2002 SPECIAL SESSION (18th) CA AB1 R2 1
ASSEMBLY ACTION Initial and Date |SENATE ACTION Initial and Date
Adopted Lost | Adopted Lost
Concurred In Not |Concurred In Not
Receded Not | Receded Not
Amend section 1, page 2, line 12, by deleting “3” and inserting “2”.
Amend section 1, page 2, by deleting line 17 and inserting:
“(b) A hospital other than a hospital described in paragraph (a);
(c) An employee of a hospital described in paragraph (a) or (b) who renders”.
Amend section 1, page 2, line 19, by deleting “(c)” and inserting “(d)”.
Amend section 1, page 2, line 21, by deleting “(a),” and inserting:
“(a) or (b),”.
Amend section 1, page 2, line 23, by deleting “(d)” and inserting “(e)”.
Amend section 1, pages 2 and 3, by deleting lines 32 through 49 on page 2 and lines 1 through 4 on page 3, and inserting:
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“that in good
faith renders care or assistance necessitated by a traumatic injury demanding
immediate medical attention, for which the patient enters the hospital through
its emergency room or trauma center, may not be held”.
Amend section 1, page 3, line 10, by deleting “3.” and inserting “2.”.
Amend section 1, page 3, line 16, by deleting:
“subsections 1 and 2” and inserting “subsection 1”.
Amend section 1, page 3, line 19, by deleting “medical emergency.” and inserting “traumatic injury.”.
Amend section 1, page 3, line 20, by deleting “4.” and inserting “3.”.
Amend section 1, page 3, line 22, by deleting:
“1 or 2;” and inserting “1;”.
Amend section 1, page 3, line 24, by deleting “medical condition” and inserting “traumatic injury”.
Amend section 1, page 3, line 25, by deleting:
“1 or 2;” and inserting “1;”.
Amend section 1, page 3, by deleting lines 28 and 29 and inserting:
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“there is a
rebuttable presumption that the medical condition was the result of the
original traumatic injury and that”.
Amend section 1, page 3, line 30, by deleting “or 2”.
Amend section 1, page 3, by deleting line 33 and inserting:
“4. For the purposes of this section:
(a) “Reckless, willful or wanton”.
Amend section 1, page 3, line 34, by deleting “or 2”.
Amend section 1, page 3, line 39, by deleting “(a)” and inserting “(1)”.
Amend section 1, page 3, line 40, by deleting “(b)” and inserting “(2)”.
Amend section 1, page 3, line 41, by deleting “(c)” and inserting “(3)”.
Amend section 1, page 3, line 42, by deleting “(d)” and inserting “(4)”.
Amend section 1, page 3, line 44, by deleting “(e)” and inserting “(5)”.
Amend section 1, page 3, between lines 44 and 45 by inserting:
“(b) “Traumatic injury” means any acute injury which, according to standardized criteria for triage in the field, involves a significant risk of death or the precipitation of complications or disabilities.”.
Amend sec. 5, page 5, line 24, by deleting “or 4”.
Amend sec. 5, page 6, by deleting line 1 and inserting:
“4. The limitation set forth in subsection 3 does not apply in an”.
Amend sec. 5, page 6, by deleting line 4 and inserting:
“of the occurrence of the alleged malpractice and on the date on which the insurer receives notice of the claim, in an amount of:”.
Amend sec. 9, page 6, by deleting lines 46 and 47 and inserting:
“malpractice, all the parties to the action, the insurers of the respective parties and the attorneys of the respective parties shall attend and”.
Amend the bill as a whole, page 12 by deleting line 29 and inserting:
“Sec. 18. Chapter 439 of NRS is hereby amended by adding thereto the provisions set forth as sections 19 to 39, inclusive, of this act.
Sec. 19. As used in sections 19 to 39, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 20 to 25, inclusive, of this act have the meanings ascribed to them in those sections.
Sec. 20. “Medical facility” means:
1. A hospital, as that term is defined in NRS 449.012 and 449.0151;
2. An obstetric center, as that term is defined in NRS 449.0151 and 449.0155;
3. A surgical center for ambulatory patients, as that term is defined in NRS 449.0151 and 449.019; and
4. An independent center for emergency medical care, as that term is defined NRS 449.013 and 449.0151.
Sec. 21. “Patient” means a person who:
1. Is admitted to a medical facility for the purpose of receiving treatment;
2. Resides in a medical facility; or
3. Receives treatment from a provider of health care.
Sec. 22. “Patient safety officer” means a person who is designated as such by a medical facility pursuant to section 35 of this act.
