S.F. _____ Section 1. Section 135B.9, Code 2009, is amended to read as 1 follows: 2 135B.9 Inspections and qualifications for hospital 3 inspectors —— protection and advocacy agency investigations. 4 1. The department shall make or cause to be made inspections 5 as it deems necessary in order to determine compliance with 6 applicable rules. Hospital inspectors shall meet the following 7 qualifications: 8 a. Upon hire, have been employed in a hospital within 9 the last five years and have current knowledge of hospital 10 operations. 11 b. Be free of conflicts of interest. A hospital 12 inspector shall not participate in an inspection or complaint 13 investigation of a hospital in which the inspector or a member 14 of the inspector’s immediate family works or has worked within 15 the last five years. For purposes of this paragraph, “immediate 16 family member” means a spouse; natural or adoptive parent, 17 child, or sibling; or stepparent, stepchild, or stepsibling. 18 c. Complete a yearly conflict of interest disclosure 19 statement. The department shall submit an annual conflict of 20 interest disclosure report compiling such conflict of interest 21 information to the hospital licensing board. 22 d. Biannually, complete a minimum of ten hours of continuing 23 education pertaining to hospital operations including but not 24 limited to quality and process improvement standards, trauma 25 system standards, and regulatory requirements. 26 2. In the state resource centers and state mental health 27 institutes operated by the department of human services, the 28 designated protection and advocacy agency as provided in 29 section 135C.2, subsection 4, shall have the authority to 30 investigate all complaints of abuse and neglect of persons 31 with developmental disabilities or mental illnesses if the 32 complaints are reported to the protection and advocacy agency 33 or if there is probable cause to believe that the abuse has 34 occurred. Such authority shall include the examination of all 35 -1- LSB 5594XC (4) 83 rh/nh 1/ 7

S.F. _____ records pertaining to the care provided to the residents and 1 contact or interview with any resident, employee, or any other 2 person who might have knowledge about the operation of the 3 institution. 4 Sec. 2. Section 135B.11, Code Supplement 2009, is amended 5 to read as follows: 6 135B.11 Functions of hospital licensing board —— 7 compensation. 8 1. The hospital licensing board shall have the following 9 responsibilities and duties: 10 a. To consult with and advise the department in matters of 11 policy affecting administration of this chapter the licensure 12 of hospitals in this state , and in the development of rules 13 and standards provided for under this chapter. This advisory 14 function shall be construed broadly and shall not be limited to 15 licensure issues pursuant to this chapter. 16 b. To review and approve rules and standards authorized 17 under this chapter prior to their approval by the state board 18 of health and adoption by the department. 19 c. To make recommendations on practice issues and policy. 20 d. To review and approve proposed educational programs 21 provided with licensure fee funds. The educational programs 22 provided may cover any subject matter relating to the licensure 23 and operation of hospitals and is not limited to licensure 24 issues pursuant to this chapter. 25 2. Each member of the board may also be eligible to receive 26 compensation as provided in section 7E.6. 27 Sec. 3. Section 235E.1, subsection 5, paragraph b, Code 28 2009, is amended by adding the following new subparagraphs: 29 NEW SUBPARAGRAPH . (4) Circumstances in which a caretaker 30 makes an error in professional judgment or medical care in the 31 care of a dependent adult regardless of the outcome. 32 NEW SUBPARAGRAPH . (5) Circumstances in which a caretaker 33 who is providing security at a facility who, in the process of 34 providing protection to the patients and staff at the facility, 35 -2- LSB 5594XC (4) 83 rh/nh 2/ 7

S.F. _____ injures a dependent adult. 1 NEW SUBPARAGRAPH . (6) Circumstances in which a caretaker 2 responds to another caretaker’s request for assistance in an 3 emergency situation and a dependent adult is injured as a 4 result of the emergency response. 5 Sec. 4. Section 235E.1, Code 2009, is amended by adding the 6 following new subsections: 7 NEW SUBSECTION . 6A. “Gross negligence” means an act or 8 omission by a caretaker where the caretaker does all of the 9 following: 10 a. Has knowledge of the peril to be apprehended. 11 b. Has knowledge that injury is a probable, as opposed to a 12 possible, result of the peril. 13 c. Consciously fails to avoid the peril. 14 NEW SUBSECTION . 12. “Willful misconduct” means an 15 intentional act committed with disregard for a known or obvious 16 risk with the expectation that harm will follow. 17 Sec. 5. Section 235E.2, subsection 2, Code Supplement 2009, 18 is amended to read as follows: 19 2. a. A staff member or employee of a facility or program 20 who, in the course of employment, directly examines, attends, 21 counsels, or treats a dependent adult in a facility or program 22 and reasonably believes the dependent adult has suffered 23 dependent adult abuse, shall report the suspected dependent 24 adult abuse to the department. 25 b. A staff member or employee of a facility or program 26 who, in the course of employment, provides indirect treatment 27 or services to a dependent adult in a facility or program 28 and who reasonably believes the dependent adult has suffered 29 dependent adult abuse may report the dependent adult abuse 30 to the department. For purposes of this paragraph, “indirect 31 treatment or services” includes treatment or services provided 32 without person-to-person contact such as those provided 33 by administrative, dietary, housekeeping, and maintenance 34 employees. A staff member or employee of a facility or program 35 -3- LSB 5594XC (4) 83 rh/nh 3/ 7

