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Rhode Island Laws Governing
Medical Error Reporting and Patient Safety

Table of Contents
Selected Health and Safety Statutes
Title 23

23-17 – Licensing of Health Care Facilities (website)
SECTION   DESCRIPTION
Information confidential
Reports public
Rights of Patients
Privileges and immunities for peer review activities
Hospital events reporting
Quality standards for volume related tertiary services
 
23-17.17 – Health Care Quality Program (website)
SECTION   DESCRIPTION
Purpose.
Definitions.
Establishment of health care quality performance measurement and reporting program.
Program requirements – Adoption of rules and regulations.
Annual Report.
Health care quality steering committee.
 

23-17 – Licensing of Health Care Facilities

  • § 23-17-15Information confidential.

    Information received by the licensing agency through filed reports, inspection, or as otherwise authorized under this chapter shall not be disclosed publicly in any manner that identifies individuals except in a proceeding involving the question of licensure.

  • § 23-17-15.1Reports public.

    Copies of survey reports from the joint commission on accreditation of health care organizations and the American Osteopathic Association and any other reports from other accrediting organizations incorporated by reference in the reports, provided to the licensing agency by hospitals shall be public records as defined in chapter 2 of title 38.

  • § 23-17-19.1Rights of patients. [Effective July 1, 2004]

    Every health care facility licensed under this chapter shall observe the following standards and any other standards that may be prescribed in rules and regulations promulgated by the licensing agency with respect to each patient who utilizes the facility:

