Report on the sunrise hearing for the regulation of certified surgical assistants

              CERTIFIED SURGICAL ASSISTANTS
SUNRISE REVIEW
FINAL REPORT
1995
DATE:
TO:
COMMITTEE OF REFERENCE
REPORT ON THE SUNRISE HEARING FOR THE
REGULATION OF CERTIFIED SURGICAL ASSISTANTS
November 15,1995
THE JOINT LEGISLATIVE AUDIT COMMITTEE
Senator Patti Noland. Chair
Representative Sue Grace, Chair
Pursuant to Title 32, Chapter 31. Arizona Revised Statues, the Committee of
Reference. after performing a sunrise review and conducting a public hearing,
recommend the following:
A board regulating certified surgical assistants not be created.
COMMITTEE OF REFERENCE
Senator Petersen
Senator James Henderson. .Ir.
/
Representative Susan Gerard. Co-Chair
7
Representative Don Aldridge
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Representative Lou-Ann Preble
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Representative Herschella orton
Representative Kathi Foster
COMMITTEE OF REFERENCE
REPORT ON THE SUNRISE HEARING FOR THE
REGULATION OF CERTIFIED SURGICAL ASSISTANTS
1. BACKGROUND
Pursuant to section 31-3104, Arizona Revised Statutes, the Joint Legislative Audit
Committee (JLAC) assigned the sunrise review of the regulation of holistic dentists to the
Senate and House Health Committee of Reference. Attached is a copy of the application
for regulation submitted to the Committee of Reference by the West Coast Surgical
Specialists, Inc. (Attachment A.)
II. COMMITTEE SUNRISE REVIEW PROCEDURE
On November 15. 1995. the Committee of Reference held a public hearing to
receive testimony on the proposed regulation of surgical assistants. Those testifying
included practicing surgical assistants. and the Arizona Medical Association.
The proposal was to create a separate hoard to certify and regulate surgical
assistants. Currently. the scope of practice for surgical assistants is regulated hy
individual hospitals which choose to utilizl' this level of medical assistant. The West
Coast Surgical Specialists. Inc. suhmittl'd a written report to the committee which
addrl'ssl'd thl' following factors:
A. A definition of thl' prohkm and why a separate regulatory hoard for
surgical assistants was nI'Cl'ssar~. including thl' extent to which consumer
nl'l'ds \\ill hl'nelit from a separate hoard.
B. An explanation ofthl' nature ofpotl'ntial harm to the public if the
profl'ssion was not regulated sl'paratcly.
C. An explanation of a need to estahlish a maintenance of ethical and
educational standards within the profession.
D. Suggested kgislati\e language.
III. COMMITTEE RECOMMENDATIONS
1. The Committee recommended that a separate regulatory board for surgical
assistants not be created.
2. The Committee recommended that the surgical assistants work with the
various groups, including the Arizona Hospital Association, Board of
Medical Examiners, Board of Nursing, and Arizona. Medical Association, to
formulate a proposal for regulation possibly under an existing board.
IV. ATTACHMENTS
A. Application for Regulation
B. Minutes of the Committee of Reference Meeting
ATTACHMENT A
oast Surgical Specialists. Inc.
Professional Surgical Assisting
October 17, 1995
Attn: Lisa Barnes
Office of Representative Sue Grace
House of Representatives
1700 West Washington
Phoenix, AZ 85007
Dear Lisa:
Here are the 15 packets vou requested for the JLAC Committee. I
hope that these will expl ain what you n~ed to kno\, about the
Certified Surgical Assistant; but if ~rou need more information,
please don't hesitate to call me.
Prior to going to an educational program in the training of a
Surgical o-\ssistant, vou must have successfully completed a Surgical
Technolo~ist program, a Registered Nursin~ program. or a Physician
Assistant program and have at least a minimum of five years
experience in the operatin~ room assisting the surgeon.
After completion of the Surgical Assistant pro!Jram a Bachelor's
de~ree is issued (a list of recommended surgical assistant programs
and educatIon requlrement.s are enclosed in the packet). ~ost of
the Surgical Assistants ~oho ha\Oe bee"n In the field for over 15
~'ears ~'ere initia11,o traIned as Surgical Technologlsts and have
recel\;ed their SurgIcal Assistar.t qualificatIons through clinical
t r a I ~J ::. 11 ~ rl n d con tin u J n g e d u cat 1 0 n .
To became CertifIed ;.\S a Sllr~lc~l ,~ossistant. ';Oll must meet the
r e q u l reme r. t sse t b .; tl; e \ a ::. ::. 0 n a 1 Sur'; I c .:11 .J,. s $ 1 S tan t s :\ S soc i a t ion
(orocnure enclosed). To remaIn ce:-tIfled. the CprtIfled Surgical
,.\ s s 1s : ."1 r. t mu s t com p 1e"tea m, ~l ::. m: Im 0 f 2 5 Con tIn II 1 n '.: ~ e d i cal
Eoucatlon llrlits per '-'e-:lr In the" scope of thE-II' practIce. These
hours can be obtalnec: through a nllmoe:- of hands-on surgIcal clinics
ofte~'ed a:-ollnd the coun:r,' b,' the AmerIcan ~ledlcal-\s50ciation,
,-\550c1at:on of Operrlt::.ng Room !\urses, AssocIatIon of Surgical
TechllOl()~lst.s.1.nd ,'lJatlon:ll Sl:rgical Assist.ants ,';ssociation.
Tl~dnK ,'cu \'er',' much for e\·er·,·t.hulg that vou are able to do for us.
Res7:'f \.11 1 ',' v 0111' S •
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t' \.~e/ sl ,_.'. ~_
Prpsloent
7610 South Wildberry Avenue. Tucson. Arizona 85747. Phone (520) 574-8055. FAX (520) 574-1185
r----,-;~..... - oast Surgical Specialists. Inc.
ProfeSSional Surgical Assisting
7610 South Wildberry Avenue. Tucson. Arizona 85747. Phone (520) 574-8055. FAX (520) 574-1185
INTRODUCTION
As in other Allied Health Care Professionals such as a Physician Assistant and Registered Nurse. the
Certified Surgical Assistant under supervision of the operating surgeon is directly involved in the
health care of the public in a specialized area The Certified Surgical Assistant is not an additional
member of the surgical team but a replacement in the role previously performed by other
surgeons or physicians. The Certified Surgical Assistant works as the sole assistant to the operating
surgeon or in some cases the second assistant. To work in this role you clearly need to have a great
amount of practical experience and knowledge and skill in ALL surgical procedures. The
demand for Certified Surgical Assistants in Arizona has increased dramatically .over the last couple
of years as more surgeons recognize the skills. knowledge. and availability of the Certified Surgical
Assistant.
Regulation of the scope of practice of the Certified Surgical Assistant has presently been left to each
individual hospital. It is clear that regulaiion and licensure is necessary for this field in order to
maintain a high standard ofsurgical care for the public who depends on this high quality especially
in life- threatening and emergent circumstances.
A Certified Surgical Assistant is a specialized, highly trained professional who is with the patient:
* prior to surgery to carry out preoperative procedures and position the patient;
* during surgery to assist the supervising operating surgeon on the patient's surgical procedure:
and.
* after surgery in the post-operative evaluation of the patient.
This assures that the patient is getting the highest quality of health care. and for this reason much of
the burden of the supervising operating surgeon is relieved.
The Certified Surgical Assistant fee for service rates are much less than the rales that another
physician or surgeon would charge in the same role as a first assistant to the operating surgeon.
Certified Surgical Assistants offer a great benefit to the public for two reasons:
1) HIgh quality of care and.
2) Less money paid out by the public for their health care.
Other than another surgeon in the specialty of the supervising operating surgeon. the Certified
Surgical Assistant is the most qualified aLternalive as an assistant to the operating surgeon in the
panicular specialty. There is no other professional who is more qualified to effectively function in
this role U1 surgery. The public needs to know who the Certified Surgical Assistant is and there is no
better way than through regulation and licensure.
DEFINITION: Certified Surgical Assistant
A Certified Surgical Assistant is one who assists the surgeon in the perfonnance of any surgical
procedure. working under the supervising operating surgeon's direction. The Certified Surgical
Assistant may be employed by the operation surgeon or as an independent contractor hired by the
operating surgeon. A Certified Surgical Assistant:
*
*
*
*
*
*
*
*
*
*
*
*
acts as a first or second assistant to the surgeon having extensive knowledge of anatomy and
physiology.
assists the surgeon in draping of the patient
retracts tissue and exposes operating field area during operative procedures.
clamps and ties vessels to control bleeding during surgical entry.
keeps the operative site dry.
affords the surgeon the best possible exposure of the anatomy incident to the operation.
assists the surgeon in identifying any structure which should not be ligated and keeps these
structures from the operative site by retraction.
performs minor surgery under direct supervision of the operating surgeon such as harvesting
saphenous vein and bone graft from various sites -- separate. but -- during the primary
procedure.
is prepared to anticipate the moves of the surgeon.
is knowledgeable in ALL surgical procedures sufficient enough to assist the surgeon in any
way.
knows all instruments used in ANY procedure.
a<;SlSts mclosure of the incision including typing off the bleeders. applying sutures and wound
dressmgs. and perfonns any and all tasks required of him by the surgeon. incident to the
pamcular surgical procedure.
They keep abreast of new developments in surgery by attending seminars. workshops. and other
educauonal acu\'Ities. conducted by profeSSIOnal surgical assisting associations.
The ability to perionn under pressure in stressful and emergency situations is a quality essential to
Certified Surgical Assistants. A stable temperament. a strong sense of responsibility. considerable
patience. and concern for order are required. Manual dexterity and physical stamina are vital. They
must be able to work quickly. but accurately. and must be oriented to detail. yet able to integrate a
number of activities according to priority.
Certified Surgical Assistants must be keenly sensitive to the needs of the patient as well as to the
needs of other members of the surgical team. Individuals who practice this profession have a strong
desire to help others and make a valuable contribution to society.
CERTIFICAnON
To qualify for the examination. a Surgical Assistant must have candidate status with National Surgical
Assistant Association (information on this association enclosed). The requirements for Candidate
Membership are as follows:
*
*
*
*
completion of a qualified Surgical Assistant program.
three years experience with 750 hours per year as a First Assistant in the Operating Room.
verification by affidavit of hours worked. by supervisor. physician. or medical records.
five letters of recommendation verifying the said person's experience (four physician. one
supervisor sponsored).
Applications for the certification examination are reviewed on an individual basis. Provisions are
made for military trained assistants.
Once cenified through the National Surgical Assistant Association. the Certified Surgical Assistant
must follow the Professional Code. (Copy Enclosed)
PRIVILEGES
To obtain privileges for the Cenified Surgical Assistant for each hospital affiliation. the process is no
different for the Certified Surgical Assistant than it is for a physician (bylaws and regulations from
a local Tucson hospital enclosed). Before the Cenified Surgical Assistant is granted privileges at the
various hospitals. all credentials and qualifications of the Certified Surgical Assistant are meticulously
investigated and researched through each Medical Staffing office and Credentialing Services of
Arizona before being presented to the Credentialing and Privileges Board and the Board of Surgery.
Only then can the Certified Surgical Assistant receive temporary privileges. Temporary privileges
are granted for a period of three to six months.
During this time the Certified Surgical Assistant. in order to obtain full privileges. must obtain
observation forms signed by the supervising operating surgeon. of at least twenty five cases the
Certified Surgical Assistant has first assisted on or three to four cases in each specialty. These
observation forms will be turned into the Surgery Committee by the surgeons so the Certified
Surgical Assistant can be evaluated. Once the temporary privileges are complete the Certified
SurgIcal Assistant can request in writing to Medical StaffIng to be removed from observation and
obtain full pnvileges. The Certified Surgical Assistant's credentials and observations then will go
through the various committees who will approve or disapprove.
