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S1141.................................................by HEALTH AND WELFARE SKILLED NURSING FACILITIES - Amends existing law to include skilled nursing facilities within procedures specified for peer review. 02/14 Senate intro - 1st rdg - to printing 02/15 Rpt prt - to Health/Wel 02/18 Rpt out - rec d/p - to 2nd rdg 02/21 2nd rdg - to 3rd rdg 02/22 3rd rdg - PASSED - 27-0-8 AYES -- Andreason, Broadsword, Bunderson, Cameron, Coiner, Compton, Corder, Darrington, Davis, Gannon, Geddes, Jorgenson, Kelly, Keough, Langhorst, Little, Lodge, Malepeai, Marley, McGee, McKenzie, Pearce, Richardson, Schroeder, Stegner, Stennett, Werk NAYS -- None Absent and excused -- Brandt, Burkett, Burtenshaw, Goedde, Hill, Noble, Sweet, Williams Floor Sponsor - Darrington Title apvd - to House 02/23 House intro - 1st rdg - to Health/Wel 03/01 Rpt out - rec d/p - to 2nd rdg 03/02 2nd rdg - to 3rd rdg 03/09 3rd rdg - PASSED - 64-0-6 AYES -- Anderson, Andrus, Barraclough, Barrett, Bastian, Bayer, Bell, Bilbao, Black, Block, Boe, Bolz, Bradford, Cannon, Chadderdon, Clark, Collins, Deal, Denney, Edmunson, Ellsworth, Field(18), Garrett, Hart, Harwood, Henbest, Henderson, Jaquet, Jones, Kemp, Lake, LeFavour, Loertscher, Martinez, Mathews, McGeachin, McKague, Mitchell, Moyle, Nielsen, Nonini, Pasley-Stuart, Pence, Ring, Ringo, Roberts, Rusche, Rydalch, Sali, Sayler, Schaefer, Shepherd(2), Shepherd(8), Shirley, Skippen, Smith(30), Smith(24), Smylie, Snodgrass, Stevenson, Trail, Wills, Wood, Mr. Speaker NAYS -- None Absent and excused -- Bedke, Crow, Eskridge, Field(23), Miller, Raybould Floor Sponsor - Ring Title apvd - to Senate 03/10 To enrol 03/11 Rpt enrol - Pres signed 03/14 Sp signed 03/15 To Governor 03/21 Governor signed Session Law Chapter 103 Effective: 07/01/05
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]] Fifty-eighth Legislature First Regular Session - 2005 IN THE SENATE SENATE BILL NO. 1141 BY HEALTH AND WELFARE COMMITTEE 1 AN ACT 2 RELATING TO PEER REVIEW PROCEDURES FOR SKILLED NURSING FACILITIES; AMENDING 3 SECTION 39-1392a, IDAHO CODE, TO DEFINE ADDITIONAL TERMS AND TO MAKE TECH- 4 NICAL CORRECTIONS; AND AMENDING SECTION 39-1392e, IDAHO CODE, TO INCLUDE 5 REFERENCES TO SKILLED NURSING FACILITIES WITHIN PROCEDURES SPECIFIED. 6 Be It Enacted by the Legislature of the State of Idaho: 7 SECTION 1. That Section 39-1392a, Idaho Code, be, and the same is hereby 8 amended to read as follows: 9 39-1392a. DEFINITIONS. The following terms shall have the following mean- 10 ings when used in this section: 11 (1) "Emergency medical services personnel" means emergency medical ser- 12 vices providers certified by the department of health and welfare pursuant to 13 section 56-1011 et seq., Idaho Code, and ambulance-based clinicians as defined 14 in the rules governing emergency medical services as promulgated by the 15 department of health and welfare. 16 (2) "Group medical practice" means a partnership, corporation, limited 17 liability company, or other association formed for the purpose of offering 18 health care services through physicians and other licensed or otherwise autho- 19 rized health care providers who are partners, shareholders, members, employ- 20 ees, or contractors of such group medical practice. 21 (3) "Health care organization" means a hospital, in-hospital medical 22 staff committee, medical society, managed care organization, licensed emer- 23 gency medical service, orgroup medical practice, or skilled nursing facility. 24 (4) "Hospital" means a facility in Idaho licensed under sections 39-1301 25 through 39-1314, Idaho Code, and defined in section 39-1301(a)(1), Idaho Code. 26 (5) "In-hospital medical staff committees" means any individual doctor 27 who is a hospital staff member, or any hospital employee, or any group of such 28 doctors and/or hospital employees, who are duly designated a committee by hos- 29 pital staff bylaws, by action of an organized hospital staff, or by action of 30 the board of directors of a hospital, and which committee is authorized by 31 said bylaws, staff or board of directors, to conduct research or study of hos- 32 pital patient cases, or of medical questions or problems using data and infor- 33 mation from hospital patient cases. 34 (6) "Licensed emergency medical service" means an ambulance service or a 35 non-transportnontransport service licensed by the department of health and 36 welfare pursuant to section 56-1011 et seq., Idaho Code. 37 (7) "Managed care organization" means a public or private person or orga- 38 nization which offers a managed care plan. 39 (8) "Managed care plan" means a contract of coverage given to an individ- 40 ual, family or group of covered individuals pursuant to which a member is 41 entitled to receive a defined set of health care benefits through an organized 42 system of health care providers in exchange for defined consideration and 43 which requires the member to use, or creates financial incentives for the mem- 2 1 ber to use, health care providers owned, managed, employed by or under con- 2 tract with the managed care organization. 