Florida Gastroenterological Society
Florida Gastroenterological Society

Clarification on Executive Order 20-72

Below is the “official communique” that we developed with the FMA. The only addition to make is that the Board of Medicine is OK with any procedure to excise or treat suspected cancer, as that is necessarily a serious condition that will worsen if not treated.

Please make sure to exercise your member benefit and contact Chris Nuland, FGS Legal Council for a free consult. He can be reached at (904) 355-1555.

Clarification on Executive Order 20-72

The Governor’s Executive Order applies to all physicians performing any procedure in a hospital, ambulatory surgical center, office surgery center, or in their office. The Executive Order prohibits physicians from “providing any medically unnecessary, non-urgent or non-emergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety, or well-being at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.”

According to the Department of Health, this order prohibits ANY medically unnecessary, non-urgent or non-emergency procedure performed in a physician’s office, not just those procedures that consume essential resources (such as personal protective equipment).

A “procedure” is any medical treatment or operation, including, but not limited to, injections, ablations, laser procedures, physical therapy, cosmetic procedures, allergy shots, etc.

The provision of in-person medical treatment of any nature is a “procedure” and thus must be postponed if doing so does not place the patient’s immediate health, safety or well-being at risk or will not contribute to the worsening of a serious or life-threatening medical condition.

Physicians can continue to see patients for purposes of evaluation and management, including the performance of a physical examination, in order to determine if they have a medical condition that needs immediate attention. Physicians, to the extent possible, should use telemedicine services to pre-screen patients so that those with clearly non-emergency conditions do not have to come to the office for evaluation. Telemedicine, as previously stated, can continue unabated.

Further clarification from the Department of Health does not appear to be forthcoming. The Department currently will only state that:

“While some specific examples of which procedures should be postponed are also contained within Executive Order 20-72, licensed health care practitioners are tasked with exercising reasonable and appropriate professional judgment in evaluating their patients’ specific circumstances, overall health, and the medical necessity of any procedures performed. Therefore, the Executive Order explicitly leaves discretion on proceeding with procedures to the medical professional, based on his or her expertise and the specific factual situation of each patient. Only the medical professional can make that determination.”

Based on this limited direction then, each physician will have to make a judgment call on whether a particular procedure is necessary to avoid putting the patient’s immediate health, safety or well-being at risk or whether delaying such procedure will contribute to the worsening of a serious or life-threatening medical condition. If the physician determines that an interventional pain procedure, ongoing course of treatment, diagnostic test, etc. is necessary under the parameters set forth above, then the physician can perform the procedure. If the physician determines that the procedure can be safely delayed, the procedure should not be done.

2019 Telehealth Bill

In 2019, Florida passed the Telehealth Bill which establishes standards of practice for telehealth services, including patient evaluations, record-keeping, and controlled substances prescribing. The bill also authorizes out-of-state health care practitioners to perform telehealth services for patients in Florida upon meeting certain eligibility requirements and registering with the department.

The Florida Department of Health has created a website that allows interested parties to sign up for updates and register to become an out-of-state telehealth provider. More information, please visit: flhealthsource.gov/telehealth

Standards of Practice
Telehealth providers must practice in a manner consistent with his or her scope of practice and the prevailing professional standard of practice for a health care professional who provides in-person health care services to patients in Florida. The applicable board, or department if there is no board, may adopt rules related to telehealth that further clarify practice standards.

Patient Evaluations
If a telehealth provider conducts a patient evaluation sufficient to diagnose and treat the patient, the telehealth provider is not required to research a patient’s medical history or conduct a physical examination before using telehealth to provide health care services.

Patient Medical Records
Telehealth providers must use the same standard of maintaining patient medical records as used for in-person services. They must also keep medical records confidential, as required in ss. 395.3025(4), F.S.

Controlled Substances Prescribing
A telehealth provider may only use telehealth to prescribe a controlled substance for the following:

  • the treatment of a psychiatric disorder;
  • inpatient treatment at a hospital licensed under Ch. 395, F.S.;
  • the treatment of a patient receiving hospice services as defined in s. 400.601, F.S.; or
  • the treatment of a nursing home resident as defined in s. 400.021, F.S.

Out-of-State Telehealth Provider Registration Requirements
Health care practitioners with an out-of-state license or certification that falls under section 456.47(1)(b), F.S, qualify for an out-of-state telehealth provider registration number when they meet the following requirements:

  • Submit the completed Application for Out-of-State Telehealth Provider Registration;
  • Maintain an active, unencumbered license from another state, the District of Columbia, or a possession or territory of the United States;
  • Not have a pending investigation, discipline, or revocation on your license within the last five years;
  • Designate a duly appointed registered agent for service of process in Florida;
  • Maintain liability coverage or financial responsibility for telehealth services provided to patients in Florida in an amount equal to or greater than Florida health care practitioner requirements;
  • Not open a Florida office or provide in-person health care services to Florida patients;
  • Only use a Florida-licensed pharmacy, registered nonresident pharmacy, or outsourcing facility to dispense medicinal drugs to patients in Florida (pharmacists only)


What is telehealth?
Telehealth is the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, the assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. Telehealth does not include audio-only telephone calls, e-mail messages, or fax transmissions.

