03/06/08 0808s

14May2008… 1536h

14May2008… 1864h

2008 SESSION

08-2795

01/09

SENATE BILL 512-FN

COMMITTEE: Health and Human Services

AMENDED ANALYSIS

This bill:

I. Authorizes the commissioner of the department of health and human services to establish temporary acute care centers for the delivery of medical services if there is a public health emergency.

II. Reestablishes the laws regarding public health emergency management powers and the safe disposal of corpses, both of which were repealed in 2002.

III. Establishes a commission to study the authority to practice or provide health and medical care in the event of a public health emergency.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/06/08 0808s

14May2008… 1536h

14May2008… 1864h

08-2795

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Eight

Be it Enacted by the Senate and House of Representatives in General Court convened:

271:1 New Subdivision; Public Health Powers and Duties; Safe Disposal of Corpses; Oversight Committee. Amend RSA 21-P by inserting after section 52 the following new subdivision:

Public Health Emergency Management Powers

21-P:53 Public Health Powers and Duties. During the existence of a state of emergency under this chapter, the commissioner of health and human services shall have the following powers and duties, subject to the direction and control of the governor, which are in addition to those set forth in RSA 141-C; provided that such powers and duties shall be limited to the specific nature of the emergency, its geographic limits, and the conditions that brought it about, as specified in the declaration of the state of emergency:

I. The commissioner shall have the responsibility and authority to carry out all public health activities within the state in cooperation and collaboration with the division of homeland security and emergency management.

II. The commissioner may, without the approval of the governor’s council or the legislative fiscal committee, and notwithstanding the provisions of RSA 4:45, 9:13-d, and 9:19, and any other law to the contrary, purchase and distribute anti-toxins, serums, vaccines, immunizing agents, antibiotics, and other pharmaceutical agents that the commissioner deems to be in the interest of public health.

III. If there is a statewide or regional shortage or threatened shortage of any anti-toxins, serums, vaccines, immunizing agents, antibiotics, and other pharmaceutical agents, the commissioner may control, restrict, and ration the use, sale, dispensing, distribution, or transportation of such products as necessary to best protect the health, safety, and welfare of the people of this state. In making rationing or other supply and distribution decisions, the commissioner shall determine high risk or critical need groups that shall receive priority for such products.

IV. The commissioner may investigate any incident or imminent threat of any disease or health condition that may be caused by a natural disaster, radiation or chemical exposure, or the release of any microorganism, infectious substance, or naturally occurring or manufactured biological product, that poses a risk of a significant number of human fatalities or incidents of permanent or long-term disability. Such investigations may include requiring information from any health care provider or other person affected by, or having information related to, the incident or threat, inspections of buildings and conveyances and their contents, laboratory analysis of samples collected during the course of such inspections, and requiring a physical examination and the provision of specimens of body secretions, excretions, fluids, and discharges for laboratory examination of any person having a disease or health condition that necessitates an investigation under this paragraph.

V. The commissioner may order a person to undergo such medical care as may be necessary to treat or prevent an incident or threat of disease or other health condition prompting an investigation pursuant to paragraph IV. Such care may include immunization of individuals as necessary to prevent the spread of contagious disease, except that an individual may refuse treatment or immunization pursuant to the provisions of RSA 141-C:15, VI.

VI. Any order compelling an investigation, physical examination, the provision of specimens, medical treatment or care, or immunization, and any other order of the commissioner under this chapter, shall be subject to the due process requirements of RSA 141-C:14-a.

VII. The department of health and human services shall acquire and retain only the minimum amount of information, specimens, and samples relating to individuals necessary to carry out its obligations under this section. Any genetic testing of specimens and samples shall be limited to the viruses, bacteria, fungi, or other microorganisms therein. Personally identifiable information shall not be acquired or retained unless necessary for the department to carry out its responsibilities under this section, RSA 141-C, or any other provision of law. Such information shall not be retained beyond the duration of the state of emergency without the approval of the governor and executive council, which information shall be subject to the confidentiality provisions of RSA 141-C:10.

