown HP Fav/CS
2. Smith Yeatman RC Pre-meeting
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 172 amends existing legislative intent under s. 456.003, F.S., relating to the regulation of
health care professions and finds that the health, safety, and welfare of the public may be harmed
or endangered by unlicensed practice or misleading representations by health care practitioners.
The bill amends ss. 458.3312 and 459.0152, F.S., to specify that only physicians who are board-
certified may use a defined list of medical specialist titles and designations—such as
“cardiologist,” “dermatologist,” or “orthopedic surgeon”— and authorizes the Board of Medicine
(BOM) and the Board of Osteopathic Medicine (BOOM), respectively, to add other titles by rule.
The bill creates s. 456.65, F.S., to prohibit health care practitioners who are not allopathic or
osteopathic physicians from using medical specialist titles within the lists of titles created by the
bill for physician specialties in ss. 458.3312 and 459.0152, F.S., unless specifically authorized by
law or in accordance with other specific exceptions. This section prohibits the use of misleading
terms, titles, or designations that may misrepresent a practitioner’s qualifications or imply
physician-level training where none exists. Practitioners specifically addressed with exceptions
in this section include chiropractic physicians, podiatric physicians, dentists, and anesthesiologist
assistants (AAs).
To enforce these requirements, the bill amends s. 456.065, F.S., to authorize the
Department of Health (DOH) to issue a notice to cease and desist and pursue other existing
remedies if the department has probable cause to believe a health care practitioner has engaged
in the unlicensed practice of medicine or osteopathic medicine in violation of s. 456.65, F.S.
REVISED: BILL: CS/SB 172 Page 2
The bill provides an effective date of July 1, 2025.
II. Present Situation:
The Health, Safety, and Welfare of the Public
Chapter 456, F.S., is entitled “Health Professions and Occupations: General Provisions.”
Section 456.003, F.S., in part, provides Legislative intent about the state’s regulation of health
care professions, as follows:
• It is the intent of the Legislature that persons desiring to engage in any lawful profession
regulated by the DOH are entitled to do so as a matter of right if otherwise qualified.
• Such professions will be regulated only for the preservation of the health, safety, and welfare
of the public under the police powers of the state. Such professions will be regulated when:
o Their unregulated practice can harm or endanger the health, safety, and welfare of the
public, and when the potential for such harm is recognizable and clearly outweighs any
anticompetitive impact which may result from regulation.
o The public is not effectively protected by other means, including, but not limited to, other
state statutes, local ordinances, or federal legislation.
o Less restrictive means of regulation are not available.
Licensure and Regulation of Health Care Practitioners
The Division of Medical Quality Assurance (MQA), within the DOH, has general regulatory
authority over health care practitioners.
1
The MQA works in conjunction with 22 regulatory
boards and four councils to license and regulate over 1.5 million health care practitioners.
2
Professions are generally regulated by individual practice acts and by ch. 456, F.S., which
provides regulatory and licensure authority for the MQA. The MQA is statutorily responsible for
the following boards and professions established within the division:
3
• The Board of Acupuncture, created under ch. 457, F.S.;
• The Board of Medicine, created under ch. 458, F.S.;
• The Board of Osteopathic Medicine, created under ch. 459, F.S.;
• The Board of Chiropractic Medicine, created under ch. 460, F.S.;
• The Board of Podiatric Medicine, created under ch. 461, F.S.;
• Naturopathy, as provided under ch. 462, F.S.;
• The Board of Optometry, created under ch. 463, F.S.;
• The Board of Nursing, created under part I of ch. 464, F.S.;
• Nursing assistants, as provided under part II of ch. 464, F.S.;
1
Pursuant to s. 456.001(4), F.S., health care practitioners are defined to include acupuncturists, physicians, physician
assistants, chiropractors, podiatrists, naturopaths, dentists, dental hygienists, optometrists, nurses, nursing assistants,
pharmacists, midwives, speech language pathologists, nursing home administrators, occupational therapists, respiratory
therapists, dieticians, athletic trainers, orthotists, prosthetists, electrologists, massage therapists, clinical laboratory personnel,
medical physicists, genic counselors, dispensers of optical devices or hearing aids, physical therapists, psychologists, social
workers, counselors, and psychotherapists, among others.
2
Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year
2023-2024, p. 7-8, https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/2024.10.28.FY23-24AR-
FINAL.pdf (last visited Mar. 24, 2025).
