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S1320.................................................by HEALTH AND WELFARE
EMERGENCY MEDICAL SERVICES PERSONNEL - Amends existing law to revise
definitions; to define "emergency medical services personnel" and "licensed
emergency medical service"; to provide that no disciplinary order of a
certification for emergency medical services personnel shall be admissible
in a civil proceeding seeking damages or other civil relief; to revise
exceptions to privilege and confidentiality to include references to
emergency medical services personnel; to provide for the submission of
certain reports on emergency medical services personnel to the Department
of Health and Welfare; to provide that the Department of Health and Welfare
shall approve forms for reports concerning emergency medical services
personnel; to require the reporting of professional review action sanctions
against emergency medical services personnel to the Department of Health
and Welfare; and to require that the report include certain statements.
02/16 Senate intro - 1st rdg - to printing
02/17 Rpt prt - to Health/Wel
02/27 Rpt out - rec d/p - to 2nd rdg
03/01 2nd rdg - to 3rd rdg
03/02 3rd rdg - PASSED - 34-0-1
AYES -- Andreason, Bailey, Brandt, Bunderson, Burkett, Burtenshaw,
Calabretta, Cameron, Compton(Duncan), Darrington, Davis, Gannon,
Geddes, Goedde, Hill, Ingram, Kennedy, Keough, Little, Lodge,
Malepeai, Marley, McKenzie, Noble(Anderson), Noh, Pearce, Richardson,
Schroeder, Sorensen, Stegner, Stennett, Sweet, Werk, Williams
NAYS -- None
Absent and excused -- McWilliams
Floor Sponsors - Compton(Duncan) & Brandt
Title apvd - to House
03/03 House intro - 1st rdg - to Health/Wel
03/05 Rpt out - rec d/p - to 2nd rdg
03/08 2nd rdg - to 3rd rdg
03/09 3rd rdg - PASSED - 70-0-0
AYES -- Andersen, Barraclough, Barrett, Bauer, Bayer, 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,
Jaquet, Jones, Kellogg, Kulczyk, Lake, Langford, Langhorst, Martinez,
McGeachin, McKague, Meyer, Miller, Mitchell, Moyle, Naccarato,
Nielsen, Pasley-Stuart, Raybould, Ridinger, Ring, Ringo, Roberts,
Robison, Rydalch, Sali, Sayler, Schaefer, Shepherd, Shirley, Skippen,
Smith(30), Smith(24), Smylie, Snodgrass, Stevenson, Trail, Wills,
Wood, Mr. Speaker
NAYS -- None
Absent and excused -- None
Floor Sponsor - Martinez
Title apvd - to Senate
03/10 To enrol
03/11 Rpt enrol - Pres signed
03/12 Sp signed
03/15 To Governor
03/19 Governor signed
Session Law Chapter 134
Effective: 07/01/04
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-seventh Legislature Second Regular Session - 2004
