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TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING ARTICLE 11, CHAPTER 47, TITLE 40 SO AS TO ENACT THE "REGISTERED SURGICAL TECHNOLOGIST AND LICENSED SURGICAL ASSISTANT PRACTICE ACT" TO REQUIRE PERSONS TO BE CERTIFIED NATIONALLY AND REGISTERED UNDER THIS ARTICLE TO PERFORM DUTIES AND PROVIDE SERVICES AS A SURGICAL TECHNOLOGIST AND TO REQUIRE PERSONS TO BE CERTIFIED NATIONALLY AND LICENSED UNDER THIS ARTICLE TO PERFORM DUTIES AND PROVIDE SERVICES AS A SURGICAL ASSISTANT; TO ESTABLISH THE ADVISORY COMMITTEE FOR SURGICAL TECHNOLOGISTS AND SURGICAL ASSISTANTS UNDER THE BOARD OF MEDICAL EXAMINERS AND TO PROVIDE FOR ITS POWERS AND DUTIES; AND TO FURTHER PROVIDE FOR THE REGULATION OF SURGICAL TECHNOLOGISTS AND SURGICAL ASSISTANTS.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 47, Title 40 of the 1976 Code is amended by adding:
Section 40-47-1500. This article may be cited as the 'Registered Surgical Technologist and the Licensed Surgical Assistant Practice Act'.
Section 40-47-1510. The purpose of this article is to protect and benefit the public without a financial burden to the people of South Carolina by setting standards of qualifications, education, training, experience, and professional conduct for those who seek to hold the title of registered surgical technologists and licensed surgical assistants. A further purpose of this article is to create a system in which no one, other than those exempted in Section 40-47-1530, may perform the duties of a surgical technologist or a surgical assistant without being a registered surgical technologist or licensed as a surgical assistant as required by this article.
Section 40-47-1520. As used in this article:
(1) 'Advisory committee' means an informal advisory committee to the board whose purpose is to advise the board regarding rules relating to the registration, licensure, and enforcement and discipline of surgical technologists and surgical assistants.
(2) 'Association of Surgical Technologists' (AST) means the national organization founded in 1969 to ensure that surgical technologists have the knowledge and skills to administer patient care of the highest standard through accreditation, certification, and education.
(3) 'Board' means the South Carolina State Board of Medical Examiners.
(4) 'CAAHEP' means the Commission on Accreditation of Allied Health Education Programs, which is a programmatic/specialized accreditor in the health sciences field.
(5) 'Continuing Education Credits' means credits that are the number of continuing education hours needed to maintain national certification while keeping updated with new and changing technologies in patient care.
(6) 'Direct supervision' means supervision by a delegating physician who is physically present and personally directs delegated acts, and remains immediately available in the operating room to respond to any emergency until the patient is released from the operating room or care has been transferred to another physician.
(7) 'Indirect supervision' means that in all instances when not under the direct supervision of a delegating physician, indirect supervision may be provided by the supervisor in the operating room in the absence of that physician.
(8) 'Liaison Council on Certification for the Surgical Technologist' (LCC-ST) means the national organization founded in 1974 that is the certifying agency for surgical technologists and that is solely responsible for all decisions regarding the certification of surgical technologists; this council is also authorized to certify surgical assistants. Certifications provided by this council must be approved by the National Association of Surgical Technologists.
(9) 'Licensed surgical assistant' means a person who:
(a) is not a physician licensed to practice medicine in all of its branches;
(b) holds current certification by the Liaison Council on Certification for the Surgical Technologist as a first assistant or the National Surgical Assistant Association on the Certification of Surgical Assistants or any entity approved by the National Association of Surgical Technologists (AST);
(c) performs duties under direct supervision;
(d) provides services only in a licensed hospital, ambulatory surgical facility, or office of a physician licensed to practice medicine in all its branches; and
(e) is licensed under this article.
(10) 'National certification' means the demonstration and documentation of initial and continuing competence of a surgical technologist or surgical assistant as set forth by the National Association of Surgical Technologists' accepted national certifying bodies. To retain certification, continuing education requirements must be met for certification periods.
