PRINTER'S NO. 2195
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1927
Session of
2021
INTRODUCED BY BENHAM, HILL-EVANS, SANCHEZ, N. NELSON, MADDEN,
A. DAVIS, FREEMAN, CRUZ, T. DAVIS, SIMS, PISCIOTTANO,
SCHLOSSBERG, KRAJEWSKI, GUENST, INNAMORATO, KINSEY,
HOHENSTEIN AND HOWARD, SEPTEMBER 28, 2021
REFERRED TO COMMITTEE ON HEALTH, SEPTEMBER 28, 2021
AN ACT
Amending Title 35 (Health and Safety) of the Pennsylvania
Consolidated Statutes, in public safety, providing for crisis
standards of care.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 35 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 59
CRISIS STANDARDS OF CARE
Sec.
5901. Scope of chapter.
5902. Definitions.
5903. Duty of department.
5904. Crisis Standards of Care Review Committee.
ยง 5901. Scope of chapter.
This chapter relates to crisis standards of care during a
disaster emergency or other catastrophic event.
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ยง 5902. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Committee." The Crisis Standards of Care Review Committee
established in section 5904.
"Crisis standards of care." The optimal level of care that
can be delivered by a health care practitioner or hospital
during a disaster emergency or catastrophic event, requiring
substantial change in the provision of health care and usual
health care operations.
"Crisis triage officer." A physician with established
expertise in the management of critically ill patients that
oversees the triage process, assesses all patients, assigns a
level of priority for each patient, communicates with treating
physicians, directs attention to the highest-priority patients
and has the responsibility and authority to apply the principles
and processes of crisis standards of care as established in this
act.
"Department." The Department of Health of the Commonwealth.
"Disability-related characteristics." A physical or mental
impairment that substantially limits one or more major life
activities.
"Disaster emergency." As defined in section 7102 (relating
to definitions).
"Health care practitioner." As defined in section 103 of the
act of July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act.
"Health care services or resources." The furnishing of
medicine, medical or surgical treatment, nursing, hospital
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services, complementary health services or any other necessary
service of like character, including, but not limited to,
attendance, examination or treatment of any kind provided by a
health care practitioner or hospital.
"Hospital." As defined in section 802.1 of the Health Care
Facilities Act.
"Medical standard of care." The type and level of medical
care required by professional norms, professional requirements
and institutional objectives, which may vary as circumstances
change, including during disaster emergencies or catastrophic
events.
"Principle." An individual who executes an advanced health
care directive, designates an individual to act or disqualifies
an individual from acting as a health care representative or an
individual for whom a health care representative acts in
accordance with this chapter.
"Sequential Organ Failure Assessment score" or "SOFA." A
scoring system to determine the extent of a person's organ
function or rate of failure. The score is based on six different
body systems: respiratory, cardiovascular, hepatic,
hematopoietic, renal and neurologic.
"Triage." The process of sorting patients and allocating
health care or aid on the basis of need for or likely benefit
from medical treatment.
"Triage team." A group of health care practitioners or other
health care professionals as appointed by a hospital to use
clinical care tools and other decision-making tools appropriate
to a disaster emergency or other catastrophic event to provide
information to the crisis triage officer and to help facilitate
and support the crisis triage officer's decision-making process
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for the allocation of scarce health care services or resources
in compliance with this act.
ยง 5903. Duty of department.
(a) Adherence to requirements.--
(1) The department shall adhere to the following
requirements when establishing a crisis standards of care
plan for use in this Commonwealth during the declaration of a
disaster emergency under section 7301(c) (relating to general
authority of Governor) or a catastrophic event, if the demand
for scarce health care services or resources exceeds the
supply. The following apply:
(i) Allocation of scarce medical services or
resources shall be made on the basis of valuing all life
equally.
(ii) All persons shall be eligible for, and
qualified to receive, lifesaving critical health care
services and resources regardless of the presence of an
underlying disability or a comorbidity.
(iii) No person or patient shall be denied health
care services or resources based on age, disability,
religion, race, ethnicity, national origin, immigration
status, sex, sexual orientation or gender or gender
identity.
(iv) No person or patient shall be denied access to
health care services or resources based on stereotypes,
perceived poor quality of life or judgments about a
person's or patient's worth.
(v) Health care practitioners and hospitals shall
only consider a patient's imminent threat of death.
(2) This section shall not apply to a patient if that
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patient will not survive in the immediate-term or short-term
or the treatment is contraindicated.
(b) Rights of patients.--A patient or the patient's
designated health care representative has the right to make
health care decisions for the principle. A health care provider
or a representative of a hospital may not pressure or coerce a
patient, a designated health care representative or a family
member of a patient to do any of the following:
(1) Sign a do-not-resuscitate order.
(2) Direct, initiate, continue, withhold or withdraw
health care services or resources from a patient.
(c) Prohibitions.--When determining how to allocate scarce
health care services and resources, a health care practitioner
or hospital may not:
(1) Use quality-of-life judgments.
(2) Consider long-term mortality, morbidity or life
expectancy.
(3) Use resource intensity and duration based on
criteria specified in subsection (a)(1)(iii) and (iv).
(4) Reallocate health care services and resources
already in use for a patient's treatment, including resources
which are for a patient's personal use.
(d) Health assessments.--Patient assessments shall be made
on a per-patient basis and shall be based solely on the best
available medical standard of care and treatment protocol and
not a patient's perceived health, preexisting conditions or
medical diagnosis.
(e) Clinical scoring and assessments and modification.--
Notwithstanding subsection (d), the department's crisis
standards of care plan shall include reasonable modifications to
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clinical scoring instruments and assessment tools used by a
health care practitioner or hospital to ensure that disability-
related characteristics that are unrelated to short-term
mortality risk do not negatively impact a patient's score. The
modifications shall include, but not be limited to:
(1) Modifications for patients whose disabilities may
require an extended period of hospitalization or treatment to
ensure continuum of care and treatment.
(2) New assessment tools that are consistent with the
Americans With Disabilities Act of 1990 (Public Law 101-336,
104 Stat. 327), if a patient cannot be accurately and fairly
assessed due to a disability, including the SOFA.
(3) Reasonable modifications to ensure that patients
with disabilities and older patients have equal access to
resources, including for:
(i) Communications, including access to mobile
telephones and other communications technologies.
(ii) Emergency messaging, including access to public
information and emergency alerts.
(iii) Mobility.
(iv) Religious accommodations.
(f) Notice of right to appeal.--Notice shall be given to a
patient, patient health care representative or a patient's
family regarding the right to appeal a triage decision and the
appeals process.
ยง 5904. Crisis Standards of Care Review Committee.
(a) Establishment of committee.--The department shall
establish a review committee within the department to review all
critical care decisions or other decision tools made or used by
the crisis triage officer, health care practitioner or triage
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team making decisions during a disaster emergency or
catastrophic event when life-sustaining resources become scarce,
including decisions to withdraw care, when crisis standards of
care guidelines are in effect. The committee shall:
(1) Maintain centralized, consistent information
relating to crisis triage decisions for assessment of
potential areas of concern.
(2) Consult with specialists if necessary and assess
whether the crisis triage officer, health care practitioner
or triage team considered all clinical information and
accurately documented the decision.
(3) Develop and recommend decision-making algorithms for
use by the crisis triage officer, health care practitioner or
triage team when crisis standards of care are in effect.
(b) Authority of committee.--The committee shall retain the
authority to overturn critical care decisions or other decision
tools that are not consistent with or do not comport with crisis
standard of care clinical guidance.
(c) Option of patient.--A patient or the patient's health
care practitioner, family member or designated health care
representative shall have the option to seek review of a
decision, particularly for withdrawal of care, from a health
care practitioner outside the review committee or from a medical
ethicist.
(d) Training.--The committee shall develop professional
training requirements for health care practitioners to undergo
implicit bias training to avoid justifying withdrawal of care
based on implicit bias and quality-of-life considerations.
Section 2. This act shall take effect in 60 days.
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