IN THE SENATE
SENATE BILL NO. 1320
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO EMERGENCY MEDICAL SERVICES PERSONNEL; AMENDING SECTION 39-1392a,
3 IDAHO CODE, TO REVISE DEFINITIONS AND TO DEFINE "EMERGENCY MEDICAL SER-
4 VICES PERSONNEL" AND "LICENSED EMERGENCY MEDICAL SERVICE"; AMENDING SEC-
5 TION 39-1392b, IDAHO CODE, TO PROVIDE THAT NO DISCIPLINARY ORDER OF A CER-
6 TIFICATION FOR EMERGENCY MEDICAL SERVICES PERSONNEL SHALL BE ADMISSIBLE IN
7 A CIVIL PROCEEDING SEEKING DAMAGES OR OTHER CIVIL RELIEF AGAINST THE EMER-
8 GENCY MEDICAL SERVICES PERSONNEL; AMENDING SECTION 39-1392e, IDAHO CODE,
9 TO REVISE EXCEPTIONS TO PRIVILEGE AND CONFIDENTIALITY TO INCLUDE REFER-
10 ENCES TO EMERGENCY MEDICAL SERVICES PERSONNEL AND TO MAKE A GRAMMATICAL
11 CORRECTION; AND AMENDING SECTION 39-1393, IDAHO CODE, TO REVISE DESCRIP-
12 TIVE LANGUAGE TO PROVIDE A REFERENCE TO EMERGENCY MEDICAL SERVICES PERSON-
13 NEL, TO PROVIDE FOR THE SUBMISSION OF CERTAIN REPORTS ON EMERGENCY MEDICAL
14 SERVICES PERSONNEL TO THE DEPARTMENT OF HEALTH AND WELFARE, TO PROVIDE
15 CLARIFYING LANGUAGE, TO PROVIDE THAT THE DEPARTMENT OF HEALTH AND WELFARE
16 SHALL APPROVE FORMS FOR REPORTS CONCERNING EMERGENCY MEDICAL SERVICES PER-
17 SONNEL, TO REQUIRE THE REPORTING OF PROFESSIONAL REVIEW ACTION SANCTIONS
18 AGAINST EMERGENCY MEDICAL SERVICES PERSONNEL TO THE DEPARTMENT OF HEALTH
19 AND WELFARE AND TO REQUIRE THAT THE REPORT INCLUDE CERTAIN STATEMENTS.
20 Be It Enacted by the Legislature of the State of Idaho:
21 SECTION 1. That Section 39-1392a, Idaho Code, be, and the same is hereby
22 amended to read as follows:
23 39-1392a. DEFINITIONS. The following terms shall have the following mean-
24 ings when used in this section:
25 (1) "Emergency medical services personnel" means emergency medical ser-
26 vices providers certified by the department of health and welfare pursuant to
27 section 56-1011 et seq., Idaho Code, and ambulance-based clinicians as defined
28 in the rules governing emergency medical services as promulgated by the
29 department of health and welfare.
30 (2) "Group medical practice" means a partnership, corporation, limited
31 liability company, or other association formed for the purpose of offering
32 health care services through physicians and other licensed or otherwise autho-
33 rized health care providers who are partners, shareholders, members, employ-
34 ees, or contractors of such group medical practice.
35 (23) "Health care organization" means a hospital, in-hospital medical
36 staff committee, medical society, managed care organization, licensed emer-
37 gency medical service or group medical practice.
38 (34) "Hospital" means a facility in Idaho licensed under sections 39-1301
39 through 39-1314, Idaho Code, and defined in section 39-1301(a)(1), Idaho Code.
40 (45) "In-hospital medical staff committees" means any individual doctor
41 who is a hospital staff member, or any hospital employee, or any group of such
42 doctors and/or hospital employees, who are duly designated a committee by hos-
43 pital staff bylaws, by action of an organized hospital staff, or by action of
2
1 the board of directors of a hospital, and which committee is authorized by
2 said bylaws, staff or board of directors, to conduct research or study of hos-
3 pital patient cases, or of medical questions or problems using data and infor-
4 mation from hospital patient cases.
5 (6) "Licensed emergency medical service" means an ambulance service or a
6 non-transport service licensed by the department of health and welfare pursu-
7 ant to section 56-1011 et seq., Idaho Code.
8 (57) "Managed care organization" means a public or private person or
9 organization which offers a managed care plan.
10 (68) "Managed care plan" means a contract of coverage given to an indi-
11 vidual, family or group of covered individuals pursuant to which a member is
12 entitled to receive a defined set of health care benefits through an organized
13 system of health care providers in exchange for defined consideration and
14 which requires the member to use, or creates financial incentives for the mem-
15 ber to use, health care providers owned, managed, employed by or under con-
16 tract with the managed care organization.
17 (79) "Medical society" means any duly constituted, authorized and recog-
18 nized professional society or entity made up of physicians licensed to prac-
19 tice medicine in Idaho, having as its purpose the maintenance of high quality
20 in the standards of health care provided in Idaho or any region or segment of
21 the state, operating with the approval of the Idaho state board of medicine,
22 or any official committee appointed by the Idaho state board of medicine.
23 (810) "Patient care records" means written or otherwise recorded, pre-
24 served and maintained records of the medical or surgical diagnostic, clinical,
25 or therapeutic care of any patient treated by or under the direction of
26 licensed professional personnel, including emergency medical services person-
27 nel, in every health care organization subject to this act, whether as an in-
28 patient or out-patient of the health care organization.
29 (911) "Peer review" means the collection, interpretation and analysis of
30 data by a health care organization for the purpose of bettering the system of
31 delivery of health care or to improve the provision of health care or to
32 otherwise reduce patient morbidity and mortality and improve the quality of
33 patient care. Peer review activities by a health care organization include,
34 without limitation:
35 (a) Credentialing, privileging or affiliating of health care providers as
36 members of, or providers for, a health care organization;
37 (b) Quality assurance and improvement, patient safety investigations and
38 analysis, patient adverse outcome reviews, and root-cause analysis and
39 investigation activities by a health care organization; and
40 (c) Professional review action, meaning an action or recommendation of a
41 health care organization which is taken or made in the conduct of peer
42 review, that is based on the competence or professional conduct of an
43 individual physician or emergency medical services personnel where such
44 conduct adversely affects or could adversely affect the health or welfare
45 of a patient or the physician's privileges, employment or membership in
46 the health care organization or in the case of emergency medical services
47 personnel, the emergency medical services personnel's scope of practice,
48 employment or membership in the health care organization.