CERTIFIED SURGICAL ASSISTANTS
GENERAL PROVISIONS
Definitions
In this chapter, unless the context otherwise requires:
1. "Adequate records" means legible medical records contammg, ala- mlmmum,
sufficient information to identify· the patient, support the diagnosis, justify the
treatment, accurately document the results, indicate advice and cautionary warnings
provided to the patient and provide sufficient information for another practitioner to
assume continuity of the patient's care at any point in the course of treatment.
2. "Board" means the joint board on the regulation of Certified Surgical Assistants.
3. "Letter of concern" means an advisory letter to notify a Certified Surgical Assistant
that, while there in insufficient evidence to support disciplinary action, the board
believes the Certified Surgical Assistant should modify or eliminate certain practices
and that continuation of the activities which led to the information being submitted
to the board may result in action against the Certified Surgical Assistant's certificate.
4. "Medically incompetent" means that a Certified Surgical Assistant lacks sufficient
medical knowledge or skills. or both. in performing delegated health care tasks to a
degree likely to endanger the health or safety of patients.
5. "Physician" means a physician licensed by the provisions of the State of Arizona.
6. "Superv;sing operating surgeon" means a physician who holds a current unrestricted
license. is a qualified member of the medical staff department of surgery, and who
provides direct supervision and direction of the functions performed by the Certified
Surgical Assistant.
7. "Certified Surgical Assistant" means a person who is certified pursuant to this
chapter. is a qualified member of the medical staff department of surgery. who is a
member of the health team. who under direct supervision and direction of the
supervising operating surgeon. carries out functions that will assist the supervising
operating surgeon in performing a safe operation with optimal results for the patient.
The Certified Surgical Assistant may either be an employee of the supervising
operating surgeon or an independent contractor hired by the supervising operating
surgeon.
8. "Grandfather clause" means a provision applicable to practitioners actively engaged
in the regulated health profession before the effective date of a law which exempts
the practitioners from meeting the prerequisite qualifications set forth in the law to
perform prescribed occupational tasks.
9. "Primary place for meeting patients" includes the supervising operating surgeon's
office and health care institutions in which the supervising operating surgeon's
patients are located.
10. "Supervision" means a supervising operating surgeon's opportunity or ability to
provide or exercise control and direction over the services of a Certified Surgical
Assistant. Supervision does not require a supervising operating surgeon's constant
physical presence if the supervising operating surgeon is or can be easily in contact
with the Certified Surgical Assistant by radio, telephone or telecommunication.
11. "Unprofessional conduct" includes the following acts by a Certified Surgical
Assistant:
(a) Violation of any federal or state law or rule which applies to the performance of
health care tasks as a Certified Surgical Assistant. Conviction in any court of
competent jurisdiction is conclusive evidence of a violation.
(b) Holding himself out as a physician or knowingly permitting another person to
represent him as a physician.
(c) Performing health care tasks which have not been delegated by the supervising
.operating surgeon.
(d) Habitual intemperance in the use of alcohol orhabitual substance abuse.
(e) Gross malpractice, repeated malpractice or any malpractice resulting in the death of
a patient.
(0 Representing that a manifestly incurable disease or infirmity can be permanently
cured or that a disease, ailment or infirmity can be cured by a secret method,
procedure, treatment, medicine or device, if this is not true.
(g) Refusing to divulge to the board on demand the means, method. procedure, modality
of treatment or medicine used in the treatment of a disease. injury, ailment or
infirmity.
(h) Any conduct or practice which is hannful or dangerous to the health of a patient or
the public.
(i) Violation of a formal order, probation or stipulation issued by the board.
(j) Failing to clearly identify himself as a Certified Surgical Assistant in the course of his
work.
(k) Failing to use and affix the initials "C.S.A." after his name _or signature on charts or
professional correspondence.
(1) Procuring or attempting to procure a Certified Surgical Assistant's certificate by fraud,
misrepresentation or knowingly taking advantage of the mistake of another.
(m) Having professional connection with or lending his name to an illegal practitioner of
any of the healing arts.
(n) Failing or refusing to maintain adequate records on a patient.
(0) Self-administration of any controlled substance.
(p) Knowingly making any written or oral false or fraudulent statement in connection
with any health care task he undertakes.
(q) Commission of a felony. whether or not involving moral turpitude, or a misdemeanor
involving moral turpitude. In either case. conviction by a court of competent
jurisdiction or a plea of no contest in conclusive evidence of the commission.
(r) Refusal. revocation, suspension. limitation or restriction of a certification by any
other licensing jurisdiction for the inability to safely and skillfully practice medicine
or for unprofessional conduct as defined by that jurisdiction which directly or
indirectly corresponds to any act of unprofessional conduct as prescribed by this
paragraph.
(5) Sanctions including restriction. suspension or removal from practice imposed by an
agency of the federal government.
(1) ViolatIng or anempting to violate, directly or indirectly, or assisting in or abetting the
violation of or conspiring to violate a provision of this chapter.
(u) Sexual intimacies with a patient in the course of direct treatment.
(v) Using the tenn "doctor" or the abbreviation "Dr." on a name tag or in a way that leads
the public to believe that the Certified Surgical Assistant is licensed to practice as an
allopathic or an osteopathic physician in this state.
(w) Failing to furnish legally requested infonnation to the board or its investigator in a
timely manner.
(x) Failing to allow properly authorized board personnel to examine on demand
documents. report and records of any ,kind relating to the Certified Surgical Assistant's
perfonnance of health care tasks.
(y) Knowingly making a false or misleading statement on a fonn required by the board
or in written correspondence or attachments furnished to the board.
(z) Failing to submit to a body fluid examination pursuant to an agreement with the board
or an order of the board.
(aa) Violating a fonnal order. probation agreement or stipulation issued or entered into by
the board or its executive director.
Joint board on the regulation of Certified Surgical Assistants; membership;
appointment; terms
A. A joint board on the regulation of Certified Surgical Assistants IS established
consisting of the following nine members:
1. The dean of the college of medicine of the university of Arizona or his designee.
2. Two CerJfied Surgical Assistants appointed by the governor from a list of qualified
candidates submitted by the :'\ational Surgical Assistant Association. The governor
may seek additional input and nominations before the governor makes the Certified
Surgical Assistant appoinunents.
3. One public member appointed by the governor.
4. Two operating surgeons who are licensed by the provisions of the State of Arizona.
who are appointed by the board of osteopathic examiners in medicine and surgery and
who shall report and be responsible to the board of osteopathic examiners in medicine
and surgery.
5. Three operating surgeons who are licensed by the provisions of the State of Arizona,
who are appointed by the allopathic board of medical examiners and who shall report
and be responsible to the allopathic board of medical examiners.
B. Except for the dean of the college of medicine of the university of Arizona, the term
of office of members of the board is four years to begin and end on July 1.
Organization; meetings; compensation
A. The dean of the college of medicine of the university of Arizona shall seIVe as
chairman of the board.
B. The board shall hold a regular meeting at least quarterly on a date and time and place
it designates. In addition, the chairman may call special meetings the board deems
necessary. The board shall hold special meetings on Saturdays as the chairman may
determine necessary to carry out the functions of the board.
C. Members of the board are eligible to receive compensation, to be determined, for each
day of actual service in the business of the board.
D. The board may annually elect officers from its membership as it deems necessary to
carry out the duties of the board. These officers shall hold their offices at the pleasure
of the board.
Powers and duties; subcommittees
A. The board shall:
1. C~nify and regulate Certified Surgical Assistants pursuant to this chapter.
2. Discipline and rehabilitate Certified Surgical Assistants pursuant to this chapter.
B. The board may make and adopt rules which are necessary or proper for the
administration of this chapter.
C. The chairman may establish subcommittees consisting of board members and define
theIr duties as he deems necessary to carry out the functions of the board.
Personnel; consultants; compensation; immunity
A. The executive director employed by the board of medical examiners shall be the
executive director of the board. The staff of the board of medical examiners shall
carry out the administrative responsibilities of the board.
B. The board may employ special medical consultants or other agents to make
investigations, gather information and perform other duties the board deems necessary
or appropriate for the effective enforcement or administration of this chapter.
Compensation for special consultants employed shall not exceed one' hundred dollars
per day ($100.00).
C. There is no monetary liability on the part of and no cause of action shall arise against
the executive director, permanent or temporary personnel or special medical
consultants of the board for any act done or proceeding undertaken or performed in
good faith and in furtherance of the purposes of this chapter.
Board of medical examiners' fund
A. All monies collected pursuant to this chapter shall be deposited with the state
treasurer who shall deposit ten percent of such monies in the general fund and ninety
percent in the board of medical examiners' fund.
CERTIFICATION
Qualifications
A. An applicant for licensure shall:
1. Have current certification bv. the National Sur-gical Assistant Association to assist the
supervising operating surgeon. and is actively engaged in the newly regulated
profession before January L 1996. which exempts the Certified Surgical Assistant
from meeting the prerequisite qualifications set forth in the law to perform surgical
assisting as stated by the grandfather clause of this chapter and in Chapter 13
Regulation of Health Professions Article 1. General Provisions 32-3101.3 of the
Arizona Revised Status. or
2. Have satisfactorily completed a program for preparing Certified Surgical Assistants
that:
(a) was at least 1 academic year in length.
(b) consisted of supervised clinical practice and at least 4 months (in the aggregate) of
classroom instruction directed toward preparing students to deliver health care.
3. Have satisfactorily completed a fonnal.educational program for preparing Certified
Surgical Assistants that does not meet the requirements of Subsection A.2 of this
chapter and has been assisting supervising operating surgeons for a total of 12 months
during the 18 month period immediately preceding January 1, 1996.
4. Pass a certifying examination approved by the board.
5. Possess a good moral and professional reputation.
6. Be physically and mentally able to engage safely in the health care tasks of a Certified
Surgical Assistant.
7. Not. at the time of application. be subject to disciplinary action in any other state or
country for an act or conduct which constitutes grounds for disciplinary action
pursuant to this chapter.
8. Not have had Certified Surgical Assistant certification refused, suspended or revoked
by any other state or country for reasons which relate to his ability to engage skillfully
and safely in the health care tasks of a Cenified Surgical Assistant.
B. The board may:
I. Require an applicant to submit written or oral proof of his credentials.
2. Make such investigations as it deems necessary to advise itself with respect to the
qualifications of the applicant including physical examinations. mental evaluations,
oral competency examinations or any combination of such examinations and
evaluations.
3. Grant an exemption from the cenification requirements of this section to:
a. A student enrolled in a Certified Surgical Assistant education program
approved by the board in order for that student to work within that program.
The student shall register with the board on a fonn prescribed by the board.
b. A Certified Surgical Assistant who is an employee of the United State
government and who works on land or in facilities owned or operated by the
United States government.
Applications; interview; withdrawal
A.
B.
C.
1.
2.
3.
D.
E.
F.
G.
1.
....,...
Each applicant shall file a verified completed application in the form required and
supplied by the board which is accompanied by the prescribed application fee.
The application shall be designed to require the submission of evidence, credentials
and other proof necessary to satisfy the board that the applicant qualified for
certification.
The application shall contain the oath of the applicant that:
All information contained in the application and evidence submitted with it are true
and correct.
The credentials submitted were not procured by fraud or misrepresentation or any
mistake of which the applicant is aware.
The applicant is the lawful holder of the credentials.
All applications submitted to the board and any attendant evidence. credentials or
other proof submitted with an application are the property of the board and part of the
permanent record of the board and shall not be returned to a withdrawing applicant.
The board shall promptly notify an applicant. in writing of the deficiencies. if any. in
his application which prevent it from being a completed application.
The board or its representatives may interview an applicant to determine whether his
application is sufficient.
Applications are considered withdrawn on any of the following conditions:
Written request of the applicant.
Failure of the applicant to appear for an interview with the board unless good cause
is shown.
3. Failure to submit a completed application within one year from the date of the mailing
by the board of a statement to him of the deficiencies in his application pursuant to
subsection E.
