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COMMITTEE REPORT
April 1, 2004
H. 4262
Introduced by Reps. Neilson, Barfield, Bales, Cobb-Hunter, Clyburn, Martin, J. Hines, Rutherford, J. Brown, Hosey, Hayes, J.E. Smith, Altman, Anthony, Bailey, Battle, Branham, Emory, Freeman, Harvin, M. Hines, Keegan, Kennedy, Koon, Leach, Rhoad, Richardson, Rivers, Scarborough, Simrill, J.R. Smith, Snow, Thompson, Young, Walker, Clemmons, Lourie, Sandifer, Owens, Clark, Weeks, McLeod, Whipper, Allen and Jennings
S. Printed 4/1/04--H. [SEC 4/5/04 3:29 PM]
Read the first time May 21, 2003.
To whom was referred a Bill (H. 4262) to amend Chapter 61, Title 44, Code of Laws of South Carolina, 1976, by adding Article 5 so as to authorize the Department of Health and Environmental Control to establish a State Trauma Care System, etc., respectfully
That they have duly and carefully considered the same and recommend that the same do pass with amendment:
Amend the bill, as and if amended, Section 44-61-520(D) as contained in SECTION 1, page 5, at line 9, by deleting /October 1, 2003/ and inserting /the effective date of this article/. So when amended SECTION 44-61-520(D) will read:
/ (D) Within one year of the effective date of regulations promulgated pursuant to this article, a Trauma Center designated prior to the effective date of this article, which wishes to remain a designated Trauma Center, must comply with the provisions of this article and submit an application and obtain approval by the department to maintain its status as a designated trauma center./
Amend the bill further, Section 44-61-540(C) as contained in SECTION 1, page 7 by deleting subsection (C) in its entirety and inserting:
/(C) If there is adequate funding in the State Trauma Fund, the department shall promulgate regulations to establish the distribution of funds in accordance with the purposes stated in subsection (B). The department is solely responsible for determining the priority of distributions and may use contracts with other agencies, including the Department of Health and Human Services, in the distribution of these funds./
Amend the bill further, by striking Section 44-61-540(E) as contained in SECTION 1, page 8, by deleting subsection (E) in its entirety and inserting:
/(E) All of the department's duties pursuant to this article including the requirement to promulgate regulations are contingent upon adequate funding to cover the department's operating and administrative costs. If adequate funding does not exist in the State Trauma Fund, the department is not obligated to carry out any duties pursuant to this article./
Amend the bill further, by deleting Section 2 in its entirety and inserting:
/SECTION 2. This act takes effect upon approval by the Governor./
Renumber sections to conform.
Amend title to conform.
ROBERT W. HARRELL, JR. for Committee.
TO AMEND CHAPTER 61, TITLE 44, CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING ARTICLE 5 SO AS TO AUTHORIZE THE DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL TO ESTABLISH A STATE TRAUMA CARE SYSTEM TO ENSURE PROVISION OF TRAUMA SERVICES TO RESIDENTS THROUGHOUT THE STATE; TO PROVIDE, AMONG OTHER THINGS, THAT THE DEPARTMENT MAY ESTABLISH STANDARDS FOR LEVELS OF TRAUMA CENTER DESIGNATIONS AND TO PROVIDE FOR THE FURTHER REGULATION OF SUCH CENTERS; TO ESTABLISH THE TRAUMA ADVISORY COUNCIL TO ADVISE THE DEPARTMENT ON THE DEVELOPMENT OF THE TRAUMA CARE SYSTEM; AND TO ESTABLISH THE TRAUMA CARE FUND FOR PAYMENT OF THE DEPARTMENT'S EXPENSES IN ESTABLISHING ADMINISTERING, AND OVERSEEING THE STATE TRAUMA CARE SYSTEM.
Whereas, the General Assembly finds that:
(1) Trauma is a severe health problem in this State and a major cause of death and long-term disability.
(2) Trauma care is an essential public service.
(3) Trauma care is significantly limited in many parts of South Carolina, particularly in rural areas where there is a growing danger that some communities may be left without adequate emergency medical care.
(4) It is essential for persons in need of trauma care to receive that care within the sixty minute period immediately following injury. It is during this period, referred to as the "golden hour", when the potential for survival is greatest, and the need for treatment for shock or injury is most critical.
(5) Trauma centers save lives and save money because access to trauma care can mean the difference between full recovery from a traumatic injury and serious disability necessitating expensive long-term care and loss of economic productivity.
(6) It is in the best interests of the citizens of South Carolina to establish an efficient and well-coordinated statewide trauma system to reduce costs of medical care and the greater economic impact of lost wages and productivity and to reduce the incidence of inappropriate and inadequate trauma care and emergency medical service.
