CODING: Words stricken are deletions; words underlined are additions.



                                                  SENATE AMENDMENT

    Bill No. CS/HB 2339

    Amendment No. ___

                            CHAMBER ACTION
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10  ______________________________________________________________

11  Senator Diaz-Balart moved the following amendment:

12

13         Senate Amendment (with title amendment) 

14         On page 105, between lines 12 and 13,

15

16  insert:

17         Section 64.  Florida Commission on Excellence in Health

18  Care.--

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

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

21  largest and most complex industries in Florida. The

22  Legislature finds that additional focus on strengthening

23  health care delivery systems by eliminating avoidable mistakes

24  in the diagnosis and treatment of Floridians holds tremendous

25  promise to increase the quality of health care services

26  available to Floridians. To achieve this enhanced focus, it is

27  the intent of the Legislature to create the Florida Commission

28  on Excellence in Health Care to facilitate the development of

29  a comprehensive statewide strategy for improving health care

30  delivery systems through meaningful reporting standards, data

31  collection and review, and quality measurement.

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 2339

    Amendment No. ___





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

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

  3  Administration.

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

  5  Excellence in Health Care.

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

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

  8  unintended act, by omission or commission.

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

10  licensed under chapter 457; chapter 458; chapter 459; chapter

11  460; chapter 461; chapter 462; chapter 463; chapter 464;

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

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

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

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

16  Statutes.

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

18  facility or other health care organization licensed or

19  certified to provide approved medical and allied health

20  services in this state.

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

22  created the Florida Commission on Excellence in Health Care.

23  The commission shall:

24         (a)  Identify existing data sources that evaluate

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

26  this data.

27         (b)  Establish guidelines for data sharing and

28  coordination.

29         (c)  Identify core sets of quality measures for

30  standardized reporting by appropriate components of the health

31  care continuum.

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 2339

    Amendment No. ___





  1         (d)  Recommend a framework for quality measurement and

  2  outcome reporting.

  3         (e)  Develop quality measures that enhance and improve

  4  the ability to evaluate and improve care.

  5         (f)  Make recommendations regarding research and

  6  development needed to advance quality measurement and

  7  reporting.

  8         (g)  Evaluate regulatory issues relating to the

  9  pharmacy profession and recommend changes necessary to

10  optimize patient safety.

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

12  that comparative information on health care quality is valid,

13  reliable, comprehensive, understandable, and widely available

14  in the public domain.

15         (i)  Sponsor public hearings to share information and

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

17  promote their acceptance.

18         (j)  Evaluate current regulatory programs to determine

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

20  safety.

21         (k)  Review public and private health care purchasing

22  systems to determine if there are sufficient mandates and

23  incentives to facilitate continuous improvement in patient

24  safety.

25         (l)  Analyze how effective existing regulatory systems

26  are in ensuring continuous competence and knowledge of

27  effective safety practices.

28         (m)  Develop a framework for organizations that

29  license, accredit, or credential health care practitioners and

30  health care providers to more quickly and effectively identify

31  unsafe providers and practitioners and to take action

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 2339

    Amendment No. ___





  1  necessary to remove the unsafe provider or practitioner from

  2  practice or operation until such time as the practitioner or

  3  provider has proven safe to practice or operate.

  4         (n)  Recommend procedures for development of a

  5  curriculum on patient safety and methods of incorporating such

  6  curriculum into training, licensure, and certification

  7  requirements.

  8         (o)  Develop a framework for regulatory bodies to

  9  disseminate information on patient safety to health care

10  practitioners, health care providers, and consumers through

11  conferences, journal articles and editorials, newsletters,

12  publications, and Internet websites.

13         (p)  Recommend procedures to incorporate recognized

14  patient safety considerations into practice guidelines and

15  into standards related to the introduction and diffusion of

16  new technologies, therapies, and drugs.

17         (q)  Recommend a framework for development of

18  community-based collaborative initiatives for error reporting

19  and analysis and implementation of patient safety

20  improvements.

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

22  adversely affecting patient safety.

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

24  STAFF.--

25         (a)  The commission shall consist of:

26         1.  The Secretary of Health and the Director of Health

27  Care Administration;

28         2.  One representative each from the following agencies

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

30  Osteopathic Medicine, the Board of Pharmacy, the Board of

31  Dentistry, the Board of Nursing, the Florida Dental

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 2339

    Amendment No. ___





  1  Association, the Florida Medical Association, the Florida

  2  Osteopathic Medical Association, the Florida Chiropractic

  3  Association, the Florida Chiropractic Society, the Florida

  4  Podiatric Medical Association, the Florida Nurses Association,

  5  the Florida Organization of Nursing Executives, the Florida

  6  Pharmacy Association, the Florida Society of Health System

  7  Pharmacists, Inc., the Florida Hospital Association, the

  8  Association of Community Hospitals and Health Systems of

  9  Florida, Inc., the Florida League of Health Systems, the

10  Florida Health Care Risk Management Advisory Council, the

11  Florida Health Care Association, the Florida Statutory

12  Teaching Hospital Council, Inc., the Florida Statutory Rural

13  Hospital Council, the Florida Association of Homes for the

14  Aging, and the Florida Society for Respiratory Care;

15         3.  Two health lawyers, appointed by the Secretary of

16  Health, one of whom must be a member of the Health Law Section

17  of The Florida Bar who defends physicians and one of whom must

18  be a member of the Academy of Florida Trial Lawyers;

19         4.  Two representatives of the health insurance

20  industry, appointed by the Director of Health Care

21  Administration, one of whom shall represent indemnity plans

22  and one of whom shall represent managed care;

23         5.  Five consumer advocates, consisting of one from the

24  Association for Responsible Medicine, two appointed by the

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

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

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

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

29  Representatives; and

30         7.  One representative of a Florida medical school

31  appointed by the Secretary of Health.

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 2339

    Amendment No. ___





  1

  2  Commission membership shall reflect the geographic and

  3  demographic diversity of the state.

  4         (b)  The Secretary of Health and the Director of Health

  5  Care Administration shall jointly chair the commission.

  6  Subcommittees shall be formed by the joint chairs, as needed,

  7  to make recommendations to the full commission on the subjects

  8  assigned. However, all votes on work products of the

  9  commission shall be at the full commission level, and all

10  recommendations to the Governor, the President of the Senate,

11  and the Speaker of the House of Representatives must pass by a

12  two-thirds vote of the full commission. Sponsoring agencies

13  and organizations may designate an alternative member who may

14  attend and vote on behalf of the sponsoring agency or

15  organization in the event the appointed member is unable to

16  attend a meeting of the commission or any subcommittee. The

17  commission shall be staffed by employees of the Department of

18  Health and the Agency for Health Care Administration.

19  Sponsoring agencies or organizations must fund the travel and

20  related expenses of their appointed members on the commission.

21  Travel and related expenses for the consumer members of the

22  commission shall be reimbursed by the state pursuant to

23  section 112.061, Florida Statutes. The commission shall hold

24  its first meeting no later 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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                                                  SENATE AMENDMENT

    Bill No. CS/HB 2339

    Amendment No. ___





  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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                                                  SENATE AMENDMENT

    Bill No. CS/HB 2339

    Amendment No. ___





  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 65.  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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                                                  SENATE AMENDMENT

    Bill No. CS/HB 2339

    Amendment No. ___





  1  Commission on Excellence in Health Care relating to the travel

  2  and related expenses of staff and consumer members and the

  3  reproduction and dissemination of documents.

  4

  5  (Redesignate subsequent sections.)

  6

  7

  8  ================ T I T L E   A M E N D M E N T ===============

  9  And the title is amended as follows:

10         On page 9, line 16, after the semicolon,

11

12  insert:

13         creating the Florida Commission on Excellence

14         in Health Care; providing legislative findings

15         and intent; providing definitions; providing

16         duties and responsibilities; providing for

17         membership, organization, meetings, procedures,

18         and staff; providing for reimbursement of

19         travel and related expenses of certain members;

20         providing certain evidentiary prohibitions;

21         requiring a report to the Governor, the

22         President of the Senate, and the Speaker of the

23         House of Representatives; providing for

24         termination of the commission; providing an

25         appropriation;

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27

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