    • (1) The patient shall be afforded considerate and respectful care.
    • (2) Upon request, the patient shall be furnished with the name of the physician responsible for coordinating his or her care.
    • (3) Upon request, the patient shall be furnished with the name of the physician or other person responsible for conducting any specific test or other medical procedure performed by the health care facility in connection with the patient's treatment.
    • (4) The patient shall have the right to refuse any treatment by the health care facility to the extent permitted by law.
    • (5) The patient's right to privacy shall be respected to the extent consistent with providing adequate medical care to the patient and with the efficient administration of the health care facility. Nothing in this section shall be construed to preclude discreet discussion of a patient's case or examination of appropriate medical personnel.
    • (6) The patient's right to privacy and confidentiality shall extend to all records pertaining to the patient's treatment except as otherwise provided by law.
    • (7) The health care facility shall respond in a reasonable manner to the request of a patient's physician, certified nurse practitioner and/or a physician's assistant for medical services to the patient. The health care facility shall also respond in a reasonable manner to the patient's request for other services customarily rendered by the health care facility to the extent the services do not require the approval of the patient's physician, certified nurse practitioner and/or a physician's assistant or are not inconsistent with the patient's treatment.
    • (8) Before transferring a patient to another facility, the health care facility must first inform the patient of the need for and alternatives to a transfer.
    • (9) Upon request, the patient shall be furnished with the identities of all other health care and educational institutions that the health care facility has authorized to participate in the patient's treatment and the nature of the relationship between the institutions and the health care facility.
    • (10) If the health care facility proposes to use the patient in any human experimentation project, it shall first thoroughly inform the patient of the proposal and offer the patient the right to refuse to participate in the project.
    • (11) Upon request, the patient shall be allowed to examine and shall be given an explanation of the bill rendered by the health care facility irrespective of the source of payment of the bill.
    • (12) Upon request, the patient shall be permitted to examine any pertinent health care facility rules and regulations that specifically govern the patient's treatment.
    • (13) The patient shall be offered treatment without discrimination as to race, color, religion, national origin, or source of payment.
    • (14) Patients shall be provided with a summarized medical bill within thirty (30) days of discharge from a health care facility. Upon request, the patient shall be furnished with an itemized copy of his or her bill. When patients are residents of state-operated institutions and facilities, the provisions of this subsection shall not apply.
    • (15) Upon request, the patient shall be allowed the use of a personal television set provided that the television complies with underwriters' laboratory standards and O.S.H.A. standards, and so long as the television set is classified as a portable television.
    • (16) No charge shall be made for furnishing a health record or part of a health record to a patient, his or her attorney or authorized representative if the record or part of the record is necessary for the purpose of supporting an appeal under any provision of the Social Security Act, 42 U.S.C. § 301 et seq., and the request is accompanied by documentation of the appeal or a claim under the provisions of the Workers' Compensation Act, chapters 29 – 38 of title 28. A provider shall furnish a health record requested pursuant to this section within thirty (30) days of the request. Further, for patients of school based health centers, the director is authorized to specify by regulation an alternative list of age appropriate rights commensurate with this section.
    • (17) The patient shall have the right to have his or her pain assessed on a regular basis.
    • (18) Notwithstanding any other provisions of this section, upon request, patients receiving care through hospitals, nursing homes, assisted living residences and home health care providers, shall have the right to receive information concerning hospice care, including the benefits of hospice care, the cost, and how to enroll in hospice care.
  • § 23-17-25Privileges and immunities for peer review activities.
    • (a) Neither the proceedings nor the records of peer review boards as defined in § 5-37-1 shall be subject to discovery or be admissible in evidence in any case save litigation arising out of the imposition of sanctions upon a physician. However, any imposition or notice of a restriction of privileges or a requirement of supervision imposed on a physician for unprofessional conduct as defined in § 5-37-5.1 shall be subject to discovery and be admissible in any proceeding against the physician for performing, or against any health care facility or health care provider which allows the physician to perform the medical procedures which are the subject of the restriction or supervision during the period of the restriction or supervision or subsequent to that period. Nothing contained in this section shall apply to records made in the regular course of business by a hospital or other provider of health care information. Documents or records otherwise available from original sources are not to be construed as immune from discovery or used in any civil proceedings merely because they were presented during the proceedings of the committee.
    • (b) There shall be no monetary liability on the part of, and no cause of action for damages shall arise against, any member of a duly appointed peer review board operated pursuant to written by-laws, for any act or proceeding undertaken or performed within the scope of the functions of any peer review board.
    • (c) There shall be no monetary liability on the part of, and no cause of action for damage shall arise against, any person on account of the communication of information in the possession of the person to any peer review board or the board of medical licensure and discipline, when the communication is intended to aid in the evaluation of the qualifications, fitness, or character of a practitioner of the healing arts, and does not represent as true any matter not reasonably believed to be true.
    • (d) Any peer review processes authorized by statute and carried out in good faith shall have the benefit of the state action exemption to the state antitrust law.
  • § 23-17-40Hospital events reporting (enacted in 1994 via Public Laws 94-52 and 94-126)
    • (a) Reportable events as defined in subsection (b) shall be reported to the department of health division of facilities regulation on a telephone number maintained for that purpose. Hospitals shall report incidents as defined in subsection (b) within twenty-four (24) hours of when the accident occurred or if later, within twenty-four (24) hours of receipt of information causing the hospital to believe that a reportable event has occurred.
    • (b) Reportable events are defined as follows:
      • (1)
        • (i) Fires or internal disasters in the facility which disrupt the provisions of patient care services or cause harm to patients or personnel;
        • (ii) Poisoning involving patients of the facility;
        • (iii) Infection outbreaks as defined by the department in regulation;
        • (iv) Kidnapping and inpatient psychiatric elopements and elopements by minors;
        • (v) Strikes by personnel;
        • (vi) Disasters or other emergency situations external to the hospital environment which adversely affect facility operations; and
        • (vii) Unscheduled termination of any services vital to the continued safe operation of the facility or to the health and safety of its patients and personnel.
      • (2) Any hospital filing a report with the attorney general's office concerning abuse, neglect and mistreatment of patients as defined in chapter 17.8 of this title shall forward a copy of the report to the department of health. In addition, a copy of all hospital notifications and reports made in compliance with the federal Safe Medical Devices Act of 1990, 21 U.S.C. § 301 et seq., shall be forwarded to the department of health within the time specified in the federal law.
    • (c) Any reportable incident in a hospital that results in patient injury as defined in subsection (d) shall be reported to the department of health with seventy-two (72) hours or when the hospital has reasonable cause to believe that an incident as defined in subsection (d) has occurred. The department of health shall promulgate rules and regulations outlining the process whereby health care professionals with knowledge of an incident shall report it to the hospital. In its reports, no personal identifiers shall be included. The hospital shall require the appropriate committee within the hospital to carry out a peer review process to determine whether the incident was within the normal range of outcomes, given the patient's condition. The hospital shall notify the department of the outcome of the internal review, and if the findings determine that the incident was within the normal range of patient outcomes no further action is required. If the findings conclude that the incident was not within the normal range of patient outcomes, the hospital will provide to the department of health the following information:
      • (1) An explanation of the circumstances surrounding the incident;
      • (2) An updated assessment of the effect of the incident on the patient;
      • (3) A summary of current patient status including follow-up care provided and post-incident diagnosis; and
      • (4) A summary of all actions taken to correct identified problems to prevent recurrence of the incident and/or to improve overall patient care and to comply with other requirements of this section.
    • (d) Incidents to be reported are those causing or involving:
      • (1) Brain injury;
      • (2) Mental impairment;
      • (3) Paraplegia;
      • (4) Quadriplegia;
      • (5) Any type of paralysis;
      • (6) Loss of use of limb or organ;
      • (7) Hospital stay extended due to serious or unforeseen complications;
      • (8) Birth injury;
      • (9) Impairment of sight or hearing;
      • (10) Surgery on the wrong patient;
      • (11) Subjecting a patient to a procedure other than that ordered or intended by the patient's attending physican;
      • (12) Any other incident that is reported to their malpractice insurance carrier or self-insurance program;
      • (13) Suicide of a patient during treatment or within five (5) days of discharge from an inpatient or outpatient unit (if known);
      • (14) Blood transfusion error; and
      • (15) Any serious or unforeseen complication, that is not expected or probable, resulting in an extended hospital stay or death of the patient.
    • (e) This section does not replace other reporting required by this chapter.
    • (f) Nothing in this section shall prohibit the department from investigating any event or incident.
    • (g) All reports to the department under this section shall be subject to the provisions of § 23-17-15. In addition, all reports under this section, together with the peer review records and proceedings related to events and incidents so reported and the participants in the proceedings shall be deemed entitled to all the privileges and immunities for peer review records set forth in § 23-17-25.
    • (h) The department shall issue an annual report by March 31 each year providing aggregate summary information on the events and incidents reported by hospitals as required by this chapter. A copy of the report shall be forwarded to the governor, the speaker of the house, the senate president and members of the health care quality steering committee established pursuant to § 23-17.17-6.
  • § 23-17-45Quality standards for volume related tertiary services

