D R A F T
FOR DISCUSSION ONLY
UNIFORM EMERGENCY VOLUNTEER
HEALTHCARE SERVICES ACT
NATIONAL CONFERENCE OF COMMISSIONERS
ON UNIFORM STATE LAWS
For the June 26, 2006
Drafting Committee MeetingTeleconference
WITH PREFATORY NOTE AND WITHOUT COMMENTS
Copyright ©2006
By
NATIONAL CONFERENCE OF COMMISSIONERS
ON UNIFORM STATE LAWS
The ideas and conclusions
set forth in this draft, including the proposed statutory language and any
comments or reporter’s notes, have not been passed upon by the National
Conference of Commissioners on Uniform State Laws or the Drafting
Committee. They do not necessarily
reflect the views of the Conference and its Commissioners and the Drafting
Committee and its Members and Reporter.
Proposed statutory language may not be used to ascertain the intent or
meaning of any promulgated final statutory proposal.
May 31 June 16,
2006
DRAFTING COMMITTEE ON UNIFORM EMERGENCY VOLUNTEER
HEALTHCARE SERVICES ACT
The
Committee appointed by and representing the National Conference of
Commissioners on Uniform State Laws in revisingdrafting
this Act consists of the following individuals:
RAYMOND P. PEPE, 17 N. Second St., 18th
Floor, Harrisburg, PA 17101-1507, Chair
ROBERT G. BAILEY, University of Missouri-Columbia, 217
Hulston Hall, Columbia, MO 65211
STEPHEN C. CAWOOD, 108 1/2 Kentucky Ave., P.O. Drawer
128, Pineville, KY 40977-0128
KENNETH W. ELLIOTT, City Place Building, 204 N.
Robinson Ave., Suite 2200, Oklahoma City, OK 73102
THOMAS T. GRIMSHAW, 1700
Lincoln St., Suite 3800, Denver, CO 80203
THEODORE C. KRAMER, 45 Walnut
St., Brattleboro, VT 05301
AMY L. LONGO, 8805 Indian
Hills Dr., Suite 280, Omaha, NE 68114-4070
JOHN J. MCAVOY, 3110
Brandywine St. NW, Washington, DC 20008
DONALD E. MIELKE, 7472 S.
Shaffer Ln., Suite 100, Littleton, CO 80127
JAMES G. HODGE, JR., Johns Hopkins Bloomberg
School of Public Health, 624 N. Broadway, Baltimore, MD 21205-1996,
Reporter
EX OFFICIO
HOWARD J. SWIBEL, 120 S. Riverside Plaza, Suite 1200,
Chicago, IL 60606, President
LEVI J. BENTON, State of
Texas, 201 Caroline, 13th Floor, Houston, TX 77002, Division Chair
AMERICAN BAR ASSOCIATION ADVISOR
BRYAN ALBERT LIANG, California Western School of Law,
350 Cedar St., San Diego, CA 92101, ABA
Advisor
EXECUTIVE DIRECTOR
WILLIAM H. HENNING, University of Alabama School of
Law, Box 870382, Tuscaloosa, AL 35487-0382, Executive Director
Copies of this Act may be obtained from:
NATIONAL CONFERENCE OF COMMISSIONERS
ON UNIFORM STATE LAWS
211 E. Ontario Street, Suite 1300
Chicago, Illinois
60611
www.nccusl.org
UNIFORM EMERGENCY VOLUNTEER
HEALTHCARE SERVICES ACT
TABLE OF CONTENTS
Prefatory Note................................................................................................................................. 1
SECTION 1. SHORT TITLE.......................................................................................................... 6
SECTION 2.