3
Section 456.001(4), F.S. BILL: CS/SB 172 Page 3
• The Board of Pharmacy, created under ch. 465, F.S.;
• The Board of Dentistry, created under ch. 466, F.S.;
• Midwifery, as provided under ch. 467, F.S.;
• The Board of Speech-Language Pathology and Audiology, created under part I of
ch. 468, F.S.;
• The Board of Nursing Home Administrators, created under part II of ch. 468, F.S.;
• The Board of Occupational Therapy, created under part III of ch. 468, F.S.;
• Respiratory therapy, as provided under part V of ch. 468, F.S.;
• Dietetics and nutrition practice, as provided under part X of ch. 468, F.S.;
• The Board of Athletic Training, created under part XIII of ch. 468, F.S.;
• The Board of Orthotists and Prosthetists, created under part XIV of ch. 468, F.S.;
• Electrolysis, as provided under ch. 478, F.S.;
• The Board of Massage Therapy, created under ch. 480, F.S.;
• The Board of Clinical Laboratory Personnel, created under part I of ch. 483, F.S.;
• Medical physicists, as provided under part II of ch. 483, F.S.;
• Genetic Counselors as provided under part III of ch. 483, F.S.;
• The Board of Opticianry, created under part I of ch. 484, F.S.;
• The Board of Hearing Aid Specialists, created under part II of ch. 484, F.S.;
• The Board of Physical Therapy Practice, created under ch. 486, F.S.;
• The Board of Psychology, created under ch. 490, F.S.;
• School psychologists, as provided under ch. 490, F.S.;
• The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling, created under ch. 491, F.S.; and
• Emergency medical technicians and paramedics, as provided under part III of ch. 401, F.S.
The DOH and the practitioner boards have different roles in the regulatory system. Boards
establish practice standards by rule, pursuant to statutory authority and directives. The DOH
receives and investigates complaints about practitioners and prosecutes cases for disciplinary
action against practitioners.
The DOH, on behalf of the professional boards, investigates complaints against practitioners.
4
Once an investigation is complete, the DOH presents the investigatory findings to the boards.
The DOH recommends a course of action to the appropriate board’s probable cause panel, which
may include:
5
• Issuing an Emergency Order;
• Having the file reviewed by an expert;
• Issuing a closing order; or
• Filing an administrative complaint.
4
Department of Health, Investigative Services, http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-
complaint-process/isu.html (last visited Mar. 24, 2025).
5
Department of Health, Prosecution Services, http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-
complaint-process/psu.html (last visited Mar. 24, 2025). BILL: CS/SB 172 Page 4
The boards determine the course of action and any disciplinary action to take against a
practitioner under the respective practice act.
6
For professions for which there is no board, the
DOH determines the action and discipline to take against a practitioner and issues the final
orders.
7
The DOH is responsible for ensuring that licensees comply with the terms and penalties
imposed by the boards.
8
If a case is appealed, DOH attorneys defend the final actions of the
boards before the appropriate appellate court.
9
The DOH and board rules apply to all statutory grounds for discipline against a practitioner.
Under current law, the DOH takes on the disciplinary functions of a board relating to violations
of a practice act only for practitioner types that do not have a board. The DOH itself takes no
final disciplinary action against practitioners for which there is a board.
The Unlicensed Activity Unit
The Unlicensed Activity (ULA) Unit protects Florida residents and visitors from the potentially
serious and dangerous consequences of receiving medical and health care services from an
unlicensed person. The ULA unit investigates and refers for prosecution all unlicensed health
care activity complaints and allegations.
The ULA unit works in conjunction with law enforcement and the state attorney’s offices to
prosecute individuals practicing without a license. In many instances, unlicensed activity is a
felony level criminal offense. More importantly, receiving health care from unlicensed persons is
dangerous and could result in further injury, disease or even death.
10
The Unlicensed Activity Investigation Process
The DOH assigns all ULA complaints a computer-generated complaint number for tracking
purposes. If the allegations are determined to be legally sufficient, the matter will be forwarded
to a ULA investigator whose office is geographically closest to the location where the alleged
unlicensed activity is occurring. In cases where the person making the allegation has provided
their identifying information, a ULA investigator will contact him or her to verify the allegations.
The investigator may also ask for more detailed information concerning certain aspects of the
complaint. He or she may also ask to meet with the complainant in person for a formal interview.
All ULA investigators are empowered to take sworn statements.
After discussing the allegations with the complainant, the ULA investigator will pursue all
appropriate investigative steps (gather documents, conduct surveillance, question witnesses, etc.)
in order to make a determination concerning the likelihood that the offense(s) took place in the
manner described by the complainant. In the event that a licensed health care provider is alleged
to be somehow involved with the unlicensed activity, the ULA investigator will also coordinate
6
Section 456.072(2), F.S.
7
Professions which do not have a board include naturopathy, nursing assistants, midwifery, respiratory therapy, dietetics and
nutrition, electrolysis, medical physicists, genetic counselors, and school psychologists.
8
Supra, note 5.
