BillCam

HOUSE BILL No. 5615

February 20, 2018, Introduced by Reps. Hammoud, Lucido, Rabhi, Wittenberg, Santana, Robinson, Runestad, Geiss, Pagan, Liberati, Garrett, Elder and Lasinski and referred to the Committee on Health Policy.

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 20104, 20902, and 20919 (MCL 333.20104,

333.20902, and 333.20919), section 20104 as amended by 2015 PA 155,

section 20902 as amended by 2000 PA 375, and section 20919 as

amended by 2017 PA 154.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 20104. (1) "Certification" means the issuance of a

document by the department to a health facility or agency attesting

to the fact that the health facility or agency meets both of the

following:

(a) It complies with applicable statutory and regulatory

requirements and standards.

(b) It is eligible to participate as a provider of care and

services in a specific federal or state health program.

(2) "Consumer" means a person who is not a health care

provider as defined in section 300jj of title 15 of the public

health service act, 42 USC 300jj.

(3) "County medical care facility" means a nursing care

facility, other than a hospital long-term care unit, that provides

organized nursing care and medical treatment to 7 or more unrelated

individuals who are suffering or recovering from illness, injury,

or infirmity and that is owned by a county or counties.

(4) "Department" Except as otherwise provided in this article,

"department" means the department of licensing and regulatory

affairs.

(5) "Direct access" means access to a patient or resident or

to a patient's or resident's property, financial information,

medical records, treatment information, or any other identifying

information.

(6) "Director" Except as otherwise provided in this article,

"director" means the director of the department.

(7) "Freestanding surgical outpatient facility" means a

facility, other than the office of a physician, dentist,

podiatrist, or other private practice office, offering a surgical

procedure and related care that in the opinion of the attending

physician can be safely performed without requiring overnight

inpatient hospital care. Freestanding surgical outpatient facility

does not include a surgical outpatient facility owned by and

operated as part of a hospital.

(8) "Good moral character" means that term as defined in

section 1 of 1974 PA 381, MCL 338.41.

Sec. 20902. (1) "Advanced life support" means patient care

that may include any care a paramedic is qualified to provide by

paramedic education that meets the educational requirements

established by the department under section 20912 or is authorized

to provide by the protocols established by the local medical

control authority under section 20919 for a paramedic.

(2) "Aircraft transport operation" means a person licensed

under this part to provide patient transport, for profit or

otherwise, between health facilities using an aircraft transport

vehicle.

(3) "Aircraft transport vehicle" means an aircraft that is

primarily used or designated as available to provide patient

transportation between health facilities and that is capable of

providing patient care according to orders issued by the patient's

physician.

(4) "Ambulance" means a motor vehicle or rotary aircraft that

is primarily used or designated as available to provide

transportation and basic life support, limited advanced life

support, or advanced life support.

(5) "Ambulance operation" means a person licensed under this

part to provide emergency medical services and patient transport,

for profit or otherwise.

(6) "Basic life support" means patient care that may include

any care an emergency medical technician is qualified to provide by

emergency medical technician education that meets the educational

requirements established by the department under section 20912 or

is authorized to provide by the protocols established by the local

medical control authority under section 20919 for an emergency

medical technician.

(7) "Clinical preceptor" means an individual who is designated

by or under contract with an education program sponsor for purposes

of overseeing the students of an education program sponsor during

the participation of the students in clinical training.

(8) "Department" means the department of health and human

services.

(9) "Director" means the director of the department.

(10) (8) "Disaster" means an occurrence of imminent threat of

widespread or severe damage, injury, or loss of life or property

resulting from a natural or man-made cause, including but not

limited to, fire, flood, snow, ice, windstorm, wave action, oil

spill, water contamination requiring emergency action to avert

danger or damage, utility failure, hazardous peacetime radiological

incident, major transportation accident, hazardous materials

accident, epidemic, air contamination, drought, infestation, or

explosion. Disaster does not include a riot or other civil disorder

unless it directly results from and is an aggravating element of

the disaster.

Sec. 20919. (1) A medical control authority shall establish

written protocols for the practice of life support agencies and

licensed emergency medical services personnel within its region.

The medical control authority shall develop and adopt the protocols

required under this section in accordance with procedures

established by the department and shall include all of the

following:

(a) The acts, tasks, or functions that may be performed by

each type of emergency medical services personnel licensed under

this part.

(b) Medical protocols to ensure the appropriate dispatching of

a life support agency based upon medical need and the capability of

the emergency medical services system.

resuscitate procedure act, 1996 PA 193, MCL 333.1051 to 333.1067.

(d) Protocols defining the process, actions, and sanctions a

medical control authority may use in holding a life support agency

or emergency medical services personnel accountable.

(e) Protocols to ensure that if the medical control authority

determines that an immediate threat to the public health, safety,

or welfare exists, appropriate action to remove medical control can

immediately be taken until the medical control authority has had

the opportunity to review the matter at a medical control authority

hearing. The protocols must require that the hearing is held within

3 business days after the medical control authority's

determination.

(f) Protocols to ensure that if medical control has been

removed from a participant in an emergency medical services system,

the participant does not provide prehospital care until medical

control is reinstated and that the medical control authority that

removed the medical control notifies the department of the removal

within 1 business day.

