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Political Pulse: Legislative Highlights of the Week
1. Governor's Supplemental Budget, L.D. 2173
Following a new revenue forecast last week, the Appropriations Committee now faces a budget shortfall that has doubled to more than $200 million. The Committee expects to receive the Governor's plan to address this shortfall some time this week. A new series of public hearings on the revised plan may be scheduled during the week of March 10th. Among the many health and social service spending cuts of concern to the MMA are the $20 million reduction in reimbursement to hospital-based physicians and a new $3 million cut anticipated in graduate medical education.
The MMA urges you to contact members of the Appropriations and HHS Committees about these items.
Joint Standing Committee on Appropriations & Financial Affairs: http://janus.state.me.us/house/jt_com/afa.htm.
Joint Standing Committee on Health & Human Services: http://janus.state.me.us/house/jt_com/hum.htm.
2. BRED Committee to Consider Staff Report on Licensure of Lay Midwifery on Tuesday
After scheduling problems prevented presentation of the report last week, the Business, Research & Economic Development Committee will receive a report recommending against licensure of lay midwives on Tuesday, March 4, 2008. The presentation of the report and work session on L.D. 1827 will take place about 1:30 p.m. following a work session on another bill. In addition to the MMA, professional societies representing pediatricians, OB/GYNs,.and family physicians have opposed licensure. Proponents of licensure have argued that a licensing framework is necessary not to protect the public, but to give these practitioners legitimacy.
You can find the report from the Department of Professional & Financial Regulation on the web at: http://mainegov-images.informe.org/pfr/legislative/documents/MidwivesSunriseReviewReport.pdf.
If you would like to communicate with members of the Business, Research & Economic Development Committee, you can find them on the web at: http://janus.state.me.us/house/jt_com/bec.htm.
3. HHS Committee Considers Bill Prohibiting Payment for So-Called "Never Events"
The HHS Committee held a public hearing last Tuesday and has scheduled a work session for tomorrow afternoon on L.D. 2044, An Act to Prohibit Payment to Health Care Facilities for Treatment to Correct Mistakes or Preventable Adverse Events. The Maine Hospital Association had been negotiating with prime sponsor Rep. Patsy Crockett (D-Augusta) and Rep. Crockett had agreed to the following language in place of the original bill.
An Act To Prohibit Payment to Health Care Facilities Hospitals from Charging for Treatment To Correct Medical Mistakes or Preventable Adverse Events
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §1721 is enacted to read:
§ 1721. Prohibition on payment charging for health care facility mistakes or preventable adverse events
1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
A. “Health care facility” means a hospital or ambulatory surgical center licensed under chapter 405.
B. “Mistake or preventable adverse event” means any of the following events that is within the health care facility’s control to avoid includes but is not limited to:
(1) Surgery performed on the wrong body part;
(2) Surgery performed on the wrong patient;
(3) The wrong surgical procedure performed on a patient;
(4) Unintended Retention of a foreign object in a patient after surgery or another procedure;
(5) Intraoperative or immediately postoperative preventable death of a patient classified as a normal healthy patient under guidelines published by a national association of anesthesiologists;
(6) Patient death or serious disability associated with caused by the use of contaminated drugs, devices or biologics provided by a hospital or ambulatory surgical center;
(7) Patient death or serious disability associated with caused by the use or function of a device in patient care in which the device is used for functions other than as intended;
(8) Patient death or serious disability associated with caused by an intravascular air embolism that occurs while being cared for in a health care facility;
(9) An infant’s being discharged to the wrong person;
(10) Patient death or serious disability associated with caused by a patient’s elopement for more than 4 hours;
(11) Patient suicide or attempted suicide resulting in serious disability while being cared for in a health care facility;
(12) Patient death or serious disability associated with caused by a medication error such as an error involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation or wrong route of administration;
(13) Patient death or serious disability associated with caused by a hemolytic reaction due to the administration of incompatible blood or blood products;
(14) Maternal death or serious disability associated with caused by labor or delivery in a low-risk pregnancy, labor and delivery while being cared for in a health care facility;
(15) Patient death or serious disability associated with caused by hypoglycemia, the onset of which occurs while the patient is being cared for in a health care facility;
(16) Death or serious disability associated with caused by failure to identify and treat hyperbilirubinemia in neonates prior to discharge;
(17) Stage 3 or 4 pressure ulcers acquired after admission to a health care facility;
(18) Patient death or serious disability due to spinal manipulative therapy;
(19) Patient death or serious disability associated with caused by an electric shock while being cared for in a health care facility;
(20) Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances;
(21) Patient death or serious disability associated with caused by a burn incurred from any source while being cared for in a health care facility;
(22) Patient death associated with caused by a fall by a patient who was or should have been identified as requiring precautions due to risk of falling while being cared for in a health care facility;
(23) Patient death or serious disability associated with caused by the use of restraints or bedrails while being cared for in a health care facility;
(24) Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist or other licensed health care provider;
(25) Abduction of a patient of any age;
(26) Sexual assault of a patient within or on the grounds of a health care facility; and
(27) Death or significant injury of a patient or staff member resulting from a physical assault that occurs within or on the grounds of a health care facility.
2. Prohibition. A health care facility is prohibited from knowingly charging a patient or the patient’s insurer for health care services it provided as a result of or to correct a mistake or preventable adverse event caused by that health care facility a mistake or preventable adverse event committed while the patient is in the care of that health care facility or for the care provided by that health care facility to correct the mistake or preventable adverse event.
The bill drew significant interest from legislators with Reps. Patsy Crockett (D-Augusta), John Brautigam (D-Falmouth), Marilyn Canavan (D-Waterville), and Sharon Treat (D-Hallowell) all speaking in favor of the bill. The MHA also spoke in favor of the bill. There was no opposition, but Trish Riley from the Governor's Office of Health Policy & Finance spoke "neither for nor against" it. The MMA submitted testimony "neither for nor against" the bill, but raised concerns about the scope of the list of events and the scope of the prohibition on non-payment.
The key provisions of the MMA testimony are:
The MMA takes a “neither for nor against” position on the amended version of L.D. 2044 presented to you today. While we concur that no payment for “mistakes or preventable adverse events” is the appropriate legal and ethical standard, we see reason for caution in implementing such a law because of the potential unintended consequences of aggressive implementation of it.
We acknowledge the sponsors of the bill for their commitment to patient safety and thank them for being responsive to the concerns raised by the Maine Hospital Association in revising the original bill.
As you enter your work sessions on L.D. 2044, please consider the following concerns of the medical community:
- Is the list of “mistakes or preventable adverse events” in the proposed §1721(1)(B) appropriate. The members of the MMA Legislative Committee who recently reviewed the revised list believe that the items in subsections (1), (2), (3), (4), (6), (7), (9), (12), (13), (19), (20), (21), and (24) are appropriate for the proposed law. They were considerably less comfortable with the following subsections because none of the procedures involved may be reduced to zero risk: subsections (5), (8), (14), (15), (16), (17), and (18). Finally, they felt that in a majority of situations the following events would not be preventable by facility staff: subsections (10), (11), (25), (26), and (27). As Dr. Wachter points out in the January 7, 2008 article mentioned above, “never events such as pressure ulcers or patient falls are not always preventable and ‘there will be lots of unintended consequences and challenges in the implementation phase that should push us to go slowly with a small number of events.” (emphasis supplied)
- Is there an appropriate limit to the extent of follow up treatment without payment? As drafted, the bill would hold the health care facility responsible for unlimited follow up care without payment forever. Without doubt disputes will arise regarding the relationship of requested treatment in the future to some prior “mistake or preventable adverse event.” Should this bill provide some “bright line” limit, such as a certain amount of time following an incident, or should it include a dispute resolution mechanism?
These are just two examples of the challenges we will face in implementing L.D. 2044.
The MMA urges you to contact members of the HHS Committee to ask them to consider narrowing the list of "mistakes or preventable adverse events" in accordance with the MMA testimony.
Joint Standing Committee on Health & Human Services: http://janus.state.me.us/house/jt_com/hum.htm.
4. Public Health Update: Chemicals in Products Subject of Public Hearing Last Week in Natural Resources Committee. A Public Health Committee priority for 2008.
During a three and one-half hour long hearing, the MMA’s Public Health Committee joined several other supporters testifying in support of two bills protecting children by adopting new disclosure rules for toxic chemicals in household products. Dr. Lani Graham represented the MMA Public Health Committee, along with the AAP, Maine Chapter, in support of creating a list of chemicals in consumer products that have been found to cause cancer or hormonal imbalances that interfere with development. (A copy of her testimony can be located on the MMA Website at www.mainemed.com) Manufacturers would have to notify the state if products sold here contain the listed chemicals, and state officials could ultimately ban them. Those in opposition to the bills included the Maine State Chamber of Commerce and representatives of chemical and product manufacturers. The two bills were called L.D. 2048, An Act to Protect Children’s Health and the Environment from Toxic Chemicals in Toys and Children’s Products and, L.D. 2210, An Act to Promote the Use of Safer Chemicals in Consumer Products.
Global climate change is the greatest environmental threat of our generation. This past week, the Natural Resources Committee heard a bill to take immediate action to dramatically reduce greenhouse gas emissions. Dr. Norma Dreyfus, member of the Maine Medical Association’s Public Health Committee testified in support of L.D. 2126, An Act to Minimize Carbon Dioxide Emissions from new Coal-Powered Industrial and Electrical Generating Facilities in Maine. Dr. Dreyfus indicated that, “[c]limate change threatens the health, welfare, and future of current and subsequent generations of children. Governments at all levels should implement aggressive policies to halt man-made contributions to climate change to mitigate its impact on children’s health.” The American Academy of Pediatrics issued a policy statement this past November on Global Climate Change and Children’s health, and can be found at http://pediatrics.aappublications.org/cgi/content/abstract/120/5/1149 . A copy of Dr. Dreyfus’s testimony will be posted on the MMA Website.
5. More than 20 People Testify on Bill to Repeal the Capital Investment Fund
On Tuesday, February 26, 2008, the HHS Committee also conducted a lengthy public hearing on L.D. 2152, An Act to Ensure Access to Necessary Health Care Services in Maine by Repealing the Capital Investment Fund. The Maine Hospital Association and a number of hospital representatives spoke in favor of the bill. Representatives of EMMC, CMMC, and St. Mary's all participated in the hearing along with contractors and contractors' associations. Representatives of the Advisory Council on Health Systems Development, BIW, UNUM, the Maine State Chamber of Commerce, the Governor's Office of Health Policy & Finance, and Consumers for Affordable Health Care spoke in opposition to the bill. Opponents acknowledged problems with the administration of the CIF, but argued that it is too important a cost containment tool to eliminate it. The Committee plans a work session on the bill for tomorrow afternoon.
6. HHS Committee Hears Two Bills on Lead Poisoning
On Friday, February 29, 2008, the HHS Committee held a public hearing on L.D. 2053, An Act to Ensure that Children's Toys and Products are Free of Lead and L.D. 2172, An Act to Protect Children from Lead Poisoning. L.D. 2053 would restrict the sale or distribution of a lead-containing children's product in this state, including a toy, child care article, lunch box, or children's jewelry. L.D. 2172 would require a blood lead level assessment for all children from age one through 5 and would require certification of an assessment to enter school. The MMA and the Maine Chapter of the American Academy of Pediatrics joined Maine CDC Director Dora Ann Mills, M.D., M.P.H. in opposition to L.D. 2172. Both Dr. Mills and the MMA raised concerns about various obstacles to screening and blood draws in the primary care setting. The bill is scheduled for work session this Friday.
7. More Legislative Information
Please remember that you can find more legislative information, including the legislative history search tool, on the web at: http://janus.state.me.us/legis/
You can leave a message for Senators at the State House by calling toll free 1-800-423-6900.
You can leave a message for Representatives at the State House by calling toll free 1-800-423-2900
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