    The director is authorized to establish through regulation quality and volume related standards to be achieved and maintained for specific tertiary health care services offered by individual licensed health care facilities where peer reviewed medical and health literature establishes significant relationships between desired quality related outcomes and volume of services provided. The standards shall include time frames for achieving stipulated volumes of services. In developing the standards the director shall seek input from affected providers and the public at large. The director may accept in regulation the standards of and the accreditation from recognized national accrediting entities in lieu of standards and assessments otherwise developed pursuant to this section.

23-17.17 – Health Care Quality Program

  • § 23-17.17-1Purpose. – The legislature finds that:
    • (a)
      • (1) The health care service system is under transition;
      • (2) The growth of managed care and utilization review, the merger of facilities and regionalization of care systems, and increased competition and conversions from nonprofit to for-profit status, are evidence of this transition;
      • (3) The changes have created strong public interest in issues relating to quality of care and access to health services, and require careful monitoring of quality of care issues and new and improved public sector approaches to measuring, evaluating and improving quality;
      • (4) It is an important public health function to promote quality in the state's health care system by developing a health care quality performance measures and reporting program to guide quality improvement initiatives.
  • § 23-17.17-2Definitions
    • (a) “Clinical outcomes” means information about the results of patient care and treatment.
    • (b) “Director” means the director of the department of health or his or her duly authorized agent.
    • (c) “Health care facility” has the same meaning as contained in the regulations promulgated by the director of health pursuant to chapter 17 of this title.
    • (d) “Patient satisfaction” means the degree to which the facility or provider meets or exceeds the patients' expectations as perceived by the patient by focusing on those aspects of care that the patient can judge.
    • (e) “Quality of care” means the result or outcome of health care efforts.
    • (f) “Risk-adjusted” means the use of statistically valid techniques to account for patient variables that may include, but need not to be limited to, age, chronic disease history, and physiologic data.
    • (g) “Performance measure” means a quantitative tool that provides an indication of an organization's performance in relation to a specified process or outcome.
    • (h) “Reporting program” means an objective feedback mechanism regarding individual or facility performance that can be used internally to support performance improvement activities and externally to demonstrate accountability to the public and other purchasers, payers, and stakeholders.
  • § 23-17.17-3Establishment of health care quality performance measurement and reporting program.

