Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-6678

Title:

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

Vote Date:

3/26/2009

Vote Action:

Joint Favorable Substitute

PH Date:

3/16/2009

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

To make various changes concerning licensing requirements applicable to health care professionals and institutions.

Substitute language changes:

● Delete existing lines 239 – 268 and insert new 239-284, reference to Section 7-65 of general statutes regarding embalmers and subregistrars.

● Additional changes were made on lines 519, 524, 551, 717, 718, 723, 725, 740, 741, 744, 745, and 771.

RESPONSE FROM ADMINISTRATION/AGENCY:

The Department of Higher Education: The Department opposes the language in Section 17 requiring it to seek certification from the Department of Public Health before authorizing an education institution for licensure in the health care fields. The Department currently works successfully and collaboratively with all partner agencies. In addition, the Department believes the proposed change of language could negatively impact the responsiveness of our colleges and universities to emerging and evolving fields of study.

Regarding Section 19, we would ask that all schools opening mortuary science should conform to the current statutory definitions.

Jennifer Filippone, Chief, Practitioner Licensing and Investigations, Department of Public Health: The Department requests the opportunity to submit revised language to clarify Section 19 regarding schools of mortuary science; would like the opportunity to work with the committee on Section 21 regarding any body that will not reach its final disposition or destination within 48 hours of death.

Section 7 would bring statutes in line with current practice regarding the Connecticut Tumor Registry and will allow for flexibility with reporting requirements, which change over time due to changes in diagnosis, treatment and prognostic considerations in oncology. In addition, the changes would provide the Department the authority to enforce reporting deadlines.

The Department requests the opportunity to submit amended language for Section 20 to clarify the duties of sextons and ensure that the sexton follows parallel procedures when completing and filing disinterment permits.

The Department is supportive of the initiative regarding the study of standing column geothermal wells, but we suggest deleting the reference to New Haven to make it a statewide effort.

In Addition, the Department would like to amend the bill by submitting language making revisions to the statutes pertaining to the Office of Emergency Services. Changes would include replacing outdated language with modern terminologies, allowing the Commissioner to annually approve a list that sets the minimum equipment requirements for ambulances, motorcycles and other rescue vehicles. Other changes include making the renewal cycle for EMT certification consistent for all providers regardless of how long the provider had been certified.

Dr. H. Wayne Carver, Chef Medical Examiner, Office of The Chief Medical Examiner (OCME): Section 12 would amend CGS 19a-323 and affect our workload and budget. Under this bill, we are authorized to issue cremation permits, I predict substantial administrative and financial burdens on this office that we are currently not prepared to shoulder. Fees are associated with the permit which would necessitate establishing a new section in accounts receivable and accounts payable back to the town registrars. Even if we became responsible for a fraction of the potential 24,000 transactions, we would need to modify our computer system.

Two ways to mitigate this problem are: (1) to specifically exempt OCME from functioning as a sub registrar for this purpose, and (2) not to expand the sub registrar's responsibilities and wait for the web based electronic registration to go on line next year.

NATURE AND SOURCES OF SUPPORT:

Nicole I. Granados, CFSP, CPC, Legislative Chair, Connecticut Funeral Directors Association, Inc.: The Funeral Directors Association supports the bill with the exception Sec. 21. Subsection (2) lines 761-770 (page 25) This section requires the unnecessary embalming of a deceased body whose death was not due to a reportable disease and will not reach its final disposition or destination with 48 hours from time of death. The lines should be deleted for the following reasons: (1) Most bodies do not reach their final disposition or destination within 48 hours and by existing statute cremation cannot take place within 48 hours; (2) subsection is not consistent with existing statute (Chapter 368a Dept. of Public Health Sec. 19a-91 Sec. (c)); (3) embalming is typically required by a funeral home for viewing purposes, thus this would force families who do not choose viewing to pay for embalming; (4) would place unnecessary financial burdens on families during a difficult time; (5) all deaths occurring on a Friday or early Saturday would require embalming; and

(6) during a pandemic or mass fatality event, it would be impossible to embalm all deceased remains.

Patrick Killeen, MS, PA-C, Connecticut Academy of Physician Assistants (ConnAPA):

ConnAPA requests amending section 15, which states that only licensed register nurses can be authorized to support a neonatal or pediatric specialty care transport. Limiting the staffing of these transports to only one profession could potentially limit access to care and create workforce issues for the neonatal transport system. Currently, the University Of Connecticut Health Center utilizes physician assistants and advance practice nurses. Pediatricians and neonatologists could be excluded unless section 15 is amended.

Pat Tadel, RN, MSN, Patient Care Administrator, VITAS Innovative Hospice Care: I am supporting Section 16 which aligns home health state licensure inspections with the Medicare survey cycle for home health agencies. The proposal would require the Department of Public Health to survey home health agencies and hospices every three years for both their Medicare and state licensure inspections. This proposal makes sense and is cost effective for both the State and home health and hospice agencies. The proposal will not decrease quality oversight, but instead align the survey processes to improve efficiencies for both the Department and provider agencies.

Samuel W. Olmstead, Associate Director of Utilities, Yale University: Yale has a strong commitment to sustainability and reducing its greenhouse gas emissions. The use of state-of –the-art geothermal well systems is a key component of that strategy. The standing column geothermal well system we propose to use cannot be used under current Connecticut General Statutes and regulations, even though such systems have proven reliable and safe. Therefore, we seek change to the statutes to enable us to design and build a standing column geothermal well system.

Dr. Arnold Goldman, Co-Chair, Government Affairs, Connecticut Veterinary Medical Association (CVMA): CVMA supports Sections 10 and 11 requiring veterinarians to obtain regular continuing education appropriate to their professional duties and employment. In light of the highly sophisticated and rapidly evolving state of veterinary medical practice today, CVMA believes such a requirement is necessary and appropriate. The requirement will ensure a minimum level of competence among veterinarians.

Cathleen A. Alex, Au. D., President, Connecticut Academy of Audiology (CTAA): CTAA proposes two separate statutes that define licensing of audiologists and speech language pathologists. Audiologists and speech pathologists are the only professions in the state that share a licensing statute. The respective scopes of practice and educational requirements for each profession have diverged, evolved and expanded. The profession of audiology has advanced its minimum education requirement to the doctoral level.

The concept of a standalone statute for each profession allows for streamlined and simplified responses to statute/licensure inquiries regarding each profession. It also allows for more efficient refinements in the future as our respective scopes' of practice continue to evolve with advances in science, technology and education.

Yale-New haven Children's Hospital (YNHCH): YNHCH supports sections 14 and 15 regarding inter-hospital Neonatal and Pediatric Specialty Care Transport. This language seeks to codify training requirements of clinical teams that assist in the safe inter-hospital transportation of newborns and children.

James Parker, MD, Medical Director of Critical Care Transport Team, Connecticut Children's Medical Center: Connecticut Children's Medical Center needs to operate a critical care transport team to bring critically ill or injured children and newborns from community hospitals to our facility when they need tertiary care services not available at the community facility. Currently, Office of Emergency Medical Services regulations prevent our team of trained pediatric critical care clinicians from providing the specialized services needed. We are not currently operating this service because of potential liability for our clinician's licenses.

The proposed legislative language in Sections 14 and 15 will allow us to provide this service. We ask that you make it effective upon passage.

Joyce P. Mascena, Chair, Legislative Committee, Connecticut Town Clerks Association, Inc. (CTCA): CTCA agrees with this legislation provided amendments submitted by the Department of Public health are incorporated. Specifically, in Section 12 we request that it insure that no loss of accountability for the delivery of the cremation certificate permit paperwork to the permanent recording town is not jeopardized.

In Section 20, we agree that adding a thirty day filing requirement for sextons' reports is the only change necessary.

Kevin Wood: I am here to convince the committee to pass a bill that would monitor prescription drug use. Without an innovative system for monitoring drug use it is easy to find doctors, pharmacies and insurance companies who are not in communication with each other.; thereby, making it easy for those addicted to prescription drugs.

He gave his personal story of his addition to prescription drugs and the ease with which he was able to purchase them.

Barbara Wood: Testified in support of strengthening the monitoring system for prescribed narcotics to improve the accountability on the part of providers. This will make it more difficult for people to become addicted to prescribed narcotics and make it more difficult for them to obtain the drugs from doctors and pharmacies. She supported her testimony with the case of her son's addition to prescribed narcotics.

The Permanent Commission on the Status of Women (PCSW): PCSW supports passage of section 9, which would amend the Commission on Health Equity's statute to add “gender” as one of the areas to focus on when addressing health disparities. There is a clear racial and ethnic disparity in health care as African-American and Hispanic women are at a greater risk for certain diseases.

Thomas M. Halaszynski, M.D., D.M.D., President, Connecticut State Society of Anesthesiologists: Truth and transparency are vital to the health care system. The language in section 8(b) requires a health care provider who works at a health care facility and provides direct patient care to wear an identification badge that indicates the provider's name and type of license or certificate held. It would also allow the health care facility to develop the policies concerning the size and content of the identification badge. This legislation will help prevent physician misrepresentation.

Carolyn Reid, Administrator, Masonicare Partners Home Health and Hospice: We support Section 16 of HB 6678. With federal reimbursement shrinking and state reimbursement for homecare below cost, home health providers are struggling to survive. Recognizing that government as well as private industry is facing daunting deficits, we look for ways to save dollars while maintaining quality. Reducing unnecessary administrative burden is one way this may be accomplished.

This proposal will not decrease quality oversight, but instead align the survey process to improve efficiencies for both the Department of Public health as well as for home health agencies. It is a way to save money for the State by decreasing redundancy in the survey process, as well as for agencies as the survey process is both time consuming and expensive taking staff away from their patients.

Kimberly Skehan, RN, MSN, Vice President, Clinical & Regulatory Services, Connecticut Association for Home Care & Hospice: The Association supports section 16, which will align the frequency of State of Connecticut licensure inspections with Medicare certification surveys for home health agencies. This is a common sense proposal, which will help both the State and home health agencies conserve resources, while maintaining appropriate quality oversight.

The Association suggests the following revision to Section 16, on line 645 after … for home health agencies, insert “, in which case such institutions will be inspected in accordance with the Medicare survey frequency.”

NATURE AND SOURCES OF OPPOSITION:

Connecticut Hospital Association (CHA): CHA opposes this bill as written, specifically with respect to Section 7 and 8. Section 7 would create new penalties for a provider's failure to properly report data to the state's tumor registry. The fines that would be imposed are not commensurate with the situation. We request you amend subsection (f) of Section 7 as follows:

● (f) (1) Failure by a hospital, clinical laboratory or health care provider to comply with the reporting requirements prescribed in this section may result in the Department electing to perform the registry services for such hospital, clinical laboratory or provider. In such case, the hospital, clinical laboratory or provider shall reimburse the Department for actual expenses incurred in performing such services.

● (2) Any hospital, clinical laboratory or health care provider that fails to comply with the provisions of this section shall be liable to a civil penalty not to exceed five hundred dollars for each failure to disclose a reportable tumor, as determined by the commissioner.

● (3) the reimbursements, expenses and civil penalties set forth in this subsection shall be assessed only after the Department provides written notice of deficiency indicating that the provider must comply within fourteen days of receipt of such notice and provider fails either (i) to timely comply, or(ii) to provide an explanation and remediation plan acceptable to the Department.

We request that subsection (b) of Section 8 be amended as follows:

(b) Any health care provider who works at a health care facility and who provides direct patient care shall be required to wear an identification badge that indicates such provider's name and type of license or certificate that the provider holds. A health care facility shall develop policies concerning the size and content of the identification badge required pursuant to this subsection, which shall be consistent with the facility's accreditation standards.

Reported by: Randall Graff

Date: April 7, 2009