DEFINITIONS........................................................................................................ 6
(1) “Comprehensive healthcare
facility”....................................................................................... 6
(2) “Coordinating entity”............................................................................................................... 4
(3) “Credentialing”..................................................................................................................... 6
(4) “Disaster relief organization”................................................................................................. 6
(5) “Emergency”........................................................................................................................ 7
(6) “Emergency declaration”....................................................................................................... 7
(7) “Emergency Management Assistance
Compact (EMAC)”...................................................... 7
(8) “Emergency Systems for Advance Registration of Volunteer Health
Professionals (ESAR-VHP)”................................................................................................ 7
(9) “Entity”................................................................................................................................ 7
(10) “Good faith”........................................................................................................................ 8
(11) “Healthcare entity”................................................................................................................ 5
(12) “Healthcare practitioner”..................................................................................................... 8
(1213) “Healthcare services”...................................................................................................... 8
(1314) “Host entity”................................................................................................................... 8
(1415) “Individual”..................................................................................................................... 8
(1516) “License”....................................................................................................................... 8
(1617) “Medical Reserve Corps (MRC)”.................................................................................... 9
(1718) “Person”......................................................................................................................... 9
(18) “Privileging”......................................................................................................................... 9
(19) “Scope of practice”............................................................................................................ 10
(20) “(19) “Privileging”………………………………………………………………………………………7
(20) “Registration
System”…………………………………………………………………………….7
(21) “Scope of practice”............................................................................................................... 7
(22) “Source
entity”.................................................................................................................. 10
(21) “Standard of care”............................................................................................................... 9
(22) “State”............................................................................................................................... 10
(23) “(23) “State”……………………………………………………………………………………………..7
(24) “Veterinary services”............................................................................................................ 7
(25) “Volunteer
healthcare practitioner”..................................................................................... 11
SECTION 3. AUTHORIZATION FOR VOLUNTEER HEALTHCARE
PRACTITIONERS TO PROVIDE HEALTHCARE SERVICES........................................ 11
SECTION 4. VOLUNTEER HEALTHCARE PRACTITIONER
REGISTRATION
SYSTEMS......................................................................................................................... 12
SECTION 5. INTERSTATE LICENSURE RECOGNITION FOR
VOLUNTEER HEALTHCARE PRACTITIONERS......................................................................................................................................... 13
SECTION 6. PROVISION OF VOLUNTEER HEALTHCARE SERVICES................................... 14
[SECTION 7. CIVIL IMMUNITYNO LIABILITY
FOR VOLUNTEER HEALTHCARE
PRACTITIONERS; EXCEPTIONS; NO VICARIOUS LIABILITY................................. 17
[SECTION 8. WORKERS’
COMPENSATION COVERAGE..................................................... 18
SECTION 9. EFFECT OF COMPENSATION ON VOLUNTEER STATUS................................... 18
SECTION 10. RELATION TO OTHER LAWS.......................................................................... 19
SECTION 11. REGULATORY AUTHORITY............................................................................ 20
SECTION 12. UNIFORMITY OF APPLICATION AND CONSTRUCTION.............................. 20
SECTION 13. SEVERABILITY................................................................................................. 20
UNIFORM EMERGENCY VOLUNTEER
HEALTHCARE
SERVICES ACT
The human
devastation in the Gulf Coast states from Hurricanes Katrina and Rita
demonstrated significant
shortcomings in the ability of the nation’s emergency services delivery system
to efficiently and expeditiously incorporate into disaster relief operations
the services provided by private sector healthcare professionals.practitioners
into disaster relief operations.
This includes employees and volunteers of non-governmental
disaster relief organizations who were needed to meet provide
surge capacity in affected areas and to provide
timely healthcare assistanceservices to hundreds
of thousands of victims of the disaster.
Although
the U.S. Public Health Service, the Armed Forces, the Federal Disaster Medical
Service, and healthcare professionals employed by state and local governments
provided much-needed healthcare services, the magnitude of the disaster swamped
the ability of these organizations to effectively handle relief operations. Additional
resources were readily available throughout the country and thousands of healthcare
professionals immediately volunteered to provide assistance. However,
state-based emergency response systems lacked a uniform process and legal
framework to recognize out-of-state professional licenses and other benefits necessary
to authorize and encourage these volunteers to provide healthcare services in
many affected areas. In some
jurisdictions, volunteer health personnel were not adequately protected against
exposure to tort claims or injuries or deaths suffered by the workers
themselves.
Still,
as numerous media reported, thousands of doctors and other healthcare
practitioners from across the country set aside their practices and traveled to
the Gulf Coast to provide emergency healthcare services to those in need. Many of these volunteers came through
organized systems, such as the federally-funded, state-based Emergency Systems
for the Advance Registration of Volunteer Health Professionals (ESAR-VHP), or
local-based Medical Reserve Corps (MRCs).
