House Bill 2169

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    Florida House of Representatives - 2000                HB 2169

        By the Committee on Health Care Licensing & Regulation and
    Representative Fasano





  1                      A bill to be entitled

  2         An act relating to health care; creating the

  3         Florida Commission on Excellence in Health

  4         Care; providing legislative findings and

  5         intent; providing definitions; providing duties

  6         and responsibilities; providing for membership,

  7         organization, meetings, procedures, and staff;

  8         providing for reimbursement of travel and

  9         related expenses of certain members; providing

10         certain evidentiary prohibitions; requiring a

11         report to the Governor, the President of the

12         Senate, and the Speaker of the House of

13         Representatives; providing for termination of

14         the commission; providing an appropriation;

15         providing an effective date.

16

17  Be It Enacted by the Legislature of the State of Florida:

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19         Section 1.  Florida Commission on Excellence in Health

20  Care.--

21         (1)  LEGISLATIVE FINDINGS AND INTENT.--The Legislature

22  finds that the health care delivery industry is one of the

23  largest and most complex industries in Florida. The

24  Legislature finds that the current system of regulating health

25  care practitioners and health care providers is one of blame

26  and punishment and does not encourage voluntary admission of

27  errors and immediate corrective action on a large scale. The

28  Legislature finds that previous attempts to identify and

29  address areas which impact the quality of care provided by the

30  health care industry have suffered from a lack of coordination

31  among the industry's stakeholders and regulators. The

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  1  Legislature finds that additional focus on strengthening

  2  health care delivery systems by eliminating avoidable mistakes

  3  in the diagnosis and treatment of Floridians holds tremendous

  4  promise to increase the quality of health care services

  5  available to Floridians, thereby reducing the costs associated

  6  with medical mistakes and malpractice and in turn increasing

  7  access to health care in the state. To achieve this enhanced

  8  focus, it is the intent of the Legislature to create the

  9  Florida Commission on Excellence in Health Care to facilitate

10  the development of a comprehensive statewide strategy for

11  improving health care delivery systems through meaningful

12  reporting standards, data collection and review, and quality

13  measurement.

14         (2)  DEFINITIONS.--As used in this act, the term:

15         (a)  "Agency" means the Agency for Health Care

16  Administration.

17         (b)  "Commission" means the Florida Commission on

18  Excellence in Health Care.

19         (c)  "Department" means the Department of Health.

20         (d)  "Error," with respect to health care, means an

21  unintended act, by omission or commission.

22         (e)  "Health care practitioner" means any person

23  licensed under chapter 457; chapter 458; chapter 459; chapter

24  460; chapter 461; chapter 462; chapter 463; chapter 464;

25  chapter 465; chapter 466; chapter 467; part I, part II, part

26  III, part V, part X, part XIII, or part XIV of chapter 468;

27  chapter 478; chapter 480; part III or part IV of chapter 483;

28  chapter 484; chapter 486; chapter 490; or chapter 491, Florida

29  Statutes.

30         (f)  "Health care provider" means any health care

31  facility or other health care organization licensed or

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  1  certified to provide approved medical and allied health

  2  services in this state, or any entity licensed by the

  3  Department of Insurance as a prepaid health care plan or

  4  health maintenance organization or as an insurer to provide

  5  coverage for health care services through a network of

  6  providers.

  7         (3)  COMMISSION; DUTIES AND RESPONSIBILITIES.--There is

  8  hereby created the Florida Commission on Excellence in Health

  9  Care. The commission shall:

10         (a)  Identify existing data sources that evaluate

11  quality of care in Florida and collect, analyze, and evaluate

12  this data.

13         (b)  Establish guidelines for data sharing and

14  coordination.

15         (c)  Identify core sets of quality measures for

16  standardized reporting by appropriate components of the health

17  care continuum.

18         (d)  Recommend a framework for quality measurement and

19  outcome reporting.

20         (e)  Develop quality measures that enhance and improve

21  the ability to evaluate and improve care.

22         (f)  Make recommendations regarding research and

23  development needed to advance quality measurement and

24  reporting.

25         (g)  Evaluate regulatory issues relating to the

26  pharmacy profession and recommend changes necessary to

27  optimize patient safety.

28         (h)  Facilitate open discussion of a process to ensure

29  that comparative information on health care quality is valid,

30  reliable, comprehensive, understandable, and widely available

31  in the public domain.

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  1         (i)  Sponsor public hearings to share information and

  2  expertise, identify "best practices," and recommend methods to

  3  promote their acceptance.

  4         (j)  Evaluate current regulatory programs to determine

  5  what changes, if any, need to be made to facilitate patient

  6  safety.

  7         (k)  Review public and private health care purchasing

  8  systems to determine if there are sufficient mandates and

  9  incentives to facilitate continuous improvement in patient

10  safety.

