Bill Amendment: FL S0876 | 2017 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Health Care Practitioners
Status: 2017-05-02 - Laid on Table, companion bill(s) passed, see CS/CS/HB 229 (Ch. 2017-41) [S0876 Detail]
Download: Florida-2017-S0876-Senate_Committee_Substitue_Amendment_318540_Amendment_420676_.html
Bill Title: Health Care Practitioners
Status: 2017-05-02 - Laid on Table, companion bill(s) passed, see CS/CS/HB 229 (Ch. 2017-41) [S0876 Detail]
Download: Florida-2017-S0876-Senate_Committee_Substitue_Amendment_318540_Amendment_420676_.html
Florida Senate - 2017 COMMITTEE AMENDMENT Bill No. SB 876 Ì318540ÅÎ318540 LEGISLATIVE ACTION Senate . House Comm: RCS . 03/14/2017 . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Health Policy (Young) recommended the following: 1 Senate Substitute for Amendment (420676) (with title 2 amendment) 3 4 Delete lines 88 - 492 5 and insert: 6 (e) “Impairment” means a potentially impairing health 7 condition that is the result of the misuse or abuse of alcohol, 8 drugs, or both, or a mental or physical condition that could 9 affect a practitioner’s ability to practice with skill and 10 safety. 11 (f) “Inability to progress” means a determination by a 12 consultant based on a participant’s response to treatment and 13 prognosis that the participant is unable to safely practice 14 despite compliance with treatment requirements and his or her 15 participant contract. 16 (g) “Material noncompliance” means an act or omission by a 17 participant in violation of his or her participant contract as 18 determined by the department or consultant. 19 (h) “Participant” means a practitioner who is participating 20 in the impaired practitioner program by having entered into a 21 participant contract. A practitioner ceases to be a participant 22 when the participant contract is successfully completed or is 23 terminated for any reason. 24 (i) “Participant contract” means a formal written document 25 outlining the requirements established by a consultant for a 26 participant to successfully complete the impaired practitioner 27 program, including the participant’s monitoring plan. 28 (j) “Practitioner” means a person licensed, registered, 29 certified, or regulated by the department under part III of 30 chapter 401; chapter 457; chapter 458; chapter 459; chapter 460; 31 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465; 32 chapter 466; chapter 467; part I, part II, part III, part V, 33 part X, part XIII, or part XIV of chapter 468; chapter 478; 34 chapter 480; part III or part IV of chapter 483; chapter 484; 35 chapter 486; chapter 490; or chapter 491; or an applicant for a 36 license, registration, or certification under the same laws. 37 (k) “Referral” means a practitioner who has been referred, 38 either as a self-referral or otherwise, or reported to a 39 consultant for impaired practitioner program services, but who 40 is not under a participant contract. 41 (l) “Treatment program” means a department- or consultant 42 approved residential, intensive outpatient, partial 43 hospitalization or other program through which an impaired 44 practitioner is treated based on the impaired practitioner’s 45 diagnosis and the treatment plan approved by the consultant. 46 (m) “Treatment provider” means a department- or consultant 47 approved state-licensed or nationally certified individual who 48 provides treatment to an impaired practitioner based on the 49 practitioner’s individual diagnosis and a treatment plan 50 approved by the consultantFor professions that do not have51impaired practitioner programs provided for in their practice52acts, the department shall, by rule, designate approved impaired53practitioner programs under this section. The department may54adopt rules setting forth appropriate criteria for approval of55treatment providers. The rules may specify the manner in which56the consultant, retained as set forth in subsection (2), works57with the department in intervention, requirements for evaluating58and treating a professional, requirements for continued care of59impaired professionals by approved treatment providers,60continued monitoring by the consultant of the care provided by61approved treatment providers regarding the professionals under62their care, and requirements related to the consultant’s63expulsion of professionals from the program. 64 (2)(a)The department mayshallretain one or moreimpaired65practitionerconsultants to operate its impaired practitioner 66 program. Each consultantwho are each licensees under the67jurisdiction of the Division of Medical Quality Assurance within68the department and whomust be: 69 (a)1.A practitioneror recovered practitionerlicensed 70 under chapter 458, chapter 459, or part I of chapter 464; or 71 (b)2.An entity that employs: 72 1.a.A medical director who ismust be a practitioner or73recovered practitionerlicensed under chapter 458 or chapter 74 459; or 75 2.b.An executive director who ismust be a registered76nurse or a recovered registered nurselicensed under part I of 77 chapter 464. 