9
Id.
10
The Department of Health, Licensing and Regulation, enforcement, Unlicensed Activity, Reporting Unlicensed Activity,
available at https://www.floridahealth.gov/licensing-and-regulation/enforcement/report-unlicensed-activity/index.html (last
visited Mar. 24, 2025). BILL: CS/SB 172 Page 5
his or her investigation with the Investigative Services Unit (ISU) regulatory investigator
assigned to investigate the licensee.
If the complainant’s allegations can be substantiated, the ULA investigation will conclude with
one or more of the following outcomes:
• The subject(s) will be issued a Cease and Desist Agreement.
• The subject(s) will be issued a Uniform Unlicensed Activity Citation (fine).
• The subject(s) will be arrested by law enforcement.
If the investigation determines that the alleged acts either did not take place or if they did occur
but all actions were lawful and proper, the investigation will be closed as unfounded. In the event
that the allegation(s) cannot be clearly proved or disproved, the matter will be closed as
unsubstantiated. In any case, a detailed investigative report will be prepared by the ULA
investigator supporting the conclusions reached by the investigation.
Under s. 456.065, F.S., investigations involving the unlicensed practice of a health care
profession are criminal investigations that require the development of sufficient evidence
(probable cause) to present to law enforcement or file charges with the State Attorney’s Office in
the county of occurrence. While ULA investigators are non-sworn, many have law enforcement
experience gained from prior careers as police officers and detectives. ULA investigators work
cooperatively with many law enforcement agencies in joint investigations that are either initiated
by the DOH or the agency concerned.
11
Health Care Specialties and Florida Licensure
The DOH does not license health care practitioners by specialty or subspecialty. A health care
practitioner’s specialty area of practice is acquired through the practitioner’s additional
education, training, or experience in a particular area of health care practice. Practitioners who
have acquired additional education, training, or experience in a particular area may also elect to
become board-certified in that specialty by private, national specialty boards, such as the
American Board of Medical Specialties (ABMS), the Accreditation Board for Specialty Nursing
Certification, and the American Board of Dental Specialties.
12
Board certification is not required
to practice a medical or osteopathic specialty.
Title Prohibitions Under Current Florida Law
Current law limits which health care practitioners may hold themselves out as board-certified
specialists. Under s. 458.3312, F.S., an allopathic physician may not hold himself or herself out
as a board-certified specialist unless he or she has received formal recognition as a specialist
11
The Department of Health, Licensing and Regulation, enforcement, Unlicensed Activity, Investigate Complaints, available
at https://www.floridahealth.gov/licensing-and-regulation/enforcement/report-unlicensed-activity/investigate-complaints.html
(last visited Mar. 24, 2025).
12
Examples of specialties include dermatology, emergency medicine, ophthalmology, pediatric medicine, certified registered
nurse anesthetist, clinical nurse specialist, cardiac nurse, nurse practitioner, endodontics, orthodontics, and pediatric dentistry. BILL: CS/SB 172 Page 6
from a specialty board of the ABMS or other recognizing agency
13
approved by the BOM.
14
Similarly, under s. 459.0152, F.S., an osteopathic physician may not hold himself or herself out
as a board-certified specialist unless he or she has successfully completed the requirements for
certification by the American Osteopathic Association (AOA) or the Accreditation Council on
Graduate Medical Education (ACGME) and is certified as a specialist by a certifying agency
15
approved by the BOOM.
16
In addition, an allopathic physician may not hold himself or herself
out as a board-certified specialist in dermatology unless the recognizing agency, whether
authorized in statute or by rule, is triennially reviewed and reauthorized by the BOM.
17
However,
a physician licensed under ch. 458 or 459, F.S., may indicate the services offered and may state
that his or her practice is limited to one or more types of services when this accurately reflects
the scope of practice of the physician.
18
A podiatric physician also may not advertise that he or she is board certified unless the
organization is approved by the Board of Podiatric Medicine (BPM) for the purposes of
advertising only and the name of the organization is identified in full in the advertisement. In
order for an organization to obtain the BPM approval it must be the American Podiatric Medical
Association, the National Council of Competency Assurance, or an organization that must:
• Be composed of podiatric physicians interested in a special area of practice demonstrated
through successful completion of examinations or case reports;
• Subscribe to a code of ethics;
• Have rules and procedures for maintaining a high level of professional conduct and discipline
among its membership;
• Have an active membership of at least seventy-five (75);
• Sponsor annual meeting and courses in Board approved continuing education; and
• Be a national organization in scope and give a certification examination at least once a year
before the podiatric physician can advertise possession of the certification.