(7) The goals and objectives of a statewide trauma system are to:
(a) pursue trauma prevention and education activities relating to traumatic injury;
(b) provide optimal care for trauma victims;
(c) prevent unnecessary death and disability from trauma without regard to insurance or ability to pay;
(d) utilize protocols statewide;
(e) contain costs of trauma care and trauma system implementation; and
(f) minimize the economic impact of lost wages and productivity; and
Whereas, the purpose of this act is to create within the Department of Health and Environmental Control a Trauma Section to develop and implement a comprehensive trauma care system that provides guidelines for the care of trauma victims and that is fully integrated with all available resources including, but not limited to, existing emergency medical services providers, hospitals, or other health care providers which would like to participate in the program. Now, therefore,
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 61, Title 44 of the 1976 Code is amended by adding:
Section 44-61-510. As used in this article:
(1) 'Department' means the South Carolina Department of Health and Environmental Control.
(2) 'Designation' means a formal determination by the department that a hospital or healthcare facility is capable of providing a specified level of trauma care services.
(3) 'Emergency Medical Services Advisory Council' means the emergency medical services council created in Section 44-61-30(c).
(4) 'Participating providers' means those providers that have been approved by the department for participation in the trauma system and include, but are not limited to, designated trauma centers, designated rehabilitation facilities, and designated fee for service physicians who provide trauma care within a designated facility.
(5) 'State Trauma Advisory Council' means the state advisory council created in this article.
(6) 'Trauma' means a major injury or wound to a living person caused by the application of an external force or by violence and the requiring immediate medical or surgical intervention to prevent death or permanent disability. For the purposes of this article, the definition of 'trauma' must be determined by current national medical standards including, but not limited to, trauma severity scales.
(7) 'Trauma Care Facility' or 'Trauma Center' means a hospital that has been designated by the department according to the rules and regulations set forth by the department to provide trauma care services at a particular level.
(8) 'Trauma Registry' means a statewide data base of information collected by the department including, but not limited to, the incidence, severity, and causes of trauma and the care and outcomes for certain types of injuries.
(9) 'Trauma System' means an organized statewide and regional system of care for the trauma patient, including the department, emergency medical service providers, hospitals, in-patient rehabilitation providers, and other providers who have agreed to participate in and coordinate with and who have been accepted by the department in an organized statewide system.
(10) 'Trauma System Fund' means the separate fund established pursuant to this article for the department to create and administer the State Trauma System.
(11) 'Verification' means the department's inspection of a participating facility in order to determine whether the facility is capable of providing a designated level of trauma care.
Section 44-61-520. (A) The Department of Health and Environmental Control, with the advice of the Trauma Advisory Council, established pursuant to Section 44-61-530, may develop standards and promulgate regulations for the creation and establishment of a State Trauma Care System to promote access to trauma care for all residents of the State.
(B) In developing this system, the department shall take into consideration current recognized national standards for trauma care systems including, but not limited to, standards for trauma care cited in 'Resources for Optimal Care of the Injured Patient' adopted by the American College of Surgeons' Committee on Trauma and the guidelines for trauma care systems adopted by the American College of Emergency Physicians.
(C) All authority and responsibility for the Trauma Care System is vested in the department and the department may:
(1) establish minimum standards for levels of designation as a trauma center, consistent with this article, through regulations promulgated by the department;
(2) require facilities applying for trauma center designation or other participation in the Trauma Care System to submit an application in a manner and form prescribed by the department;
(3) conduct on-site inspections and reviews of facilities seeking designation or participation in the Trauma Care System. As part of this process, the department may review or request records and other information it considers reasonably necessary to determine a facility's ability to comply with the minimum trauma care standards set by the department for a particular level or type of designation;
(4) when appropriate, designate applicant hospitals as trauma centers, which are authorized to provide a level of trauma care based on criteria established pursuant to this article;
(5) periodically verify, or inspect, or both, designated trauma centers and other participating providers to assure compliance with the provisions of this article and regulations promulgated pursuant to this article. Information received by the department through filed reports, inspections, or as otherwise authorized under this article must not be disclosed publicly in such a manner as to identify individuals or hospitals or other participating providers except in proceedings involving the denial, change or revocation of a trauma center designation or type, the imposition of a fine, or the determination that a provider is no longer eligible to participate in the Trauma Care System;
(6) promote access to quality trauma care by encouraging facilities in all areas of the State to participate in the trauma system and to attempt to meet the minimum standards as established by the department pursuant to this article;
(7) oversee a continuing quality improvement system for the statewide Trauma Care System.
(D) Within one year of the effective date of regulations promulgated pursuant to this article, a Trauma Center designated prior to October 1, 2003, which wishes to remain a designated Trauma Center, must comply with the provisions of this article and submit an application and obtain approval by the department to maintain its status as a designated trauma center.
(E)(1) The department may immediately revoke or change a trauma center's designation if the trauma center fails to meet prescribed requirements for designation at a particular level or no longer meets established standards and criteria.
(2) The department may immediately determine that a participating facility or provider is no longer eligible for participation in the trauma system and remove that provider from the system or impose a fine, or both, if the facility or provider no longer meets established standards and criteria.
(F) The department may fine any provider or facility that displays an inaccurate trauma center designation or holds itself out to be a designated trauma care center or participating trauma care system provider without first obtaining the department's approval and meeting established criteria for participation or designation or provides false information to the department or otherwise violates the conditions of this article or regulations promulgated pursuant to this article. The department may also levy fines on any licensed emergency medical service provider found out of compliance with this or other related emergency medical service statutes or regulations. Maximum and minimum fine limits must be established in regulation.
