1-1 By: Glaze, et al (Senate Sponsor - Madla) H.B. No. 2446
1-2 (In the Senate - Received from the House April 27, 2001;
1-3 April 30, 2001, read first time and referred to Committee on Health
1-4 and Human Services; May 7, 2001, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 6, Nays 0;
1-6 May 7, 2001, sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR H.B. No. 2446 By: Madla
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to emergency medical services.
1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12 SECTION 1. Chapter 771, Health and Safety Code, is amended
1-13 by adding Subchapter E to read as follows:
1-14 SUBCHAPTER E. STATE EMERGENCY MEDICAL DISPATCH RESOURCE CENTER
1-15 Sec. 771.101. ESTABLISHMENT OF PILOT PROGRAM. (a) The Texas
1-16 Department of Health, with the assistance of the advisory council
1-17 appointed under Section 773.012, shall establish a pilot program to
1-18 test the efficacy of using emergency medical dispatchers located in
1-19 a regional emergency medical dispatch resource center to provide
1-20 lifesaving and other emergency medical instructions to persons who
1-21 need guidance while awaiting the arrival of emergency medical
1-22 personnel. The purpose of a regional emergency medical dispatch
1-23 resource center is not to dispatch personnel or equipment resources
1-24 but to serve as a resource to provide pre-arrival instructions that
1-25 may be accessed by selected public safety answering points that are
1-26 not adequately staffed or funded to provide those services.
1-27 (b) The commission shall provide technical assistance to the
1-28 department to facilitate the implementation of the pilot program.
1-29 (c) The department, with the cooperation of the advisory
1-30 council, shall:
1-31 (1) design criteria and protocols and provide
1-32 oversight as needed to conduct the pilot program;
1-33 (2) collect the necessary data to evaluate the outcome
1-34 of the pilot program; and
1-35 (3) report its findings to the legislature.
1-36 Sec. 771.102. PARTICIPATION IN PILOT PROGRAM. (a) The Texas
1-37 Department of Health shall determine which public safety answering
1-38 points are interested in participating in the pilot program.
1-39 (b) The department shall establish criteria for selecting
1-40 qualified public safety answering points to participate in the
1-41 pilot program.
1-42 (c) Participating public safety answering points must agree
1-43 to participate in any required training and to provide regular
1-44 reports required by the department for the pilot program.
1-45 Sec. 771.103. SELECTION OF REGIONAL EMERGENCY MEDICAL
1-46 DISPATCH RESOURCE CENTER. (a) The Texas Department of Health, with
1-47 the assistance of the advisory council, shall select one public
1-48 safety answering point to serve as the regional emergency medical
1-49 dispatch resource center. The public safety answering point
1-50 selected as the resource center for the pilot program must:
1-51 (1) have a fully functional quality assurance program
1-52 that measures each emergency medical dispatcher's compliance with
1-53 the medical protocol;
1-54 (2) have dispatch personnel who meet the requirements
1-55 for emergency medical dispatcher certification or the equivalent as
1-56 determined by the Texas Department of Health;
1-57 (3) use emergency medical dispatch protocols approved
1-58 by a physician medical director knowledgeable in emergency medical
1-59 dispatch;
1-60 (4) have sufficient experience in providing
1-61 pre-arrival instructions; and
1-62 (5) have sufficient resources to handle the additional
1-63 workload and responsibilities of the pilot program.
1-64 (b) In selecting an existing public safety answering point
2-1 to act as the resource center, the department and the advisory
2-2 council shall consider a public safety answering point's ability to
2-3 keep records and produce reports to measure the effectiveness of
2-4 the pilot program.
2-5 Sec. 771.104. CRITERIA FOR EMERGENCY MEDICAL DISPATCH
2-6 INTERVENTION. The department and the advisory council shall define
2-7 criteria that establish the need for emergency medical dispatch
2-8 intervention to be used by participating public safety answering
2-9 points to determine which calls are to be transferred to the
2-10 regional emergency medical dispatch resource center for emergency
2-11 medical dispatch intervention.
2-12 Sec. 771.105. FUNDING OF PILOT PROGRAM. Money in the 9-1-1
2-13 services fee fund may be appropriated to the Texas Department of
2-14 Health to fund the pilot program. The department is also
2-15 authorized to seek grant funding for the pilot program. The
2-16 provisions in this subchapter that require the department to
2-17 establish, conduct, and evaluate the pilot program are contingent
2-18 on the department receiving funding in accordance with this
2-19 section.
