Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-6618

Title:

AN ACT CONCERNING VARIOUS REVISIONS TO PUBLIC HEALTH RELATED STATUTES.

Vote Date:

4/1/2011

Vote Action:

Joint Favorable Substitute

PH Date:

3/23/2011

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

To make various revisions to public health statutes:

Section 1: Amends the disciplinary statutes for health practitioners.

Sections 2, 29, and 31: Technical changes.

Sections 3 through 5: Amends the health professional assistance program statutes to include nursing home administrators in the list of professions that may participate in a confidential program of rehabilitation, establish mandatory reporting requirements for health professionals who are or may be unable to practice with reasonable skill and safety.

Section 6: Allows the Department to enter into negotiated agreements to restrict, suspend or otherwise limit a license or permit during or pending an investigation without having to wait for board/commission approval.

Sections 7 and 8: Updates the statute related to the Report of Foundling.

Sections 9 and 10: Requires towns to report to the Department of Public Health, a newly elected or appointed vital records registrar, as well as names of persons who have been appointed as assistant registrars.

Section 11: Revises the statute regarding access to birth certificates.

Sections 12 and 13: Allows health care practitioners to prescribe or dispense antibiotics without physical examination of the partners of patients with sexually transmitted diseases under Expedited Partner Therapy (EPT).

Section 14: Clarifies the authority of, and updates program and evaluation requirements of syringe exchange programs in Connecticut.

Section 15: Authorizes the Department of Public Health, in consultation with the Board of Chiropractic Examiners, to periodically designate certain topics that must be included in mandatory continuing education coursework.

Section 16: Authorizes the Commissioner of Public Health to grant waivers under the provisions of Section 10-204a (a)

Section 17: Clarifies that child day care services provided by relatives, regardless of the formality, is exempt from licensure. It also clarifies that care provided on a drop-in basis in retail establishments is applicable provided the parents remain not only on the premises but in the same store as the child.

RESPONSE FROM ADMINISTRATION/AGENCY:

Patricia Rehmer, Commissioner, Department of Mental Health and Addiction Services: Section 30 of the bill would allow the Department of Public Health (DPH) to have policies and procedures in place to permit individuals with opiate dependence to receive treatment in a variety of licensed substance abuse treatment facilities. This bill also proposes the availability of the medication Suboxone, by prescription in outpatient substance abuse clinic.

According to DPH regulations, outpatient substance abuse clinics are currently prohibited from prescribing Suboxone as they are typically not licensed to do so. DPH is in the process of revising regulations however, it could take many months to be finalized. The availability of Suboxone through outpatient substance abuse clinics would greatly expand access to this effective and researched medication and would provide another treatment option for individuals suffering from opiate dependency.

Wendy Furniss and Ellen Blaschinski, Department of Public Health (DPH): The bill includes changes to practitioner disciplinary statutes, day care and youth camp licensing, and electronic laboratory reporting by laboratories.

DPH supports the changes made in section 27 to correct omissions in the original statutory language, however, no deadline was given for filing a Certificate of Need application and podiatrists were inadvertently excluded from the outpatient surgical facility exception to the CON requirement for transfer or change of ownership or control by specified licensed physicians. Suggested language includes technical changes for filing a Certificate of Need application and adding a new section to make a technical change to subsection (c) of section 19a-493(b) as the current language inexplicably excludes podiatrists, who are licensed under Chapter 375 rather than section 20-13. DPH believes that this was an oversight and that there was no intent to exclude podiatrists from the benefit of this section.

DPH also respectfully requests that the Committee include additional provisions within this bill concerning licensed practical nurses and the disciplinary statutes for several health professions, as follows:

Clarify that under the direction of a registered nurse, a licensed practical nurse may carry out the orders of a physician assistant, podiatrist or optometrist. Similar language was passed during the 2010 session of the General Assembly for registered nurses and should have been extended to licensed practical nurses.

Add a new section to include technical changes to Subsection (b) of section 19a-178a which was revised in Public Act 10-118.

