CS/HB 1233

1	A bill to be entitled
2	An act relating to medical quality assurance; amending s.
3	395.0193, F.S.; requiring certain disciplinary actions to
4	be reported to the Division of Medical Quality Assurance
5	of the Department of Health instead of the Division of
6	Health Quality Assurance of the Agency for Health Care
7	Administration; amending s. 395.0197, F.S.; expanding the
8	list of health care practitioners to be reviewed by the
9	agency; requiring forwarding of incident reports to the
10	Division of Medical Quality Assurance of the Department of
11	Health for determination of need for disciplinary action
12	rather than the agency making such determination;
13	providing that certain annual reports are not required to
14	be forwarded to the department; amending s. 395.3025,
15	F.S.; transferring from the agency to the department
16	authority to access confidential patient records upon
17	issuance of a subpoena for the purpose of investigation,
18	prosecution, and appeal of disciplinary proceedings
19	relating to health care professionals; providing for a fee
20	for copies of records to be determined by rule of the
21	department; amending s. 400.147, F.S.; transferring from
22	the agency to the department certain duties relating to
23	disciplinary proceedings within the purview of the
24	department and appropriate regulatory boards; requiring a
25	copy of certain reports to be submitted to the Division of
26	Medical Quality Assurance of the department; amending ss.
27	458.309 and 459.005, F.S.; providing that the department
28	shall inspect a physician's office unless such office is
29	accredited by a nationally recognized accrediting agency;
30	providing an effective date.
31
32	Be It Enacted by the Legislature of the State of Florida:
33
34	Section 1.  Subsection (4) of section 395.0193, Florida
35	Statutes, is amended to read:
36	395.0193  Licensed facilities; peer review; disciplinary
37	powers; agency or partnership with physicians.--
38	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
39	actions taken under subsection (3) shall be reported in writing
40	to the Division of Medical Health Quality Assurance of the
41	department agency within 30 working days after its initial
42	occurrence, regardless of the pendency of appeals to the
43	governing board of the hospital. The notification shall identify
44	the disciplined practitioner, the action taken, and the reason
45	for such action. All final disciplinary actions taken under
46	subsection (3), if different from those which were reported to
47	the division agency within 30 days after the initial occurrence,
48	shall be reported within 10 working days to the division of
49	Health Quality Assurance of the agency in writing and shall
50	specify the disciplinary action taken and the specific grounds
51	therefor. The division shall review each report and determine
52	whether it potentially involved conduct by the licensee that is
53	subject to disciplinary action, in which case s. 456.073 shall
54	apply. The reports are not subject to inspection under s.
55	119.07(1) even if the division's investigation results in a
56	finding of probable cause.
57	Section 2.  Paragraphs (b) and (c) of subsection (6) and
58	subsections (7) and (13) of section 395.0197, Florida Statutes,
59	are amended to read:
60	395.0197  Internal risk management program.--
61	(6)
62	(b)  The information reported to the agency pursuant to
63	paragraph (a) which relates to health care practitioners as
64	defined in s. 456.001(4) persons licensed under chapter 458,
65	chapter 459, chapter 461, or chapter 466 shall be reviewed by
66	the agency. The agency shall forward a copy of the report of
67	each incident to the Division of Medical Quality Assurance of
68	the department to determine whether it any of the incidents
69	potentially involved conduct by a health care professional who
70	is subject to disciplinary action, in which case the provisions
71	of s. 456.073 shall apply. The Agency for Health Care
72	Administration is not required to forward its annual reports to
73	the Department of Health.
74	(c)  The report submitted to the agency shall also contain
75	the name and license number of the risk manager of the licensed
76	facility, a copy of its policy and procedures which govern the
77	measures taken by the facility and its risk manager to reduce
78	the risk of injuries and adverse incidents, and the results of
79	such measures. The annual report is confidential and is not
80	available to the public pursuant to s. 119.07(1) or any other
81	law providing access to public records. The annual report is not
82	discoverable or admissible in any civil or administrative
83	action, except in disciplinary proceedings by the agency or the
84	appropriate regulatory board. The annual report is not available
85	to the public as part of the record of investigation for and
86	prosecution in disciplinary proceedings made available to the
87	public by the agency or the appropriate regulatory board.
88	However, the agency or the appropriate regulatory board shall
89	make available, upon written request by a health care
90	professional against whom probable cause has been found, any
91	such records which form the basis of the determination of
92	probable cause.
93	(7)  Any of the following adverse incidents, whether
94	occurring in the licensed facility or arising from health care
95	prior to admission in the licensed facility, shall be reported
96	by the facility to the agency within 15 calendar days after its
97	occurrence:
98	(a)  The death of a patient;
99	(b)  Brain or spinal damage to a patient;
100	(c)  The performance of a surgical procedure on the wrong
101	patient;
102	(d)  The performance of a wrong-site surgical procedure;
103	(e)  The performance of a wrong surgical procedure;
104	(f)  The performance of a surgical procedure that is
105	medically unnecessary or otherwise unrelated to the patient's
106	diagnosis or medical condition;
107	(g)  The surgical repair of damage resulting to a patient
108	from a planned surgical procedure, where the damage is not a
109	recognized specific risk, as disclosed to the patient and
110	documented through the informed-consent process; or
111	(h)  The performance of procedures to remove unplanned
112	foreign objects remaining from a surgical procedure.
113
114	The agency may grant extensions to this reporting requirement
115	for more than 15 days upon justification submitted in writing by
116	the facility administrator to the agency. The agency may require
117	an additional, final report. These reports shall not be
118	available to the public pursuant to s. 119.07(1) or any other
119	law providing access to public records, nor be discoverable or
120	admissible in any civil or administrative action, except in
121	disciplinary proceedings by the agency or the appropriate
122	regulatory board, nor shall they be available to the public as
123	part of the record of investigation for and prosecution in
124	disciplinary proceedings made available to the public by the
125	agency or the appropriate regulatory board. However, the agency
126	or the appropriate regulatory board shall make available, upon
127	written request by a health care professional against whom
128	probable cause has been found, any such records which form the
129	basis of the determination of probable cause. The agency may
130	investigate, as it deems appropriate, any such incident and
131	prescribe measures that must or may be taken in response to the
132	incident. The agency shall forward a copy of each incident
133	report to the Department of Health, which shall determine
134	whether it potentially involved conduct by a health care
135	professional who is subject to disciplinary action, in which
136	case the provisions of s. 456.073 shall apply. The agency shall
137	review each incident and determine whether it potentially
138	involved conduct by the health care professional who is subject
139	to disciplinary action, in which case the provisions of s.
140	456.073 shall apply.
141	(13)  The agency shall have access to all licensed facility
142	records necessary to carry out the provisions of this section.
143	The records obtained by the agency under subsection (6),
144	subsection (7), or subsection (9) are not available to the
145	public under s. 119.07(1), nor shall they be discoverable or
146	admissible in any civil or administrative action, except in
147	disciplinary proceedings by the agency or the appropriate
148	regulatory board, nor shall records obtained pursuant to s.
149	456.071 be available to the public as part of the record of
150	investigation for and prosecution in disciplinary proceedings
151	made available to the public by the agency or the appropriate
152	regulatory board. However, the agency or the appropriate
153	regulatory board shall make available, upon written request by a
154	health care professional against whom probable cause has been
155	found, any such records which form the basis of the
156	determination of probable cause, except that, with respect to
157	medical review committee records, s. 766.101 controls.
158	Section 3.  Paragraph (e) of subsection (4) of section
159	395.3025, Florida Statutes, is amended to read:
160	395.3025  Patient and personnel records; copies;
161	examination.--
162	(4)  Patient records are confidential and must not be
163	disclosed without the consent of the person to whom they
164	pertain, but appropriate disclosure may be made without such
165	consent to:
166	(e)  The department agency upon subpoena issued pursuant to
167	s. 456.071, but the records obtained thereby must be used solely
168	for the purpose of the department agency and the appropriate
169	professional board in its investigation, prosecution, and appeal
170	of disciplinary proceedings. If the department agency requests
171	copies of the records, the facility shall charge a reasonable
172	fee as determined by rule of the department no more than its
173	actual copying costs, including reasonable staff time. The
174	records must be sealed and must not be available to the public
175	pursuant to s. 119.07(1) or any other statute providing access
176	to records, nor may they be available to the public as part of
177	the record of investigation for and prosecution in disciplinary
178	proceedings made available to the public by the department
179	agency or the appropriate regulatory board. However, the
180	department agency must make available, upon written request by a
181	practitioner against whom probable cause has been found, any
182	such records that form the basis of the determination of
183	probable cause.
184	Section 4.  Subsection (7) and paragraph (b) of subsection
185	(8) of section 400.147, Florida Statutes, are amended to read:
186	400.147  Internal risk management and quality assurance
187	program.--
188	(7)  The facility shall initiate an investigation and shall
189	notify the agency within 1 business day after the risk manager
190	or his or her designee has received a report pursuant to
191	paragraph (1)(d). The notification must be made in writing and
192	be provided electronically, by facsimile device or overnight
193	mail delivery. The notification must include information
194	regarding the identity of the affected resident, the type of
195	adverse incident, the initiation of an investigation by the
196	facility, and whether the events causing or resulting in the
197	adverse incident represent a potential risk to any other
198	resident. The notification is confidential as provided by law
199	and is not discoverable or admissible in any civil or
200	administrative action, except in disciplinary proceedings by the
201	Department of Health agency or the appropriate regulatory board.
202	The agency may investigate, as it deems appropriate, any such
203	incident and prescribe measures that must or may be taken in
204	response to the incident. The Department of Health agency shall
205	review each incident and determine whether it potentially
206	involved conduct by the health care professional who is subject
207	to disciplinary action, in which case the provisions of s.
208	456.073 shall apply.
209	(8)
210	(b)  A copy of the report submitted The information
211	reported to the agency pursuant to paragraph (a) which relates
212	to health care practitioners as defined in s. 456.001(4) persons
213	licensed under chapter 458, chapter 459, chapter 461, or chapter
214	466 shall be forwarded to the Division of Medical Quality
215	Assurance of the Department of Health for review reviewed by the
216	agency. The Department of Health agency shall determine whether
217	any of the incidents potentially involved conduct by a health
218	care professional who is subject to disciplinary action, in
219	which case the provisions of s. 456.073 shall apply.
220	Section 5.  Subsection (3) of section 458.309, Florida
221	Statutes, is amended to read:
222	458.309  Rulemaking authority.--
223	(3)  All physicians who perform level 2 procedures lasting
224	more than 5 minutes and all level 3 surgical procedures in an
225	office setting must register the office with the department
226	unless that office is licensed as a facility pursuant to chapter
227	395. The department shall inspect the physician's office
228	annually unless the office is accredited by a nationally
229	recognized accrediting agency or an accrediting organization
230	subsequently approved by the Board of Medicine. The actual costs
231	for registration and inspection or accreditation shall be paid
232	by the person seeking to register and operate the office setting
233	in which office surgery is performed.
234	Section 6.  Subsection (2) of section 459.005, Florida
235	Statutes, is amended to read:
236	459.005  Rulemaking authority.--
237	(2)  All physicians who perform level 2 procedures lasting
238	more than 5 minutes and all level 3 surgical procedures in an
239	office setting must register the office with the department
240	unless that office is licensed as a facility pursuant to chapter
241	395. The department shall inspect the physician's office
242	annually unless the office is accredited by a nationally
243	recognized accrediting agency or an accrediting organization
244	subsequently approved by the Board of Osteopathic Medicine. The
245	actual costs for registration and inspection or accreditation
246	shall be paid by the person seeking to register and operate the
247	office setting in which office surgery is performed.
248	Section 7.  This act shall take effect July 1, 2008.

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