08
SB549/AP
Senate
Bill 549
By:
Senator Thomas of the 54th
AS
PASSED
AN
ACT
To
amend Chapter 11 of Title 31 of the Official Code of Georgia Annotated, relating
to emergency medical services, so as to enact the "Coverdell-Murphy Act"; to
establish a two level system of certified stroke centers; to provide for
legislative findings; to provide for definitions; to provide for the
identification of primary stroke centers and remote treatment stroke centers; to
provide for a grant program; to provide for the distribution of a list of state
identified stroke centers to emergency medical services providers; to provide
for the development of a model stroke triage assessment tool; to provide for the
establishment of protocols related to the assessment, treatment, and transport
of stroke patients by licensed emergency medical services providers; to provide
for annual reporting; to provide for statutory construction; to provide that a
hospital shall not advertise that it is identified by the state as a primary or
remote treatment stroke center unless so identified; to provide for rules and
regulations; to provide for related matters; to repeal conflicting laws; and for
other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
This
Act shall be known and may be cited as the "Coverdell-Murphy Act" in honor of
the late Georgia Congressman Paul D. Coverdell and the late Georgia Speaker of
the House of Representatives Thomas B. Murphy, both revered politicians of the
great State of Georgia, and victims of massive strokes.
SECTION
2.
Chapter
11 of Title 31 of the Official Code of Georgia Annotated, relating to emergency
medical services, is amended by adding a new Article 6 to Chapter 11 to read as
follows:
"ARTICLE
6
31-11-110.
The
General Assembly finds and declares that:
(1)
The rapid identification, diagnosis, and treatment of stroke can save the lives
of stroke victims and in some cases can reverse neurological damage such as
paralysis and speech and language impairments, leaving stroke victims with few
or no neurological deficits;
(2)
Despite significant advances in diagnosis, treatment and prevention, stroke is
the third leading cause of death and the biggest cause of disability in this
country; an estimated 700,000 to 750,000 new and recurrent strokes occur each
year in this country and with the aging of the population, the number of persons
who have strokes is projected to increase;
(3)
Although new treatments are available to improve the clinical outcomes of
stroke, many acute care hospitals often face challenges in obtaining staff and
equipment required to optimally triage and treat stroke patients, including the
provision of optimal, safe, and effective emergency care for these
patients;
(4)
Although the Georgia Coverdell Acute Stroke Registry currently exists within the
Department of Human Resources as a program whose purpose is to increase
improvement of the quality of acute stroke care through collaborative efforts
with participating hospitals in this state, less than one-third of
Georgia´s hospitals are currently enrolled in the program. Therefore
increased participation in and funding of this program in conjunction with the
adherence to the tenets of this article would have profound effects on the
quality of care for acute stroke victims in this state;
(5)
An effective system to support stroke survival is needed in our communities in
order to treat stroke victims in a timely manner and to improve the overall
treatment of stroke victims in order to increase survival and a decrease the
disabilities associated with stroke. There is a public health need for acute
care hospitals in this state to establish stroke centers to ensure the rapid
triage, diagnostic evaluation and treatment of patients suffering a stroke;
(6)
Two levels of stroke centers should be established for the treatment of acute
stroke:
(A)
Primary stroke centers should be established in as many acute care hospitals as
possible to evaluate, stabilize, and provide or arrange for treatment, care, and
rehabilitative services to patients diagnosed with acute stroke;
and
(B)
Because access to stroke care is limited in the rural areas of the state due to
the limited availability of professional specialists, high-tech imaging
equipment, and transportation services, remote treatment stroke centers should
be established to evaluate, stabilize, and provide treatment to patients
diagnosed with acute stroke in rural portions of the state;
(7)
Coordination between primary stroke centers and remote treatment stroke centers
should be encouraged through the establishment of coordinated stroke care
agreements between primary stroke centers and remote treatment stroke centers;
and
(8)
Therefore, it is in the best interest of the residents of this state to
establish a program to identify certified stroke centers throughout the state,
to provide specific patient care and support services criteria that stroke
centers must meet in order to ensure that stroke patients receive safe and
effective care, and to provide financial support to acute care hospitals to
encourage them to develop stroke centers in all areas of the state. Further, it
is in the best interest of the people of this state to modify the state´s
emergency medical response system to assure that stroke victims may be quickly
identified and transported to and treated in facilities that have specialized
programs for providing timely and effective treatment for stroke
victims.
