AN ACT CONCERNING A PROFESSIONAL ASSISTANCE PROGRAM FOR HEALTH CARE PROFESSIONALS.

AN ACT CONCERNING A PROFESSIONAL ASSISTANCE PROGRAM FOR HEALTH CARE PROFESSIONALS.

This bill allows state or local health care professional societies and organizations to establish a single assistance program to serve all health care professionals. The assistance program must have one or more medical review committees. A “medical review committee” is a committee that reviews and monitors participation by health care professionals in the assistance program.

The assistance program is an alternative, voluntary, and confidential program for the rehabilitation of health care professionals. It must provide a variety of educational, rehabilitative, and supportive services to health care professionals with a chemical dependency, emotional or behavioral disorder, or physical or mental illness. It must include mandatory, periodic evaluations of each participant's ability to practice with skill and safety and without posing a threat to the health and safety of any person or patient in the health care setting.

The program must annually report certain information to the Department of Public Health (DPH), licensing boards, and the Public Health Committee.

The program is available to the following: physicians and surgeons, physician assistants, chiropractors, naturopaths, homeopathic physicians, podiatrists, athletic trainers, physical therapists, occupational therapists, alcohol and drug counselors, radiographers and radiologic technologists, nurse-midwives, nurses, dentists, dental hygienists, optometrists, opticians, respiratory care practitioners, psychologists, marital and family therapists, clinical social workers, professional counselors, veterinarians, massage therapists, dietitian-nutritionists, acupuncturists, paramedics, hearing instrument specialists, speech pathologists and audiologists, and embalmers and funeral directors.

A medical review committee must determine a person's appropriateness for the program before admittance. The bill specifies various confidentiality provisions concerning the program and participation by health care professionals.

DPH must establish an oversight committee to monitor program quality. The oversight committee must meet with the assistance program on a regular basis; the program must also undergo an annual audit.

*House Amendment “A” clarifies the definition of “medical review committee,” specifies that DPH can refer professionals to the program after it is notified that the program is in compliance with a corrective action plan, and adds the provision addressing the existing rehabilitation program for impaired physicians.

The bill authorizes state or local professional societies or membership organizations of health care professionals to establish a single health care professional assistance program to provide education, prevention, intervention, referral assistance, and support services to any health care professional (and anyone who has applied to be one) with a chemical dependency, emotional or behavioral disorder, or physical or mental illness. “Chemical dependency” means abusive or excessive use of drugs, including alcohol, narcotics, or chemicals, that result in physical or psychological dependence.

The program must establish at least one medical review committee. The program and medical review committee must comply with the bill.

The program must (1) be an alternative, voluntary, and confidential opportunity for the rehabilitation of health care professionals and licensure applicants and (2) include mandatory, periodic evaluations of each participant's ability to practice with skill and safety, and without threat to the health and safety of any person or patient in the health care setting.

Before admitting any health care professional into the program, a medical review committee must (1) determine if the professional is an appropriate candidate for rehabilitation and participation and (2) establish terms and conditions of participation. The bill specifies that a committee's actions must not be construed as practicing medicine or mental health care.

HEALTH CARE PROFESSIONAL'S DISCIPLINARY AND CRIMINAL HISTORY AND PROGRAM PARTICIPATION

The bill prohibits a medical review committee from referring to the assistance program any health care professional who has (1) pending disciplinary charges against him or her, a prior history of disciplinary action, or a consent order by a professional licensing body or (2) been charged with or convicted of a felony under Connecticut law or an offense that, if committed in Connecticut, would be a felony.

In such cases, the committee must refer the person to the Department of Public Health and provide the department with all records and files maintained by the assistance program on the individual. Upon the referral, DPH must determine if the person is eligible for the assistance program and whether participation should be confidential (see below). DPH can seek advice from professional health care societies and organizations and the assistance program to determine what intervention, referral assistance, rehabilitation program, or support services are appropriate.

The bill requires a health care professional participating in the assistance program to immediately notify the program when (1) made aware of the filing of any disciplinary charges or any disciplinary action against him or her by a professional licensing or disciplinary body or (2) charged with or convicted of a felony under Connecticut law or an offense that would be a felony if committed in Connecticut.

The assistance program must regularly review available sources to determine if disciplinary charges have been filed or taken against the individual, or felony charges have been filed or substantiated against a professional admitted into the program. After notification, the program must refer the professional to DPH and provide the department with all records and files the program maintains on the person. DPH must then determine if the individual is eligible to continue participating in the program and whether participation should be treated as confidential. DPH can seek advice from professional societies and organizations on appropriate services and interventions.