49 (102) "Peer review records" means all evidence of interviews, reports,
50 statements, minutes, memoranda, notes, investigative graphs and compilations
51 and the contents thereof, and all physical materials relating to peer review
52 of any health care organization. "Peer review records" does not mean or
53 include patient care records; provided however, that the records relating to
54 the identification of which particular patient care records were selected for,
55 or reviewed, examined or discussed in peer review by a health care organiza-
3
1 tion and the methodology used for selecting such records shall be considered
2 peer review records.
3 SECTION 2. That Section 39-1392b, Idaho Code, be, and the same is hereby
4 amended to read as follows:
5 39-1392b. RECORDS CONFIDENTIAL AND PRIVILEGED. Except as provided in sec-
6 tion 39-1392e, Idaho Code, all peer review records shall be confidential and
7 privileged, and shall not be directly or indirectly subject to subpoena or
8 discovery proceedings or be admitted as evidence, nor shall testimony relating
9 thereto be admitted in evidence, or in any action of any kind in any court or
10 before any administrative body, agency or person for any purpose whatsoever.
11 No order of censure, suspension or revocation of licensure, or of a certifica-
12 tion in the case of emergency medical services personnel, or health care orga-
13 nization privilege of any physician licensed to practice medicine in Idaho
14 shall be admissible in any civil proceeding seeking damages or other civil
15 relief against the physician, emergency medical services personnel, or health
16 care organization which may be a defendant in said cause. However, this sec-
17 tion shall not prohibit or otherwise affect the use of documents, materials or
18 testimony in health care organization proceedings, nor shall it prohibit or
19 otherwise affect the dissemination, for medical purposes, of information con-
20 tained in such documents or materials or the conclusions and findings of such
21 health care organization. This section shall not affect the admissibility in
22 evidence in any action or proceeding of the patient care records of any
23 patient.
24 SECTION 3. That Section 39-1392e, Idaho Code, be, and the same is hereby
25 amended to read as follows:
26 39-1392e. LIMITED EXCEPTIONS TO PRIVILEGE AND CONFIDENTIALITY. (a) In the
27 event of a claim or civil action against a physician, emergency medical ser-
28 vices personnel, or a hospital arising out of a particular physician-patient,
29 emergency medical services personnel-patient, or hospital-patient relation-
30 ship, or which concerns the sufficiency of the delivery of particular health
31 care to a specific patient, any health care organization having information of
32 the kind covered by section 39-1392b, Idaho Code, shall, when interrogated as
33 hereinafter provided, advise any such claimant who is or was such a patient or
34 who, in a representative capacity, acts on behalf of such patient or his
35 heirs, as follows:
36 (1) Whether it has conducted or has in progress an inquiry, proceeding or
37 disciplinary matter regarding the quality of or propriety of the health
38 care involved, which concerns the subject patient while he was under the
39 care or responsibility of a member of such health care organization or
40 while he was a patient in such hospital; and, if so,
41 (2) Whether disposition of any kind resulted or will result therefrom;
42 and, if so,
43 (3) What the disposition was, or, if not yet determined, approximately
44 when it will be determined.
45 Such disclosure of information shall be limited to the health care
46 organization's actions in connection with the physician, emergency medical
47 services personnel, or hospital against whom such claim is asserted.
48 (b) Such a claimant shall likewise be entitled to inquire of such health
49 care organization respecting the names and addresses of persons who such
50 health care organization knows to have direct knowledge of the provision of
51 the health care in question, such inquiry to be limited, however, to the par-
4
1 ticular patient and the particular times and occasions germane to the specific
2 occurrences on which the claim is based; provided, names shall not be dis-
3 closed respecting persons who have gained secondary knowledge or formed opin-
4 ions respecting the matter solely by participating as witnesses, officials,
5 investigators or otherwise on, for, or in connection with such a health care
6 organization committee, staff, governing board or the state board of medicine.
7 (c) Such limited, conditional discovery and disclosure of information as
8 provided above shall be allowed only in response to inquiries directed to such
9 a health care organization, and then only if initially propounded by a claim-
10 ant of the type above described. If the matter is in litigation, inquiry may
11 be by customary means of discovery under the Idaho rules of civil procedure,
12 or, if pending in a United States court, then under discovery as allowed by
13 its applicable rules; provided, pendency of the claim in the United States
14 court or before any other tribunal shall not operate to broaden the exception
15 to the rules of privilege, confidentiality and immunity set down in this act.