31-11-111.
As
used in this article, the term 'department' means the same state agency or state
board which regulates emergency medical services personnel and providers
pursuant to this chapter.
31-11-112.
(a)
The department shall identify hospitals that meet the criteria set forth in this
article as primary or remote treatment stroke centers.
(b)
A hospital shall apply to the department for such identification and shall
demonstrate to the satisfaction of the department that the hospital meets the
applicable criteria set forth in Code Section 31-11-113.
(c)
The department shall identify as many hospitals as primary or remote treatment
stroke centers as apply for the identification, provided that each applicant
meets the applicable criteria set forth in Code Section 31-11-113.
(d) The department may suspend or revoke a hospital´s identification as a
primary or remote treatment stroke center, after notice and hearing, if the
department determines that the hospital is not in compliance with the
requirements of this article.
31-11-113.
(a)
A hospital identified as a primary stroke center shall be certified as such by
the Joint Commission on Accreditation of Healthcare Organizations. Any hospital
wishing to receive official identification under this Code section must submit a
written application to the department, providing adequate documentation of the
hospital´s valid certification as a primary stroke center by the
commission.
(b)
Remote treatment stroke centers shall be certified and identified by the
department through an application process to be determined by the department.
Said process shall contain, at minimum, the following requirements:
(1)
Remote treatment stroke center certifications and identifications by the
department are limited to those hospitals that utilize current and acceptable
telemedicine protocols relative to acute stroke treatment as defined by the
department;
(2)
Upon receipt of complete and proper application for certification as a remote
treatment stroke center, the department shall schedule and conduct an inspection
of the applicant´s facility no later than 90 days after receipt of
application; and
(3)
Any hospital, upon certification by the department as a remote treatment stroke
center, shall automatically be identified as a remote treatment stroke center
and shall be added to the list of such hospitals as defined in subsection (a) of
Code Section 31-11-115.
(c)
Primary stroke centers are encouraged to coordinate, through agreement, with
remote treatment stroke centers throughout the state to provide appropriate
access to care for acute stroke patients. The coordinating stroke care
agreements shall be in writing and include at minimum:
(1)
Transfer agreements for the transport and acceptance of all stroke patients seen
by the remote treatment stroke center for stroke treatment therapies which the
remote treatment stroke center is not capable of providing; and
(2)
Communication criteria and protocols with the remote treatment stroke
centers.
31-11-114.
(a)
In order to encourage and ensure the establishment of stroke centers throughout
the state, the department shall award grants, subject to appropriations from the
General Assembly, to hospitals that seek identification as remote treatment
stroke centers and demonstrate a need for financial assistance to develop the
necessary infrastructure, including personnel and equipment, in order to satisfy
the criteria for identification as a remote treatment stroke center pursuant to
subsection (b) of Code Section 31-11-113.
(b)
A hospital seeking identification as a remote treatment stroke center pursuant
to this article may apply to the department for a grant, in a manner and on a
form required by the department, and provide such information as the department
deems necessary to determine if the hospital is eligible for the
grant.
(c)
The department may provide grants to as many hospitals as it deems appropriate,
subject to appropriations, taking into consideration adequate geographic
diversity with respect to locations.
(d)
The department shall, not later than September 1, 2009, prepare and submit to
the Governor, the President of the Senate, and the Speaker of the House of
Representatives a report indicating, as of June 30, 2009, the total number of
hospitals that have applied for grants pursuant to this Code section, the number
of applicants that have been determined by the department to be eligible for
such grants, the total number of grants to be awarded, the name and address of
each grantee hospital, the amount of the award to each grantee, the amount of
each award to be disbursed to the grantee, and whether or not, in the opinion of
the department, each grantee would be able to attain identification as a remote
treatment stroke center pursuant to subsection (b) of Code Section
31-11-113.
31-11-115.