19
A dentist may not hold himself or herself out as a specialist, or advertise membership in or
specialty recognition by an accrediting organization, unless the dentist has completed a specialty
education program approved by the American Dental Association and the Commission on Dental
Accreditation and the dentist is:
20
13
The Board of Medicine has approved the specialty boards of the ABMS as recognizing agencies. Fla. Admin. Code. R.
64B8-11.001(1)(f),(2025). The board has also approved the following recognizing agencies: American Board of Facial
Plastic & Reconstructive Surgery, Inc., American Board of Pain Medicine, American Association of Physician Specialists,
Inc./American Board of Physician Specialties, American Board of Interventional Pain Physicians, American Board of
Vascular Medicine, United Council for Neurologic Subspecialties, and American Board of Electrodiagnositic Medicine.
Fla.-Admin. Code. R. 64B8-11.001(8),(2025).
14
Section 458.3312, F.S.
15
The Board of Osteopathic Medicine has approved the specialty boards of the ABMS and AOA as recognizing agencies.
Fla. Admin. Code R. 64B15-14.001(2)(h),(2025). The osteopathic board has also approved the following recognizing
agencies: American Association of Physician Specialists, Inc., and American Board of Interventional Pain Physicians.
Fla.-Admin. Code R. 64B15-14.001(5),(2025).
16
Section 459.0152, F.S.
17
Id.
18
Sections 458.3312 and 459.0152, F.S.
19
Fla. Admin. Code R. 64B18-14.004 (2025).
20
Section 466.0282, F.S. A dentist may also hold himself or herself out as a specialist if the dentist has continuously held
himself or herself out as a specialist since December 31, 1964, in a specialty recognized by the American Dental Association. BILL: CS/SB 172 Page 7
• Eligible for examination by a national specialty board recognized by the American Dental
Association; or
• Is a diplomate of a national specialty board recognized by the American Dental Association.
If a dentist announces or advertises a specialty practice for which there is not an approved
accrediting organization, the dentist must clearly state that the specialty is not recognized or that
the accrediting organization has not been approved by the American Dental Association or the
Florida Board of Dentistry.
21
The Board of Chiropractic Medicine (BCM) permits a chiropractor to advertise that he or she has
attained diplomate status in a chiropractic specialty area recognized by the BCM. BCM
specialties include those which are recognized by the Councils of the American Chiropractic
Association, the International Chiropractic Association, the International Academy of Clinical
Neurology, or the International Chiropractic Pediatric Association.
22
Practitioner Discipline
Section 456.072, F.S., authorizes a regulatory board, or the DOH if there is no board, to
discipline a health care practitioner’s licensure for a number of offenses, including, but not
limited to:
• Making misleading, deceptive, or fraudulent representations in or related to the practice of
the licensee’s profession; or
• Failing to identify through writing or orally to a patient the type of license under which the
practitioner is practicing.
If a board or the DOH finds that a licensee committed a violation of a statute or rule, the board or
the DOH may:
23
• Refuse to certify, or to certify with restrictions, an application for a license;
• Suspend or permanently revoke a license;
• Place a restriction on the licensee’s practice or license;
• Impose an administrative fine not to exceed $10,000 for each count or separate offense; if the
violation is for fraud or making a false representation, a fine of $10,000 must be imposed for
each count or separate offense;
• Issue a reprimand or letter of concern;
• Place the licensee on probation;
• Require a corrective action plan;
• Refund fees billed and collected from the patient or third party on behalf of the patient; or
• Require the licensee to undergo remedial education.
21
Section 466.0282(3), F.S.
22
Fla. Admin. Code R. 64B2-15.001(2)(e), (2025). Examples of chiropractic specialties include chiropractic acupuncture,
chiropractic internist, chiropractic and clinical nutrition, radiology chiropractic, and pediatric chiropractors.
23
Section 456.072(2), F.S. BILL: CS/SB 172 Page 8
“Nurse Anesthesiologist”
On August 8, 2019, at the general Board of Nursing (BON) meeting, the BON considered
requests for declaratory statements.
24
The second request for a declaratory statement was made
by John P. McDonough, APRN,
25
CRNA,
26
license number 3344982.
27
For the meeting, McDonough’s Petition for Declaratory Statement acknowledged that the type of
Florida nursing license he held was as an advanced practice registered nurse (APRN), and that he
was a certified registered nurse anesthetist (CRNA), but requested that he be permitted to use the
phrase “nurse anesthesiologist” as a descriptor for him or his practice, and that the BON not
subject him to discipline under ss. 456.072 and 464.018, F.S.,
28
based on the following grounds:
• A New Hampshire Board of Nursing’s Position Statement that the nomenclature, Nurse
Anesthesiologist and Certified Registered Nurse Anesthesiologist, are not title changes or an
expansion of scope of practice, but are optional, accurate descriptors;
29
and
• Florida law grants no title protection to the words anesthesiologist or anesthetist.