(11) 'National Surgical Assistant Association' means the national organization founded in 1983 to offer education, testing, and certification to its surgical assistant members. Certification provided by this association must be approved by the National Association of Surgical Technologists.
(12) 'Registered surgical technologist' means a person who:
(a) is not a physician licensed to practice medicine in all of its branches;
(b) holds current certification by the Liaison Council on Certification for the Surgical Technologist or any entity approved by the National Association of Surgical Technologists (AST);
(c) performs duties under direct supervision;
(d) provides services only in a licensed hospital, ambulatory surgical facility, or office of a physician licensed to practice medicine in all its branches; and
(e) is registered under this article;
(13) 'President' means the President of the Board of Medical Examiners.
(14) 'Surgical assisting or 'first assisting' means providing aid under the direct supervision of a physician in exposure and visualization of the operative field with retraction and manipulation of tissues, hemostasis, and other intraoperative technical functions, that assist a physician in performing a safe operation with optimal results for the patient including, but not limited to, the delegated authority to provide local infiltration or the topical application of a local anesthetic and hemostatic agents at the operative site, ligation and approximation of tissues with sutures and ties, clamp and electocautery application, volume replacement or autotransfusion techinques, as appropriate, application of tourniquets and positioning of patients, and applications of casts, immobolizers, and surgical dressings.
(15) 'Surgical technology' means providing expertise in the theory and application of sterile and aseptic technique and combining the knowledge of human anatomy, surgical procedures, and implementation tools and technologies to facilitate a physician's performance of invasive and non-invasive therapeutic and diagnostic procedures under the direct supervision of the physician.
Section 40-47-1530. The following are exempt from the registration and licensure requirements of this article:
(1) a student enrolled in a surgical technology program approved by CAAHEP or a surgical assisting education program approved by the board ; a resident, intern, or medical student who is assisting in a surgical operation that is an integral part of the program of study;
(2) a surgical technologist or surgical assistant employed in the service of the federal government while performing duties related to that employment;
(3) a healthcare worker acting within the scope of that healthcare worker's license;
(4) a registered nurse, an advanced practice nurse, or a licensed practical nurse;
(5) a certified physician assistant.
Section 40-47-1540. (A) There is established the Advisory Committee for Surgical Technologists and Surgical Assistants composed of six members who must be residents of this State, appointed by the board and whose duties must be delegated by the board. These duties include furnishing records, information, or assistance to the advisory committee and is immune from any civil liability arising from that action in a suit against the person brought by or on behalf of a surgical technologist or surgical assistant to carry out the mandates of this article. The members of the committee are as follows:
(1) at least two practicing surgical technologists who have at least five years of clinical experience as surgical technologists or one of whom can be a surgical technology educator, who is a certified surgical technologist and has at least five years of clinical experience as a practicing surgical technologist;
(2) at least two practicing surgical assistants who have at least five years of clinical experience as surgical assistants or one of whom can be a surgical assistant educator, who is a certified surgical assistant and has at least five years of clinical experience as a practicing surgical assistant;
(3) two practicing physicians licensed in this State who supervise surgical technologists and surgical assistants on the operative field.
(B) Members of the committee must be appointed for two-year terms and may not serve more than two consecutive full terms. The board may determine the rotation of the membership.
(C) Not later than thirty days after the appointment of its members, the committee shall meet and elect from among its members a chairperson who shall hold office according to rules adopted by the committee.
(D) Members may not receive per diem, travel, or other expenses and have no authority to determine policy independent of the board.
(E) Meetings must be held at least twice a year and at the request of the board and may be held online or by telephone conference call.
(F) Vacancies must be filled with appointees selected by the president.
(G) A person may not be a member of the committee if the person is a registered lobbyist for compensation on behalf of a profession related to the fields of surgical technology and surgical assisting.
(H) A majority of the committee membership constitutes a quorum.
(I) The committee, under the authority of the board, shall assist the board in carrying out the provisions of this article regarding the qualifications for the regulation of surgical technologists and surgical assistants.
