HCS HB 1747 -- QUALITY OF PATIENT CARE

SPONSOR:  Harlan (Barry)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Critical
Issues by a vote of 21 to 0.

This substitute provides "whistleblower" protections by
requiring hospitals and ambulatory surgical centers licensed by
the Department of Health to implement a written policy regarding
employees who report facility mismanagement; fraudulent
activity; and violations of applicable laws or administrative
rules concerning patient care, safety, and related issues.  In
its primary whistleblower protection provisions, the substitute:

(1)  Specifies that supervisors and persons in authority at
hospitals or ambulatory surgical centers may not prohibit
employees from disclosing information pertaining to facility
mismanagement, patient safety, or related issues;

(2)  Prohibits these supervisors and persons in authority from
threatening to use their authority to knowingly discriminate,
penalize, or retaliate against employees who acted in good faith
to report or disclose mismanagement or other violations;

(3)  Requires hospitals and ambulatory surgical centers to
establish a corporate compliance program for the reporting of
claims of mismanagement; fraudulent activity; and violations of
applicable laws or administrative rules concerning patient care,
safety, or related issues and requires the department to verify
that the programs adopted meet the standards established by the
federal Department of Health and Human Services;

(4)  Requires designation of a specific person and an alternate
person for administering the reporting and investigation process
and provides employees with the option of reporting anonymously;

(5)  Requires hospitals and ambulatory surgical centers to
notify the department when an investigation is initiated and,
within 48 hours of receiving a report, to notify the complaining
employee that his or her complaint is being reviewed;

(6)  Requires investigations of reports to be completed within
30 days, with notification to the employee and to the department
of the investigation's findings; and

(7)  Authorizes an award of damages, court costs, and attorney
fees in a civil action against hospitals and ambulatory surgical
centers which do not comply with the whistleblowing provisions
of the substitute.

The whistleblowing provisions of the substitute are effective
January 1, 2001.

The substitute also contains provisions related to staffing,
needlestick injury prevention, and hospital licensure, which:

(1)  Prohibit hospitals and ambulatory surgical centers from
assigning personnel who lack appropriate training and education
to provide patient care;

(2)  Require hospitals and ambulatory surgical centers to
establish by July 1, 2001, a training program for all unlicensed
staff who provide patient care, provide documentation of the
completion of such staff training to the department, and
implement a methodology to ensure adequate staffing levels of
licensed registered nurses and ancillary nursing personnel in
accordance with accepted standards of nursing practice to meet
patient needs;

(3)  Establish a 9-member "Technical Advisory Committee on the
Quality of Patient Care and Nursing Practices" within the
Department of Health.  Each year the committee is to select one
issue and develop recommendations related to improving the
quality of patient care or nursing practices, and submit an
annual report to the Governor and the General Assembly on its
recommendations, beginning in 2001.  The initial issue to be
considered is the appropriate licensed nurse staffing levels
within hospitals and ambulatory surgical centers.  The committee
terminates on December 31, 2006;

(4)  Require the department to collaborate with the Technical
Advisory Committee to develop recommendations for standardized
minimal training requirements for unlicensed staff, and on the
use of needlestick safety technology;

(5)  Require medical facilities, as defined in the substitute,
to complete a blood-borne pathogen exposure control plan related
to needle safety by December 31, 2001, with annual updates;

(6)  Require medical facilities by December 31, 2002, to adopt
needle safety technology;

(7)  Require entities offering individual or group health
insurance policies to offer coverage for needlestick safety
devices.  This provision applies to policies or contracts of
coverage issued or renewed on or after January 1, 2001;

(8)  Require the department to annually determine the number of
hospitals and ambulatory surgical centers with a corporate
compliance plan and the number of medical facilities with a
needlestick injury prevention program;

(9)  Specify intermediate sanctions the department may impose
for violations of hospital and ambulatory surgical center
licensure requirements, in addition to hospital closure which is
currently available to the department.  Appeal rights for the
facilities are outlined; and

(10)  Authorize the department to develop regulations in order
to implement the substitute's provisions.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
$979,210 in FY 2001, $1,148,983 in FY 2002, and $1,178,091 in FY
2003.  Estimated Net Income to Insurance Dedicated Fund of
$15,050 in FY 2001, $0 in FY 2002, and $0 in FY 2003.

