OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 196 Bill Analysis
134th General Assembly
Click here for H.B. 196’s Fiscal Note
Version: As Passed by the House
Primary Sponsors: Reps. Kelly and Carruthers
Effective Date:
Elizabeth Molnar, Attorney
SUMMARY
Prohibits an individual from knowingly practicing as a surgical assistant without holding
a State Medical Board-issued license and establishes criminal penalties for violators.
Delays for one year after the bill’s effective date the bill’s prohibition on knowingly
practicing without a license.
Authorizes the holder of a surgical assistant license to assist a physician in the
performance of surgical procedures by engaging in certain activities delegated by, and
performed under the supervision and in the physical presence of, the physician.
Coordinates the Medical Board’s licensing and regulatory procedures for surgical
assistants with those for physicians and other health professionals also regulated by the
Board.
Establishes fees for initial licensure as well as license renewal, reinstatement, and
restoration.
Requires a license holder, as a condition of renewal, to certify to the Board completion
of 38 hours of continuing education over the two-year licensure period.
DETAILED ANALYSIS
Practice of surgical assistants
H.B. 196 prohibits an individual, with certain exceptions, from knowingly practicing as a
surgical assistant without holding a license to do so issued by the State Medical Board.1 The bill
specifies that a violation is a first degree misdemeanor on a first offense (punishable by a fine of
1 R.C. 4785.03.
December 2, 2022
Office of Research and Drafting LSC Legislative Budget Office
not more than $1,000 and a jail term of not more than 180 days) and a fifth degree felony on
each subsequent offense (punishable by a fine of not more than $2,500 and a prison term of
not more than six to 12 months).2
Exceptions to the licensure requirement
The bill exempts the following individuals from its licensure requirements – physicians,
podiatrists, physician assistants, licensed practical nurses, registered nurses, and advanced
practice registered nurses.3
Authorized activities
Under a license, a surgical assistant may assist a physician in the performance of surgical
procedures by engaging in any of the following activities delegated by the physician:
Providing exposure;
Maintaining hemostasis;
Making incisions;
Closing or suturing surgical sites;
Manipulating or removing tissue;
Implanting surgical devices or drains;
Suctioning surgical sites;
Placing catheters;
Clamping or cauterizing vessels or tissues;
Applying dressings to surgical sites;
Any other tasks as directed by the physician.4
Physician supervision
Note that a surgical assistant may engage in the foregoing activities only under the
supervision of a physician. And when supervising a surgical assistant, the physician must in the
physical presence of the assistant, which the bill describes as being in the same room in which
the surgical assistant practices and observing directly the activities in which the surgical
assistant engages.
2 R.C. 4785.99.
3 R.C. 4785.03.
4 R.C. 4785.08.
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As Passed by the House
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Eligibility for licensure
To be eligible for a license to practice as a surgical assistant, an applicant must
demonstrate to the Medical Board that the applicant is at least 18 years of age and has attained
a high school degree or equivalent.5 In addition, an applicant must satisfy one of the following:
Be credentialed as a surgical assistant by the National Board of Surgical Technology and
Surgical Assistants (NBSTSA) or National Commission for Certification of Surgical
Assistants (NCCSA);
Have practiced as a surgical assistant at a hospital or ambulatory surgical facility located
in Ohio during any part of the 18 months preceding the bill’s effective date; or
Have successfully completed a surgical assistant training program operated by a branch
of the U.S. armed forces.6
The applicant also must complete a criminal records check.7
License application and renewal procedures
An applicant seeking to practice as a surgical assistant must file an application with the
Medical Board in a manner prescribed by the Board and must submit a fee of $200.8 No part of
the fee is to be returned to the applicant or transferred for purposes of another application.
After reviewing the application, if the Board determines that the applicant meets the bill’s
eligibility requirements, the Secretary of the Board must issue a license to the applicant.9
A license is valid for two years, unless revoked or suspended, expires on the date that is
two years after the issuance date, and may be renewed for additional two-year periods.10 The
Board is required under the bill to provide renewal notice to license holders at least one month
prior to the expiration date.
Renewals
To renew a license, a license holder must apply to the Medical Board in a manner
prescribed by the Board and submit a $200 renewal fee.11 In addition, the applicant for renewal
must report any criminal offense to which the applicant has pleaded guilty, of which the
applicant has been found guilty, or for which the applicant has been found eligible for
intervention in lieu of conviction, since last signing an application for a license to practice.
5 R.C. 4785.04.
6 R.C. 4785.04.
7 R.C. 4785.05. See also R.C. 4776.01 to 4776.04.
8 R.C. 4785.04 and 4785.14.
9 R.C. 4785.04 and 4785.06.
10 R.C. 4785.06.
11 R.C. 4785.07.
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As Passed by the House
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An applicant seeking renewal who obtained an initial license by demonstrating an
NBSTSA or NCCSA credential must certify to the Board that the applicant has maintained this
credential. Each renewal applicant also must certify the completion of 38 hours of continuing
education approved by the NBSTSA or NCCSA.12 If the applicant submits a renewal application
that the Board considers complete, the Board must issue a renewed license to practice as a
surgical assistant.
Credentialing status and continuing education samples
The bill authorizes the Medical Board to require a random sample of surgical assistants
to submit materials documenting that their credentialing status has been maintained and that
the number of hours of continuing education has been completed. If the Board, through the
random sample, finds that an individual who certified completion of the continuing education
required to renew, reinstate, or restore a license to practice did not complete the requisite
continuing education, the Board may do either of the following:
Take disciplinary action against the individual, impose a civil penalty, or both;
Permit the individual to agree in writing to complete the continuing education and pay a
civil penalty.13
Note that the bill does not provide for these penalties if it finds that an applicant did not
maintain his or her credentialing status.