Sec. 23. “Provider of health care” means a person who is licensed, certified or otherwise authorized by the law of this state to administer health care in the ordinary course of the business or practice of a profession.
Sec. 24. “Repository” means the repository for health care quality assurance created by section 31 of this act.
Sec. 25. “Sentinel event” means an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof, including, without limitation, any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. The term includes loss of limb or function.
Secs. 26 and 27. (Deleted by amendment.)
Sec. 28. 1. Except as otherwise provided in subsection 2:
(a) A person who is employed by a medical facility shall, within 24 hours after becoming aware of a sentinel event that occurred at the medical facility, notify the patient safety officer of the facility of the sentinel event; and
(b) The patient safety officer shall, within 13 days after receiving notification pursuant to paragraph (a), report the date, the time and a brief description of the sentinel event to:
(1) The health division; and
(2) The representative designated pursuant to section 32 of this act, if that person is different from the patient safety officer.
2. If the patient safety officer of a medical facility personally discovers or becomes aware, in the absence of notification by another employee, of a sentinel event that occurred at the medical facility, the patient safety officer shall, within 14 days after discovering or becoming aware of the sentinel event, report the date, time and brief description of the sentinel event to:
(a) The health division; and
(b) The representative designated pursuant to section 32 of this act, if that person is different from the patient safety officer.
3. The administrator shall prescribe the manner in which reports of sentinel events must be made pursuant to this section.
Sec. 29. 1. The health division shall, to the extent of legislative appropriation and authorization:
(a) Collect and maintain reports received pursuant to section 28 of this act; and
(b) Ensure that such reports, and any additional documents created from such reports, are protected adequately from fire, theft, loss, destruction and other hazards and from unauthorized access.
2. Reports received pursuant to section 28 of this act are confidential, not subject to subpoena or discovery and not subject to inspection by the general public.
Sec. 30. 1. The health division shall, to the extent of legislative appropriation and authorization, contract with a quality improvement organization, as defined in 42 C.F.R. § 400.200, to analyze and report trends regarding sentinel events.
2. When the health division receives notice from a medical facility that the medical facility has taken corrective action to remedy the causes or contributing factors, or both, of a sentinel event, the health division shall:
(a) Make a record of the information;
(b) Ensure that the information is aggregated so as not to reveal the identity of a specific person or medical facility; and
(c) Transmit the information to a quality improvement organization.
3. A quality improvement organization to whom information is transmitted pursuant to subsection 2 shall, at least quarterly, report its findings regarding the analysis of aggregated trends of sentinel events to the repository for health care quality assurance.
Sec. 31. 1. The repository for health care quality assurance is hereby created within the health division.
2. The repository shall, to the extent of legislative appropriation and authorization, function as a clearinghouse of information relating to aggregated trends of sentinel events.
Sec. 32. 1. Each medical facility that is located within this state shall designate a representative for the notification of patients who have been involved in sentinel events at that medical facility.
2. A representative designated pursuant to subsection 1 shall, not later than 7 days after discovering or becoming aware of a sentinel event that occurred at the medical facility, provide notice of that fact to each patient who was involved in that sentinel event.
3. The provision of notice to a patient pursuant to subsection 2 must not, in any action or proceeding, be considered an acknowledgment or admission of liability.
4. A representative designated pursuant to subsection 1 may or may not be the same person who serves as the facility’s patient safety officer.
Sec. 33. Any report, document and any other information compiled or disseminated pursuant to the provisions of sections 19 to 39, inclusive, of this act is not admissible in evidence in any administrative or legal proceeding conducted in this state.
Sec. 34. 1. Each medical facility that is located within this state shall develop, in consultation with the providers of health care who provide treatment to patients at the medical facility, an internal patient safety plan to improve the health and safety of patients who are treated at that medical facility.
2. A medical facility shall submit its patient safety plan to the governing board of the medical facility for approval in accordance with the requirements of this section.
3. After a medical facility’s patient safety plan is approved, the medical facility shall notify all providers of health care who provide treatment to patients at the medical facility of the existence of the plan and of the requirements of the plan. A medical facility shall require compliance with its patient safety plan.