Licensure; renewal; continuing education; expiration
A. The board shall certify applicants who qualify for licensure pursuant to this chapter
'aDd applicants pay the licensure fee required by this article.
B. Each holder of license shall renew the license on or before July I of each year by
paying the prescribed renewal fee and supplying the board with information it deems
necessary including proof of having completed twenty-five hours of continuing
medical education related to the Certified Surgical Assistant approved by National
Surgical Assistants Association or other accrediting organization acceptable to the
board within the previous year, current Certified Surgical Assistant certification
through the National Surgical Assistant Association, current malpractice insurance,
and current BCLS certification.
C. If a holder of a license fails to renew the license on or before July 1 of each year that
person shall pay the prescribed penalty fee for a late renewal.
D. If a holder of a license fails to renew the license on or before October 1 of each year,
the license expires. It is unlawful for a person to perform health care tasks of a
Certified Surgical Assistant after the license expires.
E. A person whose license expires may reapply for licensure pursuant to this chapter.
License or certificate suspension
A. The certificate or license of a health professional (Certified Surgical Assistant) who
does not renew his certificate or license as prescribed by statute and who has been
advised in writing that an investigation is pending at the time his certificate or license
is due to expire or terminate does not expire or terminate until the investigation is
resolved. The certificate or license is suspended on the date it would otherwise expire
or terminate and the health professional (Certified Surgical Assistant) shall not
practice in this state until the investigation is resolved.
Temporary Licensure
A. The board may issue a temporary license to an applicant who meets all the
qualifications prescribed in Qualifications, subsection A, paragraphs, 1, 2, 3, 5, 6, 7,
8, submits evidence to the board that the applicant is eligible to take the certifying
examination and pays the prescribed application fee.
B. A temporary license is not effective for a term of more than sixteen months and
expires on the occurrence of anyone of the following:
1. Issuance of a regular license.
2. Failure to pass the certifying examination.
3. Expiration of the term for which the temporary license was issued.
C. The board shall not issue a temporary license to an applicant who has failed the
National Surgical Assistant Association examination.
Cancellation of license
A. A person who has a current license as a Certified Surgical Assistant, who is not
presently under investigation by the board as the result of a complaint or information
recei ved by it, and against whom the board has not commenced any disciplinary
proceedings may request and the board shall grant cancellation of the license.
B. The board may cancel a license of a Cenified Surgical Assistant who have been
_charged with a violation of this chapter if the Certified Surgical Assistant admits the
charges and stipulates this admission for the record.
Fees
A. The board shall. by a formal VOle at its annual October meeting, establish fees and
penalties which do not exceed the following:
1. Application for a regular license. one hundred twenty-five dollars ($125'()().
2. Application for a temporary license. fifty dollars ($50.()().
3. Conversion from a temporary license to a regular license, seventy-five dollars
($75.00).
4. Annual renewal of a regular license, a fee of not to exceed one hundred dollars
($100.00).
5. Penalty fee for late renewal of a regular license, one hundred dollars ($100.00).
6. Issuance of a duplicate license, twenty-five dollars ($25.00).
7. For services not required to be provided by this chapter, but which the board deems
appropriate to carry out the intent and purpose of this chapter, a fee not to exceed the
actual cost of providing the services. The state treasurer shall deposit all of the
monies collected under this paragraph in the board of medical examiners' fund.
Change of address; penalty
A. A person holding a current license as a Certified Surgical Assistant in this state shall
promptly and in writing inform the board of that person's current residence address,
office address and telephone number and of each change in residence and office
address or telephone number that occurs. A residential address is not available to the
public unless it is the only address of record.
B. The board may assess its costs incurred in locating a Certified Surgical Assistant who
fails to comply with subsection A within thirty days after the date of change. The
board may also assess a penalty of not to exceed one hundred dollars ($100.00)
against the Certified Surgical Assistant. Monies collected pursuant to this subsection
shall be deposited in the board of medical examiners' fund.
SCOPE OF PRACTICE
Health care tasks; scope of practice; restrictions
A. Under the direction of the supeIVising operating surgeon, that operating surgeon may
delegate surgically related tasks to the Certified Surgical Assistant. The Certified
Surgical Assistant may perfonn these tasks in any setting authorized by the
supeIVising operating surgeon, and the board, including clinics, hospitals, ambulatory
surgical centers, patient homes, nursing homes and other health care facilities. These
tasks may include:
1. Obtaining patient histories.
2. Obtaining physical examination data.
3. Carrying our preoperative procedures to prepare patient for surgery.
4. Assisting in surgery.
5. Participate in the care and evaluation of the patient in the post-operative period.
6. Caring for minor injuries.
7. Offering counseling and education to meet patient needs.
8. Making appropriate referrals.
B. The supervising operating surgeon shall:
1. Accept responsibility for all tasks and duties the supervising operating surgeon
delegates to a Certified Surgical Assistant.
2. Notify the board and the Certified Surgical Assistant if the Certified Surgical
Assistant exceeds the scope of the delegated surgical tasks.
C. Direction and supervision do not require the personal presence of the supervising
operating surgeon at the place where surgical tasks are perfonned. The board by
order may require the personal presence of a supervising operating surgeon when
designated surgical tasks are perfonned.
E. At all times a Certified Surgical Assistant shall wear a name tag with the designation
"Certified Surgical Assistant" on it.
F. The board by rule may prescribe a civil penalty for a violation of this section relating
to charting and the wearing of tags. The penalty shall not exceed fifty dollars
($50.00) for each violation. The board shall transmit monies it received from this
penalty to the state treasurer for deposit in the general fund. A Certified Surgical
Assistant and the supervising operating surgeon may contest the imposition of this
fine. The imposition of a fine is public information, and the board may use this
information in any future disciplinary actions.
Supervising operating surgeon; responsibilities
A. The supervising operating surgeon is responsible for all aspects of the performance
of a Certified Surgical Assistant, whether or not the supervising operating surgeon
actually pays the Certified Surgical Assistant a salary, and is responsible for directing
and supervising the Certified Surgical Assistant to ensure that the Certified Surgical
Assistant's activities are within the Certified Surgical Assistant's scope of training and
experience and limited to health care tasks properly delegated by the supervising
operating surgeon.
B. A supervising operating surgeon shall not direct and supervise more than two
Certified Surgical Assistants who work the same hours at the same employment
location.
Employment of Certified Surgical Assistant
A Certified Surgical Assistant mayan independent contractor hired by the supervising
operating surgeon or may be employed by the supervising operating surgeon.
The Certified Surgical Assistant will be responsible for billing the patient's insurance
company for reimbursement for services. The rate billed is to be 65% of the amount
allowed under the surgeon's fee schedule if the service was performed by a surgeon.
REGULATION
Grounds for disciplinary action; duty to report; immunity; proceedings; board action;
notice
A. The board on its own motion may investigate any evidence which appears to show
that a Certified Surgical Assistant is or may be medically incompetent, is' or may be
guilty of unprofessional conduct or is or may be mentally or physically unable to
carry out approved health care tasks. Any operating surgeon, Certified Surgical
Assistant, or health care institution shall, and any other person may, report to the
board any information the operating surgeon, Certified Surgical Assistant, health care
institution or other person has which appears to show that a Certified Surgical
Assistant is or may be medically incompetent, is or may be guilty of unprofessional
conduct or is or may be mentally or physically unable to carry out approved health
care tasks. The board shall notify the Certified First Assistant and his supervising
operating surgeon of the content of the reported infonnation in writing within one
hundred twenty (120) days of its receipt of the information. Any operating surgeon,
Certified Surgical Assistant, health care institution or other person that reports or
provides information to the board in good faith is not subject to an action for civil
damages as a result of reporting or providing information, and, if requested, the name
of the reporter shall not be disclosed unless the information is essential to proceedings
conducted pursuant to this section.
B. The board may require a mental, physical or medical competency examination or any
combination of those examinations or make investigations including investigational
interviews between representatives of the board and the Certified Surgical Assistant
and the supervising operating surgeon as it deems necessary to fully inform itself with
respect to any information reponed pursuant to subsection A of this section.
C. If the board fmds, based on the information it receives under subsections A and B of
this section. that the public safety imperatively requires emergency action, and
incorporates a finding to that effect in its order, the board may order a summary
suspension of a certificate pending proceedings for revocation or other action. If an
order of summary suspension is issued, the Certified Surgical Assistant shall also be
served with a written notice of complaint and formal hearing, setting forth the
charges, and is entitled to a formal hearing before the board or a hearing officer on
the charges within sixty days.
D. If, after completing its investigation, the board finds that the information provided
pursuant to subsection A of this section is not of sufficient seriousness to merit direct
action against the Certified Surgical Assistants license, it may take the following
actions:
1. Dismiss if, in the opinion of the board, the information is without merit.
2. 'File a letter of concern.
E. If, after completing its investigation, the board holds the opinion that the information
is or may be true and that the information may be of sufficient seriousness to merit
direct action against the Certified Surgical Assistant's license, it may request an
informal interview with the Certified Surgical Assistant and the supervising operating
surgeon. The board shall notify the Certified Surgical Assistant in writing of the time,
date and place of the informal interview at least twenty (20) days before the
interview. The notice shall include the right to be represented by counsel and shall
fully set forth the conduct or matters to be discussed.
F. After an informal interview. the board may take the following action:
1. Dismiss if. in the opinion of the board. the information is without merit.
2. File a letter of concern.
3. Issue a decree of censure which constitutes an official action against the Certified
Surgical Assistant's license.
4. Enter into a stipulation with the Certified Surgical Assistant to restrict or limit the
Certified Surgical Assistant's practice of medical activities in order to rehabilitate the
Cenified Surgical Assistant. protect the public and ensure the Certified Surgical
Assistant's ability to safely perform health care tasks.
5. Fix a period and terms of probation best adapted to protect the public health and
safety and rehabilitate or educate the Certified Surgical Assistant. Probation may
include restriction on the health care tasks the Certified Surgical Assistant may
perform or temporary suspension not to exceed twelve months. Failure to comply
with any terms of probation is cause for initiating formal proceedings pursuant to
subsection G of this section.
G. If the board finds that the information provided pursuant to subsection A of this
section warrants suspension or revocation of a Certified Surgical Assistant's license,
it shall immediately initiate formal proceedings for the suspension or revocation of
the license. The notice of complaint and hearing is fully effective by mailing a true
copy of the notice of complaint and hearing by certified mail addressed to the
Certified Surgical Assistant's last known address of record in the board's files.
The notice of complaint and hearing is complete at the time of its deposit in the mail. A
hearing officer may conduct a hearing pursuant to this subsection and shall submit a report
of his fmding to the board within thirty (30) days after the hearing. The board may affmn,
reverse, adopt, modify, supplement, amend or reject the hearing officer's report in whole or
in part.
H. A Certified Surgical Assistant who after a formal hearing as provided in this section
is found to be medically incompetent, guilty of unprofessional conduct or mentally
or physically unable to safely carry out his approved health care. tasks, or any
combination thereof, is subject to censure, probation, suspension or revocation, or any
combination of these, for a period of time or permanently and under conditions the
board deems appropriate for the protection of the public health and safety.
I. A letter of concern is a public document and may be used in future disciplinary
actions against a Certified Surgical Assistant.
Right to examine and copy evidence; subpoena authority; right to counsel;
confidentiality of records
A. In connection with an investigation by the board, the board or its duly authorized
agent or employee shall at all reasonable times have access to, for the purpose of
examination. and the right to copy any documents, reports, records or other physical
evidence of any person being investigated or the reports, the records and any other
documents maintained by and in the possession of any hospital, clinic, physician's
office. laboratory, pharmacy, health care institution or other public or private agency
if the documents. reports. records or evidence relate to a Certified Surgical Assistant's
medical competence, unprofessional conduct or mental or physical ability to safely
engage in his approved health care tasks.