Other volunteers, however, deployed spontaneously to affected areas,
complicating response efforts. Some of
these health volunteers were turned away or used for purely administrative
tasks because their out-of-state professional licenses were not recognized or
for other reasons. The Metropolitan Medical Response System program, part of
the federal Department of Homeland Security (DHS), references a report on its
website:
Volunteer physicians are pouring in to care for the
sick, but red tape is keeping hundreds of others from caring for Hurricane
Katrina survivors. The North Carolina
mobile hospital waiting to help … offered impressive state-of-the-art medical
care. It was developed with millions of tax dollars through the Office of Homeland
Security after 9-11. With capacity for 113 beds, it is designed to handle
disasters and mass casualties. It
travels in a convoy that includes two 53-foot trailers, which on Sunday
afternoon was parked on a gravel lot 70 miles north of New Orleans because
Louisiana officials for several days would not let them deploy to the flooded
city. ‘We have tried so hard to do the
right thing. It took us 30 hours to get here,’ said one of the frustrated
surgeons, Dr. Preston “Chip” Rich of the University of North Carolina at Chapel
Hill. That government officials can’t
straighten out the mess and get them assigned to a relief effort now that they’re
just a few miles away ‘is just mind-boggling,’ he said.
As
a consequence, rather than treating the injured, sick and infirm, some
qualified physicians, nurses and other healthcare practitioners found
themselves: (1) waiting in long lines in often futile attempts to navigate
through a semi-functioning bureaucracy; or (2) providing other forms of
assistance, such as general labor, which failed to utilize their desperately
needed healthcare skills. Others proceeded
to treat victims at the risk of violating existing state statutes and
potentially facing criminal, civil, or administrative penalties. Out-of-state practitioners providing medical
treatment also faced the real possibility of non-coverage under their medical
malpractice policies.
While
the magnitude of the emergency presented by Hurricane Katrina exceeded the
scope of disasters experienced in this country for many decades, foreseeable emerging
events pose similar threats. Future storms (especially in the New York
City and New England area); major earthquakes in San Francisco, Los Angeles or
other heavily urbanized areas; volcanic eruptions in the Pacific Northwest;
tidal waves on the east and west coasts; incidents of terrorism involving
weapons of mass destruction, including nuclear, biological and chemical agents;
and flu or other pandemics may overwhelm the resources of disaster healthcare
delivery systems. To meet patient surge
capacity, reliance on private sector health professionals and non-governmental
relief organizations may be needed.
Although
the U.S. Public Health Service, the Armed Forces, the Federal Disaster Medical
Service, and healthcare professionals employed by state and local governments
provided much-needed healthcare services, the magnitude of the disaster swamped
the ability of these organizations to effectively handle relief operations. While
thousands of healthcare professionals quickly volunteered to provide assistance,
state-based emergency response systems lacked a uniform process and legal
framework to recognize out-of-state professional licenses and other benefits necessary
to authorize and encourage these volunteers to provide healthcare services in
many affected areas. In some
jurisdictions, volunteer healthcare practitioners were not adequately protected
against exposure to tort claims or injuries or deaths suffered by the volunteers
themselves.
This
presupposes that the legal environment supports the deployment and use of
intra- and inter-state volunteer healthcare practitioners. In fact, there are some existing major legal
gaps and deficiencies that may stymie, rather than encourage, widespread
volunteer activities during emergencies.
The federal Congress continues to examine some of these gaps through the
introduction of multiple federal bills since September, 2005. Similarly, it has directed the Department of
Health and Human Services (DHHS) to establish the Disaster Medical Relief
Service consisting of “intermittent federal employees” who enjoy interstate
professional licensing recognition and protections from civil liability via
federal law.
States
are uniquely positioned to identify and remedy these gaps as well. Many state governments have recognized the
need to grant emergency licensing recognition on an interstate basis and to
afford disaster healthcare workers with protection from civil liability. Currently every state (except HI) have
ratified the Emergency Management Assistance Compact (EMAC), which provides for
licensing reciprocity and relief from civil liability to “state forces”
deployed to respond to emergencies. Many state laws underlying the declaration
of public health emergencies (typically framed based on the Model State
Emergency Health Powers Act developed by the Center for Law and the Public’s Health at Georgetown and Johns Hopkins
Universities) also provide for healthcare licensing licensure recognition in
many jurisdictions. However, no uniform
provisions have been drafted to date to efficiently incorporate the full
resources of our healthcare delivery system, especially volunteer healthcare
practitioners, into emergency responses.
