HB-4518,As Passed House,Jun 12, 2003

SUBSTITUTE FOR

HOUSE BILL NO. 4518

                                                                             A bill to amend 1978 PA 368, entitled                                             

"Public health code,"                                                       

by amending section 20919 (MCL 333.20919), as amended by 2000 PA            

375.                                                                        

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

1       Sec. 20919.  (1) A local medical control authority shall                    

2   establish written protocols for the practice of life support                

3   agencies and licensed emergency medical services personnel within           

4   its region.  The protocols shall be developed and adopted in                

5   accordance with procedures established by the department and                

6   shall include all of the following:                                         

7       (a) The acts, tasks, or functions that may be performed by                  

8   each type of emergency medical services personnel licensed under            

9   this part.                                                                  

10      (b) Medical protocols to ensure the appropriate dispatching                 

1   of a life support agency based upon medical need and the                    

2   capability of the emergency medical services system.                        

3       (c) Protocols for complying with the Michigan                               

4   do-not-resuscitate procedure act, 1996 PA 193, MCL 333.1051 to              

5   333.1067.                                                                   

6       (d) Protocols defining the process, actions, and sanctions a                

7   medical control authority may use in holding a life support                 

8   agency or personnel accountable.                                            

9       (e) Protocols to ensure that if the medical control authority               

10  determines that an immediate threat to the public health, safety,           

11  or welfare exists, appropriate action to remove medical control             

12  can immediately be taken until the medical control authority has            

13  had the opportunity to review the matter at a medical control               

14  authority hearing.  The protocols shall require that the hearing            

15  is held within 3 business days after the medical control                    

16  authority's determination.                                                  

17      (f) Protocols to ensure that if medical control has been                    

18  removed from a participant in an emergency medical services                 

19  system, the participant does not provide prehospital care until             

20  medical control is reinstated, and that the medical control                 

21  authority that removed the medical control notifies the                     

22  department within 1 business day of the removal.                            

23      (g) Protocols that ensure a quality improvement program is in               

24  place within a medical control authority and provides data                  

25  protection as provided in 1967 PA 270, MCL 331.531 to 331.533.              

26      (h) Protocols to ensure that an appropriate appeals process                 

27  is in place.                                                                

1   (i) Within 1 year after the effective date of the amendatory                

2   act that added this subdivision, protocols to ensure that each              

3   life support agency that provides basic life support, limited               

4   advanced life support, or advanced life support is equipped with            

5   epinephrine or epinephrine auto-injectors and that each emergency           

6   services personnel authorized to provide those services is                  

7   properly trained to recognize an anaphylactic reaction, to                  

8   administer the epinephrine, and to dispose of the epinephrine               

9   auto-injector or vial.

10      (2) A protocol established under this section shall not                     

11  conflict with the Michigan do-not-resuscitate procedure act, 1996           

12  PA 193, MCL 333.1051 to 333.1067.                                           

13      (3) The procedures established by the department for                        

14  development and adoption of written protocols under this section            

15  shall comply with at least all of the following requirements:               

16      (a) At least 60 days before adoption of a protocol, the                     

17  medical control authority shall circulate a written draft of the            

18  proposed protocol to all significantly affected persons within              

19  the emergency medical services system served by the medical                 

20  control authority and submit the written draft to the department            

21  for approval.                                                               

22      (b) The department shall review a proposed protocol for                     

23  consistency with other protocols concerning similar subject                 

24  matter that have already been established in this state and shall           

25  consider any written comments received from interested persons in           

26  its review.                                                                 

27      (c) Not later than 60 days after receiving a written draft of               

1   a proposed protocol from a medical control authority, the                   

2   department shall provide a written recommendation to the medical            

3   control authority with any comments or suggested changes on the             

4   proposed protocol.  If the department does not respond within 60            

5   days after receiving the written draft, the proposed protocol               

6   shall be considered to be approved by the department.                       

7       (d) After department approval of a proposed protocol, the                   

8   medical control authority may formally adopt and implement the              

9   protocol.                                                                   

10      (e) A medical control authority may establish an emergency                  

11  protocol necessary to preserve the health or safety of                      

12  individuals within its jurisdiction in response to a present                

13  medical emergency or disaster without following the procedures              

14  established by the department under this section for an ordinary            

15  protocol.  An emergency protocol established under this                     

16  subdivision is effective only for a limited time period and does            

17  not take permanent effect unless it is approved according to this           

18  subsection.                                                                 

19      (4) A medical control authority shall provide an opportunity                

20  for an affected participant in an emergency medical services                

21  system to appeal a decision of the medical control authority.               

22  Following appeal, the medical control authority may affirm,                 

23  suspend, or revoke its original decision.  After appeals to the             

24  medical control authority have been exhausted, the affected                 

25  participant in an emergency medical services system may appeal              

26  the medical control authority's decision to the statewide                   

27  emergency medical services coordination committee.  The statewide           

1   emergency medical services coordination committee shall issue an            

2   opinion on whether the actions or decisions of the medical                  

3   control authority are in accordance with the department-approved            

4   protocols of the medical control authority and state law.  If the           

5   statewide emergency medical services coordination committee                 

6   determines in its opinion that the actions or decisions of the              

7   medical control authority are not in accordance with the medical            

8   control authority's department-approved protocols or with state             

9   law, the emergency medical services coordination committee shall            

10  recommend that the department take any enforcement action                   

11  authorized under this code.                                                 

12      (5) If adopted in protocols approved by the department, a                   

13  medical control authority may require life support agencies                 

14  within its region to meet reasonable additional standards for               

15  equipment and personnel, other than medical first responders,               

16  that may be more stringent than are otherwise required under this           

17  part.  If a medical control authority establishes additional                

18  standards for equipment and personnel, the medical control                  

19  authority and the department shall consider the medical and                 

20  economic impact on the local community, the need for communities            

21  to do long-term planning, and the availability of personnel.  If            

22  either the medical control authority or the department determines           

23  that negative medical or economic impacts outweigh the benefits             

24  of those additional standards as they affect public health,                 

25  safety, and welfare, protocols containing those additional                  

26  standards shall not be adopted.                                             

27  (6) If adopted in protocols approved by the department, a                   

1   local medical control authority may require medical first                   

2   response services and licensed medical first responders within              

3   its region to meet additional standards for equipment and                   

4   personnel to ensure that each medical first response service is             

5   equipped with an epinephrine auto-injector, and that each                   

6   licensed medical first responder is properly trained to recognize           

7   an anaphylactic reaction and to administer and dispose of the               

8   epinephrine auto-injector, if a life support agency that provides           

9   basic life support, limited advanced life support, or advanced              

10  life support is not readily available in that location.

11  (7)  (6)  If a decision of the medical control authority                    

12  under subsection (5) or (6) is appealed by an affected person,              

13  the medical control authority shall make available, in writing,             

14  the medical and economic information it considered in making its            

15  decision.  On appeal, the statewide emergency medical services              

16  coordination committee shall review this information under                  

17  subsection (4) and shall issue its findings in writing.