On Friday, two bills were added to the Senate schedule related to last year’s state Supreme Court decision to end the practice of psychiatric boarding.
We support SB 5645, a simple bill to create a mechanism for the state to track cases when people who meet detention criteria, but for whom no appropriate bed (inpatient, evaluation and treatment, or appropriate single bed certification) can be found. We were surprised to learn the state is not collecting this data, so the scope of the problem of ongoing psychiatric detention without appropriate placement is totally unclear. We’d greatly appreciate your support for that bill.
We oppose SB 5644, which essentially seeks to override the In re Detention of D.W. case and authorize psychiatric boarding by giving broad authorization to single bed certifications— regardless of whether or not the hospital is able to safely provide the mental health services the patient truly needs.
We think this bill runs counter to the ruling from the Washington Supreme Court in D.W. and will result in violation of the constitutional rights of patients in a way the court has already found unacceptable. Inpatient psychiatric care is a regional, specialized system. The hospitals that cannot meet the single bed certification rule are mostly in the more rural areas of the state – the same areas where there are not inpatient evaluation and treatment facilities. It’s entirely unclear to us where the labor pools will come from to assist with involuntarily detained patients for the hospital that cannot meet the new single bed certification rule. (Chelene Whiteaker, 206/216-2545)
Hospital Safety Net Assessment
Since 2011, Washington State has levied a safety net assessment on acute care hospitals. When matched with federal funds, the program is used to enhance Medicaid payments and help ensure that hospitals who serve high numbers of Medicaid patients are financially stable.
The assessment also enhances state funding for health care services. The current program provides more than $100 million a year for the state, and more than $100 million to support hospital services.
Revenue from the assessment program is included in the state’s budget, and WSHA supports continuation through SFY 2019, assuming there is no decrease in benefits to the state or to hospitals.
The assessment program will be discussed in Senate Ways and Means this week. We have drafted a bill that eliminates the current phase-down of the program. We will be carefully monitoring to ensure the program is stable and continues to provide benefits to the hospitals and the state. (Claudia Sanders, 206/216-2508)
Pre-Pack Medication
For years, if a patient was discharged from an emergency department and there was no access to a pharmacy (e.g., the middle of the night), the hospital emergency department would provide a “pre-pack” (pre-filled set of medications). This is a critical service to patients who can be safely released, but still need to begin a course of antibiotics or manage their pain in the hours or days before a nearby pharmacy is open.
In 2014, the Pharmacy Quality Assurance Commission changed its position on the dispensing of pre-packs, and began citing hospitals who dispensed them. Despite multiple requests throughout an unfinished rulemaking process, the Commission still has not provided a written position on whether or not a practitioner who is already licensed to prescribe drugs can dispense pre-packs.
As a result, we are supporting SB 5460, which would allow practitioners to dispense pre-packs in times and locations when a 24-hour community pharmacy is not available. The Department of Health has indicated it will support this bill. The companion bill is HB 1402 and has not been scheduled for a hearing.
This bill will be heard in Senate Health Care on Monday. (Ian Corbridge, 206/216-2514)
Nurse Staffing Bills are Back
Although the bills are compiled slightly differently than the ones we saw in 2013 and 2014, the same three basic concepts are back, with similar language.
HB 1733 would require mandated ratios of patients to nurses. Safe staffing is a crucial component of patient safety, but mandating inflexible ratios is not proven to improve patient care or outcomes.
This bill will be heard in House Health and Wellness.
HB 1732, mandates that nurses and many other clinical staff get uninterrupted meal and rest breaks, with a few narrow exceptions. Nurses now have the flexibility to choose when to take their breaks, based on their personal needs and the needs of their patients.
HB 1732 also includes the mandatory overtime prohibition except in emergencies. This is a necessary part of medicine’s system of on-call staffing. This system allows hospitals to meet the needs of all the patients in the unit— not just the emergencies. HB 1732 seeks to limit the situations where on-call nurses and other staff can be brought into work, which could result in postponing needed care for patients.
This bill will be heard in the House Labor Committee.
These bills are inflexible tools that limit nurses’ choices and are not proven to improve nursing care. These bills would require managers to be more rigid in scheduling break times, effectively eliminating staffs’ ability to decide when to take a break or how best to meet the needs of the patients. They would also weaken the state’s commitment to nurse staffing committees, which bring together nurses and managers to jointly write staffing plans. (Chelene Whiteaker, 206/216-2545)
“Extended Stay” (Specialty) Recovery Centers
A new Senate bill proposes to create “extended stay recovery centers” that would care for post-surgical patients for 72 hours after surgery, instead of the currently permitted time of 23 hours and 59 minutes.