Sec. 35. 1. A medical facility shall designate an officer or employee of the facility to serve as the patient safety officer of the medical facility.
2. The person who is designated as the patient safety officer of a medical facility shall:
(a) Serve on the patient safety committee.
(b) Supervise the reporting of all sentinel events alleged to have occurred at the medical facility, including, without limitation, performing the duties required pursuant to section 28 of this act.
(c) Take such action as he determines to be necessary to ensure the safety of patients as a result of an investigation of any sentinel event alleged to have occurred at the medical facility.
(d) Report to the patient safety committee regarding any action taken in accordance with paragraph (c).
Sec. 36. 1. A medical facility shall establish a patient safety committee.
2. Except as otherwise provided in subsection 3:
(a) A patient safety committee established pursuant to subsection 1 must be composed of:
(1) The patient safety officer of the medical facility.
(2) At least three providers of health care who treat patients at the medical facility, including, without limitation, at least one member of the medical, nursing and pharmaceutical staff of the medical facility.
(3) One member of the executive or governing body of the medical facility.
(b) A patient safety committee shall meet at least once each month.
3. The administrator shall adopt regulations prescribing the composition and frequency of meeting of patient safety committees at medical facilities having fewer than 25 employees and contractors.
4. A patient safety committee shall:
(a) Receive reports from the patient safety officer pursuant to section 35 of this act.
(b) Evaluate actions of the patient safety officer in connection with all reports of sentinel events alleged to have occurred at the medical facility.
(c) Review and evaluate the quality of measures carried out by the medical facility to improve the safety of patients who receive treatment at the medical facility.
(d) Make recommendations to the executive or governing body of the medical facility to reduce the number and severity of sentinel events that occur at the medical facility.
(e) At least once each calendar quarter, report to the executive or governing body of the medical facility regarding:
(1) The number of sentinel events that occurred at the medical facility during the preceding calendar quarter; and
(2) Any recommendations to reduce the number and severity of sentinel events that occur at the medical facility.
5. The proceedings and records of a patient safety committee are subject to the same privilege and protection from discovery as the proceedings and records described in NRS 49.265.
Sec. 37. No person is subject to any criminal penalty or civil liability for libel, slander or any similar cause of action in tort if he, without malice:
1. Reports a sentinel event to a governmental entity with jurisdiction or another appropriate authority;
2. Notifies a governmental entity with jurisdiction or another appropriate authority of a sentinel event;
3. Transmits information regarding a sentinel event to a governmental entity with jurisdiction or another appropriate authority;
4. Compiles, prepares or disseminates information regarding a sentinel event to a governmental entity with jurisdiction or another appropriate authority; or
5. Performs any other act authorized pursuant to sections 19 to 39, inclusive, of this act.
Sec. 38. If a medical facility:
1. Commits a violation of any provision of sections 19 to 39, inclusive, of this act or for any violation for which an administrative sanction pursuant to NRS 449.163 would otherwise be applicable; and
2. Of its own volition, reports the violation to the administrator,
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such a violation must not
be used as the basis for imposing an administrative sanction pursuant to NRS
449.163.
Sec. 39. The administrator shall adopt such regulations as the administrator determines to be necessary or advisable to carry out the provisions of sections 19 to 39, inclusive, of this act.
Secs. 40-43. (Deleted by amendment.)
Sec. 44. Chapter 449 of NRS is hereby amended by adding thereto the provisions set forth as sections 45 and 46 of this act.
Sec. 45. 1. A medical facility or any agent or employee thereof shall not retaliate or discriminate unfairly against an employee of the medical facility or a person acting on behalf of the employee who in good faith:
(a) Reports to the board of medical examiners or the state board of osteopathic medicine, as applicable, information relating to the conduct of a physician which may constitute grounds for initiating disciplinary action against the physician or which otherwise raises a reasonable question regarding the competence of the physician to practice medicine with reasonable skill and safety to patients;
(b) Reports a sentinel event to the health division pursuant to section 28 of this act; or
(c) Cooperates or otherwise participates in an investigation or proceeding conducted by the board of medical examiners, the state board of osteopathic medicine or another governmental entity relating to conduct described in paragraph (a) or (b).
2. A medical facility or any agent or employee thereof shall not retaliate or discriminate unfairly against an employee of the medical facility because the employee has taken an action described in subsection 1.