2-20 Sec. 771.106. REPORT TO LEGISLATURE. The department shall
2-21 report its findings to the presiding officer of each house of the
2-22 legislature no later than December 1, 2002.
2-23 Sec. 771.107. LIABILITY. The operations of the regional
2-24 emergency medical dispatch resource center are considered to be the
2-25 provision of 9-1-1 services for purposes of Section 771.053.
2-26 Employees of and volunteers at the center have the same protection
2-27 from liability as a member of the governing body of a public
2-28 agency under Section 771.053.
2-29 Sec. 771.108. EXPIRATION. This subchapter expires September
2-30 1, 2003.
2-31 SECTION 2. Section 773.012, Health and Safety Code, is
2-32 amended by amending Subsection (a) and adding Subsections (k) and
2-33 (l) to read as follows:
2-34 (a) The governor shall appoint an advisory council to advise
2-35 the board regarding matters related to the responsibilities of the
2-36 board, commissioner, and department under this chapter. In making
2-37 appointments to the advisory council, the governor shall ensure
2-38 that approximately one-half of the members of the advisory council
2-39 are residents of rural areas of the state.
2-40 (k) The advisory council shall assess the need for emergency
2-41 medical services in the rural areas of the state.
2-42 (l) The advisory council shall develop a strategic plan for:
2-43 (1) refining the educational requirements for
2-44 certification and maintaining certification as emergency medical
2-45 services personnel; and
2-46 (2) developing emergency medical services and trauma
2-47 care systems.
2-48 SECTION 3. Subchapter A, Chapter 773, Health and Safety Code,
2-49 is amended by adding Section 773.013 to read as follows:
2-50 Sec. 773.013. PEER ASSISTANCE PROGRAM. The department may
2-51 establish, approve, and fund a peer assistance program in
2-52 accordance with Section 467.003 and board rules.
2-53 SECTION 4. Subchapter A, Chapter 773, Health and Safety
2-54 Code, is amended by adding Section 773.014 to read as follows:
2-55 Sec. 773.014. ADMINISTRATION OF EPINEPHRINE. (a) An
2-56 emergency medical services provider and a first responder
2-57 organization may acquire and possess epinephrine auto-injector
2-58 devices in accordance with this section. Emergency medical
2-59 services personnel certified as emergency medical technicians or at
2-60 a higher level of training may carry and administer epinephrine
2-61 auto-injector devices in accordance with this section.
2-62 (b) The department shall adopt rules designed to protect the
2-63 public health and safety to implement this section. The rules must
2-64 provide that emergency medical services personnel certified as
2-65 emergency medical technicians or at a higher level of training may
2-66 administer an epinephrine auto-injector device to another only if
2-67 the person has successfully completed a training course, approved
2-68 by the department, in the use of the device that is consistent with
2-69 the national standard training curriculum for emergency medical
3-1 technicians.
3-2 (c) An emergency medical services provider or first
3-3 responder organization may acquire, possess, maintain, and dispose
3-4 of epinephrine auto-injector devices, and emergency medical
3-5 services personnel certified as emergency medical technicians or at
3-6 a higher level of training may carry, maintain, administer, and
3-7 dispose of epinephrine auto-injector devices, only in accordance
3-8 with:
3-9 (1) rules adopted by the department under this
3-10 section; and
3-11 (2) a delegated practice agreement that provides for
3-12 medical supervision by a licensed physician who either:
3-13 (A) acts as a medical director for an emergency
3-14 medical services system or a licensed hospital; or
3-15 (B) has knowledge and experience in the delivery
3-16 of emergency care.
3-17 (d) Emergency medical services personnel who administer
3-18 epinephrine auto-injector devices to others shall immediately
3-19 report the use to the physician supervising the activities of the
3-20 emergency medical services personnel.
3-21 (e) The administration of an epinephrine auto-injector
3-22 device to another under this section is considered to be the
3-23 administration of emergency care for the purposes of any statute
3-24 relating to liability for the provision of emergency care. The
3-25 administration of an epinephrine auto-injector device to another in
3-26 accordance with the requirements of this section does not
3-27 constitute the unlawful practice of any health care profession.
3-28 (f) A person otherwise authorized to sell or provide an
3-29 epinephrine auto-injector device to another may sell or provide the
3-30 devices to an emergency medical services provider or a first
3-31 responder organization authorized to acquire and possess the
3-32 devices under this section.