S.F. _____ who provides indirect treatment or services shall, during an 1 orientation program, receive training regarding the prevention, 2 intervention, and detection of dependent adult abuse and 3 neglect and related reporting requirements. 4 c. Persons with de minimus contact with dependent adults 5 in a facility or program shall not be considered staff members 6 or employees for purposes of this section. Persons with de 7 minimus contact include those persons present in a facility 8 or program for a limited purpose, those persons who are not 9 present in a facility or program on a regular basis, and those 10 persons who do not provide any treatment or services to the 11 dependent adults in the facility or program. Such persons 12 include but are not limited to part-time volunteers, building 13 contractors, and repair workers. 14 Sec. 6. Section 235E.2, Code Supplement 2009, is amended by 15 adding the following new subsection: 16 NEW SUBSECTION . 14. When a caretaker in a facility or 17 program is accused of dependent adult abuse, the department has 18 reason to believe that dependent adult abuse has occurred, and 19 the caretaker wishes to appeal this determination, all of the 20 following shall occur before the caretaker’s name is listed on 21 the dependent adult abuse registry: 22 a. The caretaker shall have the right to an emergency 23 adjudicative proceeding pursuant to section 17A.18A before 24 an administrative law judge to determine whether the 25 caretaker shall be allowed to continue employment in the 26 facility or program or whether the caretaker may be placed 27 on administrative leave while waiting for a contested case 28 hearing pursuant to section 17A.12. The emergency adjudicative 29 proceeding shall take place within five business days of the 30 department’s allegation that dependent adult abuse occurred. 31 b. The administrative law judge shall determine if 32 the caretaker shall be allowed to continue employment 33 in the facility or program and in what capacity. If the 34 administrative law judge determines that the caretaker shall 35 -4- LSB 5594XC (4) 83 rh/nh 4/ 7

S.F. _____ not continue employment, the caretaker may be placed on 1 administrative leave. 2 c. A contested case hearing on whether dependent adult 3 abuse occurred shall take place within forty-five days of the 4 informal hearing in the manner provided by section 17A.12. 5 EXPLANATION 6 This bill provides for certain requirements for health 7 care facilities and programs including hospitals. The 8 bill establishes explicit qualifications for persons who 9 inspect hospitals. Inspectors must have been employed in a 10 hospital, be free of conflicts of interest, and obtain biannual 11 continuing education. 12 The bill also revises the role of the hospital licensing 13 board by enumerating the specific duties of the board, 14 including advising the department of inspections and appeals 15 concerning hospital licensure, approving legislative proposals, 16 making recommendations on practice issues and policy, and 17 reviewing and approving educational programs provided through 18 licensure fee funds. 19 The bill provides certain exclusions from the definition 20 of dependent adult abuse in a facility or program under Code 21 chapter 235E, including circumstances in which a caretaker 22 makes an error in professional judgment or medical care in 23 the care of a dependent adult regardless of the outcome, 24 circumstances in which a caretaker who is providing security at 25 a facility who, in the process of providing protection to the 26 patients and staff at the facility, injures a dependent adult, 27 and circumstances in which a caretaker responds to another 28 caretaker’s request for assistance in an emergency situation 29 and a dependent adult is injured as a result of the emergency 30 response. Under Code chapter 235E, a facility is defined as 31 a health care facility as defined in Code section 135C.1 or 32 a hospital as defined in Code section 135B.1, and a program 33 is defined as an elder group home as defined in Code section 34 231B.1, an assisted living program certified under Code section 35 -5- LSB 5594XC (4) 83 rh/nh 5/ 7

S.F. _____ 231C.3, or an adult day services program as defined in Code 1 section 231D.1. 2 The bill defines “gross negligence” and “willful misconduct” 3 for purposes of the definition of dependent adult abuse in 4 Code chapter 235E. “Gross negligence” is defined as an act or 5 omission by a caretaker where the caretaker has knowledge of 6 the peril to be apprehended, has knowledge that injury is a 7 probable, as opposed to a possible, result of the peril, and 8 consciously fails to avoid the peril. “Willful misconduct” 9 is defined as an intentional act committed with disregard for 10 a known or obvious risk with the expectation that harm will 11 follow. 12 The bill provides that a staff member or employee of 13 a facility or program who, in the course of employment, 14 provides indirect treatment or services to a dependent 15 adult in a facility or program and who reasonably believes 16 the dependent adult has suffered dependent adult abuse may 17 report the dependent adult abuse to the department. Indirect 18 treatment or services includes treatment or services provided 19 without person-to-person contact such as those provided 20 by administrative, dietary, housekeeping, and maintenance 21 employees. The bill requires a staff member or employee of a 22 facility or program who provides indirect treatment or services 23 to receive training regarding the prevention, intervention, 24 and detection of dependent adult abuse and neglect and related 25 reporting requirements. Persons with de minimus patient 26 contact shall not be considered staff members or employees for 27 purposes of the bill. 28 The bill provides an administrative review process for a 29 caretaker in a facility or program who is accused of dependent 30 adult abuse. The caretaker shall have the right to an 31 emergency adjudicative proceeding pursuant to Code section 32 17A.18A before an administrative law judge to determine if 33 the caretaker shall be allowed to continue employment in the 34 facility or program or whether the caretaker may be placed on 35 -6- LSB 5594XC (4) 83 rh/nh 6/ 7

S.F. _____ administrative leave while waiting for a contested case hearing 1 pursuant to Code section 17A.12 and an informal preliminary 2 hearing shall take place within five business days of the 3 department’s allegation that dependent adult abuse occurred. 4 An administrative law judge shall determine if the caretaker 5 shall be allowed to continue employment in the facility or 6 program and in what capacity and if not, whether the caretaker 7 may be placed on administrative leave. A contested case 8 hearing on whether dependent adult abuse occurred is required 9 to be held within 45 days of the emergency adjudicative 10 proceeding in the manner provided by Code section 17A.12. 11 -7- LSB 5594XC (4) 83 rh/nh 7/ 7