(J) Under the authority of the board the committee shall:
(1) establish a code of ethics in accordance with this article;
(2) verify the qualifications and fitness of applicants for registration, licensure, renewal, and reciprocal licensure and shall review these applications utilizing background checks and physical and mental evaluations as indicated;
(3) enforce the revocation, suspension, or denial of a registration or license, or reprimand a registration holder or license holder for a violation of this article, the code of ethics, or a regulation promulgated by the board;
(4) establish reasonable application, registration, and licensure fees and other necessary fees;
(5) verify initial and continuing national certification and continuing professional education requirements for registration or licensure, the standards of which must be at least as stringent as those established or adopted by the Association of Surgical Technologists or the National Surgical Assistants Association for national certification by their respective approved boards of certification;
(6) enforce the surgical technologist's and the surgical assistant's scope of practice and the delegating physician's oversight responsibilities as recognized by the American College of Surgeons and the National Association of Surgical Technologists;
(7) maintain a registry of registered surgical technologists and licensed surgical assistants, including their place of employment, residence, and the date and the number of their registrations and licenses and make this information available to the general public, registration and license holders, and appropriate state agencies;
(8) hear disciplinary cases and recommend findings of fact, conclusions of law, and sanctions to the board, which, after conducting a final hearing, shall make the final decision on the matter;
(9) assist with other matters dealing with surgical technology and surgical assisting as the board may direct.
Section 40-47-1550. The board, after notice of and opportunity for a hearing, may remove any member of the committee if a member:
(1) cannot discharge the member's term for a substantial part of the term due to illness or disability;
(2) is absent for more than half of the regularly scheduled meetings unless excused by a majority vote of the committee.
Section 40-47-1560. (A) The board may find grounds for denial of registration or licensure and for disciplinary action if a person:
(1) has filed or has had filed on his or her behalf with the board any false, fraudulent, or forged statement or documents;
(2) misuses alcohol or drugs to such a degree to render him or her unfit to practice;
(3) has been convicted of a felony or a crime involving moral turpitude or drugs;
(4) has sustained any physical or mental disability which renders further practice dangerous to the public;
(5) has engaged in any dishonorable or unethical conduct that is likely to deceive or harm patients;
(6) has violated or conspired with another person to violate any provision of this article;
(7) has a lack of ethical or professional competence required to practice;
(8) has willfully violated a confidential communication;
(9) has acted in a grossly negligent or willful manner which is inconsistent with the practice of surgical technology and surgical assisting;
(10) is unfit and incompetent to practice with reasonable skill and safety;
(11) has exceeded the scope of practice of surgical technology or surgical assisting delegated by the delegating physician;
(12) has been disciplined by a regulatory authority of a state, country, or nationally recognized professional organization;
(13) violates this article or any regulation relating to the practice of surgical technology or surgical assisting.
(B) A person found in violation of a provision of this article or of a regulation promulgated pursuant to this article may be required to pay costs associated with the investigation and prosecution of the case. Additionally, the board may impose on any applicant or registered surgical technologist or licensed surgical assistant random and mandatory background checks from SLED or any other source and may impose random and mandatory drug testing.
Section 40-47-1570. In addition to the board's authority to impose sanctions, the board may also impose fines of up to one thousand dollars per violation. All costs and fines imposed pursuant to this article must be paid and are subject to collection and enforcement provisions.
Section 40-47-1580. (A) It is unlawful for a person who is not registered or licensed under this article to hold himself or herself out as a registered surgical technologist or licensed surgical assistant or to practice within the job descriptions defined in Section 40-47-1520(13) and (14). A person who holds himself or herself out as such without first being registered or licensed under this article, or during a period of suspension, or after his or her registration or license has been revoked by the board, is guilty of a misdemeanor.
(B) For the purpose of any investigation or proceeding under this article, the board or a person designated by the board may administer oaths and affirmations, subpoena witnesses, take testimony, and require the production of any documents or records that the board considers relevant to the inquiry.