3-33 (g) This section does not prevent emergency medical services
3-34 personnel who are also licensed health care professionals under
3-35 another health care licensing law and who are authorized to
3-36 acquire, possess, and administer an epinephrine auto-injector
3-37 device under the other health care licensing law from acting under
3-38 the other law.
3-39 (h) This section does not impose a standard of care not
3-40 otherwise required by law.
3-41 SECTION 5. Section 773.025, Health and Safety Code, is
3-42 amended by adding Subsections (d) and (e) to read as follows:
3-43 (d) A governmental entity or nongovernmental organization
3-44 that sponsors or wishes to sponsor an emergency medical services
3-45 provider or first responder organization in a rural or underserved
3-46 area may request the bureau to provide or facilitate the provision
3-47 of initial training for emergency care attendants, if the training
3-48 is not available locally. The bureau shall ensure that the
3-49 training is provided. The bureau shall provide the training without
3-50 charge, or contract with qualified instructors to provide the
3-51 training without charge, to students who agree to perform emergency
3-52 care attendant services for at least one year with the local
3-53 emergency medical services provider or first responder
3-54 organization. The training must be provided at times and places
3-55 that are convenient to the students. The bureau shall require that
3-56 at least three students are scheduled to take any class offered
3-57 under this subsection.
3-58 (e) To facilitate all levels of emergency medical services
3-59 training, the bureau shall consult with and solicit comment from
3-60 emergency medical services providers, first responder
3-61 organizations, persons who provide emergency medical services
3-62 training, and other entities interested in emergency medical
3-63 services training programs.
3-64 SECTION 6. Section 773.095(a), Health and Safety Code, is
3-65 amended to read as follows:
3-66 (a) The proceedings and records of organized committees of
3-67 hospitals, medical societies, emergency medical services providers,
3-68 emergency medical services and trauma care systems, or first
3-69 responder organizations relating to the review, evaluation, or
4-1 improvement of an emergency medical services provider, a first
4-2 responder organization, an emergency medical services and trauma
4-3 care system, or emergency medical services personnel are
4-4 confidential and not subject to disclosure by court subpoena or
4-5 otherwise.
4-6 SECTION 7. Section 773.115(a), Health and Safety Code, is
4-7 amended to read as follows:
4-8 (a) The bureau may designate trauma facilities that are a
4-9 part of an emergency medical services and trauma care system. A
4-10 trauma facility shall be designated by the level of trauma care and
4-11 services provided in accordance with the American College of
4-12 Surgeons guidelines for level I and [,] II[, and III] trauma
4-13 facilities [centers] and rules adopted by the board for level III
4-14 and IV [and V] trauma facilities [centers]. In adopting rules
4-15 under this section, the board may consider trauma caseloads,
4-16 geographic boundaries, or minimum population requirements, but the
4-17 bureau may not deny designation solely on these criteria. The
4-18 board may not set an arbitrary limit on the number of facilities
4-19 designated as trauma facilities.
4-20 SECTION 8. Section 615.003, Government Code, is amended to
4-21 read as follows:
4-22 Sec. 615.003. APPLICABILITY. This chapter applies only to
4-23 eligible survivors of the following individuals:
4-24 (1) an individual elected, appointed, or employed as a
4-25 peace officer by the state or a political subdivision of the state
4-26 under Article 2.12, Code of Criminal Procedure, or other law;
4-27 (2) a paid probation officer appointed by the director
4-28 of a community supervision and corrections department who has the
4-29 duties set out in Section 76.002 and the qualifications set out in
4-30 Section 76.005, or who was appointed in accordance with prior law;
4-31 (3) a parole officer employed by the pardons and
4-32 paroles division of the Texas Department of Criminal Justice who
4-33 has the duties set out in Section 508.001 and the qualifications
4-34 set out in Section 508.113 or in prior law;
4-35 (4) a paid jailer;
4-36 (5) a member of an organized police reserve or
4-37 auxiliary unit who regularly assists peace officers in enforcing
4-38 criminal laws;
4-39 (6) a member of the class of employees of the
4-40 institutional division or the state jail division of the Texas
4-41 Department of Criminal Justice formally designated as custodial
4-42 personnel under Section 615.006 by the Texas Board of Criminal
4-43 Justice or its predecessor in function;