The bill states that the aim is to serve patients who do not “require the trappings of an acute care hospital during their recovery period.” In the main, these “trappings” are state and federal regulations regarding quality and safety, including licensure standards, construction review, and the responsibility to report adverse events and infection rates.
These facilities would also not be bound by the federal Emergency Medical Treatment and Labor Act (EMTALA) that requires hospitals to provide care to patients regardless of their ability to pay.
And what if something goes wrong while the patient is at the extended care facility? The facility would call an ambulance and transfer the patient back to the hospital. Extended stay facilities would be required to have a transfer agreement with the local hospital, so that if a fragile, post-surgical patient should experience cardiac arrest, seizure, or stroke, he or she would then be brought to the hospital—hopefully in time.
This bill will be heard on Thursday in Senate Health Care. (Zosia Stanley, 206/216-2511)
WSHA Legislative Testimony: February 2-6
WSHA has, or is planning to, testify on the following bills:
Friday, January 30
HB 1403: Telemedicine (Senate Health Care). WSHA is again actively working and supporting this year’s telemedicine bill. The bill requires commercial and Medicaid health plans to reimburse providers for health care services delivered through audio and video technology. (Chelene Whiteaker, 206/216-2545)
Monday, February 2
SB 5460: Pre-packs (Senate Health Care). Allowing practitioners to prescribe and distribute prepackaged emergency medications to emergency room patients when a pharmacy is not available. See article above. (Ian Corbridge, 206/216-2514)
SB 5600: Regarding restraints (Senate Human Services and Mental Health &Housing). This bill seeks to identify the “improper” use of restraints as abuse. While the legislation is likely well-intended, some of the definitions in the bill are not appropriate for a medical setting, where restraints are sometimes needed for patient safety, and are used under strict guidelines and closer supervision. WSHA will seek to amend the bill. (Andrew Busz, 206/-216-2533)
Tuesday, February 3
HB 1357: Certificate of Need (House Health Care and Wellness). This bill removes kidney dialysis centers from the Certificate of Need review process. (Zosia Stanley, 206/216-2511)
HB 1733: Concerning nursing staffing practices at hospitals (House Health Care and Wellness). See nurse staffing article above. (Chelene Whiteaker, 206/216-2545)
HB 1732: Meal and rest breaks and mandatory overtime (House Labor). See nurse staffing article above. (Chelene Whiteaker, 206/216-2545)
SB 5645: Require the state to keep records of patients in need of psychiatric detention (Senate Human Services and Mental Health). See article above. (Chelene Whiteaker, 206/216-2545)
Wednesday, February 4
HB 1173: Prohibiting non-compete agreements in physician employment contracts. (Zosia Stanley, 206/216-2511)
Work session: Hospital Safety Net Assessment (Senate Ways and Means). See article above. (Claudia Sanders, 206/216-2508)
Thursday, February 5
SB 5149: Certificate of Need Appeals Process (Senate Health Care). Removes the ability for health care facilities and health maintenance organizations to appeal the grant of a certificate of need through the Department of Health adjudicative appeals proceeding. (Zosia Stanley, 206/216-2511 or Chelene Whiteaker, 206/216-2545)
SB 5453: Establishing extended stay recovery centers. (Senate Health Care). See article above. (Zosia Stanley, 206/216-2511)
Work session: Capital Funding for Mental Health (Senate Ways and Means). The capital budget does not currently include money dedicated to increasing mental health facilities, but adding funding would help local communities meet their mental health needs. (Andrew Busz, 206/-216-2533)
Friday, February 6
HB 1186: Notification of observation status (House Health Care and Wellness). Requires notification to patients in observation status at hospitals. (Andrew Busz, 206/-216-2533)
Thank you for last week!
Last week (January 26-30) was marked by several issues we feel passionately about. Improvements in the areas of telemedicine payment, suspect and inmate guarding, meeting our workforce needs and improvements to the All-Payer Claims Database are all issues of strong interest to WSHA and Washington State hospitals.
We are very thankful for everyone who came down to testify! Your testimony is essential for helping legislators and the public understand the real impact of proposed legislation. The following people have testified already this session:
- Donna Russell-Cook, CEO, St. Elizabeth Hospital
- Dr. John Scott, Medical Director, UW Telehealth
- Dr. Bryan King, Director of the Seattle Children’s Autism Center and Director of Child and Adolescent Psychiatry
- Karla Green, RN, PMH Medical Center
- Lucy Homans, Ed.D., Director of Professional Affairs and Legislative Consultant, Washington Psychological Association
- Dr. Scott Kennedy, Chief Medical Officer, Olympic Medical Center
