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.
(c) Protocols for complying with the Michigan do-not-
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.
(c) Within 60 days after receiving a written draft of a
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.