4-44 (7) a jailer or guard of a county jail who is
4-45 appointed by the sheriff and who:
4-46 (A) performs a security, custodial, or
4-47 supervisory function over the admittance, confinement, or discharge
4-48 of prisoners; and
4-49 (B) is certified by the [Texas] Commission on
4-50 Law Enforcement Officer Standards and Education;
4-51 (8) a juvenile correctional employee of the Texas
4-52 Youth Commission;
4-53 (9) an employee of the Texas Department of Mental
4-54 Health and Mental Retardation who:
4-55 (A) works at the department's maximum security
4-56 unit; or
4-57 (B) performs on-site services for the Texas
4-58 Department of Criminal Justice;
4-59 (10) an individual who is employed by the state or a
4-60 political or legal subdivision and is subject to certification by
4-61 the Texas Commission on Fire Protection;
4-62 (11) an individual employed by the state or a
4-63 political or legal subdivision whose principal duties are aircraft
4-64 crash and rescue fire fighting;
4-65 (12) a member of an organized volunteer fire-fighting
4-66 unit that:
4-67 (A) renders fire-fighting services without
4-68 remuneration;
4-69 (B) consists of not fewer than 20 active
5-1 members, a majority of whom are present at each meeting; and
5-2 (C) conducts a minimum of two drills each month,
5-3 each two hours long; or
5-4 (13) an individual who:
5-5 (A) performs emergency medical services or
5-6 operates an ambulance;
5-7 (B) is employed by a political subdivision of
5-8 the state or is an emergency medical services volunteer as defined
5-9 by Section 773.003, Health and Safety Code; and
5-10 (C) is qualified as an emergency care attendant
5-11 [medical technician] or at a higher level of training under Section
5-12 773.046, 773.047, 773.048, [or] 773.049, or 773.0495, Health and
5-13 Safety Code.
5-14 SECTION 9. Section 61.0285(a), Health and Safety Code, is
5-15 amended to read as follows:
5-16 (a) In addition to basic health care services provided under
5-17 Section 61.028, a county may, in accordance with department rules
5-18 adopted under Section 61.006, provide other medically necessary
5-19 services or supplies that the county determines to be
5-20 cost-effective, including:
5-21 (1) ambulatory surgical center services;
5-22 (2) diabetic and colostomy medical supplies and
5-23 equipment;
5-24 (3) durable medical equipment;
5-25 (4) home and community health care services;
5-26 (5) services provided by licensed master medical
5-27 social workers--advanced clinical practitioners;
5-28 (6) psychological counseling services;
5-29 (7) services provided by physician assistants, nurse
5-30 practitioners, certified nurse midwives, clinical nurse
5-31 specialists, and certified registered nurse anesthetists;
5-32 (8) dental care;
5-33 (9) vision care, including eyeglasses;
5-34 (10) services provided by federally qualified health
5-35 centers, as defined by 42 U.S.C. Section 1396d(l)(2)(B); [and]
5-36 (11) emergency medical services; and
5-37 (12) any other appropriate health care service
5-38 identified by board rule that may be determined to be
5-39 cost-effective.
5-40 SECTION 10. Section 106.043(b), Health and Safety Code, is
5-41 amended to read as follows:
5-42 (b) The advisory committee is composed of 13 [12] members
5-43 appointed by the executive committee and must include:
5-44 (1) a rural practicing family practice physician;
5-45 (2) a rural hospital administrator;
5-46 (3) a rural practicing registered professional nurse;
5-47 (4) a rural practicing allied health professional;
5-48 (5) a dean of a medical school;
5-49 (6) a dean of a nursing school;
5-50 (7) a dean of a school of allied health science;
5-51 (8) a head of a vocational/technical institution;
5-52 (9) a community college administrator;
5-53 (10) an individual knowledgeable in student financial
5-54 assistance programs;
5-55 (11) a rural public school superintendent; [and]
5-56 (12) a rural resident; and
5-57 (13) an individual who provides emergency medical
5-58 services in a rural area and who is certified or licensed as an
5-59 emergency care attendant or at a higher level of training under
5-60 Section 773.046, 773.047, 773.048, 773.049, or 773.0495.
5-61 SECTION 11. (a) Except as provided by Subsection (b) of
5-62 this section, this Act takes effect September 1, 2001.
5-63 (b) Section 773.014, Health and Safety Code, as added by
5-64 this Act, takes effect January 1, 2002, except that Section 773.014
5-65 takes effect September 1, 2001, for the limited purpose of allowing
5-66 the Texas Department of Health to adopt rules under that law that
5-67 may take effect before January 1, 2002.
5-68 (c) Before January 1, 2002, epinephrine auto-injector
5-69 devices may be carried and administered by certain emergency
6-1 medical services personnel to the extent allowed under the law that
6-2 exists before September 1, 2001.
6-3 * * * * *