B. For the purpose of all investigations and proceedings conducted by the board:
1. The board may issue subJX>Cnas compelling the attendance and testimony of witnesses
or demanding the production of documents or any other physical evidence for
examination or copying if the evidence relates to the medical incompetence,
unprofessional conduct or mental or physical ability of a Certified Surgical Assistant.
2. A person appearing before the board may be represented by counsel.
C. The following items are not available to the public:
1. Patient records, including clinical records, medical reports and laboratory statements
and reports.
2. Files. films. reports or oral statements relating to diagnostic finding or treatment of
patients.
3. Any infonnation from which a patient or his family might be identified.
4. Infonnation received and records kept by the board in its investigations.
D. Nothing in this section or any other provision of law which makes communications
between a surgeon or a Certified Surgical Assistant and his patient a privileged
communication applies to investigations or proceedings conducted pursuant to this
chapter. The board and its employees, agents and representatives shall keep in
confidence the names of any patients whose records are reviewed during the course
of investigations and proceeding pursuant to this chapter.
E. Hospital records, medical staff records, medical staff review committee records,
testimony concerning those records and proceedings related to the creation of those
records are not available to the public, shall be kept confidential by the board and are
subj~ct to the same provisions of law concerning discovery and use in legal actions
as are the original records in the possession and control of hospitals, medical staffs
and medical staff review committees.
Judicial review
Decisions of the board are subject to judicial review pursuant to the law.
Violations; classification
A person who holds himself out as a Certified Surgical Assistant or uses any tenn
indicating or implying that he is authorized to perfonn the health care tasks of a
Certified Surgical Assistant without complying with this chapter if guilty of a felony.
Injunction
The superior court may enjoin any person from engaging in any act. practice or
transaction which constitutes a violation of this chapter. rule adopted pursuant to this
chapter or an order of the board. Issuance of an injunction does not relieve the person
from being subject to any other proceedings under law provided for in this chapter or
otherwise.
.,J I I (J1 ~t:...L.):"> I :::> I . -.J(; C;,(:" e ~ c:.. )
Nc-e 11:1 ~oe51 J JUTill;.: So A.J
!lON-PHYSICIAN CERTIFIED SURGICAL ASSISTANT 140L.-~ !~S5 J).,J (Jl,t-PLes
A. GENERAL DEJ'I!lITION
A Certified Surgical Assistant is a member of the health team
who, under the direct superv~s~on and direction of the
operating surgeon, carries out functions that will assist the
surgeon in performing a safe operation with optimal results
for the patient. He/she does not concurrently function as
scrub nurse. The CSA may either be an employee of the
operating surgeon or an independent contractor h~red by the
operating surgeon.
B. DEFINITIONS
1. "SUPERVISION" means the opportunity or ability of
operating surgeon to provide or exercise control and
direction over the services of the CSA. The constant
physical presence of the operating surgeon is required.
2. "OPERATING SURGEON" means a physician who holds a current
unrestricted license, is a qualified member of the
medical staff department of surgery, and who provides
direct supervision and direction of the functions
performed by the CSA.
3. "JOB DESCRIPTION" means a description of duties that
define the scope of practice of the CSA within defined
limits as established by the Hospital and its Medical
Staff.
C. GENERAL QUALIFICATIONS
1. Five (5) years operating room experience as a surgical
technologist, registered nurse or physician assistant.
2. Completed an internship as a certified surgical
technologist with experience as a first assistant in at
least twenty-five (25) cases with documented supervision.
Cases should represent a variety of operative procedures.
3. Passing score on the certification examination given by
the National Surgical Assistant Association.
4 . The CSA
liability
Dlrectors.
must provide
insurance as
evidence of current medical
required by the Board of
D. APPLICATION
1. The CSA shall make application at Carondelet St. Mary's
Hospital through the Surgical Services Committee.
91
Recommendations from this committee will then be
forwarded to the Medical Executive Committee and the
Board of Directors for final approval. The Medical
Executive Committee may contest the recommendations of
the Surgical Services Committee and forward any
objections to the Board of Directors for their
consideration of the application.
2. Adverse recommendation such as modification or denial of
privileges are not sUbject to the fair hearing and
appeals process as described in the Bylaw~.'
E. APPOIHTKEH'r
1. Initial appointment will be for a provisional period of
not less than ten (10) cases as a first assistant, during
which time the CSA's performance is documented by the
operating surgeon. Observation forms will be completed
by the operating surgeon and forwarded to the Surgical
Services Commitete with any recommendations.
2. The Surgical services Committee shall review the CSA
performance based on the observation forms and make
recommendations to the Medical Executive Committee and
the Board of Directors regarding acceptance or denial of
practice privileges or extension of the probationary
period.
3. The CSA's appointment shall be reviewed at least every
two (2) yeasr, as will be the supervisory performance of
the operating surgeon. Reappointment by the Board of
Directors, after review by the surgical Department, is
necessary before continuation of services by the CSA.
F. SPE::IFIC ACTIVITIES: CERTIFIED SURGICAL ASSISTANT, DEPARTKENT
OF SURGERY
1. The CSA will hold a current BCLS Certification.
2. The CSA may, on order of and in the physical presence of
the operating surgeon;
a. assist with the positioning, prepping, and draping
of the patient.
b. provide hemostasis by clamping blood vessel,
coagulating bleeding points, ligating vessels, and
by other means as directed and supervised by the
surgeon.
92
c. provide exposure through appropriate use of
instruments, retractors, suctioning, and sponging
techniques.
d. handle tissues as directed by the surgeon.
e. suture fascia, subcutaneous and skin tissues under
the direction of the surgeon.
f. place and suture drains as directed by the su~geon.
g. apply surgical dressings.
h. assist with transferring the patient from the
operating room.
i. not function as the scrub nurse while first
assisting in the operating room.
G. TERMINATION
1. Suspension, revocation or expiration of National
Certification shall result in immediate termination
of privileges as a .CSA and of all approved job
descriptions.
2. Suspension, termination or other adverse
against the CSA, not within the scope
Bylaws, Policies, Rules and Regulations
Medical Staff, shall not be sUbject
provisions of the Bylaws.
actions
of the
of the
to the
Approved CSM Credentials Committee: 08/25/92
A~~~oved Bylaws Committee: 11/17/92
Approved Surgical Services Committee: 11/19/92
P_;,~roved Medical Executive Co~ittee: 12/09/92
Approved General Staff Meeting: 01/05/93
Approved Board of Directors: 02/08/93
93
...... , •••••• t, •• , .... , t ., .... "liI' tt, 'I,ll' ill,"
surgcon in Ihe performa'nce of any surgical
procedure. working under the surgeon's direl.:­tion.
A surgical assistant
acls as a Iirst or second assislant to tile sur­gcon
having eXlensive knowledge of
anatomy and physiology.
assists the surgeon in draping of the patient,
relracls tissue and exposes operating field
area during operative procedures,
• clamps and tics vessels to control bleeding
during surgical entry,
• keeps the operative site dry,
• affords the surgeon the best possible expo­sure
of the anatomy incident to the operation.
assists the surgeon in idenlifying any struc­ture
which should not be ligated and keeps
these structures from the operative sile by
retraction,
is prepared 10 anlicipale Ihe moves of Ihe
surgeon.
is knowledgeable in all surgical procedures
suflicienl enough 10 assisllhe surgeon in any
way.
knows all inslruments used in any procedure.
and
assists in closure of Ihe incision including
lying oil the hleeders. applying sutures and
wound dressings, amI perfonns any and all
lasks required of him hy Ihe surgeon, incidenl
10 Ihe particular surgil.:al procedure.
They kccp ahreasl of new develop}llenls in sur­gery
by 'lIlending seminars, workshops. and
olher educational aClivilies. l.:onducted by pro­fessional
surgical assisting organizations. lIuch-­ItS
the NSAA· Nalional Surgical Assistanl Asso­cialion.
t','
Meulliel sllIp IS leuewell ullIIUUlly AII lIIe IIIhe rs.
regardless of lhe dale Ihey joined. will nc lellcweJ
in February. (Dues lIIay be proralnll
( 'a"didtl"
All prospeclive mcmbers who arc nol currc",ly
enrolled in an approved surgical as,i'tanl pro·
gram but wish 10 ncnJllle a Jeslgllalcd ('SA
(Cerlilied Surgical Assi'I;1Il11 mu,1 10111 a, .1 l,tn·
didale member, Each CanJidale Memncr has
Iwo years 10 lake the cerlificalloll e~;lIIlmallllll,
If Ihe Candidale Member lail, 10 wmpklc Ihe
certilicalion exam wilhin Ihe Iwoycar pcrllltl,
they forfeit the examination fee and mu,t re<lp­ply
as a Candidale Member,
Certified
The designation CSA (Certified Surgllal A"ls,
tant), is bestowed upon Ihose whll h<l\e previ'
ously joined as a l.:andidale memhcr alld h<lve
completed anJ passeJ Ihe A"o\,i,llllln, olillial
certilicalion examinalion, Cenitled IIIl'mncr,
receive a lull vole and can u'e Ihe Jl"lgn;lllllll
CSA in Iheir daily al'livilie, Cer\llleJ Ml'IllOers
musl complele 50 CME uni" C\l'fY ::!-t IllOl1lh,
Itl mainlain lheir Je,ignaleJ 'taills I hl"l' ('ME
uni" mu,l be ohtaincd throll!!h ,Ipprml'd nhH.1
lional prop'II11' anJ OIl'Opy ollhe lOlllSl' lcrilli
calc or signalure 01 Ihe IlIs!rulh.r lIIust
aceompany the neJil hour, Should.1 dl'sl!!
n<lled memncr laillo lIIeel IheSl' rC'lUIIl'lIIl'IIIs,
Ihe (,SA llesignallOlI \\, III ht.' rl'lllml'd
Studenl
Students who are currellily enrolled III CAliAI'
approveJ Surgeoll A"islalll PIl'~I.III1' or 1110111
NSAA approveJ school 01 progr.1I11 '1u,lIll) lor
lhi .. stalUs.
AUllciall'
Thi .. cl;l"lIicIIIOII 01 1I1l' II Ih<'l ,IIII' I' ,l\,lIl.lhle III
illdivldual" lII,tllull", or '""1'"1,1111 'lis \\ 1111 \\ "h
10 "eep abrea,1 01 'lIlgllill iI"I'IIII!! 11l'lId, ,111.1
aeli,ilie" hUI do not '1uOIIII) 01 !,l.lllll" sur~I"tI
assisl ing
Nl'~!'oll'ttl'tt I he A~Slll:llIltllll" ullil"lIllllll'llIlll.'1
ship ne\V"~lIer, the ('SA Niltle, ..etH" a' a UIIII
lIIulliealion lin" belwcen melllber, throughout tlil'
l'ounlry The ('SA Node proviJc, up-Io·dale in·
formation on Ihe A"ll(:ialion. lIIelllht.·r,hip alll\ I
lie" u(ll'oming Cduc'llionalprogram,. congrc"l",
l'hapter deve!opnll:nl', and 'peciOlI puhlil'alioll' 01
inkre,l The IIC" '!cllcr al,o prll\ Ilks all idl" Oil
..ome laiesl ,urglcallel'hI1l4ue, alld Irl'III" m Ihe
Opcrallllg ~ll(lm,
I\h'mh('r..hip Hindury' NSAA mOl"e, il l'a,y III
,lay HI lOuch wilh proll'"iollaicolll'ague, h) puh
II,hIll8 a direl'lory of ml'l1Incr, COlllp!ctl' wilh ad·
Jre\Sl''', phone number.., memncr,hip da"ifica·
lilln, anll area of 'pcci<llilalion, The Dirl'l'lory Is
dl\lrihUled each )l'Ur 10 members 01 NSAA alld
olher allied Health profe\\ionak
Natiunal Cunfl'renn:: This annual e\enl hrillg'
logether l1Iember, and nonllll'mncr, lhroughoul
Ihl' counlry, 10 nchallgl' idea' allillechniquc, In
,urglCal a\\isllIll! Prominenl 'pca"l'f' prl·'enl
loplc" deslgnl'lllo l'llhance kno" ledge alld ullder
,laIlJIII/; 01 currenl ,urgical prallll'e,
I-duratiunal St'minars: NSI\·\ 'l1illl'Or, 'Cilil
11.11' .lIId 11I0l!l<llll' "11h 'p"nlil' 10p1C' 01 IIIll'll"1
'I hese prOp<lf1h ,Ill' hdd IllIoUghoUllhl' UIIIIIlI\
01 \MIOll' lillie' tlurlll!! Ihl' ~l',lr ,1I1111111' ItI I1111 11,1
111111 I' \CIII 10 ml'lIIbers and IIlhl'! Ill'.tllh IHllks
'"l/I<lI, <I' Iho,e plllgr.lIlh tin l'lop
I,l'adn..hip ()I'I)<lrtunilil''': 1,Ih' ,1.1\ illIl,lgl' 1,1
lIIallY IIppol111llllll'S !t'!!,11tI dl'lllIllllIlI III Ihc A,
\lIlI,llIOIl h) Sl'r\ III!! 011.1 '"I!!ll,tI iI""IIII!! l 11111
1I1111l'l' OJ, OIJIIl tI '1'<'iI~llI!! .11 .1 'l'IIII1I,1I 1111 ,I I", ,d
Olllillll,".11 Ind III "'IIIII~ ,I pal'l'I 11I11hl' \""
1I.11I01I Nl'"sklll'!