The bill also specifies that the Board’s finding in any disciplinary action related to the
completion of continuing education must be made pursuant to an adjudication and by an
affirmative vote of at least six of its members. It also limits the civil penalty to an amount not
more than $5,000.
Automatic suspension and license restoration and reinstatement
A license to practice as a surgical assistant that is not renewed on or before its
expiration date is automatically suspended on that date.14 The bill specifies that continued
practice after the automatic suspension is unlawful and subject to the same criminal penalties
as described above.
Reinstatement
In the case of a license that has been suspended for two years or less, the Board may
reinstate the license if the applicant submits a complete renewal application and pays the $225
reinstatement fee.
12 R.C. 4785.04(B).
13 R.C. 4785.07.
14 R.C. 4785.15.
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As Passed by the House
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Restoration
And if a license has been suspended for more than two years, the Board may restore the
license if the applicant submits a complete restoration application and pays the $250
restoration fee. The applicant also must complete a criminal records check. The Board may not
restore the license unless it decides, in its discretion, that the results of the criminal records
check do not make the applicant ineligible for licensure.
Other terms and conditions
In the case of an applicant seeking either of the following (1) restoration of a license
that has been suspended or inactive for any cause for more than two years or (2) issuance of a
license after having not been engaged in practice as a surgical assistant for more than two
years, the Board may impose terms and conditions on the applicant before issuing or restoring
the license.15 These include any of the following:
Requiring the applicant to pass an oral or written examination, or both, to determine
the applicant’s present fitness to resume practice;
Requiring the applicant to obtain additional training and to pass an examination upon
completion of such training;
Requiring an assessment of the applicant’s physical skills for purposes of determining
whether the applicant’s coordination, fine motor skills, and dexterity are sufficient for
performing evaluations and procedures in a manner that meets the minimal standards
of care;
Requiring an assessment of the applicant’s skills in recognizing and understanding
diseases and conditions;
Requiring the applicant to undergo a comprehensive physical examination, which may
include an assessment of physical abilities, evaluation of sensory capabilities, or
screening for the presence of neurological disorders;
Restricting or limiting the extent, scope, or type of practice of the applicant.
The Board must consider the applicant’s moral background and activities during the
period of suspension or inactivity.
Licensure fees
In addition to the $200 initial application fee, $200 renewal fee, $225 reinstatement fee,
and $250 restoration fee the bill specifies, it also establishes a $35 fee for a duplicate license
and a $50 fee for license verification.16
15 R.C. 4785.16.
16 R.C. 4785.14 and 4785.15.
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As Passed by the House
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Medical Board regulation
The bill coordinates the Medical Board’s licensing and regulatory procedures for surgical
assistants with those for physicians and other health professionals also regulated by the Board.
In doing so, the bill addresses all of the following topics: Board investigations; reporting
misconduct; child support default; treatment of impaired practitioners; notice of criminal
prosecution; injunctive relief for practicing without a license; and compliance with human
trafficking sanctions.17
Board discipline
Similar to the other health professions regulated by the Medical Board, the bill requires
the Board to limit, revoke, or suspend a license to practice as a surgical assistant, refuse to issue
a license, refuse to renew or reinstate a license, or reprimand or place on probation a license
holder for one of several grounds, including the following:
Failure to comply with the bill’s requirements;
A departure from, or failure to conform to, minimal standards of care of similar
practitioners;
Impairment of ability to practice because of habitual or excessive drug, alcohol, or other
substance use;
Commission of a felony;
A guilty plea;
Failure to maintain one’s status as a credentialed surgical assistant or to notify the
Board that the credential has not been maintained;
Failure to comply with the profession’s code of ethics.18
As with the other Medical Board-regulated professionals, an affirmative vote of six
Board members is required before discipline may be imposed on a surgical assistant. The bill
also establishes for surgical assistants the same standards and procedures for discipline used
when imposing discipline on other professionals, including the holding of hearings.
Civil penalties
The bill authorizes the Medical Board to impose a civil penalty in the event of a violation
and requires the Board to adopt guidelines regarding the amounts of civil penalties to be
imposed, with no civil penalty amount to exceed $20,000.19 This authority is the same as the
Board’s authority to impose civil penalties on other health professionals.
17 R.C. 4785.02, 4785.10, 4785.13, 4785.17, 4731.224, 4785.12, 4785.10, 4785.20, 4785.19, and 4785.18.
18 R.C. 4785.10(B).
19 R.C. 4785.11.
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As Passed by the House
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Rulemaking
The bill requires the Medical Board to adopt rules establishing standards and
procedures for the regulation of surgical assistants, including rules that do the following:
Establish application procedures for the licensure of surgical assistants;
Establish license renewal procedures, including procedures for reporting the completion
of continuing education;
Establish procedures for reporting to the Board license holder misconduct.
The bill also authorizes the Medical Board to adopt any other rules it considers
necessary to implement and administer the bill’s provisions.
When adopting rules required by the bill, the Medical Board must do so in accordance
with the Administrative Procedure Act.20
HISTORY
Action Date
Introduced 03-09-21
Reported, H. Health 05-25-22
Passed House (69-12) 12-01-22
ANHB0196PH-134/tl
20 R.C. 4785.09.
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As Passed by the House
Statutes affected: As Introduced: 4731.07, 4731.071
As Reported By House Committee: 109.572, 4731.051, 4731.07, 4731.071, 4731.224, 4731.24, 4731.25, 4731.251