78 (3) The terms and conditions of the impaired practitioner 79 program must be established by the department by contract with a 80 consultant for the protection of the health, safety, and welfare 81 of the public and must provide, at a minimum, that the 82 consultant: 83 (a) Accepts referrals; 84 (b) Arranges for the evaluation and treatment of impaired 85 practitioners by a treatment provider, when the consultant deems 86 the evaluation and treatment necessary; 87 (c) Monitors the recovery progress and status of impaired 88 practitioners to ensure that such practitioners are able to 89 practice their profession with skill and safety. Such monitoring 90 must continue until the consultant or department concludes that 91 monitoring by the consultant is no longer required for the 92 protection of the public or until the practitioner’s 93 participation in the program is terminated for material 94 noncompliance or inability to progress; and 95 (d) Does not directly evaluate, treat, or otherwise provide 96 patient care to a practitioner in the operation of the impaired 97 practitioner program. 98 (4) The department shall specify, in its contract with each 99 consultant, the types of licenses, registrations, or 100 certifications of the practitioners to be served by that 101 consultant. 102 (5) A consultant shall enter into a participant contract 103 with an impaired practitioner and shall establish the terms of 104 monitoring and shall include the terms in a participant 105 contract. In establishing the terms of monitoring, the 106 consultant may consider the recommendations of one or more 107 approved evaluators, treatment programs, or treatment providers. 108 A consultant may modify the terms of monitoring if the 109 consultant concludes, through the course of monitoring, that 110 extended, additional, or amended terms of monitoring are 111 required for the protection of the health, safety, and welfare 112 of the public. 113 (6)(b)AAn entity retained as an impaired practitioner114 consultantunder this section which employs a medical director115or an executive directoris not required to be licensed as a 116 substance abuse provider or mental health treatment provider 117 under chapter 394, chapter 395, or chapter 397 for purposes of 118 providing services under this program. 119 (7)(c)1.EachTheconsultant shall assist the department 120 and licensure boards on matters of impaired practitioners, 121 including the determination ofprobable cause panel and the122department in carrying out the responsibilities of this section.123This includes working with department investigators to determine124 whether a practitioner is, in fact, impaired, as specified in 125 the consultant’s contract with the department. 1262.The consultant may contract with a school or program to127provide services to a student enrolled for the purpose of128preparing for licensure as a health care practitioner as defined129in this chapter or as a veterinarian under chapter 474 if the130student is allegedly impaired as a result of the misuse or abuse131of alcohol or drugs, or both, or due to a mental or physical132condition. The department is not responsible for paying for the133care provided by approved treatment providers or a consultant.134(d)A medical school accredited by the Liaison Committee on135Medical Education or the Commission on Osteopathic College136Accreditation, or another school providing for the education of137students enrolled in preparation for licensure as a health care138practitioner as defined in this chapter or a veterinarian under139chapter 474 which is governed by accreditation standards140requiring notice and the provision of due process procedures to141students, is not liable in any civil action for referring a142student to the consultant retained by the department or for143disciplinary actions that adversely affect the status of a144student when the disciplinary actions are instituted in145reasonable reliance on the recommendations, reports, or146conclusions provided by such consultant, if the school, in147referring the student or taking disciplinary action, adheres to148the due process procedures adopted by the applicable149accreditation entities and if the school committed no150intentional fraud in carrying out the provisions of this151section.152 (8)(3)Before issuing an approval of, or intent to deny, an 153 application for licensure, each board and profession within the 154 Division of Medical Quality Assurance may delegate to its chair 155 or other designee its authority to determine, before certifying156or declining to certify an application for licensure to the157department,that an applicant for licensure under its 158 jurisdiction may have an impairmentbe impaired as a result of159the misuse or abuse of alcohol or drugs, or both, or due to a160mental or physical condition that could affect the applicant’s161ability to practice with skill and safety. Upon such 162 determination, the chair or other designee may refer the 163 applicant to the consultant to facilitateforan evaluation 164 before the board issues an approval of,certifiesor intent to 165 deny,declines to certifyhis or her applicationto the166department. If the applicant agrees to be evaluatedby the167consultant, the department’s deadline for approving or denying 168 the application pursuant to s. 120.60(1) is tolled until the 169 evaluation is completed and the result of the evaluation and 170 recommendationby the consultantis communicated to the board by 171 the consultant. If the applicant declines to be evaluatedby the172consultant, the board shall issue an approval of, or intent to 173 deny,certify or decline to certifythe applicant’s application 174to the departmentnotwithstanding the lack of an evaluation and 175 recommendation by the consultant. 