I, ,llIhit,: NS,\I\ nllll>lls .1111111,11" ,II Ih,' ..\111,'11
"III ( IIl1q:l' III l.,lIl!!\'lIlh ('IiIlI,,11 ('I1I1!!ll'" \1'
1'11I"III,lld) '1lMNl dllllll',ll, ,11I01 1111,'111,1111111,11
'"lIfl'lIl1' ,IIIl'IIlIIIII' '1lI!!1,.II 1I1,','IIII!! ,,1I1' hi' 11111
III Ihl' I,II!!,"I III II' ~lIId
The National SurRical A.uiJtam A.uoc;a­tion
is an organization of pmfe.uional
Sl4r~;mlA.Hi,~tantJthrou~holllt"eUnited
Statl',\·. NSAA H'lU t'Jtahlished in 19X3,
to pr(/\'ide .HClIulard Kuidelinn, re~ula­tioll.\,
"nd e.Habli.~" rule.{ for tho.\'e H'ho
prt/('t;a mltl '/;",ction aJ Sl4r~ic,,' A.uis-tants.
NSAA examineJ, reviews, and certifies,
the traininK. education, experience, ski/lJ,
and knowledRe t~fitJ memberJ, ThoJt' in­dividlll,
1J who meet theu high ethical
prindplt'J and practices are eliKib/e to
become a DesiRnated CSA- "Certified
Surgiml A.ui.uant" Member within the
Ntllional Surgical Assistant AHociation.
NSAA is a Charter Member of the Na-tiont,
1 Organization for Competency As­surance.
NSAA promotes NOCA 'J
.{landards by offerinK certification, a
scope t1 practice and continuing medi­cal
education requirements.
To qualify fot the eltaminatinn. a surgical assis­tant
must have candidate MalUS with NSAA. The
requirements lor Candidate Memhcrship arc as
follows:
• current employment as a Surgical Assistant.
and/or
• three years ellpcrience with 7'111 hours per year
as a First Assislanl in Ihe Operallllg Room, and
• verification hy affidavil of hours worked hy
supervisor or physician, amI
• five lellers of recomrnendalion verilying Ihe
said person's ellperience (four physician- one
supervisor sponsored I.
• a person who has gradualed hom an NS AA or
CAUAP apprnved Surgical Assislanl School
shall he qualified lor Candidalc MClIlhershlp
overriding Ihe ahove lJualificalions.
All applil.:ations for Ihl'l'l:r1lficalion ClI;lIl1ln;\lIon
are reviewed on an indiVidual hasis. !'rovlslllns
arc made for mihlary lraincd 1\\\lslanl\ (inlcr·
ally lhe clIam IS glvl'n at lour Icsllng ll'nll'fs per
cakm\;1f year Wllh a hll lby nolin' a group 01
III or morc can requesl a dale and sill' lor Ihe
ellam.
N\I'o~" S.'HI; ... " A......I... "", ,\ ......1111\1111"0
~1It) Wesl ('lark Slll'l·t
Champaign, illinOIS hi H20
217/ ~'i6-"\1 H2
217/WM-41IY FAX
THE
NATIONAL
Surgical Assistant
ASSO<:IAT ION
f\lLf\lBt-.I~S'III' INH >Rf\l;\TI< >N
National Surgical Assistant Association
309 W. Clark St. • Champaign, IL 61820-4690 • (217) 356-3182 • FAX (217) 398-4119
NSAA RECOMMENDED SURGICAL ASSISTING SCHOOLS
UNIVERSITI' OF ALABAMA - BIRl\1INGHAM
Surgical Assistant Program
Depanment of Surgery
Birmingham, Alabama 35294
(205) 934-4011
UNIVERSITI' OF AKRON - OHIO
Division of Allied Health
Community & Technical College
Akron, Ohio 44325-3702
(216) 972-7111
CORNELL UNIVERSITI' MEDICAL SCHOOL - NEW YORK
Surgical Assistant Program
1300 York Avenue
New York. ~ew York 10021
(212) 746-5133
COLORADO SLRGICAL ASSISTING. INC.
3033 S Parker Road
Market Tower One
Aurora. Colorado 80014
(303) 745-9509
CSA . C~TTifi~d Surgical Assistant
National Surgical Assistant Association
PROFESSIONAL
CODE
The purpose ofthis Code is to establish clearandethical parameters for the members
ofthe National Surgical AssistantAssodation. Should a memberviolate these Codes
or Standards of Professionalism, their Designation may be revoked for a period
of time, and/or they may be expelled from the Assodation.
11
1 The Surgical Assistant should maintain a
working relationship with all members of the
operating room team and adjunct hospital
personnel based on trust, honesty, confidence
and respect.
2 The Surgical Assistant should seek input, be
willing to accept praise as well as critidsm and
possess the ability to transform such criticism
in a constructive manner.
3 The Surgical Assistant must be involved in
"self" assessment and evaluation of each sur·
gical procedure that he/she will be required to
assist on. The process of formulating clear di­rection
tor best utilization of assistant skills
should be mandatory for full benefit to pa­tient,
surgeon, and other members of the op­erative
team.
4 The Surgical AssIstant must keep abreast ot
new technology WIth respect to surgIcal inter­vention
and Its pertmence to patient manage­ment.
5 The Surgical AssIstant must maintain a quality
standard ot contmuing medical education, as
described and set forth by NSAAstandards.
6 The Surgical Assistant must be aware of the
individual requirements or techniques of indi­vidual
surgeons.
7 The Surgical Assistant must have adequate
knowledge of basic sciences as reqUired by
his/her dutIes incidental to a particular surgi­cal
procedure.
8 The Surgical Assistant must be fully aware of
his/her position with respect to maintenance of
a sterile operative field, and have a working
knowledge of the basic principals and concepts
of sterilization and infection control.
9 The Surgical Assistant will possess a working
knowledge of all operating room procedures
with respect to attire, infection control, and be
familiar with individual requirements and rec­ommended
practices of compliance.
10 The Surgical Assistant will accept responsibility
for his/her integrity with respect to mainte­nance
and compliance, to and of these policies.
This will not only promote the individual assis­tant,
but will be of best interest to NSAA.
The Surgical Assistant must have the ability to
antOicipate the needs of the surgeon, and other
team members, with respect to the require­ments
of a partirular surgical procedure.
12 The Surgical Assistant must be able to demon­strate
and maintain dexterity sufficient to suc­cessful
completion of his/her assistant duties
on that partirular procedure.
13 The Surgical Assistant must maintain a profes­sional
attitude with respect to the dignity, pri­vacy,
and safety of the patient.
14 Most of all, the Surgical Assistant must possess
the ability to only function within the limits of
his/her ability, and within the description of
duties prOVided by his/her employer.
ATTACHMENT B
ARIZONA STATE LEGISLATURE
Fony-second Legislature - First Regular Session
JOINT HEALTH COMMITTEE OF REFERENCE
HEARING ON PHARMACIST PRACTITIONERS
AND SUNRISE REVIEWS OF HOLISTIC DENTISTS AND SURGICAL ASSISTANTS
Minutes of Meeting
Wednesday, November 15, 1995
Senate Hearing Room 1 - 1.30 p.m.
(Tape 1. Side A)
Cochair Day called the meeting to order at I 38 p.m and attendance was noted by the secretary.
\1enlbers Present
Senator Henderson
Senator Kennedv
Senator Peterson
Senator Day. Cochair
Senator Brewer
Representatl\ e Foster
Representative Aldridge
Representative Honon
Representative Preble
Representative Gerard. Cochair
Members Absent
Spea\..:ers Present
Kim Roner<.on. E\ecutl\e Director -\nzona Pharmac\ ASSOCiation (APA)
Terr. J Lee PreSident. -\nzona HoltslIc Dental -\ssoclation
Barbara \1aun.::e, Co-director. Coalilion of Concerned CHlzen:; for Freedom of ChOice for Dental
Care In -\rlzona. Clarl\dale reSident
Paul B \1i11:> Teacher of \1ath and Ph\slcs. '\racl1e Junct10n High School. Teacher of Algebra
thr()u~h Calculus Central -\nzona College
Karla Klrf-.i.1n,j C(i-dlrector. Coalition ol'C()ncerned Citizens tor Dental Care In Arizona
Cawllne Dlll1dul" (';II11P \'erde re,lde111 I ep' e<.entlng herself
KJthken C("i~lt: Ht:cht PelHla rt::>ldt:111
Delnen Lt:t' "-,chul:> DDS :>pt:;d'''I1~ (ill bt'ilall or' patient Loretta Shunma\. Snov.tla\..:e reSident
Larr. Krcd Ci-dlrector. Ct';llttlon nfConcerned Clllzens for Freedom of ChOIce for Dental Care in
-\f11l ' n,1 SClentl';l El11plo\t:t:. ·\nwn:1 Depanment of Environmental Qualitv (ADEQ)
Gan J Smith D [) S J [) . <.peal-:In:: a<. a concerned Arizona citizen knowledgeable in dental
rractlces 1:1\\ and dental sCIence
Glena Gil. \ Ie~J re~ldt.'nl
lI1ml I kalth Committee Pt' Rdcrence
I kann~ lIll I'hal1l1aU,,1 1'1 ;lctilHlIl<.:rs and
"lIlll he !{.:, I':'" ollloilsllC Iknllsh alld SUI ~Ical A"slSlanls
11/151')5
11115/95
David Farnswonh, State Legislator, District 4
Drew Langley, Director, Dental Board
Greg McFarland, Executive Director, Arizona Dental Association
Wesley Smith, Cenified Surgical Assistant, Tucson resident
Caryn Lee, Cenified Surgical Assistant
David Landrith, Vice President of Policy, Arizona Medical Association
Carolyn Machold, Operating Room Registered Nurse, Tucson resident
Guest List (Attachment 1)
• • •
PHARMACIST PRACTITI01'.f£RS
Cochair Day explained that the ponion of the meeting dealing with pharmacist practitioners will not
be an actual sunrise review because cenain legislation which was to be introduced in 1996 has been
withdrawn
Kim Roberson, Executive Director. Arizona Pharmacy Association (APA), said that the APA board
of directors decided 10 fonnally \\lIhdra\\ the appltcatlon tor expansion of the scope of practice She
said that the pharmacist IS the most available vet underutilized health care individual and that the
intent of the draft legIslation was not 10 create an adversanal relationship with physicians. but to offer
pharmacist services in providing sale medIcinal management
Ms Roberson emphaSIzed that mlnlnllZlOg medication misuse IS the APA's toremost Job
SL':'\RISE RE\'IEW OF HOLISTIC DE'\TISTS
Terrv J Lee. President. Anzona HoilstlC Dental -\ssocla!Ion. said he received hIs degree from the
Lnlvers1l\ of Southem Calttomla and has practiced dentlstr\ tor t\\ent\-flve \ears He e,plalned that
tifteen vears earlier. he attended a dental course on mercur. 1O\.IClt\ and learned that some indIViduals
are hlghlv senSlllve to sd\er merCUl\ fdllng~ He dalmed that mam ~u(h merCUl\-sen~lll\e patients
e'penence Impro\ ed health once therr tradlllon.ll lililngs are replaced \\ Ith compa!Ihle materials
Dr Lee ";-lId that holistiC dentlstl\ I' practiced In mam pans of the \\(Hld and ell1pha~lzed that
(our~e~ are nOI ~I\en h\ \ (Hldl)l) dOCW1S III ha ..·l.,·,treel ,llle\~ fk re\le\\ed the a~"O(latlons WIth
\\hlch he " Ill\ol\ed and mentlolled tl1.11 t\loent\ Ih)llstlc dentIsts current" prac!I(e In ·\rllona He
,k'Cflt'l'-1 tlll1hl:!t not ;\~ a \ I~lianle ('I 111I'Ir.lteci 1'11\ 'IClan. hut Instead a~ a dentl"t n h(\ h.l~ hundreds
\I!' 11('l:I' If' tl:lllllnc: :lnd 11.'CI1111(111e, \\illch tltl' DenIal Buard. III Its IlIlllted I..no\\kd:::l' does not
rl~~('~r1Ill' .t, \ ,lliJ
Dr L~l' renl.lflo..ellth:lltilc h:1tlle t,l :lliu\\ 111l11SII( ckntlslr. re\ol\es around lealous\ ~lnd philosophy.
