HOUSE BILL REPORT
HB 1291
As Reported by House Committee On:
Health Care
Appropriations
Title: An act relating to improving health care professional and health care facility patient safety practices.
Brief Description: Improving patient safety practices.
Sponsors: Representatives Cody, Bailey, Morrell, Hinkle, Green, Moeller, Kessler, Haigh, Linville, Kagi, Santos and Ormsby.
Brief History:
Health Care: 2/4/05, 2/11/05 [DPS];
Appropriations: 2/23/05, 3/2/05 [DP2S(w/o sub HC)].
Brief Summary of Second Substitute Bill |
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HOUSE COMMITTEE ON HEALTH CARE
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 9 members: Representatives Cody, Chair; Morrell, Vice Chair; Bailey, Ranking Minority Member; Appleton, Clibborn, Green, Lantz, Moeller and Schual-Berke.
Minority Report: Do not pass. Signed by 5 members: Representatives Curtis, Assistant Ranking Minority Member; Alexander, Condotta, Hinkle and Skinner.
Staff: Chris Blake (786-7392).
Background:
Quality Improvement and Patient Safety Measures
In 1999, the Institute of Medicine reported that between 44,000 and 98,000 people die in the
United States every year due to medical errors. At the federal level, the Agency for
Healthcare Research and Quality (AHRQ) funds research to reduce medical errors and
increase patient safety. In 2001, AHRQ provided almost $50 million in funding for 94 grants
related to health care work conditions, the use of information technology, medical errors data
reporting, and other patient safety projects.
In Washington, hospitals maintain quality improvement committees to improve the quality of
health care services and prevent medical malpractice. Quality improvement proceedings
review medical staff privileges and employee competency, collect information related to
negative health care outcomes, and conduct safety improvement activities. Provider groups
and medical facilities other than hospitals are encouraged to conduct similar activities.
Offers of Settlement
Under both a statute and a court rule, evidence of furnishing or offering to pay medical
expenses needed as the result of an injury is not admissible in a civil action to prove liability
for the injury. In addition, a court rule provides that evidence of offers of compromise are
not admissible to prove liability for a claim. Evidence of conduct or statements made in
compromise negotiations are likewise not admissible.
In 2002, the Legislature passed legislation that makes expressions of sympathy relating to the
pain, suffering, or death of an injured person inadmissible in a civil trial. A statement of
fault, however, is not made inadmissible under this provision.
Summary of Substitute Bill:
Patient Safety Account
The "Patient Safety Account" (Account) is created. The Account is to be funded in two ways.
First, the Secretary of Health must collect a $2 surcharge on licenses for 16 health professions
and $2 per licensed bed are charged to acute care hospitals and psychiatric hospitals. Second,
1 percent of the fees collected by attorneys in medical malpractice cases where the plaintiff
received money in a settlement or judgment must be provided to the Department of Health
(Department) for transfer into the Account.
The Account is an appropriated account that is to be used for grants, loans, and other
arrangements that support efforts to reduce medical errors and enhance patient safety. The
Department must establish criteria for the types of programs to receive funds. The criteria
must emphasize evidence-based practices recommended by governmental and private
organizations including the Agency for Healthcare Research and Quality, the Institute of
Medicine, the Joint Commission on Accreditation of Health Care Organizations, and the
National Quality Forum. At least two of the projects must implement recommendations of
the Institute of Medicine's report Keeping Patients Safe: Transforming the Work Environment
of Nurses. Funding priority is given to projects that are proven to enhance patient safety and
reduce medical errors as opposed to those that only have a substantial likelihood of doing so.
By December 1, 2008, the Department must report to the Legislature about the funds raised,
criteria developed, and projects funded.
Statements of Apology
Limitations on the admissibility of evidence in civil proceedings of offers to pay medical
expenses to prove liability for an injury in professional negligence cases are expanded to
protect (1) statements or conduct expressing apology, fault, or sympathy or (2) statements
regarding remedial actions that may be taken to address the act. This evidence is not
admissible in a civil proceeding for any purposes.
Coordinated Quality Improvement Programs
The types of programs that may apply to the Department of Health to become coordinated
quality improvement programs are expanded to include consortiums of health care providers
that consist of at least five health care providers.
Prescription Legibility
Prescriptions for legend drugs must either be hand-printed, typewritten, or generated
electronically.
Substitute Bill Compared to Original Bill:
The substitute bill expands the collection of 1 percent of the fees of a plaintiff's attorney in a
medical malpractice case to include 1 percent of the fees of a defense attorney.
The use of evidence of offers to pay medical expenses, statements of apologies, and
statements regarding remedial actions is prohibited for any purposes, not just to prove
liability for injuries.
Consortiums of health care providers that consist of at least five health care providers may
qualify to become coordinated quality improvement programs.
Prescriptions for legend drugs must be hand-printed, typewritten, or generated electronically.
Appropriation: None.
Fiscal Note: Available.
Effective Date of Substitute Bill: The bill takes effect 90 days after adjournment of session in which bill is passed, except for section 103, regarding a surcharge on healthcare provider and facility licenses, which takes effect July 1, 2005.
Testimony For: This bill establishes sound policy for improving health care for patients.
(With concerns) The funding burden should be borne by both plaintiffs' and defendants'
attorneys.
Testimony Against: None.
Persons Testifying: (In support) Anne Tan Piazza, Washington State Nurses Association;
and Karen Merrikin, Group Health Cooperative.
(In support with concerns) Pat Greenstreet, Washington State Trial Lawyers Association.
(With concerns) Mark Johnson, Washington State Bar Association.
HOUSE COMMITTEE ON APPROPRIATIONS
Majority Report: The second substitute bill be substituted therefor and the second substitute bill do pass and do not pass the substitute bill by Committee on Health Care. Signed by 17 members: Representatives Sommers, Chair; Fromhold, Vice Chair; Cody, Conway, Darneille, Dunshee, Grant, Haigh, Hunter, Kagi, Kenney, Kessler, Linville, McDermott, McIntire, Miloscia and Schual-Berke.
Minority Report: Do not pass. Signed by 11 members: Representatives Alexander, Ranking Minority Member; Anderson, Assistant Ranking Minority Member; McDonald, Assistant Ranking Minority Member; Bailey, Buri, Clements, Hinkle, Pearson, Priest, Talcott and Walsh.
Staff: Amy Hanson (786-7118).
Summary of Recommendation of Committee On Appropriations Compared to
Recommendation of Committee On Health Care:
Nursing home administrators are not included as a health care provider subject to the $2
surcharge on licenses.
Appropriation: None.
Fiscal Note: Available.
Effective Date of Second Substitute Bill: The bill takes effect 90 days after adjournment of session in which bill is passed, except for section 103, regarding a surcharge on healthcare provider and facility licenses, which takes effect July 1, 2005.
Testimony For: Nursing home administrators do not provide care or engage in the practice of medicine and therefore should not be subject to the additional fee. We support the funding mechanism, but it is disproportionately borne by what is in essence a Business and Occupation tax on successful plaintiff lawyers who have brought the most meritorious of cases to a resolution and that is going to be two-thirds of the funding source for this mechanism. We have concerns about the expansiveness of the apology section. Early admissions and apologies have become a proven and true mechanisms to cut down on the incidence and costs of malpractice litigation. It is the scope of this that we would like to continue to work to change.
Testimony Against: None.
Persons Testifying: Deb Murphy, Washington Association of Housing and Services for the Aging; and Larry Shannon, Washington State Trial Lawyers Association.