    The director of health is authorized and directed to develop a state health care quality performance measurement and reporting program. The health care quality performance measurement and reporting program shall include quality performance measures and reporting for health care facilities licensed in Rhode Island. The program shall be phased in over a multi-year period and shall begin with the establishment of a program of quality performance measurement and reporting for hospitals. In subsequent years, quality performance measurement and reporting requirements will be established for other types of health care facilities such as nursing facilities, home nursing care providers, and other licensed facilities as determined by the director of health. Prior to developing and implementing a quality performance measurement and reporting program for hospitals or any other health care facility, the director shall seek public comment regarding the type of performance measures to be used and the methods and format for collecting the data.

  • § 23-17.17-4Program requirements – Adoption of rules and regulations.
    • (a) The quality performance measurement and reporting program established under this chapter shall, at a minimum, incorporate the following:
      • (1) A standardized data set of clinical performance measures, risk-adjusted for patient variables, that shall be collected and reported periodically to the department, and
      • (2) Comparable, statistically valid patient satisfaction measures that shall be conducted periodically by facilities and reported to the department.
    • (b) In accordance with the provisions of § 42-35-3, the director is authorized to adopt, promulgate, and enforce rules and regulations designed to implement the provisions of this chapter including the details and format for the periodic reporting requirements.
  • § 23-17.17-5Annual Report.
    • (a) The director shall prepare and submit by January fifteenth (15th) of each year an annual report to the general assembly and governor on the status of the health care quality performance measurement and reporting program. The annual report shall include information on trends in health care quality performance measures, identify areas for quality improvement initiatives, and program plans and objectives for future years. The first annual report shall include:
      • (1) Progress to date in implementing the health care quality performance measurement and reporting program for hospitals,
      • (2) A proposed timetable for adding additional types of licensed facilities to the health care quality performance measurement and reporting program, and
      • (3) A study of a cost-sharing mechanism for the operational costs of the health care quality performance measurement and reporting program.
    • (b) The director shall also prepare a statewide quality performance measurement report using the data collected from the quality performance measurement and reporting program. The report, based on risk-adjusted, scientifically valid, data-driven mechanisms, shall be made available to the public to show how individual facilities compare and to help identify both exemplary performance and best practices to facilitate the provision of bench marking services to health care organizations.
  • § 23-17.17-6Health care quality steering committee.
    • (a) The director shall establish and serve as chairperson of a health care quality steering committee of no more than nineteen (19) members to advise in the following matters:
      • (1) Determination of the comparable performance measures to be reported on;
      • (2) Assessment of factors, including, but not limited to, factors related to incidents and events reported to the department pursuant to § 23-17-40, contributing to the provision of quality health care and patient safety;
      • (3) Selection of the patient satisfaction survey measures and instrument;
      • (4) Methods and format for data collection;
      • (5) Program expansion and quality improvement initiatives;
      • (6) Format for the public quality performance measurement report;
      • (7) Consideration of nursing-sensitive performance measures to be reported on;
      • (8) Consideration of the relationship between human resources and quality, beginning with measurement and reporting for nursing staff; and
      • (9) Other related issues as requested by the director.
    • (b) The members of the health care quality performance steering committee shall include one member of the house of representatives, to be appointed by the speaker; one member of the senate, to be appointed by the president of the senate; the director or director's designee of the department of human services; the director or the director's designee of the department of mental health, retardation, and hospitals; the director or the director's designee of the department of elderly affairs; and thirteen (13) members to be appointed by the director of the department of health to include persons representing Rhode Island licensed hospitals and other licensed facilities/providers, the medical and nursing professions, the business community, organized labor, consumers, and health insurers and health plans and other parties committed to health care quality.
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