OLR Bill Analysis

sHB 6678

AN ACT CONCERNING REVISIONS TO DEPARTMENT OF PUBLIC HEALTH LICENSING STATUTES.

SUMMARY:

This bill makes a number of substantive and minor changes to laws governing Department of Public Health (DPH) programs and health professional licensing. The changes related to DPH programs address funeral home practices and death records, the Connecticut Tumor Registry, mass gatherings, the home health agency inspection schedule, and geothermal wells. The professional licensing changes affect physicians, nursing home administrators, dental hygienists, and veterinarians.

The bill requires certain health care practitioners to inform pregnant women about umbilical cord blood and cord blood banks. And it makes minor changes in laws concerning the Health Equity Commission and school-based health centers.

EFFECTIVE DATE: October 1, 2009, except for the sections on (1) the Health Equity Commission, geothermal wells, and repeal of the school-based health center entrance requirement, which take effect on passage and (2) home health agency inspections and umbilical cord blood, which take effect on July 1, 2009.

1, 13, 17 — FUNERAL HOME PRACTICES

The law requires funeral directors to wash or embalm a body before transporting it from the place where the death occurred. The bill makes an exception when the person who assumes custody of the body for burial purposes determines that doing this is contrary to the deceased's religious beliefs or customs. The law still requires funeral directors to wash, embalm, or wrap a body as soon as practicable after it arrives at the funeral home if the person died from a disease that must be reported to DPH (CGS 19a-91(c)).

The bill requires placing any body entombed in a crypt or mausoleum in a zinc-lined or plastic container (made of acrylonitrile butadiene styrene, ABS) or, if the cemetery permits, a non-rusting or ABS sheeting tray.

It extends, to six from three years:

1. the period after death that funeral homes must keep their records related to funeral services, prepaid funeral contracts, and escrow accounts;

2. the period after a body's final disposition that funeral homes must keep copies of permits, certificates, and written agreements about disposition, including the final bill; and

3. the period after last distributing them to consumers that funeral homes must keep copies of price lists.

The bill permits a college that operates an accredited mortuary science program to install working preparation embalming rooms, regardless of the law that prohibits anyone from engaging in the funeral service business without a DPH license. But another law requires any person or firm that engages in preserving dead human bodies to obtain a DPH funeral business license (CGS 20-212).

2 — PENALTIES FOR NURSING HOME ADMINISTRATORS

The bill adds another circumstance for which DPH can take action against a nursing home administrator—violating any state or federal law governing the administrator's practice in a nursing home. DPH can already take action against a licensee who is found guilty of a felony under this state's, another state's, or federal law. Sanctions include censure or reprimand, suspending or revoking the administrator's license, and civil penalties up to $ 25,000.

3 — MEDICAL RESIDENTS' PERMITS

Medical residents and interns must get a DPH permit to participate in their programs. Under the bill, the person's ability to practice medicine under the permit automatically ends when the internship or residency ends or he or she leaves the program. Anyone who continues to perform medicine is subject to DPH sanctions.

4 — DENTAL HYGIENISTS

The bill permits dental hygienists to practice independently (i. e. , without a dentist's general supervision) in a program offered or sponsored by the Women's, Infants, and Childrens (WIC) program. Hygienists can already practice independently in community health centers, group homes, schools, public preschools, and Head Start programs.

5 & 6 — MASS GATHERING LICENSE

The bill lowers the attendance and durational thresholds, from 3,000 to 1,000 people or 18 to eight consecutive hours, that trigger the requirement for an event organizer to obtain a mass event license from the local police chief or first selectman.

7—CONNECTICUT TUMOR REGISTRY

The bill updates the law governing the Connecticut Tumor Registry, which under current law and regulation (1) requires all hospitals and clinical laboratories to report, by June 30 annually, laboratory data, diagnosis, medical, treatment, and occupational history, and lifetime follow-up information for anyone newly diagnosed with cancer and (2) subjects any entity that does not report to license suspension or revocation.

The bill requires the registry to include reports of all tumors and conditions that are diagnosed or treated in the state for which DPH requires reports. It extends the reporting requirement to physicians, chiropractors, naturopaths, podiatrists, athletic trainers, physical and occupational therapists, alcohol and drug counselors, radiographers and radiologic technologists, midwives, nurses, nurse's aides, dentists, dental hygienists, optometrists, opticians, respiratory care practitioners, perfusionists, psychologists, marital and family therapists, clinical social workers, professional counselors, veterinarians, massage therapists, electrologists, hearing instrument specialists, speech and language pathologists, audiologists, paramedics, and emergency medical technicians.

It requires the reports to cover every occurrence of a reportable tumor and condition, (DPH determines what must be reported) that was diagnosed or treated during the calendar year. The reports must include information from any health care provider's records; follow-up data; and demographic, diagnostic, treatment, and other medical information. They may include actual tissue samples and other information DPH prescribes. The bill requires the DPH commissioner to develop a list of data that must be reported. Reports are due annually beginning July 1, 2010.

Any hospital, lab, or provider that fails to report within six months of a confirmed diagnosis must be assessed a $ 500 civil penalty for each day after the DPH commissioner orders it to report. (It is not clear how this reporting requirement relates to the annual reporting requirement. ) The commissioner may ask the attorney general to enforce this penalty.

The bill requires all health care providers to give DPH access to their records to perform case finding or other quality improvement audits. It allows DPH to (1) contract for the storage, holding, and maintenance of tissue samples and (2) make reciprocal reporting agreements with other states' tumor registries to exchange tumor reports.

The bill authorizes DPH to perform “registry services” for any hospital, lab, or provider that fails to comply with its reporting requirements. The bill does not define this term, but it presumably includes reporting all required data. In such cases, the hospital, lab, or provider must reimburse DPH for its expenses.

8, 12, 18, 19 — DEATH-RELATED RECORDS

Subregistrars

The bill requires local registrars of vital statistics to appoint at least two subregistrars who can issue needed permits when the registrar's office is closed; current law does not set a minimum number. It allows subregistrars to issue cremation permits as well as removal, transit and burial permits. Before authorizing a cremation permit, the bill requires the subregistrar to receive and review a completed cremation certificate and permit. The bill prohibits a funeral director, embalmer, or an employee of either, acting as a subregistrar, to issue a cremation permit to him or herself.

The bill specifies that subregistrars must forward the death and cremation certificates upon which they issued permits to the registrar of the town where the death occurred, not the registrar that appointed them. It requires them to submit a cremation permit within seven days after receiving the cremation certificate, the same time currently required for submitting a death certificate. It also specifies that the chief, deputy chief, and associate medical examiners are considered subregistrars in any town where a death occurs only for issuing removal, transit, and burial permits (thus, not for issuing cremation permits).

Cemetery Sextons

The bill specifies time frames and procedures for cemetery sextons to follow for transmitting removal, transit, and burial permits to registrars. If they record a permit on an electronic registry, they must do so within three days of the burial. The bill requires them to send the completed and signed permit in paper format to the registrar of the town where the body is buried and a copy to the registrar of the town where the death occurred. A sexton in charge of reinterring a disinterred body must (1) complete and return a disinterment permit to the registrar of the town where the body is buried and (2) send a copy to the registrar of the town where the death occurred. The bill requires sextons to send all paper permit forms within the first week of the month following the burial or disinterment.

The law requires sextons to report all interments, disinterments, and removals to the registrar of the town where the cemetery is located. Under the bill, they can fulfill this requirement by recording the removal, transit, and burial permit in an electronic registry. The bill removes requirements that the report be on a DPH-prescribed form and that sextons (1) include in their monthly reports a separate statement about bodies that were temporarily stored in their cemeteries' receiving vaults before burial and (2) send a copy of the permits for such burials to the registrar of the town where the death occurred.

Disinterment

The bill allows embalmers and funeral directors from other states that have reciprocal agreements with Connecticut to apply for a disinterment permit. It specifies that they and the DPH-licensed funeral directors and embalmers and people acting under a court order, who are currently allowed to apply for such permits, can apply to either the registrar of the town where the body is buried or of the town where the death occurred.

9 — COMMISSION ON HEALTH EQUITY

The bill adds eliminating gender-related health disparities to the Commission on Health Equity's charge and requires one of its eight public members to represent women. The top four legislative leaders each appoint two public members.

10 & 11 — VETERINARIAN CONTINUING EDUCATION

The bill requires veterinarians to take at least 24 contact hours (a contact hour is 50 minutes) of continuing education every two years as a condition of license renewal and permits DPH to sanction a veterinarian who fails to comply. The requirement applies to license renewals occurring on or after July 1, 2011.

The continuing education must (1) be in an area of the veterinarian's practice and (2) reflect his or her professional needs. In-person and online courses offered by national and state veterinarian organizations, veterinary schools, and other professional organizations all qualify as continuing education activities. A veterinarian applying for license renewal must (1) attest in writing to DPH that he or she satisfied the continuing education requirements and (2) keep records to that effect for at least three years after completion. The veterinarian must submit these records to DPH with 45 days of its asking for them.

The requirements do not apply to veterinarians who (1) renew a license for the first time or (2) submit a notarized exemption application to DPH stating they do not practice actively. The bill allows the DPH commissioner to waive the requirement or grant an extension for up to one year for a veterinarian who is ill or medically disabled. A doctor's note certifying the condition must accompany the veterinarian's waiver or extension application. Upon application, the commissioner can grant additional waivers and extensions if the condition continues.

A veterinarian whose license is voided for failure to renew must document successfully completing at least 12 contact hours of continuing education in the year immediately preceding the year he or she applies to reinstate the license.

14 — HOME HEALTH AGENCY INSPECTIONS

Under current law, DPH must conduct an unscheduled inspection of a home health agency before the agency's license can be renewed. Licenses are renewable every two years. Agencies that participate in Medicare must be inspected every three years; DPH also conducts these inspections.

The bill exempts Medicare-certified home health agencies from the two-year inspection schedule, thus bringing inspections into line with the triennial federal schedule. But it retains the biennial licensing requirement, which means inspections and license renewals will no longer be aligned. (While the bill appears to affect homemaker-home health aide agencies and homemaker-home health aide services, Medicare does not certify these. )

15 — HEALTH CARE PROVIDER EDUCATION PROGRAMS

The bill prohibits the Board of Governors of Higher Education from approving a college or university's application to operate a program related to a health care profession unless the DPH commissioner certifies in writing that DPH licenses, certifies, or registers that profession.

16 — PHYSICIAN CONTINUING MEDICAL EDUCATION

The bill adds cultural competency to the list of continuing medical education topics physicians must take every two years. The list currently covers infectious diseases, risk management, sexual assault, and domestic violence. Physicians must take at least 50 minutes (one contact hour) of education in these topics every two years.

20 — GEOTHERMAL WELLS

The bill permits the DPH commissioner, with the concurrence of the environmental and consumer protection commissioners, to give a university located in a city whose population is between 100,000 and 150,000 a variance from state regulations to install standing column geothermal wells in a class GB groundwater zone (not fit for human consumption without treatment). The commissioners may require the wells to meet minimum safeguards that exceed existing regulatory requirements.

Before the variance may be granted, the school must submit information these agencies deem necessary to assure the public health and the environment are protected. The school must hire, at its expense, an independent expert to help the state agencies develop regulations for geothermal wells.

If, once it is operating, the public health or environmental protection commissioners determine the well to be injuring public health or the environment, either may order it to be closed and abandoned according to regulatory requirements.

22 — UMBILICAL CORD BLOOD

The bill requires doctors and other health care providers who provide pregnancy-related care for women during their third trimester to provide the women with timely, relevant, and appropriate information about umbilical cord blood and cord blood banks. The information must be sufficient to allow women to make informed choices about banking or donating their child's cord blood.

25 & 26 — REPEALED STATUTES

The bill repeals the requirement that any school-based health clinic located in or attached to a school building constructed on or after July 1, 2009, that shares a first floor exterior wall with the school building include an entrance separate from the school building entrance.

It also repeals two statutes governing disinterment and sexton reporting that it incorporates into other sections the bill amends.

COMMITTEE ACTION

Public Health Committee

Joint Favorable Substitute

Yea

30

Nay

0

(03/26/2009)