30
The Florida Association of Nurse Anesthetists (FANA) and the Florida Medical Association, Inc.
(FMA), Florida Society of Anesthesiologists, Inc. (FSA), and Florida Osteopathic Medical
Association, Inc. (FOMA), filed timely and legally sufficient
31
motions to intervene
32
pursuant to
24
Section 120.565, F.S. Provides that, “[a]ny substantially affected person may seek a declaratory statement regarding an
agency’s opinion as to the applicability of a statutory provision as it applies to the petitioner’s particular set of circumstances.
The agency must give notice of the filing of a petition in the Florida Administrative Register, provide copies of the petition to
the board, and issue a declaratory statement or deny the petition within 90 days after the filing. The declaratory statement or
denial of the petition is then noticed in the next Florida Administrative Register, and disposition of a petition is a final agency
action.”
25
An APRN is an advanced practice registered nurse licensed under ch. 464, F.S.
26
A CRNA is a certified registered nurse anesthetist, or an APRN who specializes is anesthesia.
27
The Florida Board of Nursing, Meeting Minutes, Disciplinary Hearings & General Business, Declaratory Statements,
No. 2, Aug. 8, 2019, available at https://floridasnursing.gov/meetings/minutes/2019/08-august/08072019-minutes.pdf p. 28
(last visited Mar. 24, 2025).
28
Petition for Declaratory Statement Before the Board of Nursing, In re: John P. McDonough, A.P.R.N., C.R.N.A., Ed.D.,
filed at the Department of Health, July 10, 2019 (on file with the Senate Committee on Health Policy).
29
New Hampshire Board of Nursing, Position Statement Regarding the use of Nurse Anesthesiologist as a communication
tool and optional descriptor for Certified Registered Nurse Anesthetists (CRNAs), Nov. 20, 2018, available at
https://static1.squarespace.com/static/5bf069ef3e2d09d0f4e0a54f/t/5f6f8a708d2cb23bb10f50a0/1601145457231/NH+BON+
NURSE+ANESTHESIOLOGIST.pdf (last visited Mar. 24, 2025).
30
Id.
31
Fla. Adm. Code R. 28-105.0027(2) and 28.106.205(2) (2019), both of which state that to be legally sufficient, a motion to
intervene in a proceeding on a petition for a declaratory statement must contain the following information: (a) The name,
address, the e-mail address, and facsimile number, if any, of the intervenor; if the intervenor is not represented by an attorney
or qualified representative;(b) The name, address, e-mail address, telephone number, and any facsimile number of the
intervener’s attorney or qualified representative, if any; (c) Allegations sufficient to demonstrate that the intervenor is entitled
to participate in the proceeding as a matter of constitutional or statutory right or pursuant to agency rule, or that the
substantial interests of the intervenor are subject to determination or will be affected by the declaratory statement; (d) The
signature of the intervener or intervener’s attorney or qualified representative; and (e) The date.
32
The Florida Medical Association, Inc., Florida Society of Anesthesiologists, Inc., and Florida Osteopathic Medical
Association, Inc., Motion to Intervene In Florida Board of Nursing’s Consideration of the Petition for Declaratory Statement
in Opposition of Petitioner John P. McDonough, A.P.R.N., C.R.N.A., Ed.D., filed at the Department of Health, Aug. 1, 2019,
(on file with the Senate Health Policy Committee). BILL: CS/SB 172 Page 9
Florida Administrative Code Rule 28-106.205.
33
The FANA’s petition
34
was in support of
petitioner’s Declaratory Statement while the motion filed jointly by the FMA, FSA, and FOMA
was in opposition.
The FMA, FSA, and FOMA argued they were entitled to participate in the proceedings, on
behalf of their members, as the substantial interests of their members – some 32,300 – could be
adversely affected by the proceeding.
35, 36
Specifically, the FMA, FSA, and FOMA argued that
the substantial interests of their respective members would be adversely affected by the issuance
of a Declaratory Statement that a petitioner could use the term “nurse anesthesiologist,” without
violating ss. 456.072 and 464.018, F.S., on the grounds that:
• A substantial number of their members use the term “anesthesiologist” with the intent and
understanding that patients, and potential patients, would recognize the term to refer to them
as physicians licensed under chs. 458 or 459, F.S., not “nurse anesthetists;”
• Sections 458.3475(1)(a) and 459.023(1)(a), F.S., both define the term “anesthesiologist” as a
licensed allopathic or osteopathic physician and do not include in those definitions a “nurse
anesthetist;”
• The Merriam-Webster Dictionary defines an “anesthesiologist” as a “physician specializing
in anesthesiology,” not as a nurse specializing in anesthesia; and
• The Legislature clearly intended a distinction between the titles to be used by physicians
practicing anesthesiology and nurses delivering anesthesia, to avoid confusion, as
s. 464.015(6), F.S., specifically states that:
o Only persons who hold valid certificates to practice as certified registered nurse
anesthetists in this state may use the title “Certified Registered Nurse Anesthetist” and
the abbreviations “C.R.N.A.” or “nurse anesthetist;” and
o Petitioner is licensed as a “registered nurse anesthetist” under s. 464.012(1)(a), F.S., and
the term “nurse anesthesiologist” is not found in statute.