What is a telehealth provider?
Telehealth provider is defined as an individual who provides a health care service using telehealth and who is licensed under s. 393.17; part III of chapter 401; chapter 457; chapter 458; chapter 459; chapter 460; chapter 461; chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; part I, part III, part IV, part V, part X, part XIII, or part XIV of chapter 468; chapter 478; chapter 480; part II or part III of chapter 483; chapter 484; chapter 486; chapter 490; or chapter 491; who is licensed under a multi-state health care licensure compact of which Florida is a member state; or who is registered under and complies with s. 456.47(4), Florida Statutes. 

What information about out-of-state telehealth providers is published by the Florida Department of Health?
The Florida Department of Health is required to maintain a public list of all registered out-of-state telehealth providers, which includes the following information:

  • Name
  • Health care occupation
  • Completed health care training and education, including completion dates and any certificates or degrees obtained
  • Out-of-state health care license, including license number
  • Florida telehealth provider registration number
  • Specialty
  • Board certification
  • Five-year disciplinary history, including sanctions and board actions
  • Medical malpractice insurance provider and policy limits
  • Name and address of the registered agent designated for service of process in this state

Are there any exemptions from registering as an out-of-state telehealth provider?
There are two exemptions that allow an out-of-state licensee to perform telehealth for Florida patients without registering:

  • In response to an emergency medical condition, which is defined in s. 395.002, F.S.
  • In consultation with a health care professional licensed in this state who has ultimate authority over the diagnosis and care of the patient

Can Florida health care practitioners register as an out-of-state telehealth provider?
Telehealth provider registration only applies to health care practitioners who are licensed in another state, the District of Columbia, or a possession or territory of the United States. Florida licensees can already provide telehealth services to patients in Florida that they can treat in person. If a Florida licensee would like to provide telehealth services to a patient outside of Florida, they must review the laws and rules in the location of the patient.

Information provided by Florida Department of Health 

Two New Laws Impacting Gastroenterologists

As of July 1, 2019, two new laws will go into effect that will impact many gastroenterologists.

Under the first, ambulatory surgery centers will now be allowed to keep patients up to 24 hours, even if that means a stay after midnight. The old law required either a discharge or hospital transfer before midnight.

Under the second, those administering anesthesia or prescribing Schedule II opioids must discuss non-opiate options with patients and provide them with a pamphlet designed by DOH.
Download the Pamphlet Here
Now is a good time to remind you of your access to a free legal hotline as an FGS member benefit. Should you decide to take advantage of this, you may contact the Law Offices of Christopher Nuland, at 904-355-1555. Please mention you are an FGS member.

2019 Legislative Wrap-Up

FGS Legislative Update

Talk about suspense! This legislative session brought with it several high-profile issues that remained active right to the end! And, I am happy to report that our lobbyist, Chris Nuland, has provided an extraordinary final report to share with you.

On defense, we stopped 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.

Offensively, 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
  • Ceremonial resolutions from the House, Senate and Governor’s Office raising awareness of Colorectal Cancer

Thank you to everybody who visited Tallahassee, contacted a legislator, or emailed us and/or Chris, with an insightful comment. Your work was instrumental in our success! Your profession, patients, and the FGS greatly thank you for your advocacy.


Justin Bouck
FGS Executive Director

P.S. – Don’t forget!! Registration for the 2019 FGS Annual Meeting is now Open! September 13-15, 2019 at the Hilton Bonnet Creek in Orlando, FL. Use the links below to register and book your room.
Register for the course | Book your room

Legislative Updates – Week 6

When An Irresistible Force Meets an Unmovable Object…

As we write this, we are completing the sixth of the nine weeks of Florida Legislative Session, during which Medical Office Regulation and Scope of Practice issues have taken center stage.

In the wake of several death in office surgeries, we 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 our 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.  It is important to note that this new law, as amended, will NOT affect the most common minor procedures performed in physician offices or procedures performed in ASCs or hospitals.

On Scope of Practice matters, HB 821, which would allow independent practice of Nurse Practitioners and PAs, on Wednesday passed its last House committee over our objections and is expected to be passed by the House.  Moreover, the whole House has moved legislation that would allow pharmacists to diagnose and prescribe. We have, however, secured support in the Senate to stop the bill, and we  expect that support to prevent final passage of the bill.

Not all of the legislation passing the House is bad.  For instance, the House is moving legislation that would require hospitals to notify a patient’s treating physician(s) when a patient is admitted and allow such physicians, even if not on staff, to at least participate in the patient’s care.

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

Florida Senate Passes Proclamation Recognizing Colorectal Cancer Awareness Month

Today, the Senate passed our proclamation request recognizing March as Colorectal Cancer Awareness Month. We want to thank Sen. Lori Berman for her continued support of our colorectal awareness efforts in Florida.