(C) Investigative information in the possession of the board or its employees or agents that relates to discipline of a registered surgical technologist or a licensed surgical assistant is confidential and may be disclosed in the following circumstances:
(1) to the appropriate regulatory authorities in other states or in the District of Columbia or a territory or country where the surgical technologist or the surgical assistant has applied for registration, licensure or regulation;
(2) to the appropriate law enforcement agencies if a crime has been committed by the surgical technologist or surgical assistant;
(3) to a health care entity upon receipt of written request where information requested is to be used to preserve patient safety;
(4) to other persons necessary to prove guilt or innocence if required during investigations;
(D) If the board has sufficient evidence that a person is violating a provision of this article, the board, in addition to all other remedies, may order the person to immediately desist and refrain from this conduct.
(E) The board, in the name of the State, may petition an administrative law judge for the injunctive relief against a person violating this article.
(F) No provision of this article may be construed as prohibiting the respondent or his legal counsel from exercising the respondent's constitutional right of due process under the law or prohibiting the respondent from normal access to the charges and evidence filed against him or her as a part of due process under the law.
(G) A person aggrieved by a final action of the board may seek review of the decision in accordance with the Administrative Procedures Act.
Section 40-47-1590. (A) An applicant for registration as a surgical technologist or as a licensed surgical assistant shall file a written application on forms provided by the board showing to the satisfaction of the board that the applicant:
(1) has passed an Association of Surgical Technologists' nationally approved certification exam for surgical technologists or surgical assistants;
(2) has completed a dedicated training program for surgical technologists or surgical assistants in the armed forces and holds a national certification approved by the Association of Surgical Technologists;
(3) has submitted a completed notarized application form, the required fee in the form of a certified check or money order, and an acceptable legal document indicating any name changes, if applicable;
(4) may be required, at the discretion of the board, whether acting on reasonable doubt or random evaluation, to submit to a mental or physical examination, or both, by a physician or physicians designated by the board to certify mental or physical well-being, or both;
(5) has submitted verification of any current registration, licensure, or regulation in other states, if applicable;
(6) has submitted verification of any current national certification;
(7) is not in violation of this article or any regulation promulgated under this article at the time of application or renewal and can be proven by background and drug tests at the discretion of the board.
(B) However, if registration, licensure, or regulation in other states is as stringent as those set forth in this article, it may be deemed sufficient for registration or licensure in this State.
(C) The burden is upon the applicant to demonstrate to the satisfaction of the board and in the manner prescribed by the board that the applicant has the qualifications and is eligible for registration or licensure.
Section 40-47-1600. (A) All registrations and licenses are valid for a period of time not to exceed two years, and it is the registrant's or the licensee's responsibility to renew the registration or license on January first whether or not a notice is received. Every effort must be taken by the board to provide written notification for renewal, but the board is not responsible for delivery or receipt of the notice. A surgical technologist or surgical assistant who first becomes registered or licensed in the last quarter of the year must be issued a registration or license for the next licensing period.
(B) A registered surgical technologist and licensed surgical assistant before January second in every other year shall apply to the board for registration or license renewal and pay the renewal fee.
(C) If a person does not renew a registration or license before January first or if a registration or license renewal application is not postmarked before January second, the board may charge a late renewal penalty. If a person fails to renew a registration or license and if the person's registration or license renewal application is not postmarked before February first, the person's registration or license automatically lapses. A person who fails to renew a registration or license or who fails to submit a registration or license renewal application postmarked before February first and who practices as a registered surgical technologist or licensed surgical assistant after January thirty-first is deemed to be practicing without registration or a license and is subject to the penalties provided for in this article. All deadlines must be clearly marked on the renewal application; however, the burden of responsibility of meeting the deadline is on the registrant or licensee. If a lapse occurs, the board shall notify the registrant or licensee.
(D) As a condition of registration and license renewal, the continuing education requirements provided for in Section 40-47-1540(J)(5) must be satisfied, and the registrant or licensee must show evidence of continuing national certification as required in Section 40-47-1520(11)(b).
(E) If a person's registration or license lapses because the person did not satisfy the continuing education and certification requirements of subsection (D), the person shall comply with subsection (C) before the board may renew the registration or licensure.