At the hearing, the attorney for the BON advised the BON that, “[t]he first thing the Board
need[ed] to do [was] determine whether or not the organizations that [had] filed petitions to
intervene have standing in order to participate in the discussion of the Declaratory Statement”
37
and that:
“Basically in order to make a determination of whether an organization has standing, they
have to show that the members of their organization would have an actual injury in fact,
or suffer an immediate harm of some sort of immediacy were the Board to issue this
particular Declaratory Statement, and then the Board also has to make a determination of
33
Fla. Adm. Code. R. 28-106.205 (2019), in pertinent part, provides, “Persons other than the original parties to a pending
proceeding whose substantial interest will be affected by the proceeding and who desire to become parties may move the
presiding officer for leave to intervene.”
34
Florida Association of Nurse Anesthetists Motion to Intervene, filed at the Department of Health, July 31, 2019, (on file
with the Senate Committee on Health Policy).
35
Supra note 43.
36
See Florida Home Builders Association, et al., Petitioners, v. Department of Labor And Employment Security, Respondent,
412 S.2d 351 (Fla. 1982), holding that a trade association does have standing under s. 120.56(1), F.S., to challenge the
validity of an agency ruling on behalf of its members when that association fairly represents members who have been
substantially affected by the ruling.
37
Record at p. 3, ll. 13-17. Declaratory Statement, Dr. John P. McDonough, Before the Board of Nurses, State of Florida,
Department of Health, Sanibel Harbor Marriott. (on file with the Senate Committee on Health Policy). BILL: CS/SB 172 Page 10
whether the nature of the injury would be within the zone of interest that the statute is
addressing.”
38
However, the above special injury standard,
39
provided by board counsel to the BON to apply to
determine the organizations’ standing to intervene, based on their members’ substantial interests
being affected by the declaratory statement, was held inapplicable to trade associations in
Florida Home Builders Ass’n. v. Department of Labor and Employment Security,
412 So 2d 351 (Fla. 1982). The Florida Supreme Court, in Florida Home Builders, Ass’n., held
that a trade or professional association is able to challenge an agency action on behalf of its
members, even though each member could individually challenge the agency action, if the
organization could demonstrate that:
• A substantial number of the association members, though not necessarily a majority, would
be “substantially affected” by the challenged action;
• The subject matter of the challenged action is within the association’s scope of interest and
activity; and
• The relief requested is appropriate for the association’s members.
40
The FANA’s motion to intervene was granted, based on the application of an incorrect standard,
without the BON making the findings required by Florida Home Builders, Ass’n. The motion to
intervene filed by the FMA, FSA, and FOMA was denied, also based on the application of an
incorrect standard, on the grounds that:
• Their members are regulated by the Board of Medicine, not the Board of Nursing;
• Nursing disciplinary guidelines were being discussed;
• Their members’ licenses and discipline would not be affected by an interpretation of nursing
discipline;
41
and
• Their members are not regulated by the Nurse Practice Act.
A motion was made to approve McDonough’s Petition for Declaratory Statement, and it passed
unanimously. According to the BON’s approval, McDonough may now use of the term “nurse
anesthesiologist” as a descriptor, and such use is not grounds for discipline against his nursing
license. However, while s. 120.565, F.S., provides that any person may seek a declaratory
statement regarding the potential impact of a statute, rule or agency opinion on a petitioner’s
particular situation, approval or denial of the petition only applies to the petitioner. It is not a
method of obtaining a policy statement from a board of general applicability.
42
38
Id. p. 3-4, ll. 22- 25, 1-6.
39
United States Steel Corp. v. Save Sand Key, Inc., 303 So.2d 9 (Fla. 1974).
40
Florida Home Builders Ass’n. v. Department of Labor and Employment Security, 412 So.2d 351 (Fla. 1982), pp. 353-354.
41
Record at p. 7, ll. 1-13. Declaratory Statement, Dr. John P. McDonough, Before the Board of Nurses, State of Florida,
Department of Health, Sanibel Harbor Marriott. (on file with the Senate Committee on Health Policy).