Dr. Gerardo Lanes, FGS Past President, with DigestiveCARE also played a vital role in helping Florida Legislature recognize the importance of Colorectal Cancer screenings.

If you are over 45 years old or have a family history of colorectal cancer please schedule a consultation with your gastroenterologist. Despite colorectal cancer being the 2nd leading cause of cancer, it can also have over a 90% survival rate if caught early. Don’t wait, get screened now.

Governor DeSantis Supports Colon Cancer Awareness

Thanks to Joni Brown of DigestiveCARE, we have received the official proclamation from the Florida Governor Ron DeSantis’s office, recognizing March as Colon Cancer Awareness Month in Florida.

We are excited to see the newly-installed Governor waste no time recognizing the threat of this disease and the importance of colon cancer screening.

As one of the leading causes of cancer-related deaths in the United States, we must stress the importance of early screening. According to a letter from the American College of Gastroenterology, the 5-year survival rate is over 90%, but because of poor screening, less than 40% of colon cancer cases are detected early.

If you or your organization would like to get involved in raising awareness for this deadly, yet preventable disease please email us at info@flgastro.org.

Legislative Update: Debate Begin…

Especially in the House of Representatives, Scope of Practice Expansion and Telemedicine are two of the key issues of the 2019 Legislative Session, and both were placed in the limelight before a packed Health Quality Committee Room this past week. 

Committee members heard presentations on both issues, with Telemedicine taking the lead. While panel members touted the virtues of telemedicine, we continued to lobby that physicians have the final say as to whether telemedicine is appropriate and that out-of-state physicians be held accountable to both the Board of Medicine and Florida courts. While the final bill has yet to be introduced, legislators in both chambers (and on both sides of the aisle) appear to support our position. 

APRN Independent Practice was a more contentious issue, as proponents argued that independence would allow APRNs to treat more patients, while opponents such as us argued that independent practice would not increase the number of APRNs but would remove the physician from the health care team. While no vote was taken, Re. Cary Pigman, M.D. filed an APRN Independent Practice Bill (HB 821) almost immediately, which we will have to fight throughput the Session. 

In the Senate, we have been working behind the scenes on SB 732, which, as written, would require any office that performed invasive procedures of any type to be registered and inspected. We are, however, working in good faith with the sponsor, Anitere Flores, to amend the bill to allow regulation of Level II and III offices and owners, as well as physicians. It is hoped that this approach will help curb many of the abuses cited in a recent USA Today article without disrupting currently effective regulations. 

Finally, we are lobbying both chambers to enact legislation that would prohibit redundant Step Therapy, as requiring patients who have tried and failed with lesser treatments should not be required to repeat those failed therapies if they change health plans. As you can see, it will be a hectic Session, but we are currently well positioned to protect our doctors and patients, and we look forward to a successful sixty days.

2019 Legislative Update: Committee Meetings – Week 3

FGS Legislative Update

🔥🔥 2019 Legislative Season Heats Up 🔥🔥

With the third of six legislative committee weeks in the books, battle lines have already formed for the 2019 Legislative Session.

It has become painfully obvious that the House of Representatives will propose several Scope of Practice Expansion bills, such as Independent Practice for APRNs and PAs, Pharmacist Diagnosis and Prescribing Authority, and Psychologist Prescribing, while the Florida Senate has thus far indicated that it will resist such legislation.

Conversely, initiatives such as the elimination of Redundant Step Therapy and the Recognition of Prior Authorizations are likely to advance in the Senate but face a far more hostile reception in the House of Representatives.

Legislators in both chambers, however, have indicated that changes to the 2018 Opioid Law are unlikely.

What does remain to be seen is the inevitable “Wild Card” issue that nobody yet sees, but which will come out of nowhere to dominate the news cycle.

With a new Governor and scores of new legislators, ideas are percolating on all fronts, and February is destined to be a better harbinger of things to come.

2018 4th Quarter Legislative Update

Despite the holiday season, the FGS has been busy over the past few weeks at both the Legislature and the Board of Medicine.

In the Legislature, FGS received a commitments from Rep. Cary Pigman, M.D. and Sen. Lori Berman to sponsor our Cancer Awareness bill, and our lobbyist has an opportunity to meet with session leadership. While the House is expected to again introduce Independent Practice Bills for APRNs and PAs, we will oppose these measures and have received commitments from Senate members to protect our interests.

On the regulatory front, the news if even better. FGS and other secured a favorable ruling from the Department of Health that eliminates the need of gastroenterologists from checking the PDMP before administering drugs, even if those drugs are administered in an office or ASC setting. Moreover, the Board of Medicine has drastically reduced the administrative requirements pertaining to the prescription of acute pain medications, which will ease the administrative burdens of our doctors.

Please follow our updates throughout the legislative session, which is expected to be one of the more contentious in recent memory, as we fight to protect the business and profession of gastroenterology.

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