PROPONENTS:  Supporters say that this bill is an important
measure to improve the quality of patient care.  Witnesses
testified about examples of hospital employees experiencing
demotions, suspensions, and terminations when they attempted to
report issues concerning inappropriate patient care.  The
provisions concerning needlestick safety would prevent
needlestick injuries that are frequently life-threatening.  The
bill's staffing level provisions are necessary to prevent the
use of unlicensed personnel to provide professional nursing care.

Testifying for the bill were Representatives Barry, Kennedy, and
Tudor; Missouri Nurses Association; Missouri Hospital
Association; Nurses United for Improved Patient Care; and
Missouri Association of Health Plans.

OPPONENTS:  There was no opposition voiced to the committee.

Katharine Barondeau, Legislative Analyst

HB 1747 -- Quality of Patient Care

Co-Sponsors:  Barry, Kennedy, Graham (24), Backer, Tudor, Green,
Bartelsmeyer

This bill provides "whistleblower" protections by requiring
hospitals and ambulatory surgical centers licensed by the
Department of Health to implement a written policy regarding
employees who report facility mismanagement or violations of
applicable laws related to patient care, safety, and related
issues.  In its primary whistleblower protection provisions, the
bill:

(1)  Specifies that supervisors and persons in authority at
hospitals or ambulatory surgical centers may not prohibit
employees from disclosing information pertaining to facility
mismanagement or other violations;

(2)  Prohibits these supervisors and persons in authority from
threatening to use their authority to knowingly discriminate,
penalize, or retaliate against employees who acted in good faith
to report or disclose mismanagement or other violations;

(3)  Requires hospitals and ambulatory surgical centers to
establish a reporting process for claims of mismanagement or
suspected violations and requires training and continuing
education for employees on the process for reporting violations;

(4)  Requires designation of a specific person and an alternate
person for administering the reporting process, and provides
employees with the option of reporting anonymously;

(5)  Requires investigations of reports to be completed within
30 days, with notification to the employee and to the department
of the investigation findings;

(6)  Specifies that it is a rebuttable presumption that
hospitals and ambulatory surgical centers are in compliance with
the bill's whistleblowing requirements if they have a corporate
compliance program which complies with the reporting standards
established by the Office of the Inspector General of the U.S.
Department of Health and Human Services;

(7)  Contains a penalty provision for hospitals and ambulatory
surgical centers which do not comply with the whistleblowing
policy and reporting requirements of the bill;

The bill also contains provisions related to staffing,
needlestick injury prevention, and hospital licensure, which:

(1)  Require all personnel providing patient care in hospitals
and ambulatory surgical centers to demonstrate competency and
prohibits such facilities from assigning personnel who lack the
appropriate training and education to perform professional
nursing functions;

(2)  Require hospitals and ambulatory surgical centers to
establish by July 1, 2001, a training program for all unlicensed
staff who provide patient care, and provide documentation of the
completion of such staff training to the department;

(3)  Establish a 9-member Technical Advisory Committee on the
Quality of Patient Care and Nursing Practices within the
department.  Each year the committee is to select one issue and
develop recommendations related to improving the quality of
patient care or nursing practices.  The initial issue to be
considered is the appropriate licensed nurse staffing levels
within hospitals and ambulatory surgical centers.  The committee
terminates on December 31, 2006;

(4)  Require the department to collaborate with the Technical
Advisory Committee to develop recommendations for standardized
minimal training requirements for unlicensed staff;

(5)  Require hospitals and ambulatory surgical centers to
develop a methodology for adequate staffing levels of licensed
registered nurses and ancillary nursing personnel in accordance
with accepted standards of nursing practice;

(6)  Require medical facilities, as defined in the bill, to
complete a blood-borne pathogen exposure control plan related to
needle safety by December 31, 2001, with annual updates;

(7)  Require medical facilities to adopt needle safety
technology;

(8)  Require insurers, health maintenance organizations, and
other health programs to provide coverage for needlestick safety
devices.  This provision applies to policies or contracts of
coverage issued or renewed after December 31, 2000;

(9)  Require the department to annually determine the number of
hospitals and ambulatory surgical centers with a corporate
compliance plan and the number of medical facilities with a
needlestick injury prevention program;

(10)  Specify intermediate sanctions the department may impose
for violations of hospital licensure requirements, in addition
to hospital closure which is currently available to the
department.  Appeal rights for hospitals are outlined; and

(11)  Authorize the department to develop regulations in order
to implement the bill's provisions.