21-P:54 Safe Disposal of Corpses. During the existence of a state of emergency under this chapter, the commissioner of health and human services shall have the following powers and duties, subject to the direction and control of the governor, which are in addition to those set forth in RSA 141-C; provided that such powers and duties shall be limited to the specific nature of the emergency, its geographic limits, and the conditions that brought it about, as specified in the declaration of the state of emergency:

(a) Adopt and enforce such measures to provide for the safe disposal of corpses as may be necessary for the health and welfare of the community;

(b) Take possession and control of any corpse and direct the embalming, burial, cremation, interment, disinterment, transportation, and disposal of corpses;

(c) Compel any business or facility authorized to embalm, bury, cremate, inter, disinter, transport, and dispose of corpses under the laws of this state to accept any corpse or provide the use of its business or facility if such actions are necessary for emergency response;

(d) Compel any business or facility authorized to embalm, bury, cremate, inter, disinter, transport, and dispose of corpses under the laws of this state to clearly label any corpse with all available information necessary to identify the decedent and the apparent cause of death;

(e) Compel any business or facility authorized to embalm, bury, cremate, inter, disinter, transport, and dispose of corpses under the laws of this state having custody of a corpse of a person known or believed to have had an infectious disease to clearly label the corpse with a tag indicating that the corpse is so infected and indicating, if known, the infectious disease; and

(f) Compel every person in charge of disposing of any corpse to maintain a written record of each corpse and all available information to identify the decedent.

II. In carrying out the foregoing actions, the department, to the extent feasible under the circumstances, shall adhere to the religious practices and preferences of the decedents where known.

III. The costs of embalming, cremation, burial, or other disposal of a corpse pursuant to this section shall be a cost to the estate of the decedent and shall be a necessary expense of the funeral and burial of the decedent pursuant to RSA 554:19, II.

IV. Any taking of real or personal property in this section shall be subject to the provisions of RSA 4:46.

271:2 Due Process; Communicable Disease; Emergency Powers. Amend RSA 141-C:14-a, I to read as follows:

I. Any person subject to an order [to submit] for submission of a specimen [under RSA 141-C], or for examination, immunization, treatment, isolation, [or] quarantine, provision of information, inspection of a building or conveyance, or any other order of the commissioner under this chapter or RSA 21-P:53, may request a hearing in the superior court to contest such order. The commissioner shall provide, or cause to be provided, to the person both oral and written notice of the right to contest the order and the form for making the request, which form shall require no more than the person’s name, address, and signature and the time and date of the signature.

271:3 Due Process; Communicable Disease; Emergency Powers. Amend RSA 141-C:14-a, V to read as follows:

V. At the hearing the burden of proof shall be on the commissioner to prove by clear and convincing evidence that the person poses a threat to public health, or that the information to be produced or inspection of a building or conveyance is necessary to protect against a serious threat to the public health, and the order issued by the commissioner is thereby warranted to alleviate such threat.

271:4 Purchase and Distribution of Pharmaceutical Agents. Amend RSA 141-C:17 to read as follows:

141-C:17 Purchase; Distribution. The commissioner may purchase and distribute anti-toxins, serums, vaccines, immunizing agents, antibiotics and other pharmaceutical agents which the commissioner deems advisable [in the interest of health. The commissioner shall adopt rules relative to the distribution of these pharmaceutical agents] to prevent, prepare for, or respond to an outbreak of communicable disease or other serious threat to the public health. Any medications distributed in the event of a public health incident declared pursuant to RSA 508:17-a shall be exempt from labeling in accordance with RSA 318:47-b. State employees and other persons acting under the authority and direction of the commissioner may carry out the activities authorized under this section.

271:5 New Section; Communicable Disease; Acute Care Centers. Amend RSA 141-C by inserting after section 25 the following new section:

141-C:26 Acute Care Centers. The commissioner, with the written approval of the governor, may establish, operate, or authorize the operation of temporary acute care centers for the purpose of the delivery of acute medical services to persons who would normally require admission to an acute care hospital, when there is a public health incident as defined in RSA 508:17-a, II(c) and when the acute care hospitals in the area do not have the physical and human resources necessary to meet the demand or anticipated demand for medical care. Any such facility so established or designated shall be exempt from the provisions of RSA 151 and RSA 151-C. The commissioner shall adopt rules, pursuant to RSA 541-A, regarding the facility and staffing requirements, screening and admission criteria, payment and reimbursements, clinical standards, recordkeeping, and discharge criteria for acute care centers. In adopting such rules, the commissioner shall take into consideration, to the extent feasible, the rights and responsibilities of patients set forth in RSA 151:21. For purposes of immunity, actions taken pursuant to this section shall be considered an emergency management function under RSA 21-P:41, I.