16 (d) Such disclosures may be voluntarily made without judicial order or
17 formal discovery if all disciplined, accused or investigated physicians or
18 emergency medical services personnel consent thereto, and if privileged or
19 confidential information regarding any other patient, physician, emergency
20 medical services personnel, or person will not be disclosed thereby. When the
21 terms of this paragraph are complied with, such voluntary disclosures may be
22 made without civil liability therefor as if in due response to valid judicial
23 process or order.
24 (e) If any claimant makes such inquiry of any such health care organiza-
25 tion, he shall be deemed to have consented to like inquiry and disclosure
26 rights for the benefit of all parties against whom he asserts such claim or
27 brings such suit or action, and all other persons who are parties to such
28 action, and thereafter all such persons and parties may invoke the provisions
29 of this section, seeking and securing specific information as herein provided
30 for the benefit of such claimant, to the same extent as the same is allowed to
31 such claimant.
32 (f) If any physician, emergency medical services personnel, patient, per-
33 son, organization or entity whose conduct, care, chart, behavior, health or
34 standards of ethics or professional practice is the subject of investigation,
35 comment, testimony, dispositive order of any kind or other written or verbal
36 utterance or publication or act of any such health care organization or any
37 member or committee thereof in the course of research, study, disciplinary
38 proceeding or investigation of the sort contemplated by this act, makes claim
39 or brings suit on account of such health care organization activity, then, in
40 the defense thereof, confidentiality and privilege shall be deemed waived by
41 the making of such claim, and such health care organization and the members of
42 their staffs and committees shall be allowed to use and resort to such other-
43 wise protected information for the purpose of presenting proof of the facts
44 surrounding such matter, and this provision shall apply whether such claim be
45 for equitable or legal relief or for intentional or unintentional tort of any
46 kind and whether pressed by a patient, physician, emergency medical services
47 personnel, or any other person, but such waiver shall only be effective in
48 connection with the disposition or litigation of such claim, and the court
49 shall, in its discretion, enter appropriate orders protecting, and as fully as
50 it reasonably can do so, preserving the confidentiality of such materials and
51 information.
52 SECTION 4. That Section 39-1393, Idaho Code, be, and the same is hereby
53 amended to read as follows:
5
1 39-1393. NOTIFICATION OF PROFESSIONAL REVIEW ACTION IMPOSED UPON PHYSI-
2 CIAN OR EMERGENCY MEDICAL SERVICES PERSONNEL. (1) Any health care organization
3 in this state that is by law required to conduct peer review or which volun-
4 tarily formally elects to conduct professional review actions shall notify the
5 board of medicine of professional review actions taken against physicians
6 licensed in Idaho required to be reported as provided in this section. Such
7 reports shall be made to the board of medicine within fifteen (15) days of
8 completion of the professional review action by the health care organization.
9 For emergency medical services personnel, such reports shall be made to the
10 department of health and welfare within fifteen (15) days of completion of the
11 professional review action by the health care organization. Such required
12 reports shall be made on forms approved by the board of medicine for reports
13 concerning physicians, or the department of health and welfare for reports
14 concerning emergency medical services personnel, consistent with the reporting
15 requirements of this section. The reporting obligation shall not be stayed by
16 the filing of any court proceeding unless otherwise ordered by the court.
17 (2) A health care organization in Idaho shall report to the board of med-
18 icine if it:
19 (a) Takes a professional review action against a physician licensed in
20 Idaho and imposes a sanction of the type included in subsection (3) of
21 this section which lasts longer than thirty (30) days; or
22 (b) Accepts a voluntary sanction by a physician licensed in Idaho of the
23 type identified in subsection (3) of this section while the physician is
24 under investigation or to avoid investigation by the health care organiza-
25 tion relating to the professional competence or professional conduct of
26 the physician or in exchange for the health care organization not conduct-
27 ing such an investigation or initiating a professional review action, if
28 the sanction lasts longer than thirty (30) days.
29 (3) Professional review action sanctions against a physician which must
30 be reported to the board of medicine pursuant to subsection (2) of this sec-
31 tion, whether voluntary or involuntary, shall be:
32 (a) Restriction or limitation of privileges;
33 (b) Revocation of privileges;
34 (c) Suspension of privileges;
35 (d) Reduction of privileges;
36 (e) Denial of a request for initial privileges;
37 (f) Submission to monitoring of the physician's physical or mental condi-
38 tion;
39 (g) Submission to monitoring of the physician's delivery of medical ser-
40 vices other than to assess and monitor the physician's qualifications for
41 new or additional privileges;
42 (h) Surrender of privileges;
43 (i) Summary suspension or reduction of privileges lasting longer than
44 thirty (30) days;
45 (j) Termination of employment;
46 (k) Suspension of employment lasting longer than thirty (30) days.