11         (l)  Analyze how effective existing regulatory systems

12  are in ensuring continuous competence and knowledge of

13  effective safety practices.

14         (m)  Develop a framework for organizations that

15  license, accredit, or credential health care practitioners and

16  health care providers to more quickly and effectively identify

17  unsafe providers and practitioners and to take action

18  necessary to remove the unsafe provider or practitioner from

19  practice or operation until such time as the practitioner or

20  provider has proven safe to practice or operate.

21         (n)  Recommend procedures for development of a

22  curriculum on patient safety and methods of incorporating such

23  curriculum into training, licensure, and certification

24  requirements.

25         (o)  Develop a framework for regulatory bodies to

26  disseminate information on patient safety to health care

27  practitioners, health care providers, and consumers through

28  conferences, journal articles and editorials, newsletters,

29  publications, and Internet websites.

30         (p)  Recommend procedures to incorporate recognized

31  patient safety considerations into practice guidelines and

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  1  into standards related to the introduction and diffusion of

  2  new technologies, therapies, and drugs.

  3         (q)  Recommend a framework for development of

  4  community-based collaborative initiatives for error reporting

  5  and analysis and implementation of patient safety

  6  improvements.

  7         (r)  Evaluate the role of advertising in promoting or

  8  adversely affecting patient safety.

  9         (s)  Evaluate and make recommendations regarding the

10  need for licensure of additional persons who participate in

11  the delivery of health care to Floridians, including, but not

12  limited to, surgical technologists and pharmacy technicians.

13         (t)  Evaluate the benefits and problems of the current

14  medical malpractice and disciplinary systems and make

15  recommendations regarding alternative systems for reimbursing

16  patients for injuries resulting from medical errors which

17  focus on early error identification, personal responsibility,

18  corrective action, and education of other health care

19  practitioners, health care providers, and consumers to avoid

20  similar errors in the future.

21         (4)  MEMBERSHIP, ORGANIZATION, MEETINGS, PROCEDURES,

22  STAFF.--

23         (a)  The commission shall consist of:

24         1.  The Secretary of Health and the Executive Director

25  of the Agency for Health Care Administration.

26         2.  One representative each from the following agencies

27  or organizations:  the Board of Medicine, the Board of

28  Osteopathic Medicine, the Board of Pharmacy, the Board of

29  Nursing, the Board of Dentistry, the Florida Dental

30  Association, the Florida Medical Association, the Florida

31  Osteopathic Medical Association, the Florida Nurses

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  1  Association, the Florida Organization of Nursing Executives,

  2  the Florida Pharmacy Association, the Florida Society of

  3  Health System Pharmacists, Inc., the Florida Hospital

  4  Association, the Association of Community Hospitals and Health

  5  Systems of Florida, Inc., the Florida League of Health Care

  6  Systems, the Florida Health Care Risk Management Advisory

  7  Council, the Florida Health Care Association, and the Florida

  8  Association of Homes for the Aging;

  9         3.  One licensed clinical laboratory director,

10  appointed by the Secretary of Health;

11         4.  Two health lawyers, appointed by the Secretary of

12  Health, one of whom shall be a member of The Florida Bar

13  Health Law Section who defends physicians and one of whom

14  shall be a member of the Florida Academy of Trial Lawyers;

15         5.  One representative of the medical malpractice

16  professional liability insurance industry, appointed by the

17  Secretary of Health;

18         6.  Two representatives of the health insurance

19  industry, appointed by the Executive Director of the Agency

20  for Health Care Administration, one of whom shall represent

21  indemnity plans and one of whom shall represent managed care;

22         7.  Five consumer advocates, consisting of one from the

23  Association for Responsible Medicine, two appointed by the

24  Governor, one appointed by the President of the Senate, and

25  one appointed by the Speaker of the House of Representatives;

26  and

27         8.  Two legislators, one appointed by the President of

28  the Senate and one appointed by the Speaker of the House of

29  Representatives.

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  1  Commission membership shall reflect the geographic and

  2  demographic diversity of the state.

  3         (b)  The Secretary of Health and the Executive Director

  4  of the Agency for Health Care Administration shall jointly

  5  chair the commission. Subcommittees shall be formed by the

  6  joint chairs, as needed, to make recommendations to the full

  7  commission on the subjects assigned. However, all votes on

  8  work products of the commission shall be at the full

  9  commission level, and all recommendations to the Governor, the

10  President of the Senate, and the Speaker of the House of

11  Representatives must pass by a two-thirds vote of the full

12  commission. Sponsoring agencies and organizations may

13  designate an alternative member who may attend and vote on

14  behalf of the sponsoring agency or organization in the event

15  the appointed member is unable to attend a meeting of the

16  commission or any subcommittee. The commission shall be

17  staffed by employees of the Department of Health and the

18  Agency for Health Care Administration. Sponsoring agencies or

19  organizations must fund the travel and related expenses of

20  their appointed members on the commission. Travel and related

21  expenses for the consumer members of the commission shall be

22  reimbursed by the state pursuant to s. 112.061, Florida

23  Statutes. The commission shall hold its first meeting no later

24  than July 15, 2000.

