State Issues

Meeting with the Secretary of Health

On June 15 President Michael Turturro, MD, FACEP, President-Elect Daniel Wehner, MD, MBA, FACEP, Vice President Henry Unger, MD, FACEP, and Past President John Kelly, DO, FACEP, met with the new Secretary of Health, Everette James. The meeting allowed the opportunity to get acquainted, speak about the specialty of emergency medicine with Secretary James, discuss our Full Capacity Protocol (FCP) project, and review proposed regulations that would restrict all nurses except CRNA’s from giving any type of sedation, which would have significant impact in emergency departments. 

Working with the Department of Health on Full Capacity Protocol Pilot Study

The FCP is a pre-designated plan, pre-approved by the Pennsylvania Department of Health (PaDOH), to expediently decompress an ED of stabilized, admitted patients in order to allow patients arriving by ambulance or through the waiting room to be more promptly evaluated by an ED practitioner. The FCP allows for transfer of appropriate admitted patients being held in the ED to pre-designated, nontraditional areas in the inpatient area of the hospital, such as Day Surgery, PACU, and/or beds placed in atria or hallways. The chapter has worked closely with the DOH, and the following PA hospital’s protocols are operational: • Hospital of the University of Pennsylvania • UPMC Mercy • UPMC Presbyterian-Shadyside • York Hospital • The Children’s Hospital of Philadelphia
Metrics are being currently being collected to ensure that the FCP is a safe (and better) alternative than allowing admitted patients to be boarded for hours in ED’s.

Comments Submitted Regarding Urgicare Center Regulations

This summer, regulations were proposed by the Pennsylvania Department of Health (DOH) that would require hospitals to establish a separate area of the hospital to provide treatment for urgent care services on a 24/7 basis, or enter into a contractual arrangement with an entity located within 15 miles from the hospital. PaACEP leadership responded to these regulations at their meeting with the Secretary of Health. They relayed concerns, specifically that there are a number of serious EMTALA violations and that the intent to reduce ED crowding would not be realized if the regulations are adopted. The chapter also sent a formal letter to the DOH detailing specific concerns and encouraged member ED directors to forward concerns to the DOH. There has been no movement on this issue since that time.

New EMS Act (37) Finally Passed

On August 18, 2009, Governor Rendell signed Act 37 of 2009. The new EMS Act declares that “[EMS] is an essential public service and frequently the health care safety net for many Commonwealth residents.” The new Act has many system features that will improve the quality and safety of the patient care delivered by EMS personnel in the Commonwealth, and the leadership of physician medical directors will be integral to these improvements. The chapter was involved in this rewrite, and will continue to be involved in the regulatory phase.

Clear and Convincing Standard

The malpractice crisis has continued to plague physicians and influence the way they practice, in direct opposition of claims that the crisis is over. As tort reform is not a popular topic in legislature, the chapter has recently decided to pursue a different tactic. In Pennsylvania, verdicts in medical liability cases are based on the burden of proof standard of “preponderance of the evidence.” This means, that in order for the jury to render a plaintiff’s verdict, they need to agree that it was more likely than not that malpractice occurred. This is distinctly different than the “beyond a reasonable doubt” standard, which is typical in criminal cases. However, another standard exists. “Clear and convincing evidence” is a higher level of burden of proof and requires a plaintiff to demonstrate that their allegations are substantially more likely than not. This standard could encourage attorneys not to pursue marginal cases, resulting in decreased liability premiums and increased availability of liability insurance, which in turn could enhance patient access to care. The chapter has already favorably introduced this concept with the Pennsylvania Medical Society Specialty Cabinet. A motion was then passed at the Pennsylvania Medical Society Board of Trustees meeting to support the adoption of the stricter standard of clear and convincing evidence as the basic standard of proof required to prevail in medical liability cases against physicians. Although this project will be very time-intensive and complete with challenges, it is an initiative which PaACEP is committed to fighting with the help and support of members.

Loan Forgiveness

The Governor introduced a plan to expand health care coverage to most uninsured in Pennsylvania. Rep. Josh Shapiro (D-Montgomery) then added an amendment to create a Physician Retention Loan Forgiveness Program for family practice, internists, and pediatricians. In an effort to have emergency medicine included, Henry Unger, MD, FACEP, PaACEP Vice President, met with Representative Shapiro and provided PaACEP workforce survey results drawn from clinical departments and residency programs throughout the state. The chapter will continue in their attempts since emergency medicine physicians are sorely needed in many parts of the state.