271:6 Health Facility Licensing; Acute Care Center Exemption. Amend RSA 151:2, II(h) to read as follows:

(h) Acute care centers established, operated, or designated by the department pursuant to RSA 141-C:26.

(i) Any other facility exempted by rules adopted under this chapter.

271:7 Certificate of Need; Exemption. Amend RSA 151-C:13, I(h) to read as follows:

(h) Notwithstanding any other provision of this chapter, a skilled nursing facility distinct part unit established by Androscoggin Valley Hospital or Franklin Regional Hospital in order to qualify as a critical access hospital under 42 U.S.C. Section 1395i-4 and 42 CFR Part 485, Subpart F; provided, that the number of beds in the skilled nursing facility distinct part unit shall not exceed the hospital’s existing skilled nursing patient capacity. For purposes of this subparagraph, the term “existing skilled nursing patient capacity” means with respect to each month, the number of skilled nursing patient days for such month divided by the number of days in such month, and shall be the highest such number from the 12-month period ending immediately prior to the filing of the federal request for approval of the distinct part unit; provided, however, that the number determined under this subparagraph shall not exceed 10 beds; and

(i) Acute care centers established, operated, or designated by the department pursuant to RSA 141-C:26.

271:8 Pharmacy; Labeling Exemption. Amend RSA 318:47-b to read as follows:

318:47-b Labeling Exemption. Labeling requirements as specified in 318:47-a are exempted when medication is dispensed to institutionalized patients and as provided for under RSA 141-C:17.

271:9 Commission Established. There is established a commission to study the authority to practice or provide health and medical care in the event of the declaration of a state of emergency pursuant to RSA 4:45 or a public health or safety incident as defined in RSA 508:17-a, II(c).

I. The members of the commission shall be as follows:

(a) Two members of the senate, one of whom shall be a member of the joint legislative oversight committee on the emergency management system, appointed by the president of the senate.

(b) Two members of the house of representatives, one of whom shall be a member of the joint legislative oversight committee on the emergency management system, appointed by the speaker of the house of representatives.

(c) The commissioner of the department of health and human services, or designee.

(d) The commissioner of the department of safety, or designee.

(e) The director of homeland security and emergency management, or designee.

(f) The attorney general, or designee.

(g) The state epidemiologist.

(h) An emergency medical care provider, appointed by the commissioner of the department of safety.

(i) A physician, appointed by the board of medicine.

(j) A registered nurse, appointed by the board of nursing.

(k) A dentist, appointed by the board of dental examiners.

(l) A veterinarian, appointed by the board of veterinary medicine.

(m) A representative of the New Hampshire Hospital Association, appointed by such association.

(n) Two specialists in public health, one appointed by Dartmouth medical school and one appointed by the university of New Hampshire school of public health.

II. Legislative members of the commission shall receive mileage at the legislative rate when attending to the duties of the commission.

271:10 Duties. The commission shall study the need for revisions to or expansion of the authority to practice or provide health and medical care to safeguard the public health in the event of a state of emergency declared pursuant to RSA 4:45 or in the event of a public health incident as defined in RSA 508:17-a, II(c). The commission shall review and make recommendations relative to the criteria and procedures for reimbursement or other compensation for persons or entities compelled to provide services or perform other actions under RSA 4:45. The commission shall review the immunity and exemption provisions set forth in RSA 21-P:41 and shall consider the demands that might be posed by a mass casualty event or communicable disease epidemic or pandemic or other public health incident. The commission shall make recommendations, including recommendations for proposed legislation, that the commission determines are essential to protecting and preserving the public health.

271:11 Chairperson; Quorum. The members of the commission shall elect a chairperson from among the members. The first meeting of the commission shall be called by the first-named senate member. The first meeting of the commission shall be held within 45 days of the effective date of this section. Seven members of the commission shall constitute a quorum.

271:12 Report. The commission shall report its findings and any recommendations for proposed legislation to the president of the senate, the speaker of the house of representatives, the senate clerk, the house clerk, the governor, and the state library on or before November 1, 2009.

271:13 Effective Date. This act shall take effect upon its passage.

Approved: June 26, 2008

Effective Date: June 26, 2008

• SB512 at GenCourtMobile

Bill Text Revisions

SB512 Revision: 12318 Date: Jan. 1, 2008, midnight

Docket

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