HF 2593 (LSB 5426YH (4) 91)

HOUSE FILE 2593

BY  R. JOHNSON

A BILL FOR

An Act relating to infant and maternal care at health care facilities.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  SHORT TITLE.  This Act shall be known and may be cited as “The Amir Act”.
    Sec. 2.  NEW SECTION.  135E.1  Legislative findings and intent.
   1.  The general assembly finds all of the following:
   a.  Infant and maternal mortality remain critical public health concerns in this state.
   b.  Preventable harm and death can occur when patient and caregiver concerns, particularly concerns raised by mothers, are dismissed, delayed, or not adequately escalated within medical settings.
   c.  Parents and guardians are often the first to recognize signs of distress or decline in an infant.
   d.  Health care systems must ensure that concerns raised by patients, caregivers, parents, and guardians are taken seriously, documented, and promptly evaluated.
   2.  The general assembly intends for this chapter to accomplish all of the following:
   a.  Strengthen protections for infants and mothers.
   b.  Ensure timely medical response when a patient, caregiver, parent, or guardian expresses concerns regarding the condition of an infant or the infant’s mother.
   c.  Establish clear accountability and escalation protocols in health care facilities.
   d.  Reduce preventable infant and maternal morbidity and mortality.
    Sec. 3.  NEW SECTION.  135E.2  Definitions.
   For purposes of this chapter, unless the context otherwise requires:
   1.  “Caregiver” means a parent, legal guardian, legal custodian, or primary caregiver for an infant.
   2.  “Caregiver concern” means a verbal or written expression by a caregiver indicating the belief that an infant or the infant’s mother is experiencing distress, deterioration, or abnormal symptoms.
   3.  “Department” means the department of health and human services.
   4.  “Escalation protocol” means a formal process requiring review by a clinician in a supervisory position or a care team.
   5.  “Health care facility” means any of the following:
   a.  A hospital as defined in section 135B.1.
   b.  A birth center as defined in section 135.131.
   c.  A birthing hospital as defined in section 135.131.
   d.  Other medical facilities licensed to provide infant or maternal care in this state.
   6.  “Infant” means a child under one year of age.
   7.  “Infant rapid response process” means a series of actions a health care facility must immediately take to evaluate the condition of an infant, determine whether the infant’s care needs to be altered, and execute the altered care if necessary.
    Sec. 4.  NEW SECTION.  135E.3  Caregiver concern —— escalation protocols.
   1.  Each health care facility shall adopt and implement a caregiver concern escalation protocol for infant and maternal patients.
   2.  When a health care facility receives a caregiver concern, the health care facility shall do all of the following:
   a.  Provide the individual who expressed the caregiver concern an acknowledgment that the health care facility has received and will act on the caregiver concern as soon as practicable.
   b.  Document the caregiver concern in the medical record for the infant or mother to whom the caregiver concern relates.
   c.  Conduct an assessment of the caregiver concern as soon as practicable.
   d.  Refer the caregiver concern to a physician in a supervisory position, a neonatal specialist, or a rapid response team if any of the following occurs:
   (1)  The caregiver that expressed the caregiver concern believes the issue that gave rise to the caregiver concern remains unresolved after the health care facility assessed the infant or mother.
   (2)  Upon request by the caregiver that expressed the caregiver concern.
   3.  A health care facility or health care provider shall not do any of the following in response to a caregiver concern:
   a.  Retaliate against the caregiver, the caregiver’s infant, or the mother who is the subject of the caregiver concern.
   b.  Discharge the caregiver’s infant or the mother who is the subject of the caregiver concern from the health care facility or the health care provider’s care.
   c.  Dismiss the caregiver concern without taking action.
    Sec. 5.  NEW SECTION.  135E.4  Infant rapid response process.
   1.  A health care facility that provides care to infants shall maintain an infant rapid response process that may be initiated by any of the following:
   a.  Medical staff attending an infant.
   b.  A caregiver when the caregiver believes the condition of the caregiver’s infant is worsening.
   2.  When the infant rapid response process is initiated, a physician shall immediately evaluate the condition of the infant who is the subject of the infant rapid response process.
    Sec. 6.  NEW SECTION.  135E.5  Family and patient advocacy notice.
   1.  Each health care facility shall provide a written and verbal notice to an infant’s caregivers when the infant is brought to the health care facility to receive treatment. The written and verbal notice shall include a statement that the caregiver is entitled to the following rights under this chapter:
   a.  The right to make and have caregiver concerns documented.
   b.  The right to request a higher acuity of care for the caregiver’s infant or the infant’s mother, as applicable.
   c.  The right to initiate an infant rapid response process.
   2.  Each health care facility where infants receive treatment shall display a written notice that contains the information in subsection 1, paragraphs “a” through “c”, in a prominent location.
    Sec. 7.  NEW SECTION.  135E.6  Training requirements.
   All health care facility staff who provide, or assist in the provision of, infant or maternal care shall receive annual training on all of the following:
   1.  Implicit bias and patient communication.
   2.  Recognizing caregiver-reported warning signs.
   3.  Proper use of escalation protocols and infant rapid response processes.
    Sec. 8.  NEW SECTION.  135E.7  Rules.
   1.  The department shall adopt rules pursuant to chapter 17A to do all of the following:
   a.  Implement and administer section 135E.5, including but not limited to all of the following:
   (1)  Rules establishing minimum hours of annual training.
   (2)  Rules establishing which classes and training programs qualify for credit.
   (3)  Other rules related to training that the department deems relevant to effectuate the intent of this chapter.
   b.  Require each health care facility to provide data relating to all incidents with adverse outcomes when a caregiver requested a higher acuity of care for the caregiver’s infant or when an infant rapid response process was initiated.
   2.  The department of inspections, appeals, and licensing shall adopt rules pursuant to chapter 17A to implement, administer, and enforce this chapter. Rules relating to enforcement shall include the corrective action plans, administrative penalties, or licensure review for a person found in violation of this chapter.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to infant and maternal care at a health care facility (facility).
   The bill shall be known and may be cited as “The Amir Act”. The bill states several legislative findings and the intent of the bill.
   The bill defines “caregiver” as a parent, legal guardian, legal custodian, or primary caregiver for an infant.
   The bill defines “caregiver concern” as a verbal or written expression by a caregiver indicating the belief that an infant or the infant’s mother is experiencing distress, deterioration, or abnormal symptoms.
   The bill defines “escalation protocol” as a formal process requiring review by a clinician in a supervisory position or a care team.
   The bill defines “health care facility” (facility) as a hospital, a birth center, a birthing hospital, or other medical facilities licensed to provide infant or maternal care in this state.
   The bill defines “infant rapid response process” as a series of actions a facility must immediately take to evaluate the condition of an infant, determine whether the infant’s care needs to be altered, and execute the altered care if necessary.
   The bill also defines “department” and “infant”.
   The bill requires each facility to adopt and implement a caregiver concern escalation protocol for infant and maternal patients, and requires a facility to take certain actions specified in the bill when the facility receives a caregiver concern.
   The bill prohibits a facility or health care provider from retaliating against a caregiver, an infant, or a mother, or discharging an infant or a mother, due to the fact a caregiver expressed a caregiver concern. The bill also prohibits a facility from dismissing a caregiver concern without taking action.
   The bill requires a facility that provides care to infants to maintain an infant rapid response process that may be initiated by medical staff attending an infant, or a caregiver when the caregiver believes the condition of the caregiver’s infant is worsening. When an infant rapid response process is initiated, a physician shall immediately evaluate the infant’s condition.
   The bill requires a facility to provide written and verbal notice to an infant’s caregivers when the infant is brought to the facility to receive treatment. The written and verbal notice shall include a statement that the caregiver is entitled to certain rights under the bill, and the written notice must be displayed in a prominent location where infants receive treatment.
   The bill requires all facility staff who provide, or assist in the provision of, infant or maternal care to receive annual training as specified in the bill.
   The bill requires the department of health and human services to adopt rules relating to facility staff training and requiring each facility to provide data relating to all incidents with adverse outcomes when a caregiver requested a higher acuity of care for the caregiver’s infant, or when an infant rapid response process was initiated.
   The bill requires the department of inspections, appeals, and licensing to adopt rules to implement, administer, and enforce the bill. Rules relating to enforcement must include corrective action plans, administrative penalties, or licensure review for a person found in violation of the bill.