Legislative Update

2019 Legislative Wrap-Up
Christopher L. Nuland, Esq.
May 4, 2019

Amidst the usual last-minute shenanigans and deal-making, I am happy to report that, overall, we had an extraordinary 2019 Legislative Session. Not only did we pass SB 732, which will regulate office facilities and their owners, but we also had an extraordinary Session in other arenas.

On the defensive front, we thwarted all attempts at Scope of Practice expansion, including pharmacists, nurse practitioners, and physician assistants. While Scope Expansion remains a fundamental part of the House Health Care package, the steadfast support of the Senate Leadership and Governor Desantis was successful in stopping the expansion efforts in the Senate.

We also worked hard to ensure that any Telehealth Bill would require out-of-state physicians to procure a full Florida license. While the Legislature ultimately did not require full licensing, it did include in its bill a requirement that such physicians remain accountable to both the Florida courts and Board of Medicine, and the bill also included requirements to maintain the in-person standard of care and a prohibition on insurers requiring the use of telemedicine.

On the offensive front, we had the most successful session in recent memory. While we certainly did not get everything we wanted, HB 843 (which passed during the last week of Session) addressed many of our most important issues, such as:

· A requirement that a patient’s physician would be notified of any hospital admission;
· The ability of ambulatory surgery centers to keep patients for up to 24 hours;
· The expansion of last year’s Direct Primary Care agreements to all specialties;
· A prohibition on redundant step therapy.

Thank you to everybody who visited Tallahassee, contacted a legislator, or even emailed me with an insightful comment. Your work was instrumental in our success, and your profession and patients thank you for your advocacy.


FSPS Passes Monumental Office Surgery Reform Package
Christopher L. Nuland, Esq.
April 30, 2019

After years of effort, the Florida Legislature today voted favorably on the final passage of SB 732, the most sweeping change to the State’s Office Surgery Statutes in two decades.

Spurred by the torrent of adverse incidents from certain clinics, the bill’s sponsors introduced legislation to address the problems. The initial bills, however, were fundamentally flawed, and the FSPS worked feverishly to amend the legislation to regulate the bad actors while minimizing the impact on reputable plastic surgeons.

While existing law allows the Board of Medicine only to regulate physicians, the new law will allow the Board to discipline not only the doctors, but also the owners and operators of such facilities, as well as the facilities themselves. Each facility also must have a “designated physician” who is responsible for the overall compliance of a facility. The bill also requires each facility to meet the same financial responsibility standards that are currently imposed on physicians. For those who opt for state inspections, such inspections may now be unannounced. These changes are made to ensure that all responsible parties act appropriately, and that sub-standard facilities cannot merely reincorporate under a new name and avoid administrative and civil action.

Scofflaws, who choose not to register or otherwise violate the new law, are subject to fines of up to $5,000 per day.

We have many people to thank for the success of the bill, the first obviously being the bill’s fine sponsors, Senator Anitere Flores and Representative Anthony Rodriguez. FSPS Legislative Chairman Enrique J. Fernandez, M.D. also must be congratulated for his leadership, and I would be remiss if I did not thank Jeff Scott and Mary Thomas from the FMA, BOM Counsel Ed Tellechea, and literally scores of other interested parties who helped create a product that will truly save lives.


As we write this, we are on day 37 of the 60 day Florida Legislative Session, during which Office Surgery and Scope of Practice issues have taken center stage.

In the wake of several death in office surgeries, the FSPS teamed with Senator Anitere Flores and Representative Anthony Rodriguez to introduce SB 732 and HB 933, respectively, to address shortcomings in the Florida law. As amended (with FSPS’s input and support), the bills would, for the first time, make the office facilities, owners, operators, and physicians all susceptible to discipline for violations of the State’s Office Surgery Rule. Current Law only allows the Board of Medicine to discipline the surgeon, and it has been discovered that several unscrupulous practices, owned by non-physicians, have escaped responsibility for substandard care. The bills have each passed two committees in each chamber, and it is anticipated that each will pass its Appropriations stop next week. Finally passage is then expected in the final two weeks of Session.

On Scope of Practice matters, HB 821, which would allow independent practice of Nurse Practitioners and PAs, yesterday passed its last House committee over FSPS objections and is expected to be passed by the House. The FSPS has, however, secured support in the Senate to stop the bill, and we expect that support to prevent final passage of the bill.

The FSPS has also been working with the Board of Medicine on the BBL issue. A special meeting was convened last week, during which the FSPS provided testimony that the intra-muscular injection of fat into the gluteal muscle is beneath the standard of care. The Board of Medicine agreed, and formal rule-making is expected to start within the next few weeks.

We hope that the above is useful. Should you have any questions, please feel free to contact Chris Nuland at nulandlaw@aol.com.