47 (4) The reporting requirements of this section shall not apply to:
48 (a) Actions based on compliance with medical records or confidentiality
49 requirements of a health care organization;
50 (b) Voluntary requests for assistance or monitoring by a physician as
51 part of an educational process to improve physician skills or enhance
52 patient care when unrelated to a professional review action concerning the
53 quality or necessity of patient medical care;
54 (c) Voluntary or involuntary revocation, nonrenewal, denial, reduction,
55 restriction, resignation, or limitation of privileges or employment of a
6
1 physician based upon factors not directly impacting the quality of patient
2 care or safety of practice of the physician;
3 (d) Adverse actions taken against a physician by a health care organiza-
4 tion that is not required by law to conduct peer review and that has not
5 voluntarily formally elected to conduct professional review actions; and
6 (e) The denial of a physician's request for additional privileges or cre-
7 dentials with a health care organization.
8 (5) The report to the board of medicine required by this section shall
9 include a statement of the quality of care concerns or professional conduct
10 that is the basis of the professional review action or investigation and the
11 reportable professional review action sanction voluntarily accepted or invol-
12 untarily imposed.
13 (6) A health care organization required to report a professional review
14 action concerning a physician to the board of medicine pursuant to this sec-
15 tion shall, if requested by the board of medicine, provide to the board the
16 following:
17 (a) A statement of the specific quality of care concerns or professional
18 conduct which resulted in the professional review action sanction;
19 (b) A statement of the specific professional review action sanction; and
20 (c) Any patient care records of the health care organization regarding
21 the care provided by the reported physician. However, the board of medi-
22 cine may not request or require production of any peer review records from
23 any person or health care organization, including the identification of
24 which particular patient care records were selected for, or reviewed,
25 examined or discussed in any peer review activity of a health care organi-
26 zation, or the method used by the health care organization to select such
27 patient care records for peer review.
28 (7) The records lawfully requested by the board of medicine pursuant to
29 subsection (6) of this section shall be provided by the health care organiza-
30 tion without a subpoena or court order. If the health care organization fails
31 to comply with the board of medicine's lawful request, the board may petition
32 the district court for an order compelling compliance with the board's
33 request, which shall be granted if disclosure is required by law.
34 (8) Professional review action sanctions against emergency medical ser-
35 vices personnel, whether voluntary or involuntary, which are the result of any
36 action, conduct, or failure to act which is inconsistent with the
37 professionalism and/or standards established in the rules governing emergency
38 medical services personnel as promulgated by the department of health and wel-
39 fare must be reported to the department of health and welfare.
40 (9) The report to the department of health and welfare required by this
41 section shall include a statement of the quality of care concerns or profes-
42 sional conduct that is the basis of the professional review action or investi-
43 gation and the reportable professional review action sanction voluntarily
44 accepted or involuntarily imposed.
45 (10) Any person or health care organization that provides notification as
46 required by law, or in a good faith belief that such notification is required
47 by law, shall be immune from any civil or other liability arising from provid-
48 ing the notification. Such immunity shall likewise pertain to the provision of
49 files, records and information a health care organization may in good faith
50 provide to the board of medicine pursuant to this section or other applicable
51 law. Such materials provided to the board of medicine shall be subject to dis-
52 closure by the board according to chapter 3, title 9, Idaho Code, and avail-
53 able only to the board of medicine and its staff unless and until such matter
54 becomes the subject of formal proceedings by or before the board of medicine
55 or authorized by it.
STATEMENT OF PURPOSE
RS 14042
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 to improve
quality of care. Records used in peer review are confidential and
privileged and generally are not subject to subpoena or
discovery. This confidentiality allows open and honest
communication which is critical for the peer review process to
work.
Idaho's peer review statutes only apply to peer review of care
provided in hospitals and other health care organizations.
Emergency medical services (EMS) personnel provide care to
patients before they arrive in the hospital setting. The quality
of care EMS personnel provide is of critical importance to all
Idahoans. Their current attempts at peer review are severely
curtailed because they are not covered by these statutes.
This legislation would include EMS personnel within Idaho's peer
review statutes and thereby encourage their participation in this
most important quality improvement tool.
Fiscal Impact
This bill will have no fiscal impact on state or local funds.
Contacts:
Bob Seehusen, CEO, Idaho Medical Association
Ron Hodge, Assoc. Exec. Dr.
344-7888
Steve Millard, President, Idaho Hospital Association
338-5100
STATEMENT OF PURPOSE/FISCAL NOTE S 1320