| Introduced By: Representative Frank Anzeveno |
| Date Introduced: February 4, 1997 |
| Referred To: House Committee on Health, Education and Welfare |
It is enacted by the General Assembly as follows
SECTION 1. Sections 5-37-9 and 5-37-9.1 of the General Laws in Chapter 5-37 entitled "Board of Medical Licensure and Discipline" are hereby amended to read as follows:
5-37-9. Reports relating to professional conduct and capacity -- Regulations -- Confidentiality -- Immunity. -- In addition to the requirements of section 42-14-2.1:
(1) The board with the approval of the director may adopt regulations requiring any person, including, but not limited to, corporations, health care facilities, health maintenance organizations, organizations and federal, state, or local governmental agencies, or peer review boards to report to the board any:
Conviction, determination, or finding that a licensed physician has committed unprofessional conduct as defined by section 5-37-5.1 as now or hereafter amended, or to report information which indicates that a licensed physician may not be able to practice medicine with reasonable skill and safety to patients as the result of any mental or physical condition. The regulations shall include the reporting requirements of subdivision 2 (i), (ii) and (iii).(2) The following reports in writing shall be filed with the board:
(i) Every insurer providing professional liability insurance to a physician licensed under the provisions of this chapter shall send a complete report to the board setting forth any formal notice of any claim, settlement of any claim or cause of actions, or final judgment rendered in any cause of action for damages for death or personal injury caused by such physicians negligence, error or omission in practice or his or her rendering of unauthorized professional services. Such report shall be sent within thirty (30) days after service of such complaint or notice, settlement, judgment, or arbitration award on the parties. All such reports shall set forth an in depth factual summary of the claim in question.
(ii) All hospital and licensed health care facilities including, but not limited to, nursing homes and health maintenance organizations and the division of drug control must report to the board within thirty (30) days of such action, any action, disciplinary or otherwise, taken for any reason, which limits, suspends or revokes a physician's privilege to practice or requires supervision of a physician, either through formal action by the institution or facility or through any voluntary agreement with the physician.
(iii) Within ten (10) days after a judgment by a court of this state that a physician licensed under the provisions of this chapter has been convicted of a crime or is civilly liable for any death or personal injury caused by his or her negligence, error or omission in his or her practice or his or her rendering unauthorized professional services, the clerk of the court which rendered such judgment shall report the judgment to the board.
(3) The board shall publicly report any change of privilege, of which, it is aware, to the board of trustees or other appropriate body of all licensed hospitals, licensed health care facilities, health maintenance organizations and such other parties as the board shall deem appropriate within thirty (30) days, provided, however that{ADD , except as required by section 5-37-9.2 ADD} notwithstanding the provisions of this subdivision, the board may, in instances where the change of privilege is not related to quality of patient care, elect not to disseminate the report of change in privilege. Such an election may be made in executive session and no decision not to disseminate shall be made except by majority vote of the members present at the meeting and only upon a finding of fact by the board after inquiry that the change of privilege was not related to quality of patient care.
(4) {ADD Except as provided in section 5-37-9.2, ADD} {DEL T DEL} {ADD t ADD} he
contents of any report file shall be confidential and exempt from
public disclosure, except that it may be reviewed:
(i) By the licensee involved or his or her counsel or authorized representative who may submit any additional exculpatory or explanatory statements or other information, which statements or other information shall be included in the file, or
(ii) By the chief administrative officer, a representative of the board, or investigator thereof, who has been assigned to review the activities of a licensed physician.
(5) Upon determination that a report is without merit, the board's records may be purged of information relating to the report.
(6) If any person refuses to furnish a required report, the board may petition the superior court of any county in which the person resides or is found, and the court shall issue to such person an order to furnish the required report. Any failure to obey such order shall be punished by the court as a civil contempt may be punished.
(7) Every individual, medical association, medical society, hospital, health care facility, health maintenance organizations, peer review board, medical service bureau, health insurance carrier or agent, professional standards review organization, and the agency of the federal, state, or local government shall be immune from civil liability, whether direct or derivative, for providing information in good faith to the board pursuant to this statute or the regulations outlined in subdivision (1) or requirements of subdivision (2).
(8) Nondisclosure agreements are prohibited in so far as they forbid parties from making reports regarding competency and/or unprofessional conduct to the board of medical licensure and discipline.