176 (9)(a)(4)(a)WhenWheneverthe department receives a 177written or orallegally sufficient complaint alleging that a 178 practitioner has an impairmentlicensee under the jurisdiction179of the Division of Medical Quality Assurance within the180department is impaired as a result of the misuse or abuse of181alcohol or drugs, or both, or due to a mental or physical182condition which could affect the licensee’s ability to practice183with skill and safety,and no complaint exists against the 184 practitionerlicenseeother than impairmentexists, the 185 department shall refer the practitioner to the consultant, along 186 with all information in the department’s possession relating to 187 the impairment. The impairment doesreporting of such188information shallnot constitute grounds for discipline pursuant 189 to s. 456.072 orthe corresponding grounds for discipline within190 the applicable practice act ifthe probable cause panel of the191appropriate board, or the department when there is no board,192finds: 193 1. The practitionerlicenseehas acknowledged the 194 impairment;problem.195 2. The practitioner becomes a participantlicensee has196voluntarily enrolledin an impaired practitioner program and 197 successfully completes a participant contract under terms 198 established by the consultant;appropriate, approved treatment199program.200 3. The practitionerlicenseehas voluntarily withdrawn from 201 practice or has limited the scope of his or her practice ifas202 required by the consultant;, in each case, until such time as203the panel, or the department when there is no board, is204satisfied the licensee has successfully completed an approved205treatment program.206 4. The practitionerlicenseehas provided to the 207 consultant, or has authorized the consultant to obtain, all 208 records and information relating to the impairment from any 209 source and all other medical records of the practitioner 210 requested by the consultant; andexecuted releases for medical211records, authorizing the release of all records of evaluations,212diagnoses, and treatment of the licensee, including records of213treatment for emotional or mental conditions, to the consultant.214The consultant shall make no copies or reports of records that215do not regard the issue of the licensee’s impairment and his or216her participation in a treatment program.217 5. The practitioner has authorized the consultant, in the 218 event of the practitioner’s termination from the impaired 219 practitioner program, to report the termination to the 220 department and provide the department with copies of all 221 information in the consultant’s possession relating to the 222 practitioner. 223 (b) To encourage practitioners who are or may be impaired 224 to voluntarily self-refer to a consultant, the consultant may 225 not provide information to the department relating to a self 226 referring participant if the consultant has no knowledge of a 227 pending department investigation, complaint, or disciplinary 228 action against the participant and if the participant is in 229 compliance and making progress with the terms of the impaired 230 practitioner program and contract, unless authorized by the 231 participantIf, however, the department has not received a232legally sufficient complaint and the licensee agrees to withdraw233from practice until such time as the consultant determines the234licensee has satisfactorily completed an approved treatment235program or evaluation, the probable cause panel, or the236department when there is no board, shall not become involved in237the licensee’s case. 238(c)Inquiries related to impairment treatment programs239designed to provide information to the licensee and others and240which do not indicate that the licensee presents a danger to the241public shall not constitute a complaint within the meaning of s.242456.073 and shall be exempt from the provisions of this243subsection.244(d)Whenever the department receives a legally sufficient245complaint alleging that a licensee is impaired as described in246paragraph (a) and no complaint against the licensee other than247impairment exists, the department shall forward all information248in its possession regarding the impaired licensee to the249consultant. For the purposes of this section, a suspension from250hospital staff privileges due to the impairment does not251constitute a complaint.252(e)The probable cause