CODING: Words stricken are deletions; words underlined are additions.
e2742038
House
h0900-99
h0913
2002
AA
913362
Senator Campbell moved the following amendment to amendment
(913362):
On page 79, between lines 14 and 15,
On page 85, line 26,




                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038

                            CHAMBER ACTION
              Senate                               House
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  4  ______________________________________________________________

  5

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  8

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10  ______________________________________________________________

11  Senator Campbell moved the following amendment to amendment

12  (913362):

13

14         Senate Amendment (with title amendment) 

15         On page 79, between lines 14 and 15,

16

17  insert:

18         Section 27.  Subsection (4) of section 383.50, Florida

19  Statutes, is amended to read:

20         383.50  Treatment of abandoned newborn infant.--

21         (4)  Each hospital of this state subject to s. 395.1041

22  shall, and any other hospital may, admit and provide all

23  necessary emergency services and care, as defined in s.

24  395.002(11)(10), to any newborn infant left with the hospital

25  in accordance with this section. The hospital or any of its

26  licensed health care professionals shall consider these

27  actions as implied consent for treatment, and a hospital

28  accepting physical custody of a newborn infant has implied

29  consent to perform all necessary emergency services and care.

30  The hospital or any of its licensed health care professionals

31  is immune from criminal or civil liability for acting in good

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  faith in accordance with this section. Nothing in this

  2  subsection limits liability for negligence.

  3         Section 28.  Subsection (7) of section 394.4787,

  4  Florida Statutes, is amended to read:

  5         394.4787  Definitions; ss. 394.4786, 394.4787,

  6  394.4788, and 394.4789.--As used in this section and ss.

  7  394.4786, 394.4788, and 394.4789:

  8         (7)  "Specialty psychiatric hospital" means a hospital

  9  licensed by the agency pursuant to s. 395.002(30)(29) as a

10  specialty psychiatric hospital.

11         Section 29.  Present subsections (9), (10), (26), and

12  (30) of section 395.002, Florida Statutes, are amended,

13  present subsections (10) through (33) are renumbered as

14  subsections (11) through (34), respectively, and a new

15  subsection (10) is added to that section, to read:

16         395.002  Definitions.--As used in this chapter:

17         (9)  "Emergency medical condition" means:

18         (a)  A medical condition manifesting itself by acute

19  symptoms of sufficient severity, which may include severe

20  pain, psychiatric disturbances, symptoms of substance abuse,

21  or other acute symptoms, such that the absence of immediate

22  medical attention could reasonably be expected to result in

23  any of the following:

24         1.  Serious jeopardy to patient health, including a

25  pregnant woman or fetus.

26         2.  Serious impairment to bodily functions.

27         3.  Serious dysfunction of any bodily organ or part.

28         (b)  With respect to a pregnant woman:

29         1.  That there is inadequate time to effect safe

30  transfer to another hospital prior to delivery;

31         2.  That a transfer may pose a threat to the health and

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  safety of the patient or fetus; or

  2         3.  That there is evidence of the onset and persistence

  3  of uterine contractions or rupture of the membranes.

  4         (c)  With respect to a person exhibiting acute

  5  psychiatric disturbance or substance abuse, or taken into

  6  custody and delivered to a hospital under a court ex parte

  7  order for examination or placed by an authorized party for

  8  involuntary examination in accordance with chapter 394 or

  9  chapter 397, that the absence of immediate medical attention

10  could reasonably be expected to result in:

11         1.  Serious jeopardy to the health of a patient; or

12         2.  Serious jeopardy to the health of others.

13         (10)  "Emergency medical services provider" means a

14  provider licensed pursuant to chapter 401.

15         (11)(10)  "Emergency services and care" means medical

16  screening, examination, and evaluation by a physician, or, to

17  the extent permitted by applicable law, by other appropriate

18  personnel under the supervision of a physician, to determine

19  if an emergency medical condition exists and, if it does, the

20  care, treatment, or surgery by a physician necessary to

21  stabilize relieve or eliminate the emergency medical

22  condition, within the service capability of the facility.

23         (27)(26)  "Service capability" means the physical

24  space, equipment, supplies, and services that the hospital

25  provides and the level of care that the medical staff can

26  provide within the training and scope of their professional

27  licenses and hospital privileges all services offered by the

28  facility where identification of services offered is evidenced

29  by the appearance of the service in a patient's medical record

30  or itemized bill.

31         (31)(30)  "Stabilized" means, with respect to an

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  emergency medical condition, that no material deterioration of

  2  the condition is likely, within reasonable medical

  3  probability, to result from the transfer or discharge of the

  4  patient from a hospital.

  5         Section 30.  Subsections (1) and (2) and paragraphs (c)

  6  and (d) of subsection (3) of section 395.1041, Florida

  7  Statutes, are amended to read:

  8         395.1041  Access to emergency services and care.--

  9         (1)  LEGISLATIVE INTENT.--The Legislature finds and

10  declares it to be of vital importance that emergency services

11  and care be provided by hospitals and physicians to every

12  person in need of such care.  The Legislature finds that

13  persons have been denied emergency services and care by

14  hospitals.  It is the intent of the Legislature that the

15  agency vigorously enforce the ability of persons to receive

16  all necessary and appropriate emergency services and care and

17  that the agency act in a thorough and timely manner against

18  hospitals and physicians which deny persons emergency services

19  and care.  It is further the intent of the Legislature that

20  hospitals, emergency medical services providers, and other

21  health care providers work together in their local communities

22  to enter into agreements or arrangements to ensure access to

23  emergency services and care.  The Legislature further

24  recognizes that appropriate emergency services and care often

25  require followup consultation and treatment in order to

26  effectively care for emergency medical conditions.

27         (2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.--The

28  agency shall establish and maintain an inventory of hospitals

29  with emergency services.  The inventory shall list all

30  services within the service capability of the hospital, and

31  such services shall appear on the face of the hospital

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  license.  Each hospital having emergency services shall notify

  2  the agency of its service capability in the manner and form

  3  prescribed by the agency.  The agency, in cooperation with the

  4  Department of Health shall provide use the inventory to assist

  5  emergency medical services providers and shall make the

  6  inventory available to others to assist in locating

  7  appropriate emergency medical care.  The inventory shall also

  8  be made available to the general public.  On or before August

  9  1, 1992, the agency shall request that each hospital identify

10  the services which are within its service capability.  On or

11  before November 1, 1992, the agency shall notify each hospital

12  of the service capability to be included in the inventory.

13  The hospital has 15 days from the date of receipt to respond

14  to the notice.  By December 1, 1992, the agency shall publish

15  a final inventory. Each hospital shall reaffirm its service

16  capability when its license is renewed and shall notify the

17  agency of the addition of a new service or the termination of

18  a service prior to a change in its service capability.

19         (3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF

20  FACILITY OR HEALTH CARE PERSONNEL.--

21         (c)  A patient that has not been stabilized, whether

22  stabilized or not, may be transferred to another hospital

23  which has the requisite service capability or is not at

24  service capacity, if:

25         1.  The patient, or a person who is legally responsible

26  for the patient and acting on the patient's behalf, after

27  being informed of the hospital's obligation under this section

28  and of the risk of transfer, requests that the transfer be

29  effected;

30         2.  A physician has signed a certification that, based

31  upon the reasonable risks and benefits to the patient, and

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  based upon the information available at the time of transfer,

  2  the medical benefits reasonably expected from the provision of

  3  appropriate medical treatment at another hospital outweigh the

  4  increased risks to the individual's medical condition from

  5  effecting the transfer; or

  6         3.  A physician is not physically present in the

  7  emergency services area at the time an individual is

  8  transferred and a qualified medical person signs a

  9  certification that a physician, in consultation with

10  personnel, has determined that the medical benefits reasonably

11  expected from the provision of appropriate medical treatment

12  at another medical facility outweigh the increased risks to

13  the individual's medical condition from effecting the

14  transfer.  The consulting physician must countersign the

15  certification;

16

17  provided that this paragraph shall not be construed to require

18  acceptance of a transfer that is not medically necessary.

19         (d)1.  Every hospital shall ensure the provision of

20  services within the service capability of the hospital, at all

21  times, either directly or indirectly through an arrangement

22  with another hospital, through an arrangement with one or more

23  physicians, or as otherwise made through prior arrangements.

24  A hospital may enter into an agreement with another hospital

25  for purposes of meeting its service capability requirement,

26  and appropriate compensation or other reasonable conditions

27  may be negotiated for these backup services.

28         2.  If any arrangement requires the provision of

29  emergency medical transportation, such arrangement must be

30  made in consultation with the applicable emergency medical

31  service provider and may not require the emergency medical

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  service provider to provide transportation that is outside the

  2  routine service area of that emergency medical service

  3  provider or in a manner that impairs the ability of the

  4  emergency medical service provider to timely respond to

  5  prehospital emergency calls. Emergency medical transportation

  6  provided under this subparagraph is considered to be emergency

  7  services and care as defined in s. 395.002.

  8         3.  A hospital shall not be required to ensure service

  9  capability at all times as required in subparagraph 1. if,

10  prior to the receiving of any patient needing such service

11  capability, such hospital has demonstrated to the agency that

12  it lacks the ability to ensure such capability and it has

13  exhausted all reasonable efforts to ensure such capability

14  through backup arrangements.  In reviewing a hospital's

15  demonstration of lack of ability to ensure service capability,

16  the agency shall consider factors relevant to the particular

17  case, including the following:

18         a.  Number and proximity of hospitals with the same

19  service capability.

20         b.  Number, type, credentials, and privileges of

21  specialists.

22         c.  Frequency of procedures.

23         d.  Size of hospital.

24         4.  The agency shall publish proposed rules

25  implementing a reasonable exemption procedure by November 1,

26  1992.  Subparagraph 1. shall become effective upon the

27  effective date of said rules or January 31, 1993, whichever is

28  earlier.  For a period not to exceed 1 year from the effective

29  date of subparagraph 1., a hospital requesting an exemption

30  shall be deemed to be exempt from offering the service until

31  the agency initially acts to deny or grant the original

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  request.  The agency has 45 days from the date of receipt of

  2  the request for exemption to approve or deny the request.

  3  After the first year from the effective date of subparagraph

  4  1., If the agency fails to initially act within the time

  5  period, the hospital is deemed to be exempt from offering the

  6  service until the agency initially acts to deny the request.

  7         5.  The agency shall convene a workgroup consisting of

  8  representatives from the Florida Hospital Association, the

  9  Florida Statutory Teaching Hospital Council, the Florida

10  Medical Association, the Florida Osteopathic Medical

11  Association, and the Florida College of Emergency Physicians

12  to make recommendations to the Legislature for changes to this

13  paragraph regarding:

14         a.  Services performed on an infrequent basis that

15  would not be considered to be within the service capability of

16  the hospital.

17         b.  Situations in which hospitals would be deemed

18  exempt from providing services at all times that are within

19  their service capability.

20         Section 31.  Paragraph (c) of subsection (2) of section

21  395.602, Florida Statutes, is amended to read:

22         395.602  Rural hospitals.--

23         (2)  DEFINITIONS.--As used in this part:

24         (c)  "Inactive rural hospital bed" means a licensed

25  acute care hospital bed, as defined in s. 395.002(15)(14),

26  that is inactive in that it cannot be occupied by acute care

27  inpatients.

28         Section 32.  Paragraph (c) of subsection (1) of section

29  395.701, Florida Statutes, is amended to read:

30         395.701  Annual assessments on net operating revenues

31  for inpatient and outpatient services to fund public medical

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  assistance; administrative fines for failure to pay

  2  assessments when due; exemption.--

  3         (1)  For the purposes of this section, the term:

  4         (c)  "Hospital" means a health care institution as

  5  defined in s. 395.002(14)(13), but does not include any

  6  hospital operated by the agency or the Department of

  7  Corrections.

  8         Section 33.  Paragraph (b) of subsection (1) of section

  9  400.051, Florida Statutes, is amended to read:

10         400.051  Homes or institutions exempt from the

11  provisions of this part.--

12         (1)  The following shall be exempt from the provisions

13  of this part:

14         (b)  Any hospital, as defined in s. 395.002(12)(11),

15  that is licensed under chapter 395.

16         Section 34.  Section 401.23, Florida Statutes, is

17  amended to read:

18         401.23  Definitions.--As used in this part, the term:

19         (1)  "Advanced life support" means the use of skills

20  and techniques described in the most recent U.S. DOT National

21  Standard Paramedic Curriculum by a paramedic under the

22  supervision of a licensee's medical director as required by

23  rules of the department. The term "advanced life support" also

24  includes other techniques which have been approved and are

25  performed under conditions specified by rules of the

26  department. The term "advanced life support" also includes

27  provision of care by a paramedic under the supervision of a

28  licensee's medical director to one experiencing an emergency

29  medical condition as defined herein. "Advanced life support"

30  means treatment of life-threatening medical emergencies

31  through the use of techniques such as endotracheal intubation,

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  the administration of drugs or intravenous fluids, telemetry,

  2  cardiac monitoring, and cardiac defibrillation by a qualified

  3  person, pursuant to rules of the department.

  4         (2)  "Advanced life support service" means any

  5  emergency medical transport or nontransport service which uses

  6  advanced life support techniques.

  7         (3)  "Air ambulance" means any fixed-wing or

  8  rotary-wing aircraft used for, or intended to be used for, air

  9  transportation of sick or injured persons requiring or likely

10  to require medical attention during transport.

11         (4)  "Air ambulance service" means any publicly or

12  privately owned service, licensed in accordance with the

13  provisions of this part, which operates air ambulances to

14  transport persons requiring or likely to require medical

15  attention during transport.

16         (5)  "Ambulance" or "emergency medical services

17  vehicle" means any privately or publicly owned land or water

18  vehicle that is designed, constructed, reconstructed,

19  maintained, equipped, or operated for, and is used for, or

20  intended to be used for, land or water transportation of sick

21  or injured persons requiring or likely to require medical

22  attention during transport.

23         (6)  "Ambulance driver" means any person who meets the

24  requirements of s. 401.281.

25         (7)  "Basic life support" means the use of skills and

26  techniques described in the most recent U.S. DOT National

27  Standard EMT-Basic Curriculum by an emergency medical

28  technician or paramedic under the supervision of a licensee's

29  medical director as required by rules of the department. The

30  term "basic life support" also includes other techniques which

31  have been approved and are performed under conditions

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  specified by rules of the department. The term "basic life

  2  support" also includes provision of care by a paramedic or

  3  emergency medical technician under the supervision of a

  4  licensee's medical director to one experiencing an emergency

  5  medical condition as defined herein. "Basic life support"

  6  means treatment of medical emergencies by a qualified person

  7  through the use of techniques such as patient assessment,

  8  cardiopulmonary resuscitation (CPR), splinting, obstetrical

  9  assistance, bandaging, administration of oxygen, application

10  of medical antishock trousers, administration of a

11  subcutaneous injection using a premeasured autoinjector of

12  epinephrine to a person suffering an anaphylactic reaction,

13  and other techniques described in the Emergency Medical

14  Technician Basic Training Course Curriculum of the United

15  States Department of Transportation.  The term "basic life

16  support" also includes other techniques which have been

17  approved and are performed under conditions specified by rules

18  of the department.

19         (8)  "Basic life support service" means any emergency

20  medical service which uses only basic life support techniques.

21         (9)  "Certification" means any authorization issued

22  pursuant to this part to a person to act as an emergency

23  medical technician or a paramedic.

24         (10)  "Department" means the Department of Health.

25         (11)  "Emergency medical condition" means:

26         (a)  A medical condition manifesting itself by acute

27  symptoms of sufficient severity, which may include severe

28  pain, psychiatric disturbances, symptoms of substance abuse,

29  or other acute symptoms, such that the absence of immediate

30  medical attention could reasonably be expected to result in

31  any of the following:

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1         1.  Serious jeopardy to patient health, including a

  2  pregnant woman or fetus.

  3         2.  Serious impairment to bodily functions.

  4         3.  Serious dysfunction of any bodily organ or part.

  5         (b)  With respect to a pregnant woman, that there is

  6  evidence of the onset and persistence of uterine contractions

  7  or rupture of the membranes.

  8         (c)  With respect to a person exhibiting acute

  9  psychiatric disturbance or substance abuse, that the absence

10  of immediate medical attention could reasonably be expected to

11  result in:

12         1.  Serious jeopardy to the health of a patient; or

13         2.  Serious jeopardy to the health of others.

14         (12)(11)  "Emergency medical technician" means a person

15  who is certified by the department to perform basic life

16  support pursuant to this part.

17         (13)(12)  "Interfacility transfer" means the

18  transportation by ambulance of a patient between two

19  facilities licensed under chapter 393, chapter 395, or chapter

20  400, pursuant to this part.

21         (14)(13)  "Licensee" means any basic life support

22  service, advanced life support service, or air ambulance

23  service licensed pursuant to this part.

24         (15)(14)  "Medical direction" means direct supervision

25  by a physician through two-way voice communication or, when

26  such voice communication is unavailable, through established

27  standing orders, pursuant to rules of the department.

28         (16)(15)  "Medical director" means a physician who is

29  employed or contracted by a licensee and who provides medical

30  supervision, including appropriate quality assurance but not

31  including administrative and managerial functions, for daily

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  operations and training pursuant to this part.

  2         (17)(16)  "Mutual aid agreement" means a written

  3  agreement between two or more entities whereby the signing

  4  parties agree to lend aid to one another under conditions

  5  specified in the agreement and as sanctioned by the governing

  6  body of each affected county.

  7         (18)(17)  "Paramedic" means a person who is certified

  8  by the department to perform basic and advanced life support

  9  pursuant to this part.

10         (19)(18)  "Permit" means any authorization issued

11  pursuant to this part for a vehicle to be operated as a basic

12  life support or advanced life support transport vehicle or an

13  advanced life support nontransport vehicle providing basic or

14  advanced life support.

15         (20)(19)  "Physician" means a practitioner who is

16  licensed under the provisions of chapter 458 or chapter 459.

17  For the purpose of providing "medical direction" as defined in

18  subsection (14) for the treatment of patients immediately

19  prior to or during transportation to a United States

20  Department of Veterans Affairs medical facility, "physician"

21  also means a practitioner employed by the United States

22  Department of Veterans Affairs.

23         (21)(20)  "Registered nurse" means a practitioner who

24  is licensed to practice professional nursing pursuant to part

25  I of chapter 464.

26         (22)(21)  "Secretary" means the Secretary of Health.

27         (23)(22)  "Service location" means any permanent

28  location in or from which a licensee solicits, accepts, or

29  conducts business under this part.

30         Section 35.  Subsection (8) of section 409.905, Florida

31  Statutes, is amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1         409.905  Mandatory Medicaid services.--The agency may

  2  make payments for the following services, which are required

  3  of the state by Title XIX of the Social Security Act,

  4  furnished by Medicaid providers to recipients who are

  5  determined to be eligible on the dates on which the services

  6  were provided. Any service under this section shall be

  7  provided only when medically necessary and in accordance with

  8  state and federal law. Mandatory services rendered by

  9  providers in mobile units to Medicaid recipients may be

10  restricted by the agency. Nothing in this section shall be

11  construed to prevent or limit the agency from adjusting fees,

12  reimbursement rates, lengths of stay, number of visits, number

13  of services, or any other adjustments necessary to comply with

14  the availability of moneys and any limitations or directions

15  provided for in the General Appropriations Act or chapter 216.

16         (8)  NURSING FACILITY SERVICES.--The agency shall pay

17  for 24-hour-a-day nursing and rehabilitative services for a

18  recipient in a nursing facility licensed under part II of

19  chapter 400 or in a rural hospital, as defined in s. 395.602,

20  or in a Medicare certified skilled nursing facility operated

21  by a hospital, as defined by s. 395.002(12)(11), that is

22  licensed under part I of chapter 395, and in accordance with

23  provisions set forth in s. 409.908(2)(a), which services are

24  ordered by and provided under the direction of a licensed

25  physician.  However, if a nursing facility has been destroyed

26  or otherwise made uninhabitable by natural disaster or other

27  emergency and another nursing facility is not available, the

28  agency must pay for similar services temporarily in a hospital

29  licensed under part I of chapter 395 provided federal funding

30  is approved and available.

31         Section 36.  Paragraph (l) of subsection (1) of section

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





  1  468.505, Florida Statutes, is amended to read:

  2         468.505  Exemptions; exceptions.--

  3         (1)  Nothing in this part may be construed as

  4  prohibiting or restricting the practice, services, or

  5  activities of:

  6         (l)  A person employed by a nursing facility exempt

  7  from licensing under s. 395.002(14)(13), or a person exempt

  8  from licensing under s. 464.022.

  9         Section 37.  Paragraph (b) of subsection (2) of section

10  812.014, Florida Statutes, is amended to read:

11         812.014  Theft.--

12         (2)

13         (b)1.  If the property stolen is valued at $20,000 or

14  more, but less than $100,000;

15         2.  The property stolen is cargo valued at less than

16  $50,000 that has entered the stream of interstate or

17  intrastate commerce from the shipper's loading platform to the

18  consignee's receiving dock; or

19         3.  The property stolen is emergency medical equipment,

20  valued at $300 or more, that is taken from a facility licensed

21  under chapter 395 or from an aircraft or vehicle permitted

22  under chapter 401,

23

24  the offender commits grand theft in the second degree,

25  punishable as a felony of the second degree, as provided in s.

26  775.082, s. 775.083, or s. 775.084. Emergency medical

27  equipment means mechanical or electronic apparatus used to

28  provide emergency services and care as defined in s.

29  395.002(11)(10) or to treat medical emergencies.

30

31  (Redesignate subsequent sections.)

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 742038





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

  2  And the title is amended as follows:

  3         On page 85, line 26,

  4

  5  insert:

  6         amending s. 395.002, F.S.; revising definitions

  7         relating to emergency services and care

  8         provided by hospitals and related facilities;

  9         amending s. 395.1041, F.S.; revising provisions

10         relating to hospital service capability and

11         access to emergency services and care;

12         directing the Agency for Health Care

13         Administration to convene a workgroup to report

14         to the Legislature regarding hospital service

15         capability requirements; amending ss. 383.50,

16         394.4787, 395.602, 395.701, 400.051, 409.905,

17         468.505, and 812.014, F.S.; conforming

18         cross-references; amending s. 401.23, F.S.;

19         redefining the terms "advanced life support"

20         and "basic life support"; defining the term

21         "emergency medical conditions";

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