State Issues

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 is involved in the regulatory phase.

The second set of draft regulations have been released for review and comment.  The chapter’s EMS Committee will provide comment to the Department of Health.

Since regulations further detail the intent of Act 37, and are considered to have the same authority as the law, the chapter will carefully review and provide timely comment to the Department of Health. Doing so will help ensure that the final-form regulations are good for patient care, the EMS system, and the specialty.

PaACEP supports additional safety measures for teen drivers

At a May 3 chapter-sponsored press event, PaACEP President Daniel Wehner, MD, FACEP, called on the state Senate to adopt House Bill 67. The bill includes provisions to upgrade and add additional life-saving measures to Pennsylvania’s teen Graduated Driver Licensing law.    

The House passed bill banned teenagers from using cell phones and sending text messages, limited a teenage driver to one nonfamily passenger under 18, and made the failure to buckle up a primary offense.  

On May 24 the Senate amended it to make texting and cell phone use while driving a secondary offense.  The Senate also included language to phase in the passenger limit. In addition, the Senate rejected an attempt to ban all drivers from texting and using handheld cell phones.

Since the Senate amended a House passed bill, it must return to the House for concurrence. The chapter is supporting the original House –passed version, and will request non-concurrence.

PaACEP eNews
House Bill 67
House Bill 2070
Fact Sheet
Fast Facts
Press Release
Dr. Dan Wehner's Speech
Editorial
Joint Editorial, PaACEP, PAMED, PA Chapter, American Academy of Pediatrics

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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

Last 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.

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 Pennsylvania Medical Society Board of Trustees is in support of this 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 President-Elect, 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.