(F) Fees for registration of surgical technologists and licensure of surgical assistants must be established and adjusted biennially to ensure that they are sufficient, but not excessive, to cover expenses including the total of the direct and indirect costs to the State for the operations of the committee. The board shall establish fees for:
(1) initial registration or licensure;
(2) renewal of registration or licensure;
(3) late renewal fee;
(4) reduced rates for newly graduated certified surgical technologists and certified surgical assistants just entering the practice.
(G) All fees are nonrefundable and may be prorated in order to comply with a biennial schedule.
(H) A registrant or licensee who does not wish to renew an active registration or license may select inactive status on the form provided to the board and may not practice as a registered surgical technologist or licensed surgical assistant.
(I) A surgical technologist or surgical assistant whose registration or license has been inactive may apply to the board to reactivate the registration or license. Conditions for reactivation are the same as for activation.
Section 40-47-1610. A registrant or licensee shall notify the board of a change in name or mailing address within thirty days and, when requesting a name change on a license, shall submit legal documentation indicating the name change.
Section 40-47-1620. Nothing in this article may be construed to authorize a person who holds a registration or license to engage in the practice of medicine or in the practice of registered nursing or in the practice of advanced practice nursing. Nothing in this article may be construed to prohibit a hospital or physician from utilizing professional judgment and discretion in determining the respective roles of registered surgical technologists and licensed surgical assistants, with no additional registration or licensure required, generally by policy or on an individual case by case basis. Nothing in this article may be construed to restrict a physician from delegating technical and clinical tasks to surgical technologists and other surgical assistants or licensed employees who perform delegated tasks in a surgical setting. Nothing in this article may be construed to relieve the supervising physician of the professional or legal responsibility for the care and treatment of his or her patients. In addition, nothing in this article may be construed to require licensure as a surgical assistant for those individuals who are exempted, including registered nurses, advanced practice nurses, licensed practical nurses and certified physician assistants.
Section 40-47-1630. (A) Within a year from the effective date of this article, a person may apply to the board and become registered as a surgical technologist or licensed as a surgical assistant, notwithstanding the provisions of Section 40-47-1590(A)(1)-(4), if the person has been engaged in the practice of surgical technology or surgical assisting or first assisting, as defined in Section 40-47-1520, as the person's primary function:
(1) continuously for six months before the effective date of this article;
(2) for one out of the last five years before the effective date of this article; or
(3) as a recent graduate of a civilian or military surgical technology or surgical assisting program;
(B) A person establishing legal residence in this State, or residing in another state, more than one year after the effective date of this article or residing in another state, may apply to the board to become registered as a surgical technologist or licensed as a surgical assistant. If he or she is registered or licensed as such in another state with substantially similar requirements as those contained in Section 40-47-1590, he or she may acquire registration or licensure without further requirements, as determined by the board upon recommendation of the advisory committee.
(C) In applying for registration or licensure pursuant to this section, the burden of proof lies with the applicant to demonstrate that he or she meets the requirements of this section. However, if the person is applying for licensure as a surgical assistant pursuant to this section, in meeting the burden of proof, he or she must include a sworn affidavit from a supervising surgeon or a hospital operating room or ambulatory surgical facility manager demonstrating their proof of practice.
Section 40-47-1640. One year after the effective date of this article, no one may practice the profession of surgical technology or surgical or first assisting or hold themselves out to be a registered surgical technologist or a licensed surgical assistant, as defined in Section 40-47-1520, without being registered as a surgical technologist or licensed as a surgical assistant.
Section 40-47-1650. The board is authorized to promulgate regulations pursuant to this article."
SECTION 2. If any section, subsection, paragraph, subparagraph, sentence, clause, phrase, or word of this act is for any reason held to be unconstitutional or invalid, such holding shall not affect the constitutionality or validity of the remaining portions of this act, the General Assembly hereby declaring that it would have passed this article, and each and every section, subsection, paragraph, subparagraph, sentence, clause, phrase, and word thereof, irrespective of the fact that any one or more other sections, subsections, paragraphs, subparagraphs, sentences, clauses, phrases, or words hereof may be declared to be unconstitutional, invalid, or otherwise ineffective.
SECTION 3. This act takes effect upon approval by the Governor.
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