.Ifld "'lmILI! 1,\ t1,lttie~ \\.1'::1.'.1 III till' 1'.1,1 l'el\\een tr:HJ'(lllnal and allernatl\e medical pr(I\lders
i kallll~ \l111'h;IIllI.I .. I'll·I.I.. III\l\IlCI~ anJ
'I lilt! 'C 1< ..'\ IC" , \1111\ >\ 1,IIC Ikntl~h anJ ~1I1 >!Ic~l r\~slslants
~ -
In response to Mrs Preble. Dr Lee explained that "compatible material" is a substance to which the
patient is not sensitive. and is usually comprised of a quanz acrylic composite. He said that blood
compatibility tests are used to determine \',hat materials a patient is or is not reactive to
Cochair Day questioned how such a small group of professionals will be able to fund a board and
investigate complaints Dr Lee replied that holistic dentists will probably follow the homeopathic
model for licensure. In addition. he speculated that such a small group of dentists will generate very
few complaints.
Cochair Day asked if Dr. Lee is in good standing with the Dental Board Dr Lee replied in the
negative and explained that pan of the problem is the Dental Board's philosophy
In response to Senator Henderson. Dr Lee explained that most traditional dentists use fillings
comprised of si!ver and mercury. the latter of which can be harmful to gums. surrounding bone,
various organs and the overall health of the patient
~1s. Honon mqUlred as to the funding mechanism for a board which represents only twenty holistic
dentists Dr Lee answered that plans are to fnance the board through license fees He added that
although holistic dentists practice throughout the country. there is no state which licenses them.
Cochair Dav asked if there is a college or Institution which otters courses in holistic dentistry.
Dr Lee replied that courses are current!v given bv difierent organizations He noted that the
UniverSllv of Anzona. as well as Har-ard and the UnIversity of Columbia. have depanments for
alternative medicine, and he rredlcted e'panslon In thIS tield at some point In the future
Cochair Da\ questioned \\ hether the L nlverstt\ of Arizona has a diVIsion for holtstlc dentistry
Dr Lee replied In the negative t1ut shared hiS heltefthat there IS an organIzatIon \',:hlch operates in the
Great Lll--es re!.!lon
In resp<)Ose 10 Senator Pl?tersen Or lee IndlCJICd thJt he IS currentlv before the Dental Board's
f()rmal heann~ process but that actt0n ha" not Vl'l been taken He explained that the Dental Board
prohlbll" ,knll<;lS from remo\ In~ ... Ii\ t'r l11l'rCUr\ lilllng". Int"ormlng patients that tiliings contain
mercu:v ;In(~ dl'-lnhutln!.! In('rl11:1tl(1n It'~;Hdln'..: ;Jllt'rn:Hlve cientlSln - -
~en:1ll'r I't'!t', ...c:n a"ked ho\\ 1113m (111h t' (,thet h(\!htl( <.Jenll<;!S III Arizona are under InveStlgallon by
the Dental B()3rd Dr Lee replied 111:\1 ,'ne otller uentlst b under tnvestlgatlon and thaI two others
hJ\t' t'een 1f1\e'-ll~ated m the past He (Hided th,lt hIS feIl0\\ holtstlc dentists mamtam a low protile
,Irod J .. fl," 1\ i"'t' their I(kntt!\ kno\\ n h'! fear l'! rt'l'f1s:\1 from the Dental Board
In rt·"lwn ...c t,\ C,..-h.llr (Icr:lrd 0: Lt't' Ilhll..-:ttd that the four complaints tiled against hIm dealt
l'r:n1.1fII\ \\ II!: :·:n:ln~'t:li IlUllt"r... I k t"l'i.llIlt'd tlLlt he(all~e the patients \\ere unable 10 meet theIr
!',I\!1lcI11 ... 'lot": .~l'n1.ll ",'Ik \\:1'" "'ll"'l't'n,!t",~ "hk'h Illlllm prompted the tiling ofc()mplalllts
( ,<lUI! (,,::,1'.1 ...:.llt"l 111:\111:111:11"11.11 ,k!llhh ,Ill' ll'pnll1:1ndecl hased on lhe merits ofa case \\hereas
Ih>il ... ll.. ,!t"I1!' ... h .llt' ,lllh'll1.I:I~.t1h 11I"·":t',! t',I ... t'd llll pl1i1(,,,pph\
1"11lt I k;i1lh l <'I 11 III I II.:.: <'I Rd.:n:ncc.:
I i'·.llillt-: "II l'h.1I11ld~I,1 \'I,I.:lIl1llll<:h and
'111111',· I{,·\ 1,'\\ ..... III'\\"II~ 1).:1111 ...1, al1J '>lllt:l..:a! ASSistants
11115/95
In response to Senator Petersen. Dr Lee explained that ill patients who have their silver mercury
fillings replaced tend to experience a noticeable recovery while healthy patients who have them
replaced for prevention purposes generall~' see no benefit and are more likely to be dissatisfied.
Barbara Maurice. Co-director. Coalition of Concerned Citizens for Freedom of Choice for Dental
Care in Arizona., Clarkdale resident. related that prior to the onset of ill health due to improper dental
care. she was employed by a major computer manufacturer for thiny years. She said that after
searching twelve years for an answer to her continuing health problems. she found a holistic dentist
who discovered that the primary cause of her infectious disease process was an improperly completed
root canal which drained toxic substances into her jaw bone and body.
In summary. Ms Maurice claimed that holistic dentistry is responsible for staning her recovery from
a variety of serious ailments (eg.. osteoporosIs. chronic fatigue. fibromialgia. tuberculosis-like
scarring in the lungs and constant pain) (For a hard copy of Ms. Maurice's prepared testimony. see
Attachment 2 )
Paul B Mills. Teacher of Math and PhYSICS. Apache Junction High School. Teacher of Algebra
through Calculus. Central Arizona College. related his professional credentials He explained that
he began to develop neurological problems In 19S2 and that his treatment included psychological
counseling and :'00 milligrams of DilantIn per dav to help control seizures ~1r 1\1ills explained that
In August of 1987. he sutfered a seizure \\ hile at hiS dentist's oHice. and that Dr Lee. who happened
to share the same office. suggested that silver mercury tillings may have contributed to some of the
health problems
:\1r \ll1ls reponed that the sJi\er merCll[\ liliings ""ere removed In October of 1987 and that by
Januarv of I9SS. even \vlthout the dad v treatment of Ddanlln. the seizures and other health svmptoms
were gone (For a hard CoPY of\1r \1dl's prepared testlmon~. see Attachment 3 )
I'arla I'lrl--i:\nJ Co-director. CCahlll)n nfConcerned Citizens for Dental Care In Anzpna. said that
. fl H ten \ e:H:- ... he su t1ered from EP:'1 elll- Barr S\ nd rome. depres~lon and borderline III pu ~ and was
dla~no~ed h\ il hOllleopatl1li.: ph\~I(I;In.h h:\\ln:: :-e\ere s\sterlllC candida. "e\ere 1l)'II': ,ntectlon of
the la\\ :1I1l! illlt':m Cl)Jll1ltlOI1 ·\t tile il.!\I(e \'1 lhe illllllel\p.llhl": ph\"I(I.1n. "ht.' "aid ... ht.' ....1\\ .\ hl\ltstlc
dentl"l :\f1d f1,'!lceci that hl'f ile:lllh Illlpll1\ed :\!ll'r e;\ch lkntal \1:-11 ~he repL\neG tlut ,he even
dt' \ ej (' I' L' d ,! : i ;i ,. hI(1 \ \ n 'II L' J1 1111 L' c: I "1[1 ,\: t!1L' ile:\ n \\ ill (h \\ a, tr; I(e.! I" ,I \ \ I'd('l1\ 1<' I '1 h L' q rae II 0 n
pertc)rmea 111 i 'lSS 111 \\illch tilt' dellll,t t.llied 1\\ 1L'l1ll1\e 111L' perll\dl1[1\ai l11el11br;lf1e
(ar()i,nt: l)llr~JUII'> (,1111['\ \ erde rL',>ldel1i Il'lHt: ... t.'nllr1~ hL'rselt'. st;lled that "he \\a~ lhlr1~ I\\P \'ears
L',lflle! ',\I1,'n ,1 d,'c!('r l\lld hL'r \ll;\ Illl/"I'" dL'1111~1 -;ite repuned lhat her health h,I:- been Improving
,1f1,,'L' IiI,' Il"i"!k dL'nl',,: renll1\L'l1 :t11 (\filL'! '11\t.'r I11L'r,,'W, til11l1,:.!s (For J hard CPP\ llf \J.;, Dundults's
['rep:lfL'd le,tllllP!1\ 'L'e ·\tL1(11I1lL'nl ... I
f-...,lthkef1 t ("'"Ie Ik,,'!n 1','1'11:1 1ZL',>lden! ,.IIJ Ilut ,he \\:1::. dla::nl\~L'd 1\\L'nt\ \L';tr~ e.Hiler with
mUltIfile ",,'kl,',', :m.1 \\.h \\llt.'t.'k·h:lII h"llIhj 1'\ IllS';;' ShL' Illentloned that h\ In~estlll~ Chinese herbs.
,he \\:h ,It'lt.' I" eilfllJn.lle tilt.' Illllllt1f1L'" 111 ilel lelt (lrlll but \\a~ sldlunable 10 u::.e that arm
I, 'illl I k.t1th \. ..IllIllIII"·..· "I !{.:I<.:t.:m;.:
I k:'III1t: "" l'h:II111.1':',1 1'1 ,ldlll""':I" and
"11I1I1'C: 1<.:\ IC:\\' ,.'·11. ,Ii,tl': Ikill I'\- .111,1 "III L:1.::t1 '\'"hlanls
~ I 1'15/')5
Ms. Hecht explained that in 1994 she required dental work and noticed that some of her multiple
sclerosis symptoms returned After a dental procedure was completed by Dr Lee, she said that she
was able to type with the left hand that had been useless for twelve years
Ms. Hecht beseeched the Committee not to eltminate holistic dentistry as a choice for those looking
for options
Delbert Lee Nichols, DDS, speaking on behalf of patient Loretta Shumway, Snowflake resident,
who was not in attendance, reported that Mrs Shumway sought his services ten years earlier for two
broken fillings. He said that Mrs. Shumway· subsequently decided to have all her silver mercury
fillings replaced and has since experienced an increased energy level.