Specifically
concerning the deployment and use of volunteer healthcare practitioners during
emergencies or other dire circumstances, a uniform approach to drafting model
legislative language among states presents several key advantages:
Still,
as numerous media reported, thousands of doctors and other healthcare
practitioners from across the country set aside their practices and traveled to
the Gulf Coast to provide emergency healthcare services to those in need. Many of these volunteers came through
organized systems, such as the federally-funded, state-based Emergency System
for the Advance Registration of Volunteer Health Professionals (ESAR-VHP), or
local-based units of the Medical Reserve Corps (MRCs). Other volunteer healthcare practitioners,
however, deployed spontaneously to affected areas, complicating response
efforts. Some of these volunteers were
turned away or used for purely administrative tasks because their out-of-state professional
licenses were not recognized, the entities hosting them were concerned about
liability, or for other reasons. The Metropolitan Medical Response System program,
part of the federal Department of Homeland Security (DHS), references a report
on its website:
Volunteer physicians are pouring in to care for the
sick, but red tape is keeping hundreds of others from caring for Hurricane
Katrina survivors. The North Carolina
mobile hospital waiting to help … offered impressive state-of-the-art medical
care. It was developed with millions of tax dollars through the Office of
Homeland Security after 9-11. With capacity for 113 beds, it is designed to
handle disasters and mass casualties.
It travels in a convoy that includes two 53-foot trailers, which on
Sunday afternoon was parked on a gravel lot 70 miles north of New Orleans
because Louisiana officials for several days would not let them deploy to the
flooded city. ‘We have tried so hard to
do the right thing. It took us 30 hours to get here,’ said one of the
frustrated surgeons, Dr. Preston “Chip” Rich of the University of North
Carolina at Chapel Hill. That government
officials can’t straighten out the mess and get them assigned to a relief
effort now that they’re just a few miles away ‘is just mind-boggling,’ he said.
Rather
than treating the injured, sick and infirm, some qualified physicians, nurses
and other licensed healthcare practitioners found themselves: (1) waiting in
long lines in often futile attempts to navigate through a semi-functioning
bureaucracy; or (2) providing other forms of assistance, such as general labor,
which failed to utilize their desperately needed healthcare skills. Others proceeded to treat victims at the risk
of violating existing state statutes and potentially facing criminal or
administrative penalties or civil liability.
Out-of-state practitioners providing medical treatment also faced the
real possibility of noncoverage under their medical malpractice policies.
Ø
Lacking
uniformity, separate state-by-state enactments create inconsistencies and
dilemmas at a time when their solution is unwieldy if not unworkable;
Ø
An ad
hoc, state-by-state approach is less likely to benefit from the focused
participation of the key national constituencies that may support a uniform law;
and
Ø
Even
the best single-state bill cannot anticipate or reflect the valid concerns of other
states.
The Uniform Emergency Volunteer Healthcare Services
Act (UEVHSA) provides model legislative language to facilitate organized
response efforts among volunteer health professionals. UEVHSA’s provisions address
the following: While
the magnitude of the emergency presented by Hurricanes Katrina, Rita, and Wilma
exceeded the scope of disasters experienced in this country for many decades,
foreseeable emerging events pose similar threats. Future storms (especially in the New York
City and New England area); major earthquakes in San Francisco, Los Angeles or
other heavily urbanized areas; volcanic eruptions in the Pacific Northwest;
tidal waves on the east and west coasts; incidents of terrorism involving
weapons of mass destruction, including nuclear, biological and chemical agents;
and flu or other pandemics may overwhelm the resources of disaster healthcare
delivery systems. To help meet patient
surge capacity and protect the public’s health, reliance on private sector health
practitioners and nongovernmental relief organizations may be needed.
This
presupposes that the legal environment supports the deployment and use of
intra- and inter-state volunteer healthcare practitioners. In fact, there are some existing major legal
gaps and deficiencies that may stymie, rather than encourage, widespread
volunteer healthcare practitioner activities during emergencies. The U.S. Congress continues to examine some
of these gaps through the introduction of multiple bills since September,
2005. Similarly, it has directed the
Department of Health and Human Services (DHHS) to establish the Disaster
Medical Relief Service consisting of “intermittent federal employees” who enjoy
interstate professional licensing recognition and protections from civil
liability via federal law.
Ø
The
specific kinds of volunteer healthcare practitioners covered (focused on
pre-registered volunteers who act on their own free will);
Ø
Application
of its coverage to declared states of disaster, emergency, or public health
emergency (or like terms at the state or local level) or in dire circumstances;
Ø Procedures to recognize the valid and current
licenses of volunteer healthcare practitioners in other states for the duration
of an emergency or invocation of the Act;
As
first responders, states (and their local subsidiaries) are uniquely positioned
to identify and remedy these gaps as well.