(g) Protocols to ensure that a quality improvement program is

in place within a medical control authority and provides data

protection as provided in 1967 PA 270, MCL 331.531 to 331.534.

(h) Protocols to ensure that an appropriate appeals process is

in place.

(i) Protocols to ensure that each life support agency that

provides basic life support, limited advanced life support, or

advanced life support is equipped with epinephrine or epinephrine

auto-injectors and that each emergency medical services personnel

authorized to provide those services is properly trained to

recognize an anaphylactic reaction, to administer the epinephrine,

and to dispose of the epinephrine auto-injector or vial.

(j) Protocols to ensure that each life support vehicle that is

dispatched and responding to provide medical first response life

support, basic life support, or limited advanced life support is

equipped with an automated external defibrillator and that each

emergency medical services personnel is properly trained to utilize

the automated external defibrillator.

(k) Except as otherwise provided in this subdivision, before

October 15, 2015, protocols Protocols to ensure that each life

support vehicle that is dispatched and responding to provide

medical first response life support, basic life support, or limited

advanced life support is equipped with opioid antagonists and that

each emergency medical services personnel is properly trained to

administer opioid antagonists. Beginning October 14, 2017, a

medical control authority, at its discretion, may rescind or

continue the protocol adopted under this subdivision.

(l) Protocols for complying with part 56B.

(2) A medical control authority shall not establish a protocol

under this section that conflicts with the Michigan do-not-

resuscitate procedure act, 1996 PA 193, MCL 333.1051 to 333.1067,

or part 56B.

(3) The department shall establish procedures for the

development and adoption of written protocols under this section.

The procedures must include at least all of the following

requirements:

(a) At least 60 days before adoption of a protocol, the

medical control authority shall circulate a written draft of the

proposed protocol to all significantly affected persons within the

emergency medical services system served by the medical control

authority and submit the written draft to the department for

approval.

(b) The department shall review a proposed protocol for

consistency with other protocols concerning similar subject matter

that have already been established in this state and shall consider

any written comments received from interested persons in its

review.

proposed protocol from a medical control authority, the department

shall provide a written recommendation to the medical control

authority with any comments or suggested changes on the proposed

protocol. If the department does not respond within 60 days after

receiving the written draft, the proposed protocol is considered to

be approved by the department.

(d) After department approval of a proposed protocol, the

medical control authority may formally adopt and implement the

protocol.

(e) A medical control authority may establish an emergency

protocol necessary to preserve the health or safety of individuals

within its region in response to a present medical emergency or

disaster without following the procedures established by the

department under this subsection for an ordinary protocol. An

emergency protocol established under this subdivision is effective

only for a limited period and does not take permanent effect unless

it is approved according to the procedures established by the

department under this subsection.

(4) A medical control authority shall provide an opportunity

for an affected participant in an emergency medical services system

to appeal a decision of the medical control authority. Following

appeal, the medical control authority may affirm, suspend, or

revoke its original decision. After appeals to the medical control

authority have been exhausted, the affected participant in an

emergency medical services system may appeal the medical control

authority's decision to the state emergency medical services

coordination committee created in section 20915. The state

emergency medical services coordination committee shall issue an

opinion on whether the actions or decisions of the medical control

authority are in accordance with the department-approved protocols

of the medical control authority and state law. If the state

emergency medical services coordination committee determines in its

opinion that the actions or decisions of the medical control

authority are not in accordance with the medical control

authority's department-approved protocols or with state law, the

state emergency medical services coordination committee shall

recommend that the department take any enforcement action

authorized under this code.

(5) If adopted in protocols approved by the department, a

medical control authority may require life support agencies within

its region to meet reasonable additional standards for equipment

and personnel, other than medical first responders, that may be

more stringent than are otherwise required under this part. If a

medical control authority proposes a protocol that establishes

additional standards for equipment and personnel, the medical

control authority and the department shall consider the medical and

economic impact on the local community, the need for communities to

do long-term planning, and the availability of personnel. If either

the medical control authority or the department determines that

negative medical or economic impacts outweigh the benefits of those

additional standards as they affect public health, safety, and

welfare, the medical control authority shall not adopt and the

department shall not approve protocols containing those additional

standards.

(6) If adopted in protocols approved by the department, a

medical control authority may require medical first response

services and licensed medical first responders within its region to

meet additional standards for equipment and personnel to ensure

that each medical first response service is equipped with an

epinephrine auto-injector, and that each licensed medical first

responder is properly trained to recognize an anaphylactic reaction

and to administer and dispose of the epinephrine auto-injector, if

a life support agency that provides basic life support, limited

advanced life support, or advanced life support is not readily

available in that location.

(7) If a decision of the medical control authority under

subsection (5) or (6) is appealed by an affected person, the

medical control authority shall make available, in writing, the

medical and economic information it considered in making its

decision. On appeal, the state emergency medical services

coordination committee created in section 20915 shall review this

information under subsection (4) and shall issue its findings in

writing.

Enacting section 1. This amendatory act takes effect 90 days

after the date it is enacted into law.