On June 18, 2010, the Illinois Department of Public Health (Department) issued a Notice of Proposed Amendments to the Hospital Licensing Requirements, which implements two statutes enacted by the Illinois General Assembly in 2009.
Medical Staff Due Process
The first significant proposed amendment provides additional procedural rights to medical staff physicians who may have quality of care issues. Specifically, the proposed change provides for a faster review of summary suspensions of medical staff membership or clinical privileges. The current regulation only requires that a fair hearing commence within 15 days of the suspension. The new amendment, however, requires that upon the suspended physician’s request, the governance committee of the medical staff is to meet “as soon as is reasonably possible” to review the suspension and recommend whether it should be affirmed, lifted, expunged or modified. In addition, a summary suspension cannot be implemented unless there is actual documentation or other reliable information that an immediate danger to the public exists. The proposed change does not eliminate the requirement that a fair hearing be commenced within 15 days. The proposed amendment also allows a physician to review and respond to an adverse external review during the peer review process.
While the current trend in increasing patient quality of care is to tie it to provider reimbursement, either by penalizing hospitals with preventable readmissions or sharing cost savings through accountable care organizations, these amendments serve as a reminder that internal medical staff review processes remain important and vital tools for ensuring patient safety.
Vaccination Programs
The second major amendment builds upon a prior regulation issued by the Department earlier this June that requires health care facilities to provide all their health care employees with education on influenza, and offer them the opportunity to receive influenza vaccines during the influenza season unless the vaccine is unavailable. The most recent regulation now requires hospitals to also have procedures for offering influenza vaccines “when available” between September 1 and April 1, and pneumococcal vaccines upon admission or discharge to patients aged 65 and older.
Providers should also be aware that although the General Assembly granted pharmacists the power to administer vaccines to persons 14 years and older, pursuant to a doctor’s standing order (for the general public), nurses have not been afforded this same power. The view of the Illinois Department for Financial and Professional Regulation (IDFPR) is that a physician/patient relationship must exist along with a patient-specific prescription in order for a nurse to administer a vaccine. The IDFPR’s interpretation is not well known among vaccine providers in the State of Illinois as it has become common practice to have nurses administer vaccines without a physician’s standing order.
In order to get around this problem with the H1N1 vaccine, last year the IDFPR issued an emergency proclamation that temporarily gave nurses the authority to administer vaccines pursuant to a standing order; however, this proclamation is no longer in place and only applied to public vaccine initiatives, not private initiatives. As of the publication of this e-alert, it is unclear whether the IDFPR will issue another proclamation for the upcoming flue season or how IDFPR’s interpretation will be handled by the many public agencies and private vaccine providers during this time.
Despite these issues with public administration of vaccines, it is clear that the Department is focused on ensuring that persons who are most susceptible to the influenza virus are at least presented with the option of receiving the vaccine. As we are currently in the midst of the planning period for the seasonal influenza vaccine, providers need to make certain that they are making the correct changes to their internal procedures to respond to the directives of the Department on this important public health issue.
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