(G) The Trauma Fund, established pursuant to Section 44-61-540, may retain fines collected pursuant to this article up to an amount of twenty-five thousand dollars per fiscal year. Amounts collected in excess of twenty-five thousand dollars per fiscal year must be deposited into the general fund of the State.
(H) An appeal of a department decision involving an application, the revocation or changing of a designation, or a decision involving fines imposed under this article are governed by the Administrative Procedures Act.
Section 44-61-530. (A) There is established the Trauma Advisory Council composed of the following members to be appointed by the director of the department for terms of three years and members may be reappointed:
(1) a surgeon who oversees trauma care at each designated level, upon the recommendation of the South Carolina Chapter of the American College of Surgeons;
(2) a hospital administrator from each designated level, upon the recommendation of the South Carolina Hospital Association;
(3) a hospital administrator from a nondesignated facility, upon the recommendation of the South Carolina Hospital Association;
(4) an emergency physician representative from each designated level, upon the recommendation of the South Carolina Chapter of the College of Emergency Physicians;
(5) a trauma nurse coordinator from each designated level, upon the recommendation of the Trauma Association of South Carolina;
(6) the Chairman of the South Carolina Department of Health and Environmental Control's Medical Control Committee;
(7) one public and one private field emergency medical services provider, upon the recommendation of the Emergency Medical Services Association;
(8) a physician, upon the recommendation of the South Carolina Medical Association;
(9) the Chairman of the Committee on Trauma of the South Carolina Chapter of the American College of Surgeons;
(10) a rehabilitation center administrator, upon the recommendation of the South Carolina Hospital Association;
(11) the Chairman of the Emergency Medical Services Advisory Council of the South Carolina Department of Health and Environmental Control;
(12) a representative from the South Carolina State Office of Rural Health;
(13) a third party payor representative, upon the recommendation of the Insurance Commissioner;
(14) a consumer representative appointed by the director;
(15) a representative from the South Carolina Department of Disabilities and Special Needs;
(16) a representative from the South Carolina Department of Health and Human Services.
(B) The Chairman of the Trauma Advisory Council must be appointed by the director of the department from the membership of the council. The council members shall select a vice chairman from their membership. The council shall meet at least twice a year or at the call of the chairman. The council is authorized to create an executive committee made up of the chairman and vice chairman and no more than five other members from the membership of the council. The department's Emergency Medical Services Division shall provide staff support to the council.
(C) The Trauma Advisory Council shall act as an advisory body for trauma care system development and provide technical support to the department in areas of trauma care system design, trauma standards, data collection and evaluation, quality improvement, trauma system funding, and evaluation of the trauma care system and trauma care programs.
Section 44-61-540. (A) There is created the South Carolina State Trauma Care Fund. In addition to those monies appropriated to the fund in the general appropriations act, the fund may receive gifts, bequests, grants, fees, or other contributions or donations from public or private entities.
(B) The fund must be a separate and distinct fund for the payment of the Department of Health and Environmental Control's expenses in establishing, administering, and overseeing the Trauma Care System. After the payment of the department's operating expenses from the fund, the department may authorize and allocate the distribution of any remaining funds for any or all of the following purposes:
(1) distribution of financial aid to participating providers using a formula based on criteria and factors identified in regulations promulgated by the department pursuant to this article. All providers receiving funds must be located within this State;
(2) distribution of any remaining funds for grants for proposals related to trauma care in this State which may include, but are not limited to, research, injury prevention, education, and planning and development of related services under this article;
(3) other expenses or providers considered appropriate by the department related to the purposes of this article.
(C) The department shall promulgate regulations to establish the distribution of funds in accordance with the purposes stated in subsection (B), the department shall determine the priority of distributions and may contract with other agencies, including the Department of Health and Human Services.
(D) Money remaining in the fund at the end of a fiscal year carries forward to the next fiscal year for the purposes stated in this article. If the trauma system ceases to exist and money remains in the Trauma Fund, the remaining money must be distributed in accordance with this article.
(E) The department's duties under this article are contingent upon adequate funding to cover the department's operating and administrative costs. If inadequate funding exists in the State Trauma Fund, the department is not obligated to carry out any duties under this article.
Section 44-61-550. (A) The department may establish a trauma data collection and evaluation system, known as the 'Trauma Registry'. The Trauma Registry must be designed to include, but must not be limited to, trauma studies, patient care and outcomes, compliance with standards of verification, and types and severity of injuries in the State.
(B) The department may collect, as considered necessary and appropriate, data and information regarding patients admitted to a facility through the emergency department, through a trauma center, or directly to a special care unit. Data and information must be collected in a manner that protects and maintains the confidential nature of patient and staff identifying information.
(C) Records and reports made pursuant to this section must be held confidential within the department and must not be available to the public, admissible as evidence, or subject to discovery by subpoena. Information that identifies individual patients must not be disclosed publicly without the patient's consent.
(D) All data collection and data inquiry activity shall follow federally established Health Insurance Portability and Accountability Act guidelines."
SECTION 2. This act takes effect October 1, 2003.
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