Larry Krcil, Co-director, Coalition of Concerned Citizens for Freedom of Choice for Dental Care in
Arizona; ScientistlEmployee, Arizona Department of Environmental Quality (ADEQ), reported that
he began to expenence health problems which advanced over the years to the point that he was forced
to take medical leave and disabilitv in 1994 He said that a medical doctor reviewing his health
history noticed that the onset of phvslcal Illness coincided with a root canal performed in 1983 and
referred him to Dr Terry Lee, a holistiC dentist He said that although possessed of a skeptical and
scientific mind, he submitted to holistiC dentistrY and received a second chance at life
Mr. Krcil asked that his freedom of choice as an informed dental consumer be protected, and he
requested support for the establishment of a separate board for holistic/alternative working solutions.
(For a hard copy ofMr Krcll's prepared testlmon\', see Attachment 5 )
Gar\' J Smith. DDS. J D . speakll1~ as a concerned Arizona CItizen kno\'\:led~eable In dental
practices. la\\ and dental sCIence. related that he and hIS \\Ife made an Intormed deCISion to have their
sliver merCUf\ lillln~s remo\ed He said II IS trollblln~ thaI gO\ernment feels entitled to claim lack
o[sltff'ClL'II' 'ClL'l/fl/ic L'\'/dl'lIcl' and Inlrude upon the health care deCISIons of pnvate clttzens
Dr SmIth pro\1ded the Committee wllh unoniclal transcnpts of the t\\O most recent meetings of the
Dental Board (Attachments 6 and 7 - tiled \\I!h anginal minutes In the Office of the Chief Clerk) and
dre\\ allentlOn to an e,chan~e fr0r11 the OC10ber :Oth meelln:; (-\ttachment - page I:. lines 9
throu~h : II \\ hlch addresses the dilh.>renl denIal rhdos0rhle"
In summ;1!, Dr ~mtlh rel111e'led lhal ~'1117t'n, nl't be denIed ;\Ccess In InfOrmall()n and Ilnhstlc dental
care
(ilen.l (It! \k,.l rL'-;ldent <lId th;lt ,ilL' \ 1'11Cd t\\(1 dL'ntlsts \..110 refused her request 1,\ t"tract all her
tt:eth ~ht' ';;:IIc1 lhal CIH1{)~ln~ 'lich Jl1 "l'IIPn I' her f1~I1t
Da\ld Farn.;\\\'nn Slale l t:::I"lalOl DI"lrtCI ~ l'plned that the hoilSIIC dt:ntlSI dt:l1ate mtnnges on
lreedom 01 ch(\lct' ! k C!:lIn1l'cl th:11 \\ hen hnarcts or or~,wlzatI0ns are ~ranted p0\\ers thev tend to
abuse th0se r(H\er,
:, '1111 I k.i1tll l, '11l1l1l11~~· <>, \{dt.:n:nLt.:
I k;lIlll~ ,Ill i'I1.11111;1'-I" I ;1.l~lItll'Il<:I" ;mJ
"111lI1''''!{C\lc\\,,'III,,\i'lIL Ikntlsh anJ .... ul~lLal ASSIstants
.:; 111\:5/95
Drew Langley, Director, Dental Board, said that although choice is good, the Dental Board is bound
to comply with statutory regulations He pointed out that Dr Lee has tour complaints in the formal
hearing process -- three of which were filed by patients with the remaining complaint being filed by
the Dental Board
Dr Langley asserted that the Dental Board does not prevent the distribution of information as long
as that information is valid Further, he pointed out that the Board was unable to tind an accredited
holistic dental school in the state or anywhere else in the world, and that holistic dentistry is not a
recognized specialty by the American Dental Association,
(Tape 1, Side B)
Dr. Langley stated that the Board is against dentists broadly stating that everyone should have their
silver mercury fillings removed
Dr Langley stated that protection of the public would not be improved by the addition of a separate
holistic dentistry regulating board
Cochair Gerard repeated Dr Lee's comment that holistic dentists cannot even discuss silver mercury
fillings with patients Dr Langlev said that the Dental Board restricts against making false
statements For Instance, he explained that a patient may request that a cracked filling be replaced
with a composlle matena!. but specltied that a dentist may not make a blanket statement that patients
should have sliver mercur.' tillings removed
In response to Cochair Gerard, Dr Langlev Indicated that It IS unethical by American Dental
ASSOCiatIon standards to remo\e sll\er Illercur" tillmgs WIthout a patient diagnOSIs
\1r -\Idnd!:!e pOinted out that the Dental Board Itself has a less than sparkling record Given that
holls!IC denll~lS as a base, IllUSt obtain a degree from a certltied school and pass the state board. he
Cjuestloned \\11\ the Dental Board chooses not to accept their dinerent philosoph~ Dr Langley
rephed that 1tH~ Dental Board reacts to patient complamts and IS ver. proud of IlS slngle-dlgll case
bad.lo!.:
\Ir ·\Idrld~t' U,Jt:~tloned the rea~on 1('1 the ,,'onllIC! bet\\een traditional and holiStiC dentists He
repeated ltl,ll hOlistiC dentlsb are bo;m1 certified and stated that any dental praclllloner should have
the nrtlnn ('I t'ntenn~ Into hnilstk dentlstf\ \Ir -\Idndge Cjueslloned the linanclal feaSibility of
t·,rJbJI,tlll1~ ,I 't'f'.lr:lle b(J;lrd lor t\\t'nt\ dentl'!'> ;Ind therefore suggested that a hohstlc dentist serJe
on the Den!;l! Bpard Dr Langie\ cOllllllented that Dental Board members are appointed by the
(1l1\ ern,\~ IIt- 'lJld n(\ jler"nn:ll nh,ectlpn to the suggestion but pOinted out that hIS charge IS to
1(111(1\\ !I'l' :,1\\ ,I' cllllt'ntl\ \\II!ten
In re~t'(II""t' !.' \lr ,\Idnci~e [)r LUl~It'\ ~hMed IllS opll1lon that holistiC dentlstf\' helps some people
fl(,\\t'\L'r Ill' t'lllnted ('lII llnl lIlltli 11lllTe ,-clentllie c\ldence IS available, humans cannot be used as
1''1111 I kalllll'''I11I11Ilh.:..: ,'I 1{.:I..:I.<:n.:.:
I k';\1I11!2 "11 l'hal111;1..:1....1 1'1.;1.:1I1 lont:I.S and
"11111 h,,' !{L'\ 1,,'\\ ... "II h,It ...II': lknllsh and Sur~l.:al ASSistants
6 11J1.5/l).5
Mr Aldridge said it is surprising to see how many developments which were ignored several years
ago have since proven to be on the cutting edge of treatment As an example, he commented that
the legislature has heard no complaints about the Homeopathic Medical Board while the Board of
Medical Examiners (BOMEX) continues to be burdened with a heavy backlog of cases Dr Langley
indicated that as standards of care are developed over the years through scientific evidence. holistic
dentistry Olav become the path of the future
Cochair Day stated that the market is demanding greater integration between the scopes of practice
.and discipline. and said that the market must resolve its conflicts without funher regulation.
In response to Ms Honon. Dr Langley stated that the Dental Board is collecting facts against
Dr Lee and said that this process IS being mIsrepresented to the legislature.
In response to Ms. Honon, Dr Langley said that until new scientific data results in modified
standards from respected agencies such as the American Dental Association and the National Institute
of Health, the Dental Board must accept \vhat IS taught in dental schools.
Ms Horton asked if the Dental Board is attemptmg to shut down the practice of holistic dentistry.
Dr Langlev replied in the negatl\e
Ms Horton stated that twenty dentists should not be prohibited from otfering alternative dentistry
simply because thev have a dltferent philosophv. and she questioned why the traditional and holistic
dentists do not ll\' harder to get along Dr Langlev repeated that the Dental Board is obligated to
review IndiVidual patient complaints to determme whether harm was done to the patient so that
appropriate action can be taken
Coch:m (Jerard rO!nted out that It I" unl~lIr {(1 COl11p;ue 80\1E:\ to the Homeopathic 1\1edlcal Board
hecause BO\lE:\ llcen"es 10.000 ph\ "IClans \\ hill' the HOl11eopathlc \1edical Board licenses 66. less
than :'11 of\dllch rractlce \\lth!n Arizona To Dr L:lI1glev she stated that the enltre conthct between
lradltll)nal and holistiC dentists 1:- extrel11el\ pfel11;lture hecau~e people v. ho deSIre holtstlc dentIstry
are m)! pre\ enled access III Il
(jre~ \lcF:uland Executl\e Director 4.flZnna lkntal 4.SS0clatlon. concurred \\lIh Of Langley's
comn1t'nt:- ,1{)l)U! SClentlt'lC data and 'c!!I)ol, and pl'mled l'Llt that the Committee IS entertaJnm~ a
prorl',,;1! lr()!11 an anol1\'mous group of !'eople \\ hI' J,) nnt pos"ess speCIal accredltatloll from a school
Dr \lct,lfl.lfhl ',lid th,lt Ireedn!11 ()lcilpl(\.' 111 d\.'nll ...ll\ alreach eXIsts He explatned that less than one
1'\.'[ ~ t"': ,,! : !It' :'1 'rUI;1W)n l1Ia\ ex 11L'11\.'I1~'t: ;1!1 ,II kr ~ IC feaCtlOn to mercury. and saId that such cases
... 11I'1I',: !'t' 1\.'lt'rr\.'{j 11' ,1l'1'II'!'ILll\.' In\.·dl~',\! !'l.kll(lI)flt:r, lie emphaSized that absolutelv nothtng
l'f(,'\\.'f1h:l ,1''''l,': 111 '\117()I1,l 11"111 r\..'111(1\1I1-.: liliJ,,~, tnf allef~lc or aesthetIC reasons, and clallned that
;!1'CII'I!!1,If\ .1,llIlfl nill Ill'l I',' LI~e!1 III ~',I'\.'''' nll,'l\.' the rendering of services IS deellled necessary
Sen:HPf Peler,en "lI!.!::e"lt:d lil:\1 ralle"", could 'I~n a letter stating that there IS no proof that
1,'nll)\I"'.: "'Ii\\.'r l1lt:r,,'lIf\ ,'111111:'::- \\111 ""!)f(l\t: h\..'allh Dr \1cFarland replied that an "informed
((1n,\.':1; 1'.\ ,:,1\'\1111\.'111 "'1-.:11\.'d h :11',111,'111 \\ 11\,,'11 IdentIties tl1lll!:!S that m,l\" or ma,' not occur
1""11 I k;dl!l l, 1111111111\'<: "I R<:kn.:n\:t:
i k,lIlllt: I III 1'!l;lI111;I<:I 1 I', ;1<:lilillll<:l" and
.... 'lIlIl', I<~'\ 1,'\\, .,111,,11,11<: I kllll"''' ;1111.1 m~I<::)1 i\""I"lams
11115/')5
Mr. Aldridge mentioned that more than a hundred traditional dentists have phoned his office and he
asked if the concern over the twenty holistic dentists is the result of a turf war. Dr, McFarland
claimed that there is no vendetta against holistic dentists,
Mr. Aldridge moved that the Committee recommend that the legislature have
a holistic dentist serve on the Dent;,1 Bm,rd. I\ls. Horton seconded the motion.
Cochair Day remarked that a motion regarding Dental Board membership would be more
appropriately made during Dental Board hearings
Mr. Aldridge withdrew his motion with approv;" of the second.