3 (9) "Medical society" means any duly constituted, authorized and recog- 4 nized professional society or entity made up of physicians licensed to prac- 5 tice medicine in Idaho, having as its purpose the maintenance of high quality 6 in the standards of health care provided in Idaho or any region or segment of 7 the state, operating with the approval of the Idaho state board of medicine, 8 or any official committee appointed by the Idaho state board of medicine. 9 (10) "Patient care records" means written or otherwise recorded, preserved 10 and maintained records of the medical or surgical diagnostic, clinical, or 11 therapeutic care of any patient treated by or under the direction of licensed 12 professional personnel, including emergency medical services personnel, in 13 every health care organization subject to this act, whether as an in-patient14 inpatient or out-patientoutpatient of the health care organization. 15 (11) "Peer review" means the collection, interpretation and analysis of 16 data by a health care organization for the purpose of bettering the system of 17 delivery of health care or to improve the provision of health care or to 18 otherwise reduce patient morbidity and mortality and improve the quality of 19 patient care. Peer review activities by a health care organization include, 20 without limitation: 21 (a) Credentialing, privileging or affiliating of health care providers as 22 members of, or providers for, a health care organization; 23 (b) Quality assurance and improvement, patient safety investigations and 24 analysis, patient adverse outcome reviews, and root-cause analysis and 25 investigation activities by a health care organization; and 26 (c) Professional review action, meaning an action or recommendation of a 27 health care organization which is taken or made in the conduct of peer 28 review, that is based on the competence or professional conduct of an 29 individual physician or emergency medical services personnel where such 30 conduct adversely affects or could adversely affect the health or welfare 31 of a patient or the physician's privileges, employment or membership in 32 the health care organization or in the case of emergency medical services 33 personnel, the emergency medical services personnel's scope of practice, 34 employment or membership in the health care organization. 35 (12) "Peer review records" means all evidence of interviews, reports, 36 statements, minutes, memoranda, notes, investigative graphs and compilations 37 and the contents thereof, and all physical materials relating to peer review 38 of any health care organization. "Peer review records" does not mean or 39 include patient care records; provided however, that the records relating to 40 the identification of which particular patient care records were selected for, 41 or reviewed, examined or discussed in peer review by a health care organiza- 42 tion and the methodology used for selecting such records shall be considered 43 peer review records. 44 (13) "Skilled nursing facility" means a facility licensed under chapter 45 13, title 39, Idaho Code, to provide skilled care to recipients. 46 SECTION 2. That Section 39-1392e, Idaho Code, be, and the same is hereby 47 amended to read as follows: 48 39-1392e. LIMITED EXCEPTIONS TO PRIVILEGE AND CONFIDENTIALITY. (a) In the 49 event of a claim or civil action against a physician, emergency medical ser- 50 vices personnel, ora hospital or a skilled nursing facility arising out of a 51 particular physician-patient, emergency medical services personnel-patient, or52 hospital-patient relationship, or skilled nursing facility-patient, or which 53 concerns the sufficiency of the delivery of particular health care to a spe- 3 1 cific patient, any health care organization having information of the kind 2 covered by section 39-1392b, Idaho Code, shall, when interrogated as hereinaf- 3 ter provided, advise any such claimant who is or was such a patient or who, in 4 a representative capacity, acts on behalf of such patient or his heirs, as 5 follows: 6 (1) Whether it has conducted or has in progress an inquiry, proceeding or 7 disciplinary matter regarding the quality or propriety of the health care 8 involved, which concerns the subject patient while he was under the care 9 or responsibility of a member of such health care organization or while he 10 was a patient in such hospital or facility; and, if so, 11 (2) Whether disposition of any kind resulted or will result therefrom; 12 and, if so, 13 (3) What the disposition was, or, if not yet determined, approximately 14 when it will be determined. 15 Such disclosure of information shall be limited to the health care 16 organization's actions in connection with the physician, emergency medical 17 services personnel, orhospital or skilled nursing facility against whom such 18 claim is asserted. 19 (b) Such a claimant shall likewise be entitled to inquire of such health 20 care organization respecting the names and addresses of persons who such 21 health care organization knows to have direct knowledge of the provision of 22 the health care in question, such inquiry to be limited, however, to the par- 23 ticular patient and the particular times and occasions germane to the specific 24 occurrences on which the claim is based; provided, names shall not be dis- 25 closed respecting persons who have gained secondary knowledge or formed opin- 26 ions respecting the matter solely by participating as witnesses, officials, 27 investigators or otherwise on, for, or in connection with such a health care 28 organization committee, staff, governing board or the state board of medicine. 29 (c) Such limited, conditional discovery and disclosure of information as 30 provided above shall be allowed only in response to inquiries directed to such 31 a health care organization, and then only if initially propounded by a claim- 32 ant of the type above described. If the matter is in litigation, inquiry may 33 be by customary means of discovery under the Idaho rules of civil procedure, 34 or, if pending in a United States court, then under discovery as allowed by 35 its applicable rules; provided, pendency of the claim in the United States 36 court or before any other tribunal shall not operate to broaden the exception 37 to the rules of privilege, confidentiality and immunity set down in this act. 38 (d) Such disclosures may be voluntarily made without judicial order or 39 formal discovery if all disciplined, accused or investigated physicians or 40 emergency medical services personnel consent thereto, and if privileged or 41 confidential information regarding any other patient, physician, emergency 42 medical services personnel, or person will not be disclosed thereby. When the 43 terms of this paragraph are complied with, such voluntary disclosures may be 44 made without civil liability therefor as if in due response to valid judicial 45 process or order. 46 (e) If any claimant makes such inquiry of any such health care organiza- 47 tion, he shall be deemed to have consented to like inquiry and disclosure 48 rights for the benefit of all parties against whom he asserts such claim or 49 brings such suit or action, and all other persons who are parties to such 50 action, and thereafter all such persons and parties may invoke the provisions 51 of this section, seeking and securing specific information as herein provided 52 for the benefit of such claimant, to the same extent as the same is allowed to 53 such claimant. 54 (f) If any physician, emergency medical services personnel, patient, per- 55 son, organization or entity whose conduct, care, chart, behavior, health or 4 1 standards of ethics or professional practice is the subject of investigation, 2 comment, testimony, dispositive order of any kind or other written or verbal 3 utterance or publication or act of any such health care organization or any 4 member or committee thereof in the course of research, study, disciplinary 5 proceeding or investigation of the sort contemplated by this act, makes claim 6 or brings suit on account of such health care organization activity, then, in 7 the defense thereof, confidentiality and privilege shall be deemed waived by 8 the making of such claim, and such health care organization and the members of 9 their staffs and committees shall be allowed to use and resort to such other- 10 wise protected information for the purpose of presenting proof of the facts 11 surrounding such matter, and this provision shall apply whether such claim be 12 for equitable or legal relief or for intentional or unintentional tort of any 13 kind and whether pressed by a patient, physician, emergency medical services 14 personnel, or any other person, but such waiver shall only be effective in 15 connection with the disposition or litigation of such claim, and the court 16 shall, in its discretion, enter appropriate orders protecting, and as fully as 17 it reasonably can do so, preserving the confidentiality of such materials and 18 information.
STATEMENT OF PURPOSE RS 14877 The peer review privilege and immunity has been found in Idaho laws for many years. The peer review process helps lead to effective internal investigations and reviews which require frank and candid disclosures and evaluations by those participating in the process, including facility employees, staff, and physicians. Similar protection is provided physicians for the same reasons under the Health Care Quality Improvement Act, 42 U.S.C. 11101 et seq. Unfortunately, however, when the peer review statute was originally drafted, skilled nursing facilities were simply not included. The requested amendment is designed to cure the oversight and provide skilled nursing facilities the protection offered to other health care organizations in order to facilitate effective quality improvement investigations, peer review, and improve over all health care. FISCAL NOTE There is no fiscal impact of this bill. Contact Name: Robert Vande Merwe Executive Director Idaho Health Care Association 802 W. Bannock,Suite 304 Boise, ID 83702 Phone: 343-9735 STATEMENT OF PURPOSE/FISCAL NOTE S 1141