42
Florida Department of Health, Board of Nursing, What is a Declaratory Statement?, available at
https://floridasnursing.gov/help-center/what-is-a-declaratory-statement/ (last visited Mar. 24, 2025). BILL: CS/SB 172 Page 11
News media have reported that the BON’s Declaratory Statement in favor of McDonough has
created significant concern for patient safety and the potential for confusion in the use of the
moniker “anesthesiologist” among Florida’s medical professionals.
43, 44
III. Effect of Proposed Changes:
Section 1 of the bill amends s. 456.003(2), F.S., regarding Legislative intent for the regulation of
health care professions to provide a Legislative finding that the health, safety, and welfare of the
public may be harmed or endangered under any of the following conditions:
• By the unlawful practice of a profession;
• By a misleading, deceptive, or fraudulent representation relating to a person’s authority to
practice a profession lawfully; or
• When patients are uninformed about the profession under which a practitioner is practicing
before receiving professional consultation or services from the practitioner.
The bill provides that the Legislature’s regulation of health care professions as provided under
current law in s. 456.003(2), F.S., is a matter of great public importance.
Section 2 of the bill amends s. 456.065, F.S., to establish that the DOH may issue a notice to
cease and desist if a health care practitioner has engaged in the unlicensed practice of a health
care profession by violating s. 456.65, F.S., regarding the unlicensed practice of medicine or
osteopathic medicine, as created in section 3 of the bill and may pursue other remedies
authorized under s. 456.065, F.S., which apply to the unlicensed practice of a health care
profession. In practice, the DOH would be authorized to treat a health care practitioner’s
unlawful practice of medicine or osteopathic medicine under the bill as the department would for
an unlicensed person, starting with a notice to cease and desist and potentially exercising other
authorities in current law if the unlawful practice continues.
Section 3 of the bill creates s. 456.65, F.S., to prohibit a health care practitioner not licensed as a
physician under ch. 458, F.S., or ch. 459, F.S., from holding himself or herself out to a patient or
the general public as a specialist by describing himself or herself or his or her practice through
the use of any medical specialist title or designation specifically listed under s. 458.3312(2), F.S.,
as created in section 3 of the bill, or under s. 459.0152(2), as created in section 4 of the bill,
either alone or in combination, or in connection with other words, unless the practitioner is
specifically authorized by law to use that medical specialist title or designation.
The bill creates ss. 458.3312(3) and 459.0152(3), F.S., to authorize the BOM and the BOOM to,
by rule, create other specialist titles that are subject to the respective prohibitions on physicians
licensed under those chapters of statute.
43
Christine Sexton, The News Service of Florida, “Nursing Board Signs Off On ‘Anesthesiologist’ Title,” August 16, 2019,
The Gainesville Sun, available at: https://www.gainesville.com/news/20190816/nursing-board-signs-off-on-anesthesiologist-
title (last visited Mar. 24, 2025).
44
Christine Sexton, The News Service of Florida, “Florida Lawmaker Takes Aim At Health Care Titles,” October 10, 2019,
Health News Florida, available at https://health.wusf.usf.edu/post/florida-lawmaker-takes-aim-health-care-titles (last visited
Mar. 24, 2025). BILL: CS/SB 172 Page 12
A violation of this prohibition would constitute the unlicensed practice of medicine or
osteopathic medicine, as applicable, and DOH may pursue enforcement remedies under s.
456.065, F.S., as amended in section 2 of the bill.
Exceptions
Notwithstanding the prohibition created in this section, the bill provides that a licensed health
care practitioner may use the name or title of his or her profession that is authorized under his
or her practice act, and any corresponding designations or initials so authorized, to describe
himself or herself and his or her practice.
Additionally, the bill provides that a licensed health care practitioner who has a specialty
area of practice authorized under his or her practice act may use the following format to
identify himself or herself or describe his or her practice: “...(name or title of the practitioner’s
profession)..., specializing in ...(name of the practitioner’s specialty)....”
A chiropractic physician licensed under ch. 460, F.S., is authorized to use the title “chiropractic
radiologist” and other titles, abbreviations, or designations authorized under his or her practice
act reflecting those chiropractic specialty areas in which the chiropractic physician has attained
diplomate status as recognized by the American Chiropractic Association, the International
Chiropractors Association, the International Academy of Clinical Neurology, or the International
Chiropractic Pediatric Association.
A podiatric physician licensed under ch. 461, F.S., may use the following titles and
abbreviations as applicable to his or her license, specialty, and certification: “podiatric surgeon,”
“Fellow in the American College of Foot and Ankle Surgeons,” and any other titles or
abbreviations authorized under his or her practice act.