Cochair Gerard moved that based on information presented in Committee, the
Committee recommend that no action be taken for licensure of a separate
holistic dental hoard. Mrs. Preble seconded the motion.
Cochair Gerard said there IS no e\ldence that holistic dentists are being put out of business,
However. she shared her opinIon that the Comlmttee should recommend that the Dental Board work
with holistic dentists to resolve am concerns
Cochair Day mentIOned that establishment of a separate board is highly unlikely given the small
number of holistic dentIsts
The motion carried by a ma.jority voice \"ote.
SL"\."RISE RE\'IE\\' OF SLRGIC-\L -\SSIST -\"\."TS
\\'esle\ Smith C'enlf,ed Sur~IGli ASSistant, Tucson resident. e,plalned that there are twenty-six
certified sur~lcal assistants In -'\fizona He said that hiS rractlce In Tucson performs about 1.000
surgICal case~ per \ear and ;b"ISt~ el~hl\ "Ul~el)fb Il1llle Tucsl)f1 area He requested licensure tor the
follo\\ In\.! rea,ons
-\ re~ulatln~ hoard \\ ill nlrer belter dlsclp~lne for cenltied surgical assIstants
Because cen,fled sU'~lcal assI"t;lnb are nut licensed. Ihe Afizona Health Care Cost
(l)ntatnment :-;\ stell) I ·\lleeeS I iLl" fe\ oked 11" prOVIder number
\11' .... mllh e\rl:llned that an tndl\ldu:li 1l1U'\t cOlllplete ""tv hours of prerequisite coursework.
C,)Il1f\lete ;1 '1Ir\.!h::al tecllnnlng\ pfO~rall1. "Ild "pend at least fl\e vears In an operating room as a
'llr~IC.111l'C:1n\\I(':'!'1 I'l'lor\.' .11'1'1\111:' II': till' '11f\.!lcd :ISSI~I:Jnt pwgram He added that the aspiring
"ur~lcal as",Q:1nt must then complete mme tll:Jn 7"(1 hours In surgef'\' each year tor three vears before
;ll1pl\ In~ II H Cl'rlilic:Jtlnn
J"II1! II.:allh l "111111111.:.: ,I! I<d':l~m;.:
Ikanl1t: "11 l'hal11l;lel,1 1'I'a..:l II 1"11":1 " al1J
'011\11 I'..: i<.~'\ 1':\\' "I II,dhlll: 1)':1111,,'" allJ ...111 ~Ieal :\'''htanh
S 11/1 :')/'):')
In response to Cochair Gerard. Mr Smith said that none of the states presently license certified
surgical assistants. He advised that certification is obtained through the National Surgical Assisting
Association. and that coursework varies per school
In response to Cochair Gerard. Mr Smith indicated that he functions primarily as a cardio-thorasic
surgery assistant He explained that in all hospitals in the Tucson area except one. he is allowed to
remove vein from a patient's leg for bypass surgery He reviewed the other surgeries in which he is
qualified to assist.
Mr Smith said that aside from his privileges to perform a particular minor surgery, he is responsible
for assisting the surgeon by draping patients. retracting tissue and exposing the operating tield area,
clamping and drying vessels, and keeping the operative site dry
Cochair Gerard questioned how certified surgical assistants differ from surgical nurses Mr Smith
explained that his training is utilized onl~' in the operating room and does not include any nursing
services He mentioned that some 11Ighlv trained registered nurses and physicians assistants have
expanded their scope of practice to Include surgical assisting
Mr Smith stated that he has hundreds of signatures of support from surgeons. nurses. operating room
directors and adminIstrators CochaIr Oav menlloned that all the associations whIch signed up to
testify on the matter are not In support of certlticatlon for surgIcal assistants
In response to Cochair Da\', Mr Smith explained that AHCCCS stripped surgical assIstants of their
prOVIder number slmplv because the\ were not licensed
In response to Cochair Oa\'. \1r Smith mdlcated that a nev, speclalt\' \>,·ill not be created because
surgical assistants haw ah\a\ sheen utIlized In the operating room He said that -\HCCCS. a major
contract. no 10nger relll1burses surglcd ,1sslstants hut that most msurance C0mranlt~s d0 reimburse
because the\ recognIze that the lield of non-tixed surgical assistants \>,111 grow III the luture
\Ir Smith expressed tear that loss of -\HCCCS and FHP relmhursement mIght estahll,h :1 p:lltern that
Insurance C\11llP:inles \\I1llc.lI()\\ He "tated that sur~lcal a~Slqanh d() n(1t retuse JTl\ 'lIr~er. hut do
ma~e an etrpn IC' a\ Old procedures h:lnrlled b\ \ 1edlcare -
Cochair D.I\ 'liggesled th;lt the 1"'lIe ~',Ildd bl.' dl,tined .1'-;\ (nntraCl<1r agreemenl pfllbkm hetween
sur!,!lcal as"I"t3nts and the hosPllal~ "urger. center" \1r SmIth replied III the ne!,!atl\ t' Jnd explained
ttMt "lIrglc.li .1"-1'1.1nl' (1\1 n(ll \\<11 ~ 1(lf flit' 11("-1'11:\1, hllt mereh hd\t' 1'r1\ Iie:,.:e' Il' I't'rll l fll1 ,er.·lces
:It hC"T'lt:I" I:~ ,tCd'l d.lIh:~ \\ tIll h,I'III!.t! Il';':Ul.tll\lIh
Reternn:= h' 1111.' h,\nd\llll t'nll1kd \\ \.· ... t ( \l:hl SlIl::II.::11 Speclalhh ('\ll:lchlllt:nt S - likd \\lIh ongmal
1l11nute" In thL' Ot1ice (It' rhe elHet' Cler~) \1rs Preble as~ed If De:ln Dalen al the l nl\'ersltv of
\nz('nJ CPlhl'l1te<1 t(, ,e(\l'.b Ch:lIfm:1I1 (Irllle £Soard \1r Smith replied In the nt'::.1tl\e and said that
am rt1\SIC1:1n ~'()IJid "er. t' :h Chalrm.ln
:.'1111 I k.dlill "11111l11k~ ,,1 l<ci<:l<:lll:<:
i 1<:;111111.: "111'11.11111.1,,1': \'1.1,11111'11<:1, .IIlJ
.... 11111""· 1<,,'11 ..'\\,"111,1\"11": ikl1ll'" .111.1 .... llIl.:k.Ji \,,"1;1111-
q I I 1)/1))
Cochair Day asked whether BOMEX, the Arizona Hospital Association or any nursing associations
were consulted prior to drafting of the proposal for certification (Attachment 8). Mr Smith replied
that meetings were held with the National Surgical Association.
Caryn Lee, Certified Surgical Assistant, said that for many years, a second physician fulfilled the role
of surgical assistant. She said that the certified surgical assistant profession is increasing
tremendously because many physicians can no longer spend four hours each day assisting in surgery
Ms. Lee explained that because of the increased demand for qualified certified surgical 'assistants,
there has been an increase in //llq//o/{j/eJ certitied surgical assistants
(Tape 2, Side A)
Ms. Lee noted that AHCCCS granted a provider status number in 1994 but revoked it six months
later because certified surgical assistants were not licensed. She said that the majority of trauma calls
she responds to are AHCCCS cases and that she often works all night on these cases only to learn
later that she cannot be reimbursed
\.1s Lee mentioned that each hospital facility has ditTerent regulations and she emphasized that every
patient deserves quality care
In response to Mrs Preble. Ms Lee mdicated that she attended the Arizona College of Medical
Careers in Phoemx which has been closed tor seven years She gave a history of her work experience
and traininl!
David Landnth. \'Ice President of Polic\'. :\nzona Medical Association. spoke against the sunrise
proposal for surgical assistants and confessed to an overwhelming ignorance of the profession He
c"pressed concern that the sunrISe proposal consists of a two-page letter. which does not seem to
compl\ \\1111 ~unnse prO\ISIUnS, and Oilers drali legislation which was developed simply bv taking
current ~tatute appl\ln~ to pl1\SIC}:\Ih ;h~l~tant~ and substituting "surgical a~slstant" for "phvsician
aSSistant" He mentioned that thiS I~ the reason \\hv Dean Dalen's name appears In the proposal
\1r Landnth mentioned that he onl\ ";:1\\ the prorosal the prevIous day and said that on further
ched:mg, hl' !()und th,lt BO\1E:\. the-\nzona HOSf1ll,ll and Healthcare ASSOCiation. the Osteopathic
-\SSOCI3tlon. tile '-..urses ASSOCiation and other aSS()CI:llions In the health care tield 'Were not consulted
He said tnat hased on the proposal (Attachment S), there IS no \\aV [0 determine If there IS Indeed a
prohiem
In adaltl"n \ Ir Lindrith pl11nteJ oul Ih:l1 til\,' prop(1-;ed Iicensmg board funding scheme IS un'Workable
and \,til (1nl\ ::ener:ue S::,:'II(I!ll S~ (1(11/ a \c:n·· one-tlmd of the COSt ora clencal pOSItIon He
\.'ll1pha~lze(j Ih:ll pI1\"I":I:\f1::> \\110 \,ele n(\t ..:(\n~ulled ahout the proposal. \\t11 be expected to subSIdize
t hiS re~u 1;11 (\(\ ".: 11 \,'111 C
\1r Landrith ~:\Id 111:11 In leallt\ 1I11l1Llaiitied people ma\' not be runnmg amok through hospitals
p\.'rt'()rnlln~ ~lIr~\.'(\ hCCdth\,' !l(\,,;pII.1b \""tahllsh their own cfltena Funher. he saId it IS a revealing
.1111111 I kallh L\1111111l1l1':": lll· Rdl:I..:nl.:t:
I kallll~ \111 l'ha1111a-:I,,1 1'lal.:lIlllllll.:I" and
"111111 .....: 1<..:\ 1\.'\\'" llili. lhsill.: Iknllsh and SUI\lI\;al A...sI"tanb
10 ' 1111.5/'))
message that AHCCCS discontinued the provider number and he encouraged the Committee to
consult AHCCCS and request the basis tor this decision
In summary. Mr Landrith stated that not enough information is available to determine the merit of
the idea, public safety or sutliciency of standards On basis of lack of knowledge, he opposed the
proposal for licensure of certified surgical assistants
Carolyn Machold, Operating Room Registered Nurse, Tucson resident, said that although opposed
to the issue before the Committee, she is not necessarily opposed to regulation of unlicensed assisted
personnel in the operating room She said she shudders to think what could happen to her own
license every time she is responsible for an unlicensed person in the operating room. She pointed out
that although she and Mr Smith basically perform the same job in the operating room, she holds a
bachelor's degree and master's degree
i\1s Machold remarked that based on previous testimony, the issue of primary importance for
certified surgical assistants seems to be reimbursement as opposed to the provision of health care.
She noted that standards. regulation and scope of practice are the primary issues of concern for
providers
In closing. \ls ;"'1achold said that although she supports the concept of regulation tor surgical
assistants. the proposal before the Committee does not adequately address the issues required for
sunnse
Cochair Ger:lrd recommended against licensure for the time being ;lIJd
suggested that certified surgical assistants spend time in 1995 working with
nursing llssociations, BO!'l EX, doctors of osteopl1th l1nd hospital associations.
and then come before the legislature with an agreement. Cochair Day seconded
the motion. The motion carried hy a majorit~· voice vote.
'Ir Smllh ::lpologlzed and saId he \\as not a\\are that so man\ other aSSOCIatIons had to be Involved
In the dneil1pmenl ot' the proposal
.:tu fAA ~ _
Teresa .~taf\
.IIIIn! I kalth L(lIlH11Illl:<: (It' Ikli.:n:m:e
I kannt: t\n !'h:l11l1al.:l,;t !'ral.:1I1IOnt:rs and
"111111 ....: 1<..:\ 1':\\ ... 1I111(lI1 ... l"; D<:nllSts and SurCIl.::J! ASSIstants
II • I III 5!':!5