panel, or the department when there253is no board, shall work directly with the consultant, and all254information concerning a practitioner obtained from the255consultant by the panel, or the department when there is no256board, shall remain confidential and exempt from the provisions257of s. 119.07(1), subject to the provisions of subsections (6)258and (7).259(f)A finding of probable cause shall not be made as long260as the panel, or the department when there is no board, is261satisfied, based upon information it receives from the262consultant and the department, that the licensee is progressing263satisfactorily in an approved impaired practitioner program and264no other complaint against the licensee exists.265 (10)(5)In any disciplinary action for a violation other 266 than impairment in which a practitionerlicenseeestablishes the 267 violation for which the practitionerlicenseeis being 268 prosecuted was due to or connected with impairment and further 269 establishes the practitionerlicenseeis satisfactorily 270 progressing through or has successfully completed an impaired 271 practitioner programapproved treatment programpursuant to this 272 section, such information may be considered by the board, or the 273 department when there is no board, as a mitigating factor in 274 determining the appropriate penalty. This subsection does not 275 limit mitigating factors the board may consider. 276 (11)(a)(6)(a)Upon request by the consultant, and with the 277 authorization of the practitioner when required by law, an 278 approved evaluator, treatment program, or treatment provider 279 shall, upon request,disclose to the consultant all information 280 in its possession regarding a referral or participantthe issue281of a licensee’s impairment and participation in the treatment282program. All information obtained by the consultant and283department pursuant to this section is confidential and exempt284from the provisions of s. 119.07(1), subject to the provisions285of this subsection and subsection (7). Failure to provide such 286 information to the consultant is grounds for withdrawal of 287 approval of such evaluator, treatment program, or treatment 288 provider. 289 (b) When a referral or participant is terminated from the 290 impaired practitioner program for material noncompliance with a 291 participant contract, inability to progress, or any other reason 292 than completion, the consultant shall discloseIf in the opinion293of the consultant, after consultation with the treatment294provider, an impaired licensee has not progressed satisfactorily295in a treatment program,all informationregarding the issue of a296licensee’s impairment and participation in a treatment program297 in the consultant’s possession relating to the practitioner 298shall be disclosedto the department. Such disclosure shall 299 constitute a complaint pursuant to the general provisions of s. 300 456.073. In addition, whenever the consultant concludes that 301 impairment affects a practitioner’slicensee’spractice and 302 constitutes an immediate, serious danger to the public health, 303 safety, or welfare, the consultant shall immediately communicate 304 suchthatconclusionshall be communicatedto the department and 305 disclose all information in the consultant’s possession relating 306 to the practitioner to the departmentState Surgeon General. 307 (12) All information obtained by the consultant pursuant to 308 this section is confidential and exempt from s. 119.07(1) and s. 309 24(a), Art. I of the State Constitution. 310 (13)(7)A consultant, or a director, officer, employee, or 311 agent of a consultant, may not be held liable financially or may 312 not have a cause of action for damages brought against him or 313 her for making a disclosure pursuant to this section, for any 314 other action or omission relating to the impaired practitioner 315 program, or for the consequences of such disclosure or action or 316 omission, including, without limitation, action by the 317 department against a license, registration, or certification 318licensee, or approved treatment provider who makes a disclosure319pursuant to this section is not subject to civil liability for320such disclosure or its consequences. 321 (14) The provisions of s. 766.101 apply to any consultant 322 and the consultant’s directors, officers, employees, or agents 323 in regards to providing information relating to a participant to 324 a medical review committee if the participant authorizes such 325 disclosureofficer, employee, or agent of the department or the326board and to any officer, employee, or agent of any entity with327which the department has contracted pursuant to this section. 