3. A medical facility or any agent or employee thereof shall not prohibit, restrict or attempt to prohibit or restrict by contract, policy, procedure or any other manner the right of an employee of the medical facility to take an action described in subsection 1.
4. As used in this section:
(a) “Physician” means a person licensed to practice medicine pursuant to chapter 630 or 633 of NRS.
(b) “Retaliate or discriminate”:
(1) Includes, without limitation, the following action if such action is taken solely because the employee took an action described in subsection 1:
(I) Frequent or undesirable changes in the location where the employee works;
(II) Frequent or undesirable transfers or reassignments;
(III) The issuance of letters of reprimand, letters of admonition or evaluations of poor performance;
(IV) A demotion;
(V) A reduction in pay;
(VI) The denial of a promotion;
(VII) A suspension;
(VIII) A dismissal;
(IX) A transfer; or
(X) Frequent changes in working hours or workdays.
(2) Does not include action described in sub-subparagraphs (I) to (X), inclusive, of paragraph (1) if the action is taken in the normal course of employment or as a form of discipline.
Sec. 46. An employee of a medical facility who believes that he has been retaliated or discriminated against in violation of section 45 of this act may file an action in a court of competent jurisdiction for such relief as may be appropriate under the law.
Sec. 47. Chapter 630 of NRS is hereby amended by adding thereto the provisions set forth as sections 48 and 49 of this act.
Sec. 48. 1. A physician or any agent or employee thereof shall not retaliate or discriminate unfairly against an employee of the physician or a person acting on behalf of the employee who in good faith:
(a) Reports to the board information relating to the conduct of the physician which may constitute grounds for initiating disciplinary action against the physician or which otherwise raises a reasonable question regarding the competence of the physician to practice medicine with reasonable skill and safety to patients;
(b) Reports a sentinel event to the health division pursuant to section 28 of this act; or
(c) Cooperates or otherwise participates in an investigation or proceeding conducted by the board or another governmental entity relating to conduct described in paragraph (a) or (b).
2. A physician or any agent or employee thereof shall not retaliate or discriminate unfairly against an employee of the physician because the employee has taken an action described in subsection 1.
3. A physician or any agent or employee thereof shall not prohibit, restrict or attempt to prohibit or restrict by contract, policy, procedure or any other manner the right of an employee of the physician to take an action described in subsection 1.
4. As used in this section, “retaliate or discriminate”:
(a) Includes, without limitation, the following action if such action is taken solely because the employee took an action described in subsection 1:
(1) Frequent or undesirable changes in the location where the employee works;
(2) Frequent or undesirable transfers or reassignments;
(3) The issuance of letters of reprimand, letters of admonition or evaluations of poor performance;
(4) A demotion;
(5) A reduction in pay;
(6) The denial of a promotion;
(7) A suspension;
(8) A dismissal;
(9) A transfer; or
(10) Frequent changes in working hours or workdays.
(b) Does not include action described in subparagraphs (1) to (10), inclusive, of paragraph (a) if the action is taken in the normal course of employment or as a form of discipline.
Sec. 49. An employee of a physician who believes that he has been retaliated or discriminated against in violation of section 48 of this act may file an action in a court of competent jurisdiction for such relief as may be appropriate.
Sec. 50. (Deleted by amendment.)”.
Amend sec. 55, page 15, by deleting lines 12 through 14.
Amend sec. 55, page 15, line 15, by deleting “5.” and inserting “4.”
Amend the bill as a whole, page 15, by deleting line 42 and inserting:
“Sec. 59. 1. An osteopathic physician or any agent or employee thereof shall not retaliate or discriminate unfairly against an employee of the osteopathic physician or a person acting on behalf of the employee who in good faith:
(a) Reports to the board information relating to the conduct of the osteopathic physician which may constitute grounds for initiating disciplinary action against the osteopathic physician or which otherwise raises a reasonable question regarding the competence of the osteopathic physician to practice medicine with reasonable skill and safety to patients;
(b) Reports a sentinel event to the health division pursuant to section 28 of this act; or
(c) Cooperates or otherwise participates in an investigation or proceeding conducted by the board or another governmental entity relating to conduct described in paragraph (a) or (b).
2. An osteopathic physician or any agent or employee thereof shall not retaliate or discriminate unfairly against an employee of the osteopathic physician because the employee has taken an action described in subsection 1.