Many state governments have recognized the need to grant emergency
licensing recognition on an interstate basis and to afford disaster relief
workers (which may include volunteer healthcare practitioners) with protection
from civil liability. Every state has
ratified the Emergency Management Assistance Compact (EMAC), which provides for
licensing reciprocity, relief from civil liability, and workers’ compensation protections
to “state forces” deployed to respond to emergencies. Many state laws
underlying the declaration of public health emergencies (typically framed based
on the Model State Emergency Health Powers Act developed by the Center for Law and the Public’s Health at
Georgetown and Johns Hopkins Universities) also provide for interstate healthcare
licensure recognition in many jurisdictions.
However, no uniform provisions have been drafted to date to efficiently
incorporate the full resources of volunteer healthcare practitioners into
emergency responses.
Concerning
the deployment and use of volunteer healthcare practitioners during
emergencies, a uniform legal approach among the states presents several key
advantages:
Ø Lacking uniformity, separate state-by-state
enactments create inconsistencies and dilemmas in legal authorities or
protections at a time when their solution is unwieldy, if not unworkable;
Ø An ad hoc, state-by-state approach is less likely
to benefit from the focused participation of the key national constituencies
that may support a uniform law; and
Ø Even the best single-state bill cannot anticipate
or reflect the valid concerns of other states.
The Uniform Emergency Volunteer Healthcare Services
Act (UEVHSA) provides uniform legislative language to facilitate organized
response efforts among volunteer healthcare practitioners. UEVHSA’s provisions address
the following:
Ø Application of its coverage to declared states of emergency,
disaster, or public health emergency (or like terms at the state or local
level);
Ø The coverage of volunteer healthcare practitioners who
are registered with ESAR-VHP, MRC, or other similar systems and volunteer based
on their own volition);
Ø Procedures to recognize the valid and current
licenses of volunteer healthcare practitioners in other states for the duration
of an emergency declaration;
Ø Requirements for volunteer healthcare practitioners
to adhere to scope of practice standards during the emergency (subject to
modifications or restrictions);
Ø Removal of significant disciplinary sanctions or civil
liability against volunteer healthcare practitioners, or those who employ,
deploy, or supervisehost them; and
Ø Worker’sWorkers’
compensation protections for volunteer healthcare practitioners.
Legislative
Notes
To be provided.
UNIFORM EMERGENCY VOLUNTEER HEALTHCARE SERVICES ACT
SECTION 1. SHORT TITLE.
This [act]
may be cited as the Uniform Emergency Volunteer Healthcare Services Act.
SECTION 2. DEFINITIONS.
As used in
this [act]:
(1) “Comprehensive healthcare facility” means a healthcare entity that provides comprehensive
inpatient and outpatient services on a regional basis. The term includes tertiary care and teaching
hospitals.
[Reporter’s Note: This definition needs additional work. The term is used in Section 4(a)(2) to
describe a type of registration system that will be recognized by an enacting
state without action by an agency of that state.]
[(2) “Coordinating entity” means an entity that acts as a
liaison to facilitate
communication and cooperation between
source and host entities but does not provide healthcare or veterinary services
in the ordinary course of its activities as liaison.]
[Reporter’s Note: This definition needs additional work. The major idea is to identify those entities
other than host and source entities that should be immunized from vicarious
liability under Section 7(c).]
(3) “Credentialing” means obtaining, verifying, and assessing the qualifications
of a healthcare practitioner to provide patient care, treatment, and services
in or for a healthcare entity.
(4) “Disaster relief organization” means an entity that provides emergency or disaster relief
services that include healthcare or veterinary services
provided by volunteer healthcare practitioners and that (A) is designated or
recognized as a provider of such services pursuant to a disaster response and
recovery plan adopted by the [name of appropriate
agency or agencies]], or (B) conducts
its activities in coordination with the [name
of appropriate agency or agencies].
(5) “Emergency” means an emergency, disaster, or public
health emergency or similar term as defined by the laws of this state[, a
political subdivision of this state, or a municipality or other local
government within this state].