328 (15)(a)(8)(a)A consultant retained pursuant to this 329 section andsubsection (2),a consultant’s directors, officers, 330andemployees, or agentsand those acting at the direction of331the consultant for the limited purpose of an emergency332intervention on behalf of a licensee or student as described in333subsection (2) when the consultant is unable to perform such334interventionshall be considered agents of the department for 335 purposes of s. 768.28 while acting within the scope of the 336 consultant’s duties under the contract with the departmentif337the contract complies with the requirements of this section.The338contract must require that:3391.The consultant indemnify the state for any liabilities340incurred up to the limits set out in chapter 768.3412.The consultant establish a quality assurance program to342monitor services delivered under the contract.3433.The consultant’s quality assurance program, treatment,344and monitoring records be evaluated quarterly.3454.The consultant’s quality assurance program be subject to346review and approval by the department.3475.The consultant operate under policies and procedures348approved by the department.3496.The consultant provide to the department for approval a350policy and procedure manual that comports with all statutes,351rules, and contract provisions approved by the department.3527.The department be entitled to review the records353relating to the consultant’s performance under the contract for354the purpose of management audits, financial audits, or program355evaluation.3568.All performance measures and standards be subject to357verification and approval by the department.3589.The department be entitled to terminate the contract359with the consultant for noncompliance with the contract.360 (b) In accordance with s. 284.385, the Department of 361 Financial Services shall defend any claim, suit, action, or 362 proceeding, including a claim, suit, action, or proceeding for 363 injunctive, affirmative, or declaratory relief, against the 364 consultant, or the consultant’s directors, officers,or365 employees, and agents brought as the result of any action or 366 omission relating to the impaired practitioner programor those367acting at the direction of the consultant for the limited368purpose of an emergency intervention on behalf of a licensee or369student as described in subsection (2) when the consultant is370unable to perform such intervention, which claim, suit, action,371or proceeding is brought as a result of an act or omission by372any of the consultant’s officers and employees and those acting373under the direction of the consultant for the limited purpose of374an emergency intervention on behalf of the licensee or student375when the consultant is unable to perform such intervention, if376the act or omission arises out of and is in the scope of the377consultant’s duties under its contract with the department. 378 (16)(c)If atheconsultant retained by the department 379 pursuant to this sectionsubsection (2)is also retained by 380 anotherany otherstate agency to operate an impaired 381 practitioner program for that agency, this section also applies 382 to the consultant’s operation of an impaired practitioner 383 program for that agency, and if the contract between such state384agency and the consultant complies with the requirements of this385section, the consultant, the consultant’s officers and386employees, and those acting under the direction of the387consultant for the limited purpose of an emergency intervention388on behalf of a licensee or student as described in subsection389(2) when the consultant is unable to perform such intervention390shall be considered agents of the state for the purposes of this391section while acting within the scope of and pursuant to392guidelines established in the contract between such state agency393and the consultant. 394 (17)(9)AAn impaired practitioner consultant is the395official custodian of records relating to the referral of an396impaired licensee or applicant to that consultant and any other397interaction between the licensee or applicant and the398consultant. Theconsultant may disclose to a referral or 399 participant documents, records, or other information from the 400 consultant’s file on the referral or participantthe impaired401licensee or applicant or his or her designee any information402that is disclosed to or obtained by the consultant or that is403confidential under paragraph (6)(a), but onlyto the extent that 404 it is necessary to do so to carry out the consultant’s duties 405 under the impaired practitioner program and this section, or as 406 otherwise required by law.The department, and any other entity407that enters into a contract with the consultant to receive the408services of the consultant, has direct administrative control409over the consultant to the extent necessary to receive410disclosures from the consultant as allowed by federal law.If a 411 disciplinary proceeding is pending, a referral or participant 412 may obtain a complete copy of the consultant’s file from the 413 department as provided byan impaired licensee may obtain such414information from the department unders. 456.073. 415 (18)(a) The consultant may contract with a school or 416 417 ================= T I T L E A M E N D M E N T ================ 418 And the title is amended as follows: 419 Delete line 26 420 and insert: 421 practitioners; making technical changes; requiring the 422 department to refer