25         (5)  EVIDENTIARY PROHIBITIONS.--

26         (a)  The findings, recommendations, evaluations,

27  opinions, investigations, proceedings, records, reports,

28  minutes, testimony, correspondence, work product, and actions

29  of the commission shall be available to the public, but may

30  not be introduced into evidence at any civil, criminal,

31  special, or administrative proceeding against a health care

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  1  practitioner or health care provider arising out of the

  2  matters which are the subject of the findings of the

  3  commission. Moreover, no member of the commission shall be

  4  examined in any civil, criminal, special, or administrative

  5  proceeding against a health care practitioner or health care

  6  provider as to any evidence or other matters produced or

  7  presented during the proceedings of this commission or as to

  8  any findings, recommendations, evaluations, opinions,

  9  investigations, proceedings, records, reports, minutes,

10  testimony, correspondence, work product, or other actions of

11  the commission or any members thereof. However, nothing in

12  this section shall be construed to mean that information,

13  documents, or records otherwise available and obtained from

14  original sources are immune from discovery or use in any

15  civil, criminal, special, or administrative proceeding merely

16  because they were presented during proceedings of the

17  commission. Nor shall any person who testifies before the

18  commission or who is a member of the commission be prevented

19  from testifying as to matters within his or her knowledge in a

20  subsequent civil, criminal, special, or administrative

21  proceeding merely because such person testified in front of

22  the commission.

23         (b)  The findings, recommendations, evaluations,

24  opinions, investigations, proceedings, records, reports,

25  minutes, testimony, correspondence, work product, and actions

26  of the commission shall be used as a guide and resource and

27  shall not be construed as establishing or advocating the

28  standard of care for health care practitioners or health care

29  providers unless subsequently enacted into law or adopted in

30  rule. Nor shall any findings, recommendations, evaluations,

31  opinions, investigations, proceedings, records, reports,

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  1  minutes, testimony, correspondence, work product, or actions

  2  of the commission be admissible as evidence in any way,

  3  directly or indirectly, by introduction of documents or as a

  4  basis of an expert opinion as to the standard of care

  5  applicable to health care practitioners or health care

  6  providers in any civil, criminal, special, or administrative

  7  proceeding unless subsequently enacted into law or adopted in

  8  rule.

  9         (c)  No person who testifies before the commission or

10  who is a member of the commission may specifically identify

11  any patient, health care practitioner, or health care provider

12  by name. Moreover, the findings, recommendations, evaluations,

13  opinions, investigations, proceedings, records, reports,

14  minutes, testimony, correspondence, work product, and actions

15  of the commission may not specifically identify any patient,

16  health care practitioner, or health care provider by name.

17         (6)  REPORT; TERMINATION.--The commission shall provide

18  a report of its findings and recommendations to the Governor,

19  the President of the Senate, and the Speaker of the House of

20  Representatives no later than February 1, 2001. After

21  submission of the report, the commission shall continue to

22  exist for the purpose of assisting the Department of Health,

23  the Agency for Health Care Administration, and the regulatory

24  boards in their drafting of proposed legislation and rules to

25  implement its recommendations and for the purpose of providing

26  information to the health care industry on its

27  recommendations. The commission shall be terminated June 1,

28  2001.

29         Section 2.  The sum of $91,000 in nonrecurring general

30  revenue is hereby appropriated from the General Revenue Fund

31  to the Department of Health to cover costs of the Florida

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  1  Commission on Excellence in Health Care relating to the travel

  2  and related expenses of staff, consumer members, and members

  3  appointed by the department or agency; the hiring of

  4  consultants, if necessary; and the reproduction and

  5  dissemination of documents.

  6         Section 3.  This act shall take effect upon becoming a

  7  law.

  8

  9            *****************************************

10                          HOUSE SUMMARY

11
      Creates the Florida Commission on Excellence in Health
12    Care to help develop a comprehensive statewide strategy
      for improving health care delivery systems. Provides the
13    duties and responsibilities of the commission and its
      membership, organization, meetings, and procedures.
14    Provides for staffing by employees of the Department of
      Health and the Agency for Health Care Administration.
15    Requires sponsoring agencies and organizations to fund
      the travel and related expenses of their members on the
16    commission. Provides for reimbursement of travel and
      related expenses of consumer members of the commission.
17    Provides certain evidentiary prohibitions. Requires the
      commission to submit a report of its findings and
18    recommendations to the Governor, the President of the
      Senate, and the Speaker of the House of Representatives
19    and to provide subsequent assistance and information with
      respect to those recommendations. Provides for
20    termination of the commission on a specified date.

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