Report to the General Assembly
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Report to the General Assembly Scope of Practice Review Committee Report on a Definition of Surgery Raul Pino, MD, MPH, Commissioner February 1, 2017 State of Connecticut Department of Public Health 410 Capitol Avenue P.O. Box 340308 Hartford, CT 06134-0308 State of Connecticut Department of Public Health Report to the General Assembly Scope of Practice Review Committee Report on a Definition of Surgery Table of Contents Executive Summary ..................................................................................................................... 3 Background ..................................................................................................................................... 4 Scope of Practice Request ......................................................................................................... 4 Impact Statements and Responses to Impact Statements .......................................... 5 Scope of Practice Review Committee Membership ........................................................ 6 Scope of Practice Review Committee Evaluation of Request ..................................... 7 Findings/Conclusions .............................................................................................................. 12 P a g e |2 Executive Summary In accordance with Connecticut General Statutes Section 19a-16d, the Connecticut Chapter of the American College of Surgeons Professional Association, Inc. (CCACS) submitted a scope of practice request to the Department of Public Health to adopt a definition of surgery in the Connecticut General Statutes. The definition proposed is based on formal definition adopted by the American Medical Association with the approval of various national specialty societies. The term “surgery” is referenced in the Connecticut General Statutes but undefined. The CCACS believes that the lack of a definition can make standards and requirements for surgery difficult for the public to understand. The CCACS states that public health and safety will not technically be harmed without establishing a definition in statute, but that quality and safety can be improved with a standard definition. The CCACS’ request states that adopting a definition of surgery is not expected to impact access to health care and not expected to increase healthcare costs. The CCACS asserts that the proposed definition of surgery will not impact other professions ability to practice to the full extent of their training, education and licensure in Connecticut. The Department received impact statements from physician and non-physician professional associations and individuals. Physician associations were in favor of establishing a definition of surgery. However, non-physician associations and individuals expressed varied ranges of concern and opposition to establishing a definition of surgery in statute. The primary concern expressed by those opposed to the proposal was that it would have a negative impact on their ability to practice their profession to the full extent of their training, education and licensure. A scope of practice review committee was established to review and evaluate the request as well as impact statements submitted in response to the request. The committee met three times and opinions remained divided between the physician and non-physician members represented on the committee. The physician participants expressed almost unanimous strong support for adopting a definition of surgery. The non-physician participants expressed opinions to the proposal that ranged from concern to strong opposition. P a g e |3 Background Connecticut General Statutes Sections 19a-16d through 19a-16f delineate a process for the submission and review of requests from health care professions seeking to revise or establish a scope of practice prior to consideration by the General Assembly. Under the provisions of this act, persons or entities acting on behalf of a health care profession that may be directly impacted by a scope of practice request may submit a written impact statement to the Department of Public Health. The Commissioner of Public Health shall, within available appropriations, establish and appoint members to a scope of practice review committee for each timely scope of practice request received by the Department. Committees shall consist of the following members: 1. Two members recommended by the requestor to represent the health care profession making the scope of practice request; 2. Two members recommended by each person or entity that has submitted a written impact statement, to represent the health care profession(s) directly impacted by the scope of practice request; and 3. The Commissioner of Public Health or the Commissioner’s designee, who shall serve as an ex-officio, non-voting member of the committee. Scope of practice review committees shall review and evaluate the scope of practice request, subsequent written responses to the request and any other information the committee deems relevant to the scope of practice request. Such review and evaluation shall include, but not be limited to, an assessment of any public health and safety risks that may be associated with the request, whether the request may enhance access to quality and affordable health care and whether the request enhances the ability of the profession to practice to the full extent of the profession’s education and training. Upon concluding its review and evaluation of the scope of practice request, the committee shall provide its findings to the joint standing committee of the General Assembly having cognizance of matters relating to public health. The Department of Public Health is responsible for receiving requests and for establishing and providing support to the review committees, within available appropriations. Scope of Practice Request The Connecticut Chapter of the American College of Surgeons Professional Association, Inc. (CCACS) submitted a scope of practice request to adopt a formal definition of surgery in the Connecticut General Statutes (Appendix C). The request was submitted by the CCACS in cooperation with the American College of Surgeons, the Connecticut State Medical Society, the Connecticut Dermatology and Dermatologic Surgery Society, the Connecticut Ear, Nose and Throat (ENT) Society, the Connecticut Society of Eye Physicians, the Connecticut Orthopaedic Society, and the Connecticut Urology Society. The request highlights that the P a g e |4 term “surgery” is referenced many times in the Connecticut General Statutes with privileges granted to a number of licensed professionals, but there is not a specific definition in the Connecticut General Statutes. The definition of surgery proposed by the CCACS was based on the American Medical Association’s definition of surgery as taken from the American College of Surgeons Statement ST-11: “Surgery” is defined as the structural alteration of the human body by cutting into, destroying, transposing, adding or removing live human tissue for the diagnosis and/or treatment of medical conditions. “Surgery” may be performed by mechanical instruments such as scalpels, probes, and needles, or by instruments that use thermal or light based energies, electromagnetic or chemical means, and high pressure water jets to cut, burn, vaporize, freeze, probe or re-approximate living tissue. “Surgery” includes the injection of diagnostic or therapeutic products into body cavities, joints, internal organs, the central nervous system, and the sensory organs, excluding the skin. It also includes the closed reduction of dislocations and/or fractures that require anesthesia. After reviewing the impact statements submitted in response to the request and prior to the first committee meeting, the CCACS submitted an additional paragraph to include with the proposed definition to address concerns that the above definition would cause any loss of scope for any practitioner (Appendix H) Nothing in this definition shall be construed to restrict, limit, change, or expand the scope of practice in effect on <date of adoption>, of any profession licensed by any of the health regulatory boards within the Department of Public Health. Impact Statements and Responses to Impact Statements Written impact statements in response to the scope of practice request submitted by CCACS were received from several individuals and organizations (Appendix D): Connecticut Academy of Physician Assistants Connecticut Advanced Practice Registered Nurse Society Connecticut Association of Nurse Anesthetists Connecticut Association of Optometrists Connecticut Chiropractic Association Connecticut Coalition of Advanced Practice Nurses Connecticut College of Emergency Physicians P a g e |5 Connecticut Dental Hygienists’ Association Connecticut Dermatology and Dermatologic Surgery Society Connecticut Ear, Nose and Throat (ENT) Society Connecticut Hospital Association Connecticut Naturopathic Medical Association Connecticut Nurses’ Association Connecticut Occupational Therapy Association Connecticut Orthopaedic Society Connecticut Physical Therapy Association Connecticut Podiatric Medical Association Connecticut Society for Respiratory Care Connecticut Society of Eye Physicians Connecticut State Dental Association Connecticut State Electrology Association Connecticut State Medical Society Connecticut Urology Society International Aesthetic & Laser Association Merry Schlamowitz (Licensed Electrologist) Nikki Rasmussen, APRN-FNP-C (Med Spa) University of Bridgeport - Division of