3. An osteopathic physician or any agent or employee thereof shall not prohibit, restrict or attempt to prohibit or restrict by contract, policy, procedure or any other manner the right of an employee of the osteopathic physician to take an action described in subsection 1.
4. As used in this section, “retaliate or discriminate”:
(a) Includes, without limitation, the following action if such action is taken solely because the employee took an action described in subsection 1:
(1) Frequent or undesirable changes in the location where the employee works;
(2) Frequent or undesirable transfers or reassignments;
(3) The issuance of letters of reprimand, letters of admonition or evaluations of poor performance;
(4) A demotion;
(5) A reduction in pay;
(6) The denial of a promotion;
(7) A suspension;
(8) A dismissal;
(9) A transfer; or
(10) Frequent changes in working hours or workdays.
(b) Does not include action described in subparagraphs (1) to (10), inclusive, of paragraph (a) if the action is taken in the normal course of employment or as a form of discipline.
Sec. 60. An employee of an osteopathic physician who believes that he has been retaliated or discriminated against in violation of section 59 of this act may file an action in a court of competent jurisdiction for such relief as may be appropriate under the law.
Sec. 61. (Deleted by amendment.)”.
Amend sec. 64, page 17, by deleting lines 9 through 11.
Amend sec. 64, page 17, line 12, by deleting “5.” and inserting “4.”.
Amend the bill as a whole by adding a new section designated sec. 72.5, following sec. 72, to read as follows:
“Sec. 72.5. 1. For the period beginning on October 1, 2002, and ending on October 1, 2005, the division shall monitor and maintain records of all:
(a) Premiums charged for policies of insurance covering the liability of a practitioner licensed to practice medicine, dentistry or osteopathic medicine pursuant to chapter 630, 631 or 633 of NRS for a breach of his professional duty toward a patient; and
(b) Jury verdicts and settlements of cases and claims relating to the liability of a practitioner licensed to practice medicine, dentistry or osteopathic medicine pursuant to chapter 630, 631 or 633 of NRS for a breach of his professional duty toward a patient, including, without limitation:
(1) The amount of each jury verdict or settlement;
(2) For each case or claim, whether any limitation on the amount of any damages applied; and
(3) For each case or claim, the effect of any applicable limitation on the amount of any damages.
2. Not later than November 1, 2005, the division shall deliver to the commissioner for review a report which must include, without limitation:
(a) A summary of the information obtained pursuant to subsection 1; and
(b) Analyses of any changes or trends in the amounts of or volumes of premiums or jury verdicts and settlements as evidenced by the information obtained pursuant to subsection 1.
3. Not later than December 1, 2005, the commissioner shall submit to the director of the legislative counsel bureau for transmission to the legislative commission and the legislature a report which must include, without limitation:
(a) The findings of the division delivered to the commissioner pursuant to this section; and
(b) Any recommendations of the commissioner for legislation based upon the findings of the division, including, without limitation, any recommendations for annual adjustments for inflation for any limitations on damages applicable to cases and claims relating to the liability of a practitioner licensed to practice medicine, dentistry or osteopathic medicine pursuant to chapter 630, 631 or 633 of NRS for a breach of his professional duty toward a patient.
4. As used in this section:
(a) “Commissioner” has the meaning ascribed to it in NRS 679A.060.
(b) “Division” has the meaning ascribed to it in NRS 679A.085.”.
Amend sec. 75, page 19, line 47, by deleting “This” and inserting “1. This”.
Amend sec. 75, page 19, after line 49, by
inserting:
“2. Sections 18 to 39, inclusive, 44 to 49, inclusive, 59 and 60 of
this act become effective on July 1, 2003.”.
Amend the title of the bill, sixteenth line, after “negligence;” by inserting:
“requiring the commissioner of insurance to report to the legislative commission and the legislature regarding certain premiums for insurance and certain jury verdicts and settlements;”.
Amend the bill as a whole by adding the following senators as primary joint sponsors:
Senators Raggio and Titus.
Amend the bill as a whole by adding the following senators as nonprimary joint sponsors:
Senators Amodei, Care, Carlton, Coffin, Jacobsen, Mathews, McGinness, Milburn, Neal, O’Connell, O’Donnell, Paulk, Rawson, Rhoads, Schneider, Shaffer, Townsend, Washington and Wiener.