Legislative
Note: The terms “emergency,” “disaster,”
and “public health emergency” are the most commonly used terms to describe the
circumstances that may lead to the issuance of an emergency declaration
referred to in this [act]. States that
use other terminology should consider amending this definition to reflect their
terminology.
(6) “Emergency declaration” means a declaration of an emergency issued by a person
authorized to do so by the laws of this state [, a
political subdivision of this state, or a municipality or other local
government within this state].
(7)
“Emergency Management Assistance Compact
(EMAC)” refers to the mutual aid agreement
ratified by Congress and signed into law in 1996 as Public Law 104-321, and
subsequently enacted by this state and codified at [cite].
(8) “Emergency Systems for Advance Registration of Volunteer Health
Professionals (ESAR-VHP)” means that the state-based
program created with funding through the Health Resources Services AgencyAdministration
under Section 107 of the federal Public Health Security and Bioterrorism
Preparedness and Response Act of 2002, P.L. 107-188, to facilitate the
effective deployment and use of volunteers to provide healthcare services
during emergencies.
(9)
“Entity” means a corporation,
business trust, estate, trust, partnership, limited
liability company, association, joint venture, public corporation, government,
or governmental subdivision, agency, or instrumentality, or any other legal or
commercial organization. The term does not include an individual. or
estate.
[Reporter’s Note: While this is a standard conference
definition for this term, it may be both too broad and too narrow in the
context of this act. We might consider
adding “disaster relief organization” and “healthcare facility” and excluding
those types of entities (e.g., business trusts, estates, trusts) that will
never be involved in the kinds of activities contemplated by the act.]
(10)
“Good faith” means honesty in fact.
(11) “Healthcare
entity” means
an entity that provides healthcare or veterinary services.
(12) “Healthcare practitioner” means a person licensed in any state to provide healthcare or
veterinary services.
(1213) “Healthcare services” means the provision of care, services, or supplies related
to the health or death of an individual individuals, or to
populations, including (A) preventive, diagnostic, therapeutic,
rehabilitative, maintenance, or palliative care, and counseling,
service, assessment, or procedure concerning the physical or mental condition,
or functional status, of an individual or that affects the structure or
function of the body; (B) sale or dispensing of a drug, device, equipment, or
other item to an individual in accordance with a prescription; and (C) mortuary
services.
(1314) “Host entity” means a healthcare entity, disaster relief organization, or
other entity in this state that uses volunteer healthcare practitioners to
provide healthcare services during the period of an emergency or other
invocation of this [act]. or veterinary services while
an emergency declaration is in effect.
(1415) “Individual” means a natural person.
(1516) “License” means official permission granted by a competent governmental
authority to engage in healthcare or veterinary services
otherwise considered unlawful without such permission. [The term includes
permission granted by the laws of this state to an individual to provide
healthcare or veterinary services based upon a national certification issued by
a public or private entity.]
(16[Reporter’s
Note: The last sentence is bracketed to
signify the need for a policy decision for the drafting committee.]
(17)
“Medical Reserve Corps (MRC)” means a local unit consisting of trained and equipped
emergency response, public health, and medical personnel formed pursuant to
Section 2801 of the Public Health Security and Bioterrorism Preparedness and
Response Act of 2002, P.L. 107-188, to ensure that state and local governments
have appropriate capacity to detect and respond effectively to an emergency.
(1718) “Person” means an individual or an entity.
(1819) “Privileging” means the authorization granted by an appropriate authority,
such as a governing body, to a healthcare practitioner to provide specific
care, treatment, and services inat a
healthcare entity subject to well -defined
limits based on factors that include license, education, training, experience,
competence, health status, and judgment.
(19) “Scope
of practice” means the services routinely performed by a
healthcare practitioner consonant with the practitioner’s education, training,
and specialized judgment.
(20) “Source entity” means a healthcare or
other entity located in any state that employs or uses the services of
healthcare practitioners who volunteer to provide healthcare services during
the period of an emergency declaration or other invocation of this [act].
(21) “Standard of care” means the reasonable diligence, skill, and
competence employed by healthcare
practitioners in the same capacity or general field of practice who have
available to them the same general facilities, equipment, and options to
provide appropriate care or treatment as required by the laws of this state.
(20) “Registration
system” means a system that facilitates the registration of volunteer
healthcare practitioners prior to the time their services may be needed and that:
(A) includes organized information about the volunteers that is accessible by
authorized personnel; and (B) can be used to verify the accuracy of information
concerning whether the volunteers are licensed and in good standing.