A dentist licensed under ch. 466, F.S., may use the following titles and abbreviations as
applicable to his or her license, specialty, and certification: “doctor of dental surgery,” “D.D.S.,”
“oral surgeon,” “maxillofacial surgeon,” “oral and maxillofacial surgeon,” “O.M.S.,” “dental
anesthesiologist,” “oral pathologist,” “oral radiologist,” and any other titles or abbreviations
authorized under his or her practice act.
An anesthesiologist assistant licensed under ch. 458, F.S., or ch. 459, F.S., may use the titles
“anesthesiologist assistant” or “certified anesthesiologist assistant” and the abbreviations “A.A.”
or “C.A.A.,” as applicable.
A physician licensed under ch. 458, F.S., or ch. 459, F.S., may use a specialist title or
designation according to s. 458.3312, F.S., or s. 459.0152, F.S., as applicable.
Section 4 of the bill amends s. 458.3312, F.S., for allopathic physician specialties and section 5
of the bill amends s. 459.0152, F.S., for osteopathic physician specialties.
Under current law, an allopathic physician licensed under ch. 458, F.S., may not hold himself or
herself out as a board-certified specialist unless the physician has received formal recognition as BILL: CS/SB 172 Page 13
a specialist from a specialty board of the American Board of Medical Specialties or other
recognizing agency that has been approved by the BOM.
Similarly, an osteopathic physician licensed under ch. 459, F.S., may not hold himself or herself
out as a board-certified specialist under current law unless the osteopathic physician has:
• Successfully completed the requirements for certification by the American Osteopathic
Association (AOA) or the Accreditation Council on Graduate Medical Education (ACGME);
and
• Is certified as a specialist by a certifying agency approved by the BOOM.
In sections 4 and 5, the bill creates identical lists of medical specialist titles and designations that
may be used only by physicians licensed under ch. 458 or ch. 459, F.S., respectively, who have
met the above requirements and become board-certified. The BOM and the BOOM are
authorized to adopt additional specialist titles and designations by rule that would be reserved for
use by board-certified physicians. Such rules would apply only to licensed allopathic or
osteopathic physicians, respectively.
The bill reserves the use of the following medical specialist titles and designations for board-
certified allopathic and osteopathic physicians:
• Surgeon.
• Neurosurgeon.
• General surgeon.
• Plastic Surgeon.
• Thoracic Surgeon.
• Allergist.
• Anesthesiologist.
• Cardiologist.
• Dermatologist.
• Endocrinologist.
• Gastroenterologist.
• Geriatrician
• Gynecologist.
• Hematologist.
• Hospitalist.
• Immunologist.
• Intensivist.
• Internist.
• Laryngologist.
• Nephrologist.
• Neurologist.
• Neurotologist.
• Obstetrician.
• Oncologist.
• Ophthalmologist.
• Orthopedic surgeon. BILL: CS/SB 172 Page 14
• Orthopedist.
• Otologist.
• Otolaryngologist.
• Otorhinolaryngologist.
• Pathologist.
• Pediatrician.
• Proctologist.
• Psychiatrist.
• Pulmonologist.
• Radiologist.
• Rheumatologist.
• Rhinologist.
• Urologist.
In conjunction with the statute created in section 3 of the bill, a health care practitioner who is
not a licensed allopathic or osteopathic physician may not hold himself or herself out to a patient
or the public at large as a specialist by describing himself or herself or his or her practice using
any of the titles or designations that appear in the statutory lists above.
Section 6 of the bill provides an effective date of July 1, 2025.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None. BILL: CS/SB 172 Page 15
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
To the extent persons violate the bill’s provisions, the bill could have a potential
workload increase and an increase in costs for the DOH’s ULA Unit of an indeterminate
amount.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 456.003, 456.065,
458.3312, and 459.0152.
This bill creates section 456.65 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Health Policy on March 25, 2025:
The committee substitute establishes that the DOH may issue a notice to cease and desist
and may pursue other existing remedies, if a health care practitioner has engaged in the
unlicensed practice of a health care profession by violating s. 456.65, F.S., regarding the
unlicensed practice of medicine or osteopathic medicine, as created in section 3 of the
bill. The CS deletes a provision providing construction for s. 456.65, F.S., and reaffirms
under that section that a physician licensed under ch. 458, F.S., or ch. 459, F.S., may use
a specialist title or designation according to s. 458.3312, F.S., or s. 459.0152, F.S., as
applicable.
To the lists of specialist titles that may be used only by physicians licensed under ch.
458, F.S., or ch. 459, F.S., and who have met statutory requirements and become board- BILL: CS/SB 172 Page 16
certified specialists, the CS adds the following titles: plastic surgeon, thoracic surgeon,
allergist, geriatrician, immunologist, neurotologist, and pulmonologist.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.