(9) The board with the approval of director shall promulgate rules and regulations setting forth standards for hospital or health maintenance organization supervision of physicians by peer review committees. Such regulations, including without limiting the generality thereof, shall require that each hospital or health maintenance organization, as the case may be, shall report annually to the board the activities, findings, studies and determinations of its peer review committees.
5-37-9.1. Requirements relating to professional conduct. --
The board shall receive and maintain a confidential file which will be available to the board to precipitate or aid in their investigations. The information shall also be available to licensed health care facilities including health maintenance organization in connection with the granting of staff privileges and to the individual physicians themselves {DEL(1) Cases of malpractice suits against a physician as reported to the board by insurers and self-insurers, including those pending as of July 1, 1986.
(2) Cases of malpractice suits that result in allegations being dropped, a dismissal, a settlement, or court judgment or arbitration award adverse to the physician.
(3) Reports by any hospital or state or local professional medical association/society of disciplinary action taken against any physician. This should also include any resignation of a physician if related to unprofessional conduct as defined in law or any withdrawal of an application for hospital privileges relating to unprofessional conduct.
(4) Reports by state and federal courts of physicians found guilty of a felony.
(5) Reports by the professional review organization and third party health insurers of sanctions imposed on a physician.
(6) Annual reports by hospitals and health maintenance organizations of current appointments to their medical staffs.
(7) Information supplied to the board by the federation of state medical boards and the American medical association. The file may contain such other data as the board by reasonable rule or regulation deems appropriate.
SECTION 2. Chapter 5-37 of the General Laws entitled "Board of Medical Licensure and Discipline" is hereby amended by adding thereto the following section:
{ADD 5-37-9.2. Physicians -- Public access to data. -- ADD} {ADD The board shall collect the following information to create individual profiles on licensed physicians, in a format created by the board, that shall be available for dissemination to the public.
(a) a description of any criminal convictions for felonies and serious misdemeanors as determined by the board, within the most recent ten (10) years. For the purposes of this subsection, a person shall be deemed to be convicted of a crime if he pleaded guilty or if he was found or adjudged guilty by a court of competent jurisdiction;
(b) a description of any charges to which a physician pleads nolo contendere or where sufficient facts of guilt were found and the matter was continued without a finding by a court of competent jurisdiction;
(c) a description of any final board disciplinary actions within the most recent ten (10) years;
(d) a description of any final disciplinary actions by licensing boards in other states within the most recent ten (10) years;
(e) a description of revocation or involuntary restriction of hospital privileges for reasons related to competence or character that have been taken by the hospital's governing body or any other official of the hospital after procedural due process has been afforded, or the resignation from or nonrenewal of medical staff membership or the restriction of privileges at a hospital taken in lieu of or in settlement of a pending disciplinary case related to competence or character in that hospital. Only cases which have occurred within the most recent ten (10) years shall be disclosed by the board to the public;
(f) all medical malpractice court judgments and all medical malpractice arbitration awards in which a payment is awarded to a complaining party during the most recent ten (10) years and all settlements of medical malpractice claims in which a payment is made to a complaining party within the most recent ten (10) years. Dispositions of paid claims shall be reported in a minimum of three (3) graduated categories indicating the level of significance of the award or settlement. Information concerning paid medical malpractice claims shall be put in context by comparing an individual physician's medical malpractice judgment awards and settlements to the experience of other physicians within the same specialty. Information concerning all settlements shall be accompanied by the following statement: "Settlement of a claim may occur for a variety of reasons which do not necessarily reflect negatively on the professional competence or conduct of the physician. A payment in settlement of a medical malpractice action or claim should not be construed as creating a presumption that medical malpractice has occurred." Nothing herein shall be construed to limit or prevent the board from providing further explanatory information regarding the significance of categories in which settlements are reported.
Pending malpractice claims shall not be disclosed by the board to the public. Nothing herein shall be construed to prevent the board from investigating and disciplining a licensee on the basis of medical malpractice claims that are pending.
(g) names of medical schools and dates of graduation;
(h) graduate medical education;
(i) specialty board certification;
(j) number of years in practice;
(k) names of the hospitals where the physician has privileges;
(l) appointments to medical school faculties and indication as to whether a physician has a responsibility for graduate medical education within the most recent ten (10) years;
(m) information regarding publications in peer-reviewed medical literature within the most recent ten (10) years;
(n) information regarding professional or community service activities and awards;
(o) the location of the physician's primary practice setting;
(p) the identification of any translating services that may be available at the physician's primary practice location;
(q) an indication of whether the physician participates in the Medicaid program.