(21)
“Scope of practice” means the healthcare or veterinary services which
a volunteer healthcare practitioner is licensed to perform.
(22)
“Source entity” means a healthcare entity, disaster relief
organization, or other entity located in any state that employs or uses the
services of healthcare practitioners who volunteer to provide healthcare or
veterinary services while an emergency declaration is in effect.
(23) “State” means a state of the
United States, the District of Columbia, Puerto Rico,
the United States Virgin Islands, or any territory or insular
possession subject to the jurisdiction of the United States. The term also includes an Indian tribe or band
that has jurisdiction to issue emergency declarations[, or any other jurisdiction
recognized as suitable to provide volunteer healthcare practitioners for use in
this state by the [name of appropriate
agency or agencies][, including any jurisdiction that is a party to the
International Emergency Assistance Compact]].nation.
(2324) “Veterinary services” means [the
provision of care, services or supplies related to the health or death of
animals, including the removal or disposal of dead animals.]
[Reporter’s Note: The definition of veterinary services needs
further development based on forthcoming input from the American Veterinary
Medical Association or others.]
(25) “Volunteer healthcare practitioner” means a healthcare practitioner who, as an act
of the practitioner’s own volition, provides
healthcare or veterinary services in this state during
the period ofwhile an emergency declaration or
other invocation of this [act]is in effect.
SECTION 3.
AUTHORIZATION FOR VOLUNTEER HEALTHCARE PRACTITIONERS TO PROVIDE
HEALTHCARE SERVICES.
(a) This [act] authorizes volunteer healthcare
practitioners to provide healthcare or veterinary services
in this state during the time while an
emergency declaration is in effect subject to the
requirements of this [act].
(b) This [act]
authorizes volunteer healthcare practitioners to provide healthcare services in
this state if the [name of appropriate agency or agencies] determines that the services
of volunteer healthcare practitioners are necessary within this state to
respond to nonemergency circumstances at a local, regional, or state-wide level,
including the care of victims of emergencies evacuated or displaced from other
states or the conduct of activities necessary to prepare for an anticipated or
threatened emergency. The person who
invokes this act under this subsection must terminate its invocation upon
determining that the circumstances or conditions that justified the invocation
no longer exist. This [act] may not be invoked under this
subsection to the extent the invocation overlaps with an existing or
subsequently issued emergency declaration under subsection (a).
(c) During the
period of an emergency declaration or other invocation of this [act], the [name of appropriate agency or agencies]
may issue orders limiting, restricting, or regulating (1) the duration of
practice by volunteer healthcare practitioners, (2) the geographical areas in
which volunteer healthcare practitioners may practice, (3) the class of
volunteer healthcare practitioners who may practice, and (4) any other matters as
necessary to coordinate effectively the provision of healthcare services.
(b) While
an emergency declaration is in effect, the [name
of appropriate agency or agencies] may issue orders limiting, restricting,
or regulating (1) the duration of practice by volunteer healthcare
practitioners, (2) the geographical areas in which volunteer healthcare
practitioners may practice, (3) the class or classes of volunteer healthcare
practitioners who may practice, and (4) any other matter necessary to
coordinate effectively the provision of healthcare or veterinary services.
SECTION 4. VOLUNTEER
HEALTHCARE PRACTITIONER REGISTRATION SYSTEMS.
(a) This [act] applies only to
volunteer healthcare practitioners registered as volunteers with: a
registration system that is:
(1)
an ESAR-VHP
or MRC; system;
(2) a similar registration system
operated by a disaster relief organization, licensing board,
association of licensing boards or healthcare professionals
practitioners,
comprehensive healthcare facility, or governmental entity; or
(3) a system approved
pursuant to subsection (b).
(b) The [name
of appropriate agency or agencies] may designate registration systems
other than those set forth in subsection (asubsections (a)(1) and (2)
and extend to volunteer healthcare practitioners registered with them the
protections and privileges of this [act].
No system may be so designated unless it
facilitates the registration of volunteer healthcare practitioners prior to the
time their services may be needed.
(c) During the period of
While
an emergency declaration or other invocation of this [act] is in
effect, the [name of appropriate agency or agencies]],
or a person or persons authorized to act on behalf of the [agency or agencies], may confirm whether volunteer healthcare
practitioners utilized in this state are entitled to the
protections of this [act]. If required,
confirmation registered with a registration system. Confirmation is limