H0220B0187A05660 NAD:CDM 09/28/22 #90 A05660
AMENDMENTS TO HOUSE BILL NO. 220
Sponsor: SENATOR BROWNE
Printer's No. 187
Amend Bill, page 1, line 23, by striking out the period after
"duties" and inserting
; in powers and duties of the Department of Health and its
departmental administrative and advisory boards, providing
for death review teams; imposing duties on the Department of
Health; and making an editorial change.
Amend Bill, page 2, line 25, by striking out all of said line
and inserting
Section 2. Article XXI of the act is amended by adding a
subarticle heading to read:
(a) General Provisions
Section 3. Article XXI of the act is amended by adding a
subarticle to read:
(b) Death Review Teams
Section 2127. Definitions.
The following words and phrases when used in this subarticle
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"County." A county of the first class, second class, second
class A, third class, fourth class, fifth class, sixth class,
seventh class and eighth class.
"Death review team." A suicide or overdose death review team
established under section 2128.
"Deceased individual." An individual who died by suicide or
fatal overdose.
"Department." The Department of Health of the Commonwealth.
"Drug." A substance which produces a physiological effect
when ingested or introduced into the body. The term includes an
illicit or legal substance.
"EMS provider." The term includes the following:
(1) An emergency medical responder.
(2) An emergency medical technician.
(3) An advanced emergency medical technician.
(4) A paramedic.
(5) A prehospital registered nurse.
(6) A prehospital physician extender.
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(7) A prehospital EMS physician.
(8) An individual prescribed by regulation of the
department to provide specialized EMS.
"Health care provider." A physician, advanced practice nurse
practitioner or physician assistant who is licensed to practice
medicine in this Commonwealth.
"Hospital." An institution having an organized medical staff
established for the purpose of providing to inpatients, by or
under the supervision of physicians, diagnostic and therapeutic
services for the care of individuals who are injured, disabled,
pregnant, diseased, sick or mentally ill or rehabilitation
services for the rehabilitation of individuals who are injured,
disabled, pregnant, diseased, sick or mentally ill. The term
includes facilities for the diagnosis and treatment of disorders
within the scope of specific medical specialties.
"Law enforcement agency." The Pennsylvania State Police, a
local law enforcement agency or the Office of Attorney General.
"Local department of health." Any of the following:
(1) A local department of health established by a
municipality under the act of August 24, 1951 (P.L.1304,
No.315), known as the Local Health Administration Law.
(2) A single-county department of health or joint-county
department of health established under the Local Health
Administration Law.
"Local law enforcement agency." A police department of a
city, borough, incorporated town or township.
"Mental health provider." A psychiatrist, psychologist,
advanced practice nurse practitioner with a specialty in
psychiatric mental health, clinical social worker, professional
clinical counselor or marriage and family therapist who is
licensed to practice in this Commonwealth.
"Multicounty team." A multidisciplinary and multiagency
suicide or overdose death review team jointly created by two or
more counties in this Commonwealth.
"Municipality." A county, city, borough, incorporated town
or township.
"Overdose." An alcohol or substance overdose.
"Overdose death." A fatality resulting from one or more
substances taken in excessive amounts.
"Overdose death review." A process in which a multiagency,
multidisciplinary team performs a series of individual overdose
death reviews to effectively identify system gaps and innovative
community-specific overdose prevention and intervention
strategies.
"School." A facility providing elementary, secondary or
postsecondary educational services. The term includes the
following:
(1) A school of a school district.
(2) An area career and technical school.
(3) A joint school.
(4) An intermediate unit.
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(5) A charter school or regional charter school.
(6) A cyber charter school.
(7) A private school licensed under the act of January
28, 1988 (P.L.24, No.11), known as the Private Academic
Schools Act.
(8) A private school accredited by an accrediting
association approved by the State Board of Education.
(9) A nonpublic school.
(10) An institution of higher education.
(11) A private school licensed under the act of December
15, 1986 (P.L.1585, No.174), known as the Private Licensed
Schools Act.
(12) A private residential rehabilitative institution as
defined in section 914.1-A(c) of the act of March 10, 1949
(P.L.30, No.14), known as the Public School Code of 1949.
"Substance use disorder." A pattern of use of alcohol or
other drugs leading to clinical or functional impairment.
"Substance use disorder treatment provider." An individual
or entity who is licensed, registered or certified within this
Commonwealth to treat substance use disorders or who has a drug
addiction treatment waiver under section 303(g) of the
Controlled Substances Act (Public Law 91-513, 84 Stat. 1236)
from the Substance Abuse And Mental Health Services
Administration to treat individuals with substance use disorder
using medications approved for that indication by the United
States Food and Drug Administration.
"Suicide death." A fatality caused by injuring oneself with
the intent to die.
Section 2128. Suicide or overdose death review teams.
(a) Establishment.--A county, or two or more counties, may
establish a suicide death review team, an overdose death review
team, or both, for the purposes of collecting and examining
information and records concerning suicide or overdose
fatalities in this Commonwealth to improve community resources
and systems of care to reduce suicide or overdose fatalities.
The following shall apply:
(1) A county may establish an independent county death
review team or jointly with other counties. If a joint county
death review team is established, the multicounty team
members shall execute a memorandum of understanding between
participating counties regarding team membership, staffing
and operations.
(2) Upon the establishment of a death review team, the
death review team shall notify the department of the
establishment of the team.
(3) A death review team shall be multidisciplinary and
culturally diverse and include professionals and
representatives from organizations that provide services or
community resources for families in the community served by
the death review team.
(b) Membership.--
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(1) In counties where there is a local health
department, the local health department shall be the lead
organization to oversee and coordinate the death review team
in a form and manner as prescribed by the department. In
counties choosing to establish a death review team, if there
is not a local health department, an organization interested
in being selected as the lead organization shall submit an
application, in a form and manner as prescribed by the
department, for review and approval. Prior to submitting an
application, a county's commissioners shall approve the
submission of an organization as a lead organization.
(2) The lead organization shall select the membership of
the death review team. The following shall apply:
(i) Members of the overdose death review team shall
be selected from any of the following categories:
(A) A coroner or medical examiner.
(B) A pathologist.
(C) A psychologist licensed under the act of
March 23, 1972 (P.L.136, No.52), known as the
Professional Psychologists Practice Act.
(D) A physician licensed under the act of
December 20, 1985 (P.L.457, No.112), known as the
Medical Practice Act of 1985, or a physician licensed
under the act of October 5, 1978 (P.L.1109, No.261),
known as the Osteopathic Medical Practice Act, who
practices as a psychiatrist.
(E) A local behavioral health representative.
(F) An individual who is a member of the
education community with experience regarding
existing and potential overdose prevention efforts
for students in primary and secondary schools.
(G) An individual who is a member of the law
enforcement community with experience regarding
existing and potential overdose prevention efforts
for individuals who are involved with the law
enforcement system.
(H) A representative of an organization that
advocates for individuals with behavioral health
issues and their family members.
(I) A representative of an organization that
advocates for individuals with substance use
disorders and their family members.
(J) A representative from a single county
authority.
(K) The county health officer, or the officer's
designee, if applicable.
(L) The director of the local office responsible
for human services or the director's designee.
(M) The local district attorney or the district
attorney's designee.
(ii) Members of the suicide death review team shall
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be selected from any of the following categories:
(A) At least three mental health providers
specializing in trauma, youth mental health, veteran
and military mental health, or other relevant
specialty.
(B) A crisis counselor specializing in suicide
prevention.
(C) An advocate for the prevention of suicide
fatalities.
(D) A medical examiner or coroner responsible
for recording fatalities.
(E) A family medicine specialist or other
relevant medical specialty.
(F) An individual who is a member of the
education community with experience regarding
existing and potential suicide prevention efforts for
students in primary and secondary schools.
(G) An individual who is a member of the law
enforcement community with experience regarding
existing and potential suicide prevention efforts for
individuals who are involved with the law enforcement
system.
(H) The county health officer or the officer's
designee, if applicable.
(I) The director of the local office responsible
for human services or the director's designee.
(3) In addition to the members selected under paragraph
(2), the lead organization may select additional members for
a death review team as deemed necessary by the lead
organization to administer the death review team's duties
under section 2129, including individuals with experience and
knowledge in the following areas:
(i) Physical health services.
(ii) Social services.
(iii) Law enforcement.
(iv) Education.
(v) Emergency medicine.
(vi) Behavioral health services.
(vii) Juvenile delinquency.
(viii) Adult or juvenile probation.
(ix) Drug and alcohol substance use disorder.
(c) Chair, vacancies and meetings.--A death review team
shall select a chair by a majority vote of a quorum of the death
review team's members. A majority of a death review team's
selected members shall constitute a quorum. The death review
team shall meet at least quarterly to conduct business and
review suicide deaths and overdose deaths. A vacancy on the
death review team shall be filled in accordance with subsection
(b).
Section 2129. Duties of death review team.
(a) Authorization.--Upon receipt of a report of a suicide
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death or overdose death, a death review team may perform the
following:
(1) Inquire into cause of death upon receipt of a report
of a qualifying death.
(2) Conduct a multidisciplinary review of available
information collected regarding a deceased individual.
(3) Establish policies and procedures for collecting and
reviewing available information and records under section
2131 regarding the deceased individual from State, county and
local agencies, law enforcement and private entities.
(4) Identify points of contact between the deceased
individual and health care systems, social services systems,
criminal justice systems and other systems involved with the
deceased individual.
(5) Identify the risk factors that put individuals at
risk for an overdose or suicide within the death review
team's jurisdiction.
(6) Promote cooperation and coordination across State,
county and local agencies involved in overdose or suicide
investigations.
(7) Recommend improvements in sources of information
relating to investigating reported overdose or suicide
deaths, including standards for the uniform and consistent
reporting of overdose or suicide deaths by law enforcement or
other emergency service responders within the death review
team's jurisdiction.
(8) Recommend improvements to State laws and local
partnerships, policies and practices to prevent overdose and
suicide deaths.
(b) Interviews.--If a death review team opts to contact a
family member or caregiver of a deceased individual to conduct
an interview, the death review team shall develop protocols for
initiating the contact and conducting the interview. The
protocols shall be based on trauma-informed care principles and
shall address all of the following:
(1) The death review team's collection, use and
disclosure of information and records from the family member
or caregiver.
(2) Providing notice to the family member or caregiver
that the interview is voluntary.
(3) Ensuring that information and records attained from
the interview is confidential.
(c) Annual report.--A death review team shall prepare and
submit to the department an annual report. The team shall
publish the annual report on the local department of health's or
local government's publicly accessible Internet website for the
purpose of evaluations, policy considerations and health care
program enhancements. The annual report shall comply with
confidentiality requirements under subarticle and shall include
all of the following information:
(1) A summary of the aggregated, nonindividually
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identifiable findings of the death review team for the
previous year.
(2) Recommendations to improve systems of care and
community resources to reduce fatal suicides or overdoses in
the death review team's jurisdiction.
(3) Proposed solutions for inadequacies in the systems
of care.
(4) Recommendations to improve sources of information
regarding the investigation of reported suicides and overdose
deaths, including standards for the uniform and consistent
reporting of fatal suicides and overdoses by law enforcement
or other emergency service responders within the death review
team's jurisdiction.
(5) Recommendations for improvements to State laws and
local partnerships, policies and practices to prevent suicide
and overdose fatalities.
Section 2130. Duties of department.
The department, in consultation with State or local
government agencies, shall have all of the following duties:
(1) Provide technical assistance to a death review team
in conducting suicide and overdose death reviews.
(2) Facilitate communication between death review teams.
(3) Transmit available information to the appropriate
death review team regarding a fatal suicide or overdose in
the death review team's jurisdiction, including all of the
following information:
(i) The deceased individual's age, race, gender,
county of residence and county of death.
(ii) The date, manner, cause and specific
circumstances of the suicide or overdose death as
recorded on the deceased individual's completed death
certificate.
(4) Promulgate regulations as necessary to implement
this subarticle.
(5) Submit an annual report to the Governor and the
General Assembly by September of each year which includes a
summary of reports received from local death review teams and
recommendations relating to the reduction of risk of death by
suicide and overdose.
Section 2131. Authority to access records.
To the extent permitted by Federal law, a death review team
may access records as follows:
(1) If deemed necessary for its review, the death review
team may petition the court for leave to review and inspect
all files and records of the court relating to a deceased
individual pursuant to a proceeding under 42 Pa.C.S. Ch. 63
(relating to juvenile matters) in accordance with 42 Pa.C.S.
§ 6307 (relating to inspection of court files and records).
This paragraph shall not apply to a file and record of the
court subject to a child fatality or near fatality review
under 23 Pa.C.S. Ch. 63 (relating to child protective
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services).
(2) Notwithstanding any other provision of law and
consistent with the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191, 110 Stat.
1936) and 42 CFR Pt. 2 (relating to confidentiality of
substance use disorder patient records), persons or entities
that provide substance use disorder treatment services shall
provide to an overdose death review team the records of a
deceased individual under review without need for
authorization of any person, including the executor,
administrator or personal representative of the deceased
individual for purposes of review under this subarticle.
(3) Notwithstanding any other provision of law and
consistent with the Health Insurance Portability and
Accountability Act, the team may review and inspect mental
health care service files and records of a deceased
individual under review without the need for authorization of
any person, including the executor, administrator or personal
representative of the deceased individual for purposes of
review under this subarticle.
(4) Notwithstanding any other provision of law and
consistent with the Health Insurance Portability and
Accountability Act, health care facilities and health care
providers, pharmacies and mental health care providers shall
provide medical records of a deceased individual under review
without the need for authorization of any person, including
the executor, administrator or personal representative of the
deceased individual for purposes of review under this
subarticle.
(5) Other records pertaining to the deceased under
review for the purposes of this subarticle shall be open to
inspection as permitted by law.
Section 2132. Requests for records.
(a) Request for information and records by a death review
team.--Notwithstanding any other provision of law, the following
shall be provided to a death review team on written request of
the lead organization or chair of a death review team:
(1) Records regarding the treatment for substance use
disorder, maintained by a Federally assisted substance use
disorder treatment provider, for a deceased individual under
review by a death review team, as permitted to be shared in
accordance with Federal law, including 42 CFR Pt. 2 (relating
to confidentiality of substance use disorder patient
records).
(2) Records regarding the physical health and mental
health, maintained by a health care provider, hospital or
health system, for a deceased individual under review by a
death review team.
(3) Records maintained by a State or local government
agency or entity, including death investigative information,
medical examiner investigative information, law enforcement
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investigative information, emergency medical services
reports, fire department records, prosecutorial records,
parole and probation information and records, court records,
school records and information and records of a social
services agency, including the Department of Human Services,
if the agency or entity previously provided services to the
deceased individual under review by a death review team.
(4) The following shall comply with a records request by
a death review team made under this subsection:
(i) Coroner or medical examiner.
(ii) Fire department.
(iii) Health system.
(iv) Hospital.
(v) Law enforcement agency.
(vi) State or local governmental agency, including
the department, Department of Human Services and the
Department of Corrections.
(vii) Mental health provider.
(viii) Health care provider.
(ix) Substance use disorder treatment provider.
(x) School.
(xi) EMS provider.
(xii) Social services provider.
(xiii) Prescription drug monitoring program
representative.
(xiv) Any other person or entity who is in
possession of records pertinent to the overdose death
review team investigation of an overdose death.
(b) Cost to provide records.--A person or entity subject to
a records request by a death review team under subsection (a)
may charge the death review team a reasonable fee for the
service of duplicating any records requested by the death review
team for which duplication is required.
(c) Disclosure of substance use disorder records.--The
disclosure or redisclosure of a medical record developed in
connection with the provision of substance use treatment
services, without the authorization of a person in interest,
shall be subject to any limitations that exist under section 8
of the act of April 14, 1972 (P.L.221, No.63), known as the
Pennsylvania Drug and Alcohol Abuse Control Act, section 543 of
the Public Health Service Act (58 Stat. 682, 42 U.S.C. 290dd-2)
or 42 CFR Pt. 2.
(d) Provision of information.--Information, if requested by
the lead organization or chair of the death review team, shall
be provided within five business days of receipt of the written
request, excluding weekends and holidays, unless an extension is
granted by the lead organization or chair. Written requests may
include a request submitted via email or facsimile transmission.
(e) Administrative subpoena.--Notwithstanding any other
provision of law, a death review team shall not need an
administrative subpoena or other form of legal compulsion to
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receive requested records under this subarticle. This subsection
shall not negate any right the death review team has to obtain
an administrative subpoena or other form of legal compulsion.
(f) Sharing of information.--Information received by the
lead organization or chair in response to a request under this
section may be shared at a death review team meeting in
accordance with section 2133.
(g) Prohibition.--A record may not be released during the
pendency of an investigation if the release of the record would
hinder the progress of an active investigation or criminal
proceeding.
(h) Applicability.--This section shall apply to the extent
permitted by Federal law.
Section 2133. Confidentiality of death review team records and
meetings.
(a) Meetings.--A death review team meeting shall be closed
to the public and information discussed at the meeting shall be
confidential.
(b) Records.--
(1) The proceedings, records and information maintained
by and shared with a death review team may not be:
(i) Disclosed under the act of February 14, 2008
(P.L.6, No.3), known as the Right-to-Know Law.
(ii) Subject to discovery, subpoena or introduction
into evidence in a criminal or civil proceeding.
(2) Information presented in or opinions formed as a
result of a meeting of a death review team may not be subject
to subpoena, discovery or admissible in evidence in a civil
or criminal action. Nothing under this subsection shall be
construed to prevent a member of a death review team from
testifying in a criminal or civil proceeding to information
obtained independently of participation in the death review
team or to information which is publicly available.
Section 2134. Criminal and civil liability protections.
(a) Confidentiality.--An individual not a member of a death
review team may, in good faith, provide information to a death
review team for the purposes of this subarticle. A member of a
death review team may discuss confidential matters during a
meeting of the death review team. The following shall apply:
(1) A member of a death review team shall comply with
applicable Federal and State laws regarding confidentiality.
(2) Except as provided under subsection (b), a member of
a death review team or an individual who, in good faith,
provides information to a death review team may not be
disciplined, criminally prosecuted or held administratively
or civilly liable for complying with the provisions of this
subarticle.
(b) Liability.--The immunity specified under subsection (a)
(2) shall not apply to a member of a death review team or an
individual providing information to a death review team by
invitation who either rediscloses confidential information in a
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manner not in accordance with Federal or State law, or who
discloses confidential information to the death review team with
malice, in bad faith or in a negligent manner.
Section 4. The provisions of this act are severable. If any
provision of this act or its application to any person or
circumstance is held invalid, the invalidity shall not affect
other provisions or applications of this act which can be given
effect without the invalid provision or application.
Section 5. This act shall take effect as follows:
(1) This section shall take effect immediately.
(2) The amendment of section 2301-A(1)(xviii) shall take
effect in 60 days.
(3) The remainder of this act shall take effect in 30
days.
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See A05660 in
the context
of HB0220