DPH attached additional requests for language changes.

NATURE AND SOURCES OF SUPPORT:

Abby Beale, Homeopathy for Connecticut: We propose language to allow nationally certified homeopaths the ability to practice in Connecticut. Connecticut is one of three states that require a license to practice homeopathy. Trained and nationally certified professional homeopaths cannot practice in Connecticut and this has limited the availability of their services in the state.

We respectfully request the following language be included in the bill:

● “Certified Homeopath” means an individual who has successfully passed the requirements and examination provided by the National Council for Homeopathic Certification.

● A certified Homeopath may prescribe homeopathic remedies, selected from the law of similars, excluding a legend drug or controlled substance.

● The Commissioner of Public Health shall obtain from the National Council for Homeopathic Certification, a listing of all state residents maintained on said organization's registry of certified homeopaths. The Commissioner shall make such listing available for public inspection

The Connecticut Hospital Association: Section 2 discusses the patient care team parameters for patients on oxygen, as set forth in general statutes Section 19a-903b, and includes a technical correction to the title of nuclear medical “technologist” (instead of “technician”). However, an additional revision to the patient care team parameters in 19a-903b would better align the law with current practice in hospitals. Specifically, with respect to the transport of patients on portable oxygen, the law should be revised to expressly permit a person who is authorized by a hospital to transport a patient with a portable oxygen source, as follows:

Sec. 2. Section 19a-903b of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2011):

A hospital, as defined in section 19a-490b, may designate any licensed health care provider and any certified ultrasound or nuclear medicine [technician] technologist to perform the following oxygen-related patient care activities in a hospital: (1) Connecting or disconnecting oxygen supply; (2) [transporting a portable oxygen source; (3)] connecting, disconnecting or adjusting the mask, tubes and other patient oxygen delivery apparatus; and [(4)] (3) adjusting the rate or flow of oxygen consistent with a medical order. Any person authorized by a hospital may transport a patient with a portable oxygen source. Such provider or technician may perform such activities only to the extent permitted by hospital policies and procedures, including bylaws, rules and regulations applicable to the medical staff. A hospital shall document that each person designated to perform oxygen-related patient care activities has been properly trained, either through such person's professional education or through training provided by the hospital. In addition, a hospital shall require that such person satisfy annual competency testing. The provisions of this section shall not apply to any type of ventilator, continuous positive airway pressure or bi-level positive airway pressure units or any other noninvasive positive pressure ventilation.

Section 5 attempts to mandate that every licensed health care provider report, under oath, concerns about the capability of all other health care providers to the DPH. This section should be deleted in its entirety because it would substantially interfere with numerous other existing rights, including due process and peer review, and also because the language is too broad. If the Section is not deleted, we propose the following language:

Sec. 5. (NEW) (Effective October 1, 2011) A health care professional with information which appears to show that another health care professional is or may be unable to practice with reasonable skill and safety due to (1) physical illness or loss of motor skills, including, but not limited to, deterioration through the aging process, (2) emotional disorder or mental illness, or (3) chemical dependency may shall, not later than thirty days after obtaining such information, file a petition with the Department of Public Health. Such petition shall be filed on forms supplied by the department, shall be signed and sworn to, and shall set forth in detail the matters complained of. Nothing herein shall affect the protections set forth in section 19a-17b of the general statutes, or any other statutory or common law that provides protection for reports to a public agency.

Jean Rexford, CT Center for Patient Safety: Section 1 proposes to allow the (DPH) and any health care licensing boards to examine a health care practitioner's negative disciplinary/malpractice conduct in other jurisdictions and then use this negative conduct as a basis for imposing disciplinary sanctions against the practitioner here in Connecticut. This is a very good proposal.

In addition, please bring together members of the Medical Examining boards, the Department of Public Health, and most importantly knowledgeable consumers to sit down and attempt to solve problems with the allotted resources.

Dr. Martin Pressman, Podiatrist: Podiatrists are licensed under Title 20 of the Connecticut General Statutes, but podiatrists are licensed pursuant to Chapter 375. This drafting error works a real hardship for Milford Podiatry, in that unlike physicians licensed under Section 20-13, we are unable to allow for transfers of ownership interests in our outpatient surgical facility without a CON approval, despite the fact that our facility is licensed under the exact same provisions of the Public Health Code as other physician-owned facilities. This impacts our ability to structure succession planning for the practice and personal financial affairs.

The amendment to the statutes to correct this error is simple: Subsection (c) of CT General Statutes Section 19a-493b will simply be revised so that the references to “persons licensed pursuant to section 20-13” would instead read “persons licensed pursuant to section 20-13 or chapter 375” in each instance.

Planned Parenthood of Southern New England Inc.: Section 12 of the proposed bill would allow expedited partner therapy in the case of a patient being treated for Chlamydia or gonorrhea. It is critical in the prevention of the spread of sexually transmitted disease that each patient who receives treatment also convinces his or her sex partner to do likewise, in order to avoid re-infection. According to the CDC this is a central component of prevention and control of bacterial sexually transmitted diseases, and a hallmark of sound public health practice.

Dr. Lester Silberman , Planned Parenthood of Southern New England: Section 12 provides for the prescription and dispensing of oral antibiotics to partners of patients diagnosed with Chlamydia and/or gonorrhea. Even though antibiotics are very effective for the treatment of these two infections, recurrence still occurs and is far more likely to be caused by re-infection from an untreated partner than a result of failure to complete a course of medication or failure of the antibiotic treatment itself.

Mag Morelli, CANPFA President: CANPFA proposes revisions and updates to the Public Health Code as it relates to residential care homes. These revisions are a means of potential cost savings for the residential care homes without the risk of compromising resident care:

● Allow the sharing of dining and recreation areas when a residential care home is part of a continuum.

● Reduce the minimum temperature from 75 degrees F to 71 degrees F.

● Remove the unnecessary personal mental and physical recertification by a physician of the residential care home licensee.

● Replace the unnecessary paperwork approval of meal and snack schedules with a standard maximum time span between meals similar to the provisions adopted last session for the skilled nursing facilities.

● Permit a residential care home that is part of a continuum to request permission to share attendant personnel during the evening hours.

● The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to amend section 19-13-D6 of the CT Public Health Code to conform with the provisions of this Act.

Connecticut Medical Society: There is support for the provision of Section 1 (a) (8) (B) allowing professional boards to rely on finding and conclusions from other states and districts. Section 5 would expand mandatory reporting by health care professionals of other healthcare professionals suffering from substance abuse or mental health impairment. While support for the concept of the language is strong, the identification and treatment of such disorders is a difficult situation. Language should be added to provide immunity for concerned professionals staking their reputations on making such reports.

Section 12 (e) codifies what is known as “extended partner therapy” in the treatment of sexually transmitted diseases (STD's). It allows for the prescribing of antibiotics without physical examination to the partners of patients with STD's. It is important to note that physicians take seriously the potential liability for improperly treating patients and would be more cautious of prescribing medications for patients for whom they have not completed a physical examination.

Health Assistance Intervention Education Network (HAVEN) We support the concepts raised in sections 3, 4, and 5, however there are concerns over language as written and have been discussed with the DPH and it is understood that DPH has submitted revised language.

Regarding Section 5, the initial language of HB 6618 failed to recognize Section 5 of the bill and mistakenly attributed the mandated reporting requirement set forth in Connecticut General Statutes Section 20-13d to all professionals, while using language limited to physicians. The revised language more accurately reflects (1) mandated reporting applies to all health care professionals, (2) a referral to HAVEN satisfies the requirement to file a petition with the Department, affording health care professionals confidential non-disciplinary access to treatment and monitoring, and (3) properly sets forth the applicable statutes.

NATURE AND SOURCES OF OPPOSITION:

None

Reported by: Danielle Dueno

Date: 04/06/11