(a)
Beginning June 1, 2009, and each year thereafter, the department shall send the
list of primary and remote treatment stroke centers identified pursuant to Code
Section 31-11-113 the medical director of each licensed emergency medical
services provider in this state, shall maintain a copy of the list in the office
designated with the department to oversee emergency medical services, and shall
post a list of primary and remote treatment stroke centers on the
department´s website.
(b)
The department shall adopt or develop a sample stroke triage assessment tool.
The department shall post this sample assessment tool on its website and
distribute a copy of the sample assessment tool to each licensed emergency
medical services provider no later than December 31, 2008. Each licensed
emergency medical services provider shall use a stroke triage assessment tool
that is substantially similar to the sample stroke triage assessment tool
provided by the department.
(c)
The office designated within the department to oversee emergency medical
services shall establish protocols related to the assessment, treatment, and
transport of stroke patients by licensed emergency medical services providers in
this state.
31-11-116.
(a)
In order to assure that the patients are receiving the appropriate level of care
and treatment at each primary stroke center in the state, each hospital
identified as a primary stroke center shall annually report the following
information to the department:
(1)
The number of patients evaluated;
(2)
The number of patients receiving acute interventional therapy;
(3)
The amount of time from patient presentation to delivery of acute interventional
therapy;
(4)
Patient length of stay;
(5)
Patient functional outcome;
(6)
Patient morbidity;
(7)
Deep vein thrombosis prophylaxis given;
(8)
Number of patients discharged on antiplatelet or antithrombotics medication;
(9)
Number of patients with atrial fibrillation receiving anticoagulation
therapy;
(10)
Patients on which the administration of tissue plasminogen activator was
considered;
(11)
Antithrombotic medication administered within 48 hours of
hospitalization;
(12)
Number of lipid profiles ordered during hospitalization;
(13)
Number of screens for dysphagia performed;
(14)
Stroke education provided;
(15)
Number of smoking cessation programs provided or discussed;
(16)
The number of patients assessed for rehabilitation and whether a plan for
rehabilitation was considered;
(17)
The number of emergency medical services stroke patients who were transported to
the facility;
(18)
The number of emergency medical services stroke patients who were admitted to
the facility;
(19)
The number and percentage of stroke cases treated with intravenous or
intra-arterial tissue plasminogen activator; and
(20)
The number of patients discharged on cholesterol reducing
medication.
(b)
In order to assure that the patients are receiving the appropriate level of care
and treatment at each remote treatment stroke center in the state, each hospital
identified as a remote treatment stroke center shall annually report the
following information to the department:
(1)
The number of patients evaluated;
(2)
The number of patients receiving acute interventional therapy;
(3)
The amount of time from patient presentation to delivery of acute interventional
therapy;
(4)
Patient length of stay;
(5)
The number of emergency medical services stroke patients who were transported to
the facility;
(6)
The number of emergency medical services stroke patients who were admitted to
the facility; and
(7)
The number and percentage of stroke cases treated with intravenous or
intra-arterial tissue plasminogen activator.
(c)
The department shall collect the information reported pursuant to subsections
(a) and (b) of this Code section and shall post such information in the
form of a report card annually on the department´s website and present such
report to the Governor, the President of the Senate, and the Speaker of the
House of Representatives. The results of this report card may be used by the
department to conduct training with the identified facilities regarding best
practices in the treatment of stroke.
(d)
In no way shall this article be construed to require disclosure of any
confidential information or other data in violation of the federal Health
Insurance Portability and Accountability Act of 1996, P.L. 104-191.
31-11-117.
This
article shall not be construed to be a medical practice guideline and shall not
be used to restrict the authority of a hospital to provide services for which it
has received a license under state law. The General Assembly intends that all
patients be treated individually based on each patient´s needs and
circumstances.
31-11-118.
A
hospital may not advertise to the public, by way of any medium whatsoever, that
it is identified by the state as a primary or remote treatment stroke center
unless the hospital has been identified as such by the department pursuant to
this article.
31-11-119.
The
department shall be authorized to promulgate rules and regulations to carry out
the purposes of this article."
SECTION
3.
All
laws and parts of laws in conflict with this Act are repealed.