The board shall provide individual physicians with a copy of their profiles prior to release to the public. A physician shall be provided a reasonable time to correct factual inaccuracies that appear in such profile.
A physician may elect to have his profile omit certain information provided pursuant to clauses (l) to (n), inclusive, concerning academic appointments and teaching responsibilities, publication in peer-reviewed journals and professional and community service awards. In collecting information for such profiles and in disseminating the same, the board shall inform physicians that they may choose not to provide such information required pursuant to said clauses (l) to (n), inclusive. ADD}
SECTION 3. Chapter 23-1 of the General Laws entitled "Department of Health" is hereby amended by adding thereto the following section:
{ADD 23-1-1.4. Health care provider reports. -- ADD} {ADD When collecting information or compiling reports intended to compare individual health care providers, the department of health shall require that:
(a) provider organizations which are representative of the target group for profiling shall be meaningfully involved in the development of all aspects of the profile methodology, including collection methods, formatting and methods and means for release and dissemination;
(b) the entire methodology for collecting and analyzing the data shall be disclosed to all relevant provider organizations and to all providers under review;
(c) data collection and analytical methodologies shall be used that meet accepted standards of validity and reliability;
(d) the limitations of the data sources and analytic methodologies used to develop provider profiles shall be clearly identified and acknowledged, including, but not limited to, the appropriate and inappropriate uses of the data;
(e) to the greatest extent possible, provider profiling initiatives shall use standard-based norms derived from widely accepted, provider-developed practice guidelines;
(f) provider profiles and other information that have been compiled regarding provider performance shall be shared with providers under review prior to dissemination; provided, however, that opportunity for corrections and additions of helpful explanatory comments shall be provided prior to publication; and, provided, further, that such profiles shall only include data which reflect care under the control of the provider for whom such profile is prepared;
(g) comparisons among provider profiles shall adjust for patient case-mix and other relevant risk factors and control for provider peer groups, when appropriate;
(h) effective safeguards to protect against the unauthorized use or disclosure of provider profiles shall be developed and implemented;
(i) effective safeguards to protect against the dissemination of inconsistent, incomplete, invalid, inaccurate or subjective profile data shall be developed and implemented;
(j) the quality and accuracy of provider profiles, data sources and methodologies shall be evaluated regularly;
(k) providers shall be reimbursed for the reasonable costs that are required for assembling, formatting and transmitting data and information to organizations that develop or disseminate provider profiles; and
(l) the benefits of provider profiling shall outweigh the costs of developing and disseminating the profiles. ADD}
SECTION 4. {ADD The department of health care shall conduct a study of reports which provide comparative performance and other information concerning health plans, hospitals, physicians and other providers and shall provide any recommendations it may have for legislation to facilitate the production of such reports and the reasons therefor to the joint committee on health care of the general assembly on or before March first, nineteen hundred and ninety-seven.
In evaluating such reports and the methodologies used in producing such reports and in developing its recommendations, said department shall consider the following issues:
(a) the appropriate role of the state in developing such reports, and whether purchasers and providers can reasonably be anticipated to continue to develop such reports in response to market forces;
(b) the necessity or advisability of state mandates concerning the collection and evaluation of information for such reports;
(c) the means and methods for defining and protecting the reliability and validity of data and information including, but not limited to, variations in the relative severity presented by individual patients;
(d) the extent to which existing data sources and indicators are valid; and
(e) the costs of establishing and maintaining systems producing such reports and possible sources of revenue to defray the same. ADD}
SECTION 5. {ADD The board, in implementing the provisions of section 5-37-9.2, shall not disseminate a physician profile by electronic media, including the World Wide Web of the Internet, so-called, or on CD-Rom, so-called before May first, nineteen hundred and ninety-seven. The board shall conduct a study of the impact of publication of physician profiles by electronic media on the personal safety of physicians and their families, and shall report its findings to the joint committee on health care on or before January first, nineteen hundred and ninety-seven. The board shall include in such report a sample profile designed with safeguards recommended by the board pursuant to the aforementioned study. Not later than March first, nineteen hundred and ninety-seven and after public hearing, the board shall promulgate regulations to eliminate, to the extent practicable, the possibility that certain information contained in such profiles may jeopardize that personal safety of physicians and their families. ADD}
SECTION 6. This act shall take effect upon passage.
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This act would make available to the public certain information regarding physicians' misconduct.
This act would take effect upon passage.