If DPH determines that the health professional is an appropriate candidate for confidential participation in the assistance program, the entire record of the person's referral and investigation is confidential and cannot be disclosed, except if requested by the health care professional, for the duration of the professional's participation in, and after successful completion of, the program. Participation must be according to the terms agreed to by DPH, the program, and the individual.

Under the bill, if (1) the assistance program determines that a professional cannot practice with skill and safety or poses a threat to the health and safety of any person or patient and the professional does not stop practicing or fails to participate in a recommended program or (2) a health care professional referred to the program fails or refuses to participate, the assistance program must refer that professional to DPH and submit to the department all related program records and files.

Upon such a referral, DPH must determine if the person is eligible to participate in the program and whether participation should be confidential. As discussed above, DPH can seek the advice of professional societies or organizations and the assistance program to determine the services appropriate for the individual. The same confidentiality provisions apply.

The bill prohibits a medical review committee from referring to the assistance program a health care professional who is alleged to have harmed a patient. After being made aware of such an allegation, the committee and the assistance program must refer the professional to DPH along with all maintained records and files. The referral may include recommendations for appropriate services, referrals, and interventions. DPH must then determine if the person is eligible for such assistance and if so, whether they should be provided confidentially. Again, DPH can seek outside advice. If DPH determines that the person is an appropriate candidate for confidential participation in the program, the confidentiality provisions discussed above apply.

The bill requires the assistance program to report on the program annually to the appropriate professional licensing board or commission, or to DPH. (Not every health care profession has a separate licensing board or commission; in some cases DPH is the licensing authority. ) The report must include the number of health care professionals participating in the program, the purpose for participating, and whether participants are practicing health care with skill and safety and without posing a threat to the health and safety of any person or patient. By December 31 annually, the program must also report this information to the Public Health Committee.

Under the bill, all information given or received about an intervention, rehabilitation, referral assistance, or support services provided, including a health care professional's identity, is confidential. The information cannot be disclosed to a third party or entity unless disclosure is reasonably necessary to (1) accomplish the purposes of the intervention, rehabilitation, referral assistance, or support services or (2) to accomplish an audit (see below). It cannot be requested or disclosed in any civil, criminal, legal, or administrative proceeding, unless the health care professional waives the privilege or disclosure is otherwise required by law.

Under the bill, medical review committee proceedings are not subject to discovery and cannot be introduced as evidence in any civil action for or against a health care professional arising out of matters subject to evaluation and review by the committee. A person who attends such proceedings cannot be allowed or required to testify in any civil action about the content of the proceedings.

On the other hand, the bill specifies that it should not be construed as precluding in any civil action:

1. use of any writing recorded independently of such proceedings;

2. anyone's testimony about his or her knowledge, acquired independently of the proceedings, of the facts that are the basis of the civil action;

3. arising out of allegations of patient harm caused by the professional who, at the time of providing services, had been requested to refrain from practicing or whose practice was restricted, disclosure of such request or restriction; or

4. against a professional, disclosure of the fact that the individual participated in the assistance program, dates of participation, reason for participation, and confirmation of successful completion.

The court must determine that good cause exists for the disclosure after (a) notifying the professional of the disclosure request; (b) a hearing is held concerning the disclosure, at the request of any party; and (c) the court imposes appropriate safeguards against unauthorized disclosure or publication of the information.

The bill specifies that it should not be construed to prevent the assistance program from disclosing information about administrative proceedings related to disciplinary action taken against a professional whom the assistance program or oversight committee referred to DPH.

Current law requires physicians, hospitals, and medical societies to report an impaired physician or physician assistant to DPH within 30 days of knowing of the impairment (CGS §§ 20-12e & 20-13d). Impairment means that the physician is or may be unable to practice medicine with reasonable skill or safety because of:

1. physical illness or loss of motor skill;

2. emotional disorder or mental illness;

3. drug abuse;

4. illegal, incompetent, or negligent conduct in the practice of medicine;

5. possession, use, or distribution of controlled substances or legend drugs (except for therapeutic purposes); or

6. misrepresentation or concealment of a material fact in obtaining or reinstating a medical license.

Under the bill, any physician, physician assistant, hospital, or state or local professional society of health care professionals that refers a physician or physician assistant for intervention to the assistance program is deemed to have satisfied the obligations of the existing law described above.

By November 1, 2007 and annually afterwards, the assistance program must select an individual the program and DPH determine qualified to audit the assistance program. The audit's purpose is to examine the program's quality control and compliance with the bill. By November 1, 2011, DPH, with the agreement of the professional assistance oversight committee (see below), may waive the audit requirement in writing.

An audit must be a random sampling of the greater of at least 20% of the assistance program's files or 10 files. Before auditing, the auditor must agree in writing not to (1) copy any program files or records; (2) remove any program files or records from the premises; (3) disclose personally identifying information about professionals in the program to anyone other than a person or entity employed by the program and authorized to receive disclosure; and (4) disclose in any audit report any personally identifying information about professionals participating.

The auditor must also agree to destroy all personally identifying information about health care professionals participating in assistance programs after the audit is complete.

After completing the audit, the auditor must submit a written audit report to the assistance program, the oversight committee, and the Public Health Committee.

The bill requires DPH to establish a seven-member professional assistance oversight committee to oversee the program's quality assurance. The committee must include the following: (1) three members selected by DPH, who are health care professionals with training and experience in mental health or addiction services; (2) three members selected by the assistance program, who are not employees, board, or committee members of the assistance program and who are health care professionals with training and experience in mental health or addiction services; and (3) one member selected by the Department of Mental Health and Addiction Services, who is a health care professional. The bill requires the assistance program to provide administrative support to the committee.

Beginning January 1, 2008, the oversight committee must meet with the assistance program at least four times a year.

Under the bill, the committee may request and is entitled to receive copies of files or other assistance program records it deems necessary, provided the program redacts all information about the identity of any professional. Oversight committee members cannot copy, retain, or maintain any redacted records. If the committee determines that a professional is unable to practice with skill and safety or poses a threat to the health and safety of any person or patient, and the professional has not stopped practicing or has failed to comply with the terms and conditions of participation in the assistance program, the oversight committee must notify the assistance program to refer the person to DPH. Upon notification, the assistance program must refer the professional to DPH, according to the procedures specified above.

Failure of the Assistance Program to Act According to Law; Corrective Action Plan

The bill requires the oversight committee to notify the assistance program within 30 days of a determination that the assistance program (1) has not acted according to law or (2) requires remedial action based on the audit. The assistance program must develop a corrective action plan within 30 days of the notification. If the assistance program fails to comply with the corrective action plan, the oversight committee can amend it or direct the program to refer some or all of the records of persons in the program to DPH. DPH must then determine if each referred person is eligible for continued services and whether such participation should be treated as confidential.

DPH can refer health care professionals back to the program for continued intervention, rehabilitation, referral assistance, or support services after the oversight committee gives DPH written notice that the assistance program is in compliance with the corrective action plan. DPH must provide the assistance program with all records and files about the health care professionals.

Under the bill, oversight committee records are not public records and not subject to the Freedom of Information Act. They must be treated as confidential. Oversight committee proceedings are not subject to discovery or introduction into evidence in any civil action for or against a health care professional arising out of matters subject to evaluation and review by the committee. No person in attendance at committee proceedings is allowed or required to testify in any civil action about the proceedings. The bill allows the same disclosures and uses of information in civil actions as described above in the “Confidentiality” section.

Under current law, physicians, hospitals, and medical societies that know a physician is unable to practice skillfully or safely due to a variety of specified reasons must report the physician to DPH, by filing a petition. The Medical Examining Board and individuals may also make such reports. The mandatory reports must be made within 30 days of knowing of the impairment. Impairment basically means that the physician is or may be unable to practice with reasonable skill or safety because of (1) physical illness or loss of motor skill; (2) emotional disorder or mental illness; (3) drug abuse; (4) illegal, incompetent or negligent conduct in the practice of medicine; (5) possession, use or distribution of controlled substances or legend drugs; or (6) misrepresentation or concealment of a material fact in obtaining or reinstating a license. DPH must investigate each report to determine if probable cause exists to issue a statement of charges and institute proceedings against the physician. The investigation is confidential and must be concluded within 18 months. After that time, the record becomes public information.

Existing law allows DPH to recommend that the physician participate in an appropriate rehabilitation program. DPH must determine that the physician will pose no threat to the health and safety of any person in his practice during his participation in the program. Such a determination becomes part of the record of the investigation of the physician. DPH can seek the advice of established medical organizations in determining the appropriateness of any rehabilitation program. Following completion of the rehabilitation program and during his continued participation in it according to the terms agreed upon by the physician and DPH, all records remain confidential.

Under the bill, if DPH determines the physician is an appropriate candidate for rehabilitation it can refer him or her to the assistance program established under the bill. The bill specifies that the petition and all records of a physician determined eligible for participation in the existing physician rehabilitation program before the bill is enacted, must remain confidential during the physician's participation in, and upon successful completion of, the program, according to the terms and conditions agreed to by the physician and DPH.

Yea

Nay

(03/26/2007)

Yea

Nay

(04/10/2007)

Yea

Nay

(05/02/2007)

Yea

Nay

(05/09/2007)