HOUSE AMENDMENT Bill No. HB 1105 CS
1	CHAMBER ACTION
2	Senate House
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12	Representative Murman offered the following:
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14	Amendment (with title amendment)
15	Remove line(s) 541-835, and insert:
16	Section 7. Subsections (5) through (15) of section
17	400.147, Florida Statutes, are amended to read:
18	400.147 Internal risk management and quality assurance
19	program.--
20	(5) For purposes of reporting to the agency under this
21	section, the term "adverse incident" means:
22	(a) An event over which facility personnel could exercise
23	control and which is associated in whole or in part with the
24	facility's intervention, rather than the condition for which
25	such intervention occurred, and which results in one of the
26	following:
27	1. Death;
28	2. Brain or spinal damage;
29	3. Permanent disfigurement;
30	4. Fracture or dislocation of bones or joints;
31	5. A limitation of neurological, physical, or sensory
32	function;
33	6. Any condition that required medical attention to which
34	the resident has not given his or her informed consent,
35	including failure to honor advanced directives; or
36	7. Any condition that required the transfer of the
37	resident, within or outside the facility, to a unit providing a
38	more acute level of care due to the adverse incident, rather
39	than the resident's condition prior to the adverse incident;
40	(b) Abuse, neglect, or exploitation as defined in s.
41	415.102;
42	(c) Abuse, neglect and harm as defined in s. 39.01;
43	(d) Resident elopement; or
44	(e) An event that is reported to law enforcement for
45	investigation.
46	(6) The internal risk manager of each licensed facility
47	shall:
48	(a) Investigate every allegation of sexual misconduct
49	which is made against a member of the facility's personnel who
50	has direct patient contact when the allegation is that the
51	sexual misconduct occurred at the facility or at the grounds of
52	the facility.;
53	(b) Report every allegation of sexual misconduct to the
54	administrator of the licensed facility.; and
55	(c) Notify the resident representative or guardian of the
56	victim that an allegation of sexual misconduct has been made and
57	that an investigation is being conducted.
58	(7) The facility shall initiate an investigation and shall
59	notify the agency within 1 business day after the risk manager
60	or his or her designee has received a report pursuant to
61	paragraph (1)(d). The notification must be made in writing and
62	be provided electronically, by facsimile device or overnight
63	mail delivery. The notification must include information
64	regarding the identity of the affected resident, the type of
65	adverse incident, the initiation of an investigation by the
66	facility, and whether the events causing or resulting in the
67	adverse incident represent a potential risk to any other
68	resident. The notification is confidential as provided by law
69	and is not discoverable or admissible in any civil or
70	administrative action, except in disciplinary proceedings by the
71	agency or the appropriate regulatory board. The agency may
72	investigate, as it deems appropriate, any such incident and
73	prescribe measures that must or may be taken in response to the
74	incident. The agency shall review each incident and determine
75	whether it potentially involved conduct by the health care
76	professional who is subject to disciplinary action, in which
77	case the provisions of s. 456.073 shall apply.
78	(7)(8)(a) Each facility shall complete the investigation
79	and submit an adverse incident report to the agency for each
80	adverse incident within 15 calendar days after its occurrence.
81	If, after a complete investigation, the risk manager determines
82	that the incident was notan adverse incident as defined in
83	subsection (5), the facility shall include this information in
84	the report. The agency shall develop a form for reporting this
85	information.
86	(b) The information reported to the agency pursuant to
87	paragraph (a) which relates to persons licensed under chapter
88	458, chapter 459, chapter 461, or chapter 466 shall be reviewed
89	by the agency. The agency shall determine whether any of the
90	incidents potentially involved conduct by a health care
91	professional who is subject to disciplinary action, in which
92	case the provisions of s. 456.073 shall apply.
93	(c) The report submitted to the agency must also contain
94	the name of the risk manager of the facility.
95	(d) The adverse incident report is confidential as
96	provided by law and is not discoverable or admissible in any
97	civil or administrative action, except in disciplinary
98	proceedings by the agency or the appropriate regulatory board.
99	(8)(9)By the 10th of each month, each facility subject to
100	this section shall report any notice received pursuant to s.
101	400.0233(2) and each initial complaint that was filed with the
102	clerk of the court and served on the facility during the
103	previous month by a resident or a resident's family member,
104	guardian, conservator, or personal legal representative. The
105	report must include the name of the resident, the resident's
106	date of birth and social security number, the Medicaid
107	identification number for Medicaid-eligible persons, the date or
108	dates of the incident leading to the claim or dates of
109	residency, if applicable, and the type of injury or violation of
110	rights alleged to have occurred. Each facility shall also submit
111	a copy of the notices received pursuant to s. 400.0233(2) and
112	complaints filed with the clerk of the court. This report is
113	confidential as provided by law and is not discoverable or
114	admissible in any civil or administrative action, except in such
115	actions brought by the agency to enforce the provisions of this
116	part.
117	(9)(10)The agency shall review, as part of its licensure
118	inspection process, the internal risk management and quality
119	assurance program at each facility regulated by this section to
120	determine whether the program meets standards established in
121	statutory laws and rules, is being conducted in a manner
122	designed to reduce adverse incidents, and is appropriately
123	reporting incidents as required by this section.
124	(10)(11)There is no monetary liability on the part of,
125	and a cause of action for damages may not arise against, any
126	risk manager for the implementation and oversight of the
127	internal risk management and quality assurance program in a
128	facility licensed under this part as required by this section,
129	or for any act or proceeding undertaken or performed within the
130	scope of the functions of such internal risk management and
131	quality assurance program if the risk manager acts without
132	intentional fraud.
133	(11)(12)If the agency, through its receipt of the adverse
134	incident reports prescribed in subsection (7),or through any
135	investigation, has a reasonable belief that conduct by a staff
136	member or employee of a facility is grounds for disciplinary
137	action by the appropriate regulatory board, the agency shall
138	report this fact to the regulatory board. The agency must use
139	the 15-day report to fulfill this reporting requirement. This
140	subsection does not require dual reporting or additional, new
141	documentation and reporting by the facility to the appropriate
142	regulatory board.
143	(12)(13)The agency may adopt rules to administer this
144	section.
145	(13)(14)The agency shall annually submit to the
146	Legislature a report on nursing home adverse incidents. The
147	report must include the following information arranged by
148	county:
149	(a) The total number of adverse incidents.
150	(b) A listing, by category, of the types of adverse
151	incidents, the number of incidents occurring within each
152	category, and the type of staff involved.
153	(c) A listing, by category, of the types of injury caused
154	and the number of injuries occurring within each category.
155	(d) Types of liability claims filed based on an adverse
156	incident or reportable injury.
157	(e) Disciplinary action taken against staff, categorized
158	by type of staff involved.
159	(14)(15)Information gathered by a credentialing
160	organization under a quality assurance program is not
161	discoverable from the credentialing organization. This
162	subsection does not limit discovery of, access to, or use of
163	facility records, including those records from which the
164	credentialing organization gathered its information.
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167	================= T I T L E A M E N D M E N T =================
168	Remove line(s) 30-42, and insert:
169	definition of "resident care plan"; amending s. 400.147, F.S.;
170	revising the definition of "adverse incident"; revising adverse
171	incident reporting requirements; amending s. 400.195,