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S1102aa...............................................by HEALTH AND WELFARE
HOSPITALS - RECORDS - Amends, repeals and adds to existing law relating to
hospital license and inspection; to define terms; to revise provisions
relating to confidential records, civil liability, immunity and peer review
records of health care organizations; to delete a section relating to
notification of disciplinary action; to provide for notification of
professional review action imposed upon a physician; to provide that no
physician or surgeon shall report certain information relating to peer
review records; and to provide that health care organizations shall not be
relieved of certain notification obligations.
02/10 Senate intro - 1st rdg - to printing
02/11 Rpt prt - to Health/Wel
02/26 Rpt out - to 14th Ord
03/04 Rpt out amen - to engros
03/05 Rpt engros - 1st rdg - to 2nd rdg as amen
03/06 2nd rdg - to 3rd rdg as amen
03/10 3rd rdg as amen - PASSED - 33-0-2
AYES -- Andreason, Bailey, Brandt, Burkett, Burtenshaw, Calabretta,
Cameron, Compton, Darrington, Davis, Gannon, Geddes, Goedde, Hill,
Ingram, Kennedy, Keough, Little, Lodge, Malepeai, Marley, McKenzie,
McWilliams, Noh, Pearce, Richardson, Schroeder, Sorensen, Stegner,
Stennett, Sweet, Werk, Williams
NAYS -- None
Absent and excused -- Bunderson, Noble
Floor Sponsor - Darrington
Title apvd - to House
03/11 House intro - 1st rdg - to Health/Wel
03/21 Rpt out - rec d/p - to 2nd rdg
03/24 2nd rdg - to 3rd rdg
03/28 3rd rdg - PASSED - 69-0-1
AYES -- Andersen, Barraclough, Barrett, Bauer, Bedke, Bell, Black,
Block, Boe, Bolz, Bradford, Campbell, Cannon, Clark, Collins, Crow,
Cuddy, Deal, Denney, Douglas, Eberle, Edmunson, Ellsworth, Eskridge,
Field(18), Field(23), Gagner, Garrett, Harwood, Henbest(Bray),
Jaquet, Jones, Kellogg, Kulczyk, Lake, Langford, Langhorst, Martinez,
McGeachin, McKague, Meyer, Miller, Mitchell, Moyle, Nacarrato,
Nielsen, Raybould, Ridinger, Ring, Ringo, Roberts, Robison, Rydalch,
Sali, Sayler, Schaefer, Shepherd, Shirley, Skippen, Smith(30),
Smith(24), Smylie, Snodgrass, Stevenson, Tilman, Trail, Wills, Wood,
Mr. Speaker
NAYS -- None
Absent and excused -- Bieter
Floor Sponsor - Garrett
Title apvd - to Senate
03/31 To enrol
04/01 Rpt enrol - Pres signed
04/02 Sp signed
04/03 To Governor
04/08 Governor signed
Session Law Chapter 244
Effective: 07/01/03
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
IN THE SENATE
SENATE BILL NO. 1102
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO HOSPITAL LICENSES AND INSPECTION; AMENDING SECTION 39-1392a, IDAHO
3 CODE, TO DEFINE TERMS AND TO MAKE TECHNICAL AND GRAMMATICAL CHANGES;
4 AMENDING SECTION 39-1392b, IDAHO CODE, TO REVISE PROVISIONS RELATING TO
5 CONFIDENTIAL AND PRIVILEGED RECORDS; AMENDING SECTION 39-1392c, IDAHO
6 CODE, TO REVISE PROVISIONS RELATING TO CIVIL LIABILITY IMMUNITY; AMENDING
7 SECTION 39-1392d, IDAHO CODE, TO REVISE PROVISIONS RELATING TO PEER REVIEW
8 RECORDS OF HEALTH CARE ORGANIZATIONS AND TO PROVIDE REFERENCES TO PATIENT
9 CARE RECORDS; REPEALING SECTION 39-1393, IDAHO CODE, RELATING TO NOTIFICA-
10 TION OF DISCIPLINARY ACTION IMPOSED UPON A PHYSICIAN; AMENDING CHAPTER 13,
11 TITLE 39, IDAHO CODE, BY THE ADDITION OF A NEW SECTION 39-1393, IDAHO
12 CODE, TO PROVIDE FOR NOTIFICATION OF PROFESSIONAL REVIEW ACTION IMPOSED
13 UPON A PHYSICIAN; AND AMENDING SECTION 54-1818, IDAHO CODE, TO PROVIDE A
14 CORRECT CODE REFERENCE AND TO PROVIDE THAT NO PHYSICIAN OR SURGEON SHALL
15 REPORT CERTAIN INFORMATION RELATING TO PEER REVIEW RECORDS AND TO PROVIDE
16 THAT HEALTH CARE ORGANIZATIONS SHALL NOT BE RELIEVED OF CERTAIN NOTIFICA-
17 TION OBLIGATIONS.
18 Be It Enacted by the Legislature of the State of Idaho:
19 SECTION 1. That Section 39-1392a, Idaho Code, be, and the same is hereby
20 amended to read as follows:
21 39-1392a. DEFINITIONS. The following terms shall have the following mean-
22 ings when used in this section:
23 (a1) "Group medical practice" means a partnership, corporation, limited
24 liability company, or other association formed for the purpose of offering
25 health care services through physicians and other licensed or otherwise autho-
26 rized health care providers who are partners, shareholders, members, employ-
27 ees, or contractors of such group medical practice.
28 (b2) "Health care organization" means a hospital, in-hospital medical
29 staff committee, medical society, managed care organization, or group medical
30 practice.
31 (c3) "Hospital" shall means a facility in Idaho licensed under sections
32 39-1301 through 39-1314, Idaho Code, and defined in section 39-1301(a)(1),
33 Idaho Code.
34 (d4) "In-hospital medical staff committees" shall means any individual
35 doctor who is a hospital staff member, or any hospital employee, or any group
36 of such doctors and/or hospital employees, who are duly designated a committee
37 by hospital staff bylaws, by action of an organized hospital staff, or by
38 action of the board of directors of a hospital, and which committee is autho-
39 rized by said bylaws, staff or board of directors, to conduct research or
40 study of hospital patient cases, or of medical questions or problems using
41 data and information from hospital patient cases.
42 (e5) "Managed care organization" means a public or private person or
43 organization which offers a managed care plan.
2
1 (f6) "Managed care plan" means a contract of coverage given to an indi-
2 vidual, family or group of covered individuals pursuant to which a member is
3 entitled to receive a defined set of health care benefits through an organized
4 system of health care providers in exchange for defined consideration and
5 which requires the member to use, or creates financial incentives for the mem-
6 ber to use, health care providers owned, managed, employed by or under con-
7 tract with the managed care organization.
8 (g7) "Medical society" shall means any duly constituted, authorized and
9 recognized professional society or entity made up of physicians licensed to
10 practice medicine in Idaho, having as its purpose the maintenance of high
11 quality in the standards of health care provided in Idaho or any region or
12 segment of the state, operating with the approval of the Idaho state board of
13 medicine, or any official committee appointed by the Idaho state board of med-
14 icine.
15 (8) "Patient care records" means written or otherwise recorded, preserved
16 and maintained records of the medical or surgical diagnostic, clinical, or
17 therapeutic care of any patient treated by or under the direction of licensed
18 professional personnel in every health care organization subject to this act,
19 whether as an in-patient or out-patient of the health care organization.
20 (9) "Peer review" means the collection, interpretation and analysis of
21 data by a health care organization for the purpose of bettering the system of
22 delivery of health care or to improve the provision of health care or to
23 otherwise reduce patient morbidity and mortality and improve the quality of
24 patient care. Peer review activities by a health care organization include,
25 without limitation:
26 (a) Credentialing, privileging or affiliating of health care providers as
27 members of, or providers for, a health care organization;
28 (b) Quality assurance and improvement, patient safety investigations and
29 analysis, patient adverse outcome reviews, and root-cause analysis and
30 investigation activities by a health care organization; and
31 (c) Professional review action, meaning an action or recommendation of a
32 health care organization which is taken or made in the conduct of peer
33 review, that is based on the competence or professional conduct of an
34 individual physician where such conduct adversely affects or could
35 adversely affect the health or welfare of a patient or the physician's
36 privileges, employment or membership in the health care organization.
37 (10) "Peer review records" means all evidence of interviews, reports,
38 statements, minutes, memoranda, notes, investigative graphs and compilations
39 and the contents thereof, and all physical materials relating to peer review
40 of any health care organization. "Peer review records" does not mean or
41 include patient care records; provided however, that the records relating to
42 the identification of which particular patient care records were selected for,
43 or reviewed, examined or discussed in peer review by a health care organiza-
44 tion and the methodology used for selecting such records shall be considered
45 peer review records.
46 SECTION 2. That Section 39-1392b, Idaho Code, be, and the same is hereby
47 amended to read as follows:
48 39-1392b. RECORDS CONFIDENTIAL AND PRIVILEGED. Except as provided in sec-
49 tion 39-1392e, Idaho Code, all written records of interviews, all reports,
50 statements, minutes, memoranda, charts, and the contents thereof, and all
51 physical materials relating to research, discipline or medical study of any
52 health care organization, for the purposes set forth in section 39-1392, Idaho
53 Code, peer review records shall be confidential and privileged, and shall not
3
1 be directly or indirectly subject to subpoena or discovery proceedings or be
2 admitted as evidence, nor shall testimony relating thereto be admitted in evi-
3 dence, or in any action of any kind in any court or before any administrative
4 body, agency or person for any purpose whatsoever.; provided further nNo order
5 of censure, suspension or revocation of licensure or hospital health care
6 organization privilege of any physician licensed to practice medicine in Idaho
7 shall be admissible in any civil proceeding seeking damages or other civil
8 relief against the physician or hospital health care organization which may be
9 a party defendant in said cause.; provided, hHowever, this section shall not
10 prohibit or otherwise affect the use of said documents, materials or testimony
11 in health care organization proceedings, nor shall it prohibit or otherwise
12 affect the dissemination, for medical purposes, of information contained in
13 such documents or materials or the conclusions and findings of such health
14 care organization., and provided further, that tThis section shall not affect
15 the admissibility in evidence in any action or proceeding of any original med-
16 ical records the patient care records of any patient.
17 SECTION 3. That Section 39-1392c, Idaho Code, be, and the same is hereby
18 amended to read as follows:
19 39-1392c. IMMUNITY FROM CIVIL LIABILITY. The furnishing of information or
20 provision of opinions to any health care organization, as herein defined, or
21 their authorized representatives or investigators, or the receiving and use of
22 such information and opinions shall not subject any person, hospital, managed
23 care organization, sanitarium, nursing or rest home health care organization
24 or other person or agency to any liability or action for money damages or
25 other legal or equitable relief.; provided further, cCustodians of such
26 records and persons becoming aware of such data and opinions shall not dis-
27 close the same except as authorized by the Idaho state board of medicine or
28 pursuant to rules or regulations duly promulgated by said board, except that
29 any licensed hospital in the state of Idaho, acting through its governing
30 board or its medical staff, or by its duly authorized administrative staff,
31 rules adopted by the board of medicine or as otherwise authorized by law. Any
32 health care organization may upon request receive such disclosures, subject to
33 an obligation to preserve the confidential privileged character thereof and
34 subject further to the requirement that such requests shall be made and such
35 use shall be limited to the aid of such hospital in determining hospital priv-
36 ileges which may properly be allowed or refused any physician who is a member
37 of or who is seeking to secure or reinstate membership upon the medical staff
38 of such institution the health care organization in conducting peer review.
39 SECTION 4. That Section 39-1392d, Idaho Code, be, and the same is hereby
40 amended to read as follows:
41 39-1392d. PROPERTY OF HEALTH CARE ORGANIZATION. All such written and
42 other records of interviews, all reports, statements, minutes, memoranda,
43 charts and physical property or materials of any kind used in connection with
44 or relating to any such items or investigation or hearing or research disci-
45 pline or medical study for any of the purposes set forth in section 39-1392,
46 Idaho Code, peer review records of a health care organization shall be the
47 property of the health care organization concerned which obtains or compiles
48 the same.; provided, however, this A health care organization may provide peer
49 review records to persons or entities that perform accreditation, certifica-
50 tion or quality assurance review or evaluation of the health care organiza-
51 tion. The provision of any peer review records to such persons or entities
4
1 shall not be deemed to be a waiver by the health care organization of any peer
2 review privilege. Persons and entities receiving peer review records shall
3 preserve the confidential privileged character thereof and such persons and
4 entities shall not be subject to subpoena or order compelling production of
5 peer review records. Nothing in this section shall be deemed to require the
6 health care organization to provide persons or entities with peer review
7 records. A health care organization may provide peer review records to persons
8 or entities with whom the health care organization is affiliated through any
9 common ownership interest or by contract, which affiliation or contract
10 includes the person's or entity's involvement in the peer review process or
11 the provision of any management or administrative services to the health care
12 organization. The provision of peer review records to such persons or entities
13 shall not be deemed to be a waiver by the health care organization of any peer
14 review privilege. Such persons and entities receiving peer review records
15 shall preserve the confidential privileged character thereof, and such persons
16 and entities shall not be subject to any subpoena or order compelling produc-
17 tion of peer review records. Nothing in this section shall be deemed to
18 require the health care organization to provide such persons or entities with
19 peer review records. This section shall in no way impair the rights of indi-
20 viduals conducting such research or studies in the exercise of any right or
21 the discharge of any legitimate responsibility which they may have in connec-
22 tion with such research and/or studies and the results thereof. ; and provided
23 further, nNothing in this act shall be construed as restricting or altering
24 the rights of inspection and copying by patients and their duly authorized
25 representatives with respect to the such patients' official chart maintained
26 in connection with the course of care provided such patients patient care
27 records, which right of copying and inspection and to use of such charts
28 patient care records and their contents in appropriate judicial proceedings is
29 unaltered by this enactment.
30 SECTION 5. That Section 39-1393, Idaho Code, be, and the same is hereby
31 repealed.
32 SECTION 6. That Chapter 13, Title 39, Idaho Code, be, and the same is
33 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
34 ignated as Section 39-1393, Idaho Code, and to read as follows:
35 39-1393. NOTIFICATION OF PROFESSIONAL REVIEW ACTION IMPOSED UPON PHYSI-
36 CIAN. (1) Any health care organization in this state that is by law required
37 to conduct peer review or which voluntarily formally elects to conduct profes-
38 sional review actions shall notify the board of medicine of professional
39 review actions taken against physicians licensed in Idaho required to be
40 reported as provided in this section. Such reports shall be made to the board
41 of medicine within fifteen (15) days of completion of the professional review
42 action by the health care organization. Such required reports shall be made on
43 forms approved by the board of medicine consistent with the reporting require-
44 ments of this section. The reporting obligation shall not be stayed by the
45 filing of any court proceeding unless otherwise ordered by the court.
46 (2) A health care organization in Idaho shall report to the board of med-
47 icine if it:
48 (a) Takes a professional review action against a physician licensed in
49 Idaho and imposes a sanction of the type included in subsection (3) of
50 this section which lasts longer than thirty (30) days; or
51 (b) Accepts a voluntary sanction by a physician licensed in Idaho of the
52 type identified in subsection (3) of this section while the physician is
5
1 under investigation or to avoid investigation by the health care organiza-
2 tion relating to the professional competence or professional conduct of
3 the physician or in exchange for the health care organization not conduct-
4 ing such an investigation or initiating a professional review action, if
5 the sanction lasts longer than thirty (30) days.
6 (3) Professional review action sanctions against a physician which must
7 be reported to the board of medicine pursuant to subsection (2) of this sec-
8 tion, whether voluntary or involuntary, shall be:
9 (a) Restriction or limitation of privileges;
10 (b) Revocation of privileges;
11 (c) Suspension of privileges;
12 (d) Reduction of privileges;
13 (e) Denial of a request for initial privileges;
14 (f) Submission to monitoring of the physician's physical or mental condi-
15 tion;
16 (g) Submission to monitoring of the physician's delivery of medical ser-
17 vices other than to assess and monitor the physician's qualifications for
18 new or additional privileges;
19 (h) Surrender of privileges;
20 (i) Summary suspension or reduction of privileges lasting longer than
21 thirty (30) days;
22 (j) Termination of employment;
23 (k) Suspension of employment lasting longer than thirty (30) days.
24 (4) The reporting requirements of this section shall not apply to:
25 (a) Actions based on compliance with medical records or confidentiality
26 requirements of a health care organization;
27 (b) Voluntary requests for assistance or monitoring by a physician as
28 part of an educational process to improve physician skills or enhance
29 patient care when unrelated to a professional review action concerning the
30 quality or necessity of patient medical care;
31 (c) Voluntary or involuntary revocation, nonrenewal, denial, reduction,
32 restriction, resignation, or limitation of privileges or employment of a
33 physician based upon factors not directly impacting the quality of patient
34 care or safety of practice of the physician;
35 (d) Adverse actions taken against a physician by a health care organiza-
36 tion that is not required by law to conduct peer review and that has not
37 voluntarily formally elected to conduct professional review actions; and
38 (e) The denial of a physician's request for additional privileges or cre-
39 dentials with a health care organization.
40 (5) The report to the board of medicine required by this section shall
41 include a statement of the quality of care concerns or professional conduct
42 that is the basis of the professional review action or investigation and the
43 reportable professional review action sanction voluntarily accepted or invol-
44 untarily imposed.
45 (6) A health care organization required to report a professional review
46 action concerning a physician to the board of medicine pursuant to this sec-
47 tion shall, if requested by the board of medicine, provide to the board the
48 following:
49 (a) A statement of the specific quality of care concerns or professional
50 conduct which resulted in the professional review action sanction;
51 (b) A statement of the specific professional review action sanction; and
52 (c) Any patient care records of the health care organization regarding
53 the care provided by the reported physician. However, the board of medi-
54 cine may not request or require production of any peer review records from
55 any person or health care organization, including the identification of
6
1 which particular patient care records were selected for, or reviewed,
2 examined or discussed in any peer review activity of a health care organi-
3 zation, or the method used by the health care organization to select such
4 patient care records for peer review.
5 (7) The records lawfully requested by the board of medicine pursuant to
6 subsection (6) of this section shall be provided by the health care organiza-
7 tion without a subpoena or court order. If the health care organization fails
8 to comply with the board of medicine's lawful request, the board may petition
9 the district court for an order compelling compliance with the board's
10 request, which may be granted if disclosure is required by law.
11 (8) Any person or health care organization that provides notification as
12 required by law, or in a good faith belief that such notification is required
13 by law, shall be immune from any civil or other liability arising from provid-
14 ing the notification. Such immunity shall likewise pertain to the provision of
15 files, records and information a health care organization may in good faith
16 provide to the board of medicine pursuant to this section or other applicable
17 law. Such materials provided to the board of medicine shall be subject to dis-
18 closure by the board according to chapter 3, title 9, Idaho Code, and avail-
19 able only to the board of medicine and its staff unless and until such matter
20 becomes the subject of formal proceedings by or before the board of medicine
21 or authorized by it, and then only to the extent the board of medicine is
22 required by law to disclose such records, files or information.
23 SECTION 7. That Section 54-1818, Idaho Code, be, and the same is hereby
24 amended to read as follows:
25 54-1818. REPORTING OF VIOLATIONS BY PHYSICIANS. A licensed physician and
26 surgeon possessing knowledge of a violation of section 54-18104, Idaho Code,
27 by any other physician and surgeon licensed to practice medicine in Idaho
28 shall with reasonable promptness report such knowledge to the board of medi-
29 cine or its duly authorized committee, agency or representative, and failure
30 to do so shall subject such person to disciplinary action by the state board
31 of medicine as in its discretion the board shall deem proper, pursuant to pro-
32 cedures provided in chapter 18, title 54, Idaho Code; provided, no person
33 shall be civilly liable for communications, reports or acts of any kind made,
34 given or handled under the provisions of this act. However, notwithstanding
35 the foregoing, no physician or surgeon shall be required to report, nor shall
36 any physician or surgeon report, any information known, learned or discovered
37 by that physician or surgeon as a result of participation in peer review or
38 access to peer review records, as defined in section 39-1392a, Idaho Code.
39 This provision shall not relieve a health care organization of its notifica-
40 tion obligations as set forth in section 39-1393, Idaho Code.
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
Moved by Darrington
Seconded by Brandt
IN THE SENATE
SENATE AMENDMENT TO S.B. NO. 1102
1 AMENDMENTS TO SECTION 6
2 On page 6 of the printed bill, in line 10, delete "may" and insert:
3 "shall"; and delete lines 21 and 22 and insert: "or authorized by it.".
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
IN THE SENATE
SENATE BILL NO. 1102, As Amended
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO HOSPITAL LICENSES AND INSPECTION; AMENDING SECTION 39-1392a, IDAHO
3 CODE, TO DEFINE TERMS AND TO MAKE TECHNICAL AND GRAMMATICAL CHANGES;
4 AMENDING SECTION 39-1392b, IDAHO CODE, TO REVISE PROVISIONS RELATING TO
5 CONFIDENTIAL AND PRIVILEGED RECORDS; AMENDING SECTION 39-1392c, IDAHO
6 CODE, TO REVISE PROVISIONS RELATING TO CIVIL LIABILITY IMMUNITY; AMENDING
7 SECTION 39-1392d, IDAHO CODE, TO REVISE PROVISIONS RELATING TO PEER REVIEW
8 RECORDS OF HEALTH CARE ORGANIZATIONS AND TO PROVIDE REFERENCES TO PATIENT
9 CARE RECORDS; REPEALING SECTION 39-1393, IDAHO CODE, RELATING TO NOTIFICA-
10 TION OF DISCIPLINARY ACTION IMPOSED UPON A PHYSICIAN; AMENDING CHAPTER 13,
11 TITLE 39, IDAHO CODE, BY THE ADDITION OF A NEW SECTION 39-1393, IDAHO
12 CODE, TO PROVIDE FOR NOTIFICATION OF PROFESSIONAL REVIEW ACTION IMPOSED
13 UPON A PHYSICIAN; AND AMENDING SECTION 54-1818, IDAHO CODE, TO PROVIDE A
14 CORRECT CODE REFERENCE AND TO PROVIDE THAT NO PHYSICIAN OR SURGEON SHALL
15 REPORT CERTAIN INFORMATION RELATING TO PEER REVIEW RECORDS AND TO PROVIDE
16 THAT HEALTH CARE ORGANIZATIONS SHALL NOT BE RELIEVED OF CERTAIN NOTIFICA-
17 TION OBLIGATIONS.
18 Be It Enacted by the Legislature of the State of Idaho:
19 SECTION 1. That Section 39-1392a, Idaho Code, be, and the same is hereby
20 amended to read as follows:
21 39-1392a. DEFINITIONS. The following terms shall have the following mean-
22 ings when used in this section:
23 (a1) "Group medical practice" means a partnership, corporation, limited
24 liability company, or other association formed for the purpose of offering
25 health care services through physicians and other licensed or otherwise autho-
26 rized health care providers who are partners, shareholders, members, employ-
27 ees, or contractors of such group medical practice.
28 (b2) "Health care organization" means a hospital, in-hospital medical
29 staff committee, medical society, managed care organization, or group medical
30 practice.
31 (c3) "Hospital" shall means a facility in Idaho licensed under sections
32 39-1301 through 39-1314, Idaho Code, and defined in section 39-1301(a)(1),
33 Idaho Code.
34 (d4) "In-hospital medical staff committees" shall means any individual
35 doctor who is a hospital staff member, or any hospital employee, or any group
36 of such doctors and/or hospital employees, who are duly designated a committee
37 by hospital staff bylaws, by action of an organized hospital staff, or by
38 action of the board of directors of a hospital, and which committee is autho-
39 rized by said bylaws, staff or board of directors, to conduct research or
40 study of hospital patient cases, or of medical questions or problems using
41 data and information from hospital patient cases.
42 (e5) "Managed care organization" means a public or private person or
43 organization which offers a managed care plan.
2
1 (f6) "Managed care plan" means a contract of coverage given to an indi-
2 vidual, family or group of covered individuals pursuant to which a member is
3 entitled to receive a defined set of health care benefits through an organized
4 system of health care providers in exchange for defined consideration and
5 which requires the member to use, or creates financial incentives for the mem-
6 ber to use, health care providers owned, managed, employed by or under con-
7 tract with the managed care organization.
8 (g7) "Medical society" shall means any duly constituted, authorized and
9 recognized professional society or entity made up of physicians licensed to
10 practice medicine in Idaho, having as its purpose the maintenance of high
11 quality in the standards of health care provided in Idaho or any region or
12 segment of the state, operating with the approval of the Idaho state board of
13 medicine, or any official committee appointed by the Idaho state board of med-
14 icine.
15 (8) "Patient care records" means written or otherwise recorded, preserved
16 and maintained records of the medical or surgical diagnostic, clinical, or
17 therapeutic care of any patient treated by or under the direction of licensed
18 professional personnel in every health care organization subject to this act,
19 whether as an in-patient or out-patient of the health care organization.
20 (9) "Peer review" means the collection, interpretation and analysis of
21 data by a health care organization for the purpose of bettering the system of
22 delivery of health care or to improve the provision of health care or to
23 otherwise reduce patient morbidity and mortality and improve the quality of
24 patient care. Peer review activities by a health care organization include,
25 without limitation:
26 (a) Credentialing, privileging or affiliating of health care providers as
27 members of, or providers for, a health care organization;
28 (b) Quality assurance and improvement, patient safety investigations and
29 analysis, patient adverse outcome reviews, and root-cause analysis and
30 investigation activities by a health care organization; and
31 (c) Professional review action, meaning an action or recommendation of a
32 health care organization which is taken or made in the conduct of peer
33 review, that is based on the competence or professional conduct of an
34 individual physician where such conduct adversely affects or could
35 adversely affect the health or welfare of a patient or the physician's
36 privileges, employment or membership in the health care organization.
37 (10) "Peer review records" means all evidence of interviews, reports,
38 statements, minutes, memoranda, notes, investigative graphs and compilations
39 and the contents thereof, and all physical materials relating to peer review
40 of any health care organization. "Peer review records" does not mean or
41 include patient care records; provided however, that the records relating to
42 the identification of which particular patient care records were selected for,
43 or reviewed, examined or discussed in peer review by a health care organiza-
44 tion and the methodology used for selecting such records shall be considered
45 peer review records.
46 SECTION 2. That Section 39-1392b, Idaho Code, be, and the same is hereby
47 amended to read as follows:
48 39-1392b. RECORDS CONFIDENTIAL AND PRIVILEGED. Except as provided in sec-
49 tion 39-1392e, Idaho Code, all written records of interviews, all reports,
50 statements, minutes, memoranda, charts, and the contents thereof, and all
51 physical materials relating to research, discipline or medical study of any
52 health care organization, for the purposes set forth in section 39-1392, Idaho
53 Code, peer review records shall be confidential and privileged, and shall not
3
1 be directly or indirectly subject to subpoena or discovery proceedings or be
2 admitted as evidence, nor shall testimony relating thereto be admitted in evi-
3 dence, or in any action of any kind in any court or before any administrative
4 body, agency or person for any purpose whatsoever.; provided further nNo order
5 of censure, suspension or revocation of licensure or hospital health care
6 organization privilege of any physician licensed to practice medicine in Idaho
7 shall be admissible in any civil proceeding seeking damages or other civil
8 relief against the physician or hospital health care organization which may be
9 a party defendant in said cause.; provided, hHowever, this section shall not
10 prohibit or otherwise affect the use of said documents, materials or testimony
11 in health care organization proceedings, nor shall it prohibit or otherwise
12 affect the dissemination, for medical purposes, of information contained in
13 such documents or materials or the conclusions and findings of such health
14 care organization., and provided further, that tThis section shall not affect
15 the admissibility in evidence in any action or proceeding of any original med-
16 ical records the patient care records of any patient.
17 SECTION 3. That Section 39-1392c, Idaho Code, be, and the same is hereby
18 amended to read as follows:
19 39-1392c. IMMUNITY FROM CIVIL LIABILITY. The furnishing of information or
20 provision of opinions to any health care organization, as herein defined, or
21 their authorized representatives or investigators, or the receiving and use of
22 such information and opinions shall not subject any person, hospital, managed
23 care organization, sanitarium, nursing or rest home health care organization
24 or other person or agency to any liability or action for money damages or
25 other legal or equitable relief.; provided further, cCustodians of such
26 records and persons becoming aware of such data and opinions shall not dis-
27 close the same except as authorized by the Idaho state board of medicine or
28 pursuant to rules or regulations duly promulgated by said board, except that
29 any licensed hospital in the state of Idaho, acting through its governing
30 board or its medical staff, or by its duly authorized administrative staff,
31 rules adopted by the board of medicine or as otherwise authorized by law. Any
32 health care organization may upon request receive such disclosures, subject to
33 an obligation to preserve the confidential privileged character thereof and
34 subject further to the requirement that such requests shall be made and such
35 use shall be limited to the aid of such hospital in determining hospital priv-
36 ileges which may properly be allowed or refused any physician who is a member
37 of or who is seeking to secure or reinstate membership upon the medical staff
38 of such institution the health care organization in conducting peer review.
39 SECTION 4. That Section 39-1392d, Idaho Code, be, and the same is hereby
40 amended to read as follows:
41 39-1392d. PROPERTY OF HEALTH CARE ORGANIZATION. All such written and
42 other records of interviews, all reports, statements, minutes, memoranda,
43 charts and physical property or materials of any kind used in connection with
44 or relating to any such items or investigation or hearing or research disci-
45 pline or medical study for any of the purposes set forth in section 39-1392,
46 Idaho Code, peer review records of a health care organization shall be the
47 property of the health care organization concerned which obtains or compiles
48 the same.; provided, however, this A health care organization may provide peer
49 review records to persons or entities that perform accreditation, certifica-
50 tion or quality assurance review or evaluation of the health care organiza-
51 tion. The provision of any peer review records to such persons or entities
4
1 shall not be deemed to be a waiver by the health care organization of any peer
2 review privilege. Persons and entities receiving peer review records shall
3 preserve the confidential privileged character thereof and such persons and
4 entities shall not be subject to subpoena or order compelling production of
5 peer review records. Nothing in this section shall be deemed to require the
6 health care organization to provide persons or entities with peer review
7 records. A health care organization may provide peer review records to persons
8 or entities with whom the health care organization is affiliated through any
9 common ownership interest or by contract, which affiliation or contract
10 includes the person's or entity's involvement in the peer review process or
11 the provision of any management or administrative services to the health care
12 organization. The provision of peer review records to such persons or entities
13 shall not be deemed to be a waiver by the health care organization of any peer
14 review privilege. Such persons and entities receiving peer review records
15 shall preserve the confidential privileged character thereof, and such persons
16 and entities shall not be subject to any subpoena or order compelling produc-
17 tion of peer review records. Nothing in this section shall be deemed to
18 require the health care organization to provide such persons or entities with
19 peer review records. This section shall in no way impair the rights of indi-
20 viduals conducting such research or studies in the exercise of any right or
21 the discharge of any legitimate responsibility which they may have in connec-
22 tion with such research and/or studies and the results thereof. ; and provided
23 further, nNothing in this act shall be construed as restricting or altering
24 the rights of inspection and copying by patients and their duly authorized
25 representatives with respect to the such patients' official chart maintained
26 in connection with the course of care provided such patients patient care
27 records, which right of copying and inspection and to use of such charts
28 patient care records and their contents in appropriate judicial proceedings is
29 unaltered by this enactment.
30 SECTION 5. That Section 39-1393, Idaho Code, be, and the same is hereby
31 repealed.
32 SECTION 6. That Chapter 13, Title 39, Idaho Code, be, and the same is
33 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
34 ignated as Section 39-1393, Idaho Code, and to read as follows:
35 39-1393. NOTIFICATION OF PROFESSIONAL REVIEW ACTION IMPOSED UPON PHYSI-
36 CIAN. (1) Any health care organization in this state that is by law required
37 to conduct peer review or which voluntarily formally elects to conduct profes-
38 sional review actions shall notify the board of medicine of professional
39 review actions taken against physicians licensed in Idaho required to be
40 reported as provided in this section. Such reports shall be made to the board
41 of medicine within fifteen (15) days of completion of the professional review
42 action by the health care organization. Such required reports shall be made on
43 forms approved by the board of medicine consistent with the reporting require-
44 ments of this section. The reporting obligation shall not be stayed by the
45 filing of any court proceeding unless otherwise ordered by the court.
46 (2) A health care organization in Idaho shall report to the board of med-
47 icine if it:
48 (a) Takes a professional review action against a physician licensed in
49 Idaho and imposes a sanction of the type included in subsection (3) of
50 this section which lasts longer than thirty (30) days; or
51 (b) Accepts a voluntary sanction by a physician licensed in Idaho of the
52 type identified in subsection (3) of this section while the physician is
5
1 under investigation or to avoid investigation by the health care organiza-
2 tion relating to the professional competence or professional conduct of
3 the physician or in exchange for the health care organization not conduct-
4 ing such an investigation or initiating a professional review action, if
5 the sanction lasts longer than thirty (30) days.
6 (3) Professional review action sanctions against a physician which must
7 be reported to the board of medicine pursuant to subsection (2) of this sec-
8 tion, whether voluntary or involuntary, shall be:
9 (a) Restriction or limitation of privileges;
10 (b) Revocation of privileges;
11 (c) Suspension of privileges;
12 (d) Reduction of privileges;
13 (e) Denial of a request for initial privileges;
14 (f) Submission to monitoring of the physician's physical or mental condi-
15 tion;
16 (g) Submission to monitoring of the physician's delivery of medical ser-
17 vices other than to assess and monitor the physician's qualifications for
18 new or additional privileges;
19 (h) Surrender of privileges;
20 (i) Summary suspension or reduction of privileges lasting longer than
21 thirty (30) days;
22 (j) Termination of employment;
23 (k) Suspension of employment lasting longer than thirty (30) days.
24 (4) The reporting requirements of this section shall not apply to:
25 (a) Actions based on compliance with medical records or confidentiality
26 requirements of a health care organization;
27 (b) Voluntary requests for assistance or monitoring by a physician as
28 part of an educational process to improve physician skills or enhance
29 patient care when unrelated to a professional review action concerning the
30 quality or necessity of patient medical care;
31 (c) Voluntary or involuntary revocation, nonrenewal, denial, reduction,
32 restriction, resignation, or limitation of privileges or employment of a
33 physician based upon factors not directly impacting the quality of patient
34 care or safety of practice of the physician;
35 (d) Adverse actions taken against a physician by a health care organiza-
36 tion that is not required by law to conduct peer review and that has not
37 voluntarily formally elected to conduct professional review actions; and
38 (e) The denial of a physician's request for additional privileges or cre-
39 dentials with a health care organization.
40 (5) The report to the board of medicine required by this section shall
41 include a statement of the quality of care concerns or professional conduct
42 that is the basis of the professional review action or investigation and the
43 reportable professional review action sanction voluntarily accepted or invol-
44 untarily imposed.
45 (6) A health care organization required to report a professional review
46 action concerning a physician to the board of medicine pursuant to this sec-
47 tion shall, if requested by the board of medicine, provide to the board the
48 following:
49 (a) A statement of the specific quality of care concerns or professional
50 conduct which resulted in the professional review action sanction;
51 (b) A statement of the specific professional review action sanction; and
52 (c) Any patient care records of the health care organization regarding
53 the care provided by the reported physician. However, the board of medi-
54 cine may not request or require production of any peer review records from
55 any person or health care organization, including the identification of
6
1 which particular patient care records were selected for, or reviewed,
2 examined or discussed in any peer review activity of a health care organi-
3 zation, or the method used by the health care organization to select such
4 patient care records for peer review.
5 (7) The records lawfully requested by the board of medicine pursuant to
6 subsection (6) of this section shall be provided by the health care organiza-
7 tion without a subpoena or court order. If the health care organization fails
8 to comply with the board of medicine's lawful request, the board may petition
9 the district court for an order compelling compliance with the board's
10 request, which shall be granted if disclosure is required by law.
11 (8) Any person or health care organization that provides notification as
12 required by law, or in a good faith belief that such notification is required
13 by law, shall be immune from any civil or other liability arising from provid-
14 ing the notification. Such immunity shall likewise pertain to the provision of
15 files, records and information a health care organization may in good faith
16 provide to the board of medicine pursuant to this section or other applicable
17 law. Such materials provided to the board of medicine shall be subject to dis-
18 closure by the board according to chapter 3, title 9, Idaho Code, and avail-
19 able only to the board of medicine and its staff unless and until such matter
20 becomes the subject of formal proceedings by or before the board of medicine
21 or authorized by it.
22 SECTION 7. That Section 54-1818, Idaho Code, be, and the same is hereby
23 amended to read as follows:
24 54-1818. REPORTING OF VIOLATIONS BY PHYSICIANS. A licensed physician and
25 surgeon possessing knowledge of a violation of section 54-18104, Idaho Code,
26 by any other physician and surgeon licensed to practice medicine in Idaho
27 shall with reasonable promptness report such knowledge to the board of medi-
28 cine or its duly authorized committee, agency or representative, and failure
29 to do so shall subject such person to disciplinary action by the state board
30 of medicine as in its discretion the board shall deem proper, pursuant to pro-
31 cedures provided in chapter 18, title 54, Idaho Code; provided, no person
32 shall be civilly liable for communications, reports or acts of any kind made,
33 given or handled under the provisions of this act. However, notwithstanding
34 the foregoing, no physician or surgeon shall be required to report, nor shall
35 any physician or surgeon report, any information known, learned or discovered
36 by that physician or surgeon as a result of participation in peer review or
37 access to peer review records, as defined in section 39-1392a, Idaho Code.
38 This provision shall not relieve a health care organization of its notifica-
39 tion obligations as set forth in section 39-1393, Idaho Code.
Statement of Purpose/Fiscal Impact
Statement of Purpose
RS12918C1
Health care organizations maintain a formal peer review process in
order to reduce the occurrence of illness and death and to enforce
and improve standards of medical practice. This process enables
research, discipline, and medical study. Records used in peer
review are confidential and privileged and are not subject to
subpoena or discovery proceedings, as set forth in Idaho Code
39-1392.
This legislation serves to clearly define key terminology, to
include: "peer review," "peer review records," and "patient care
records." It also delineates the circumstances upon which records
lawfully may be released by the health care organization that owns
them; and it clarifies immunity from civil liability. Further, a
new section fully delineates the health care organizations'
reporting obligations to the state board of medicine and details
the sanctions and content of mandatory reports. In addition, the
measure clarifies that no physician or surgeon shall be required
to report information known, learned or discovered as a result of
access to peer review records or participation in peer review.
Fiscal Impact
This bill will have no fiscal impact on the state general fund.
CONTACTS:
Steven A. Millard, President Nancy M. Kerr, Director
Idaho Hospital Association Idaho State Board of Medicine
615 N. Seventh Street 1755 Westgate Drive,
P.O. Box 1278 Suite 140
Boise, ID 83701-1278 P.O. Box 83720
208/338-5100 ext. 203 Boise, ID 83720-0058
208/338-7800 (fax) 208/327-7000
208/327-7005 (fax)
Robert K. Seehusen, Chief
Executive
Idaho Medical Association
305 W. Jefferson Street
P.O. Box 2668
Boise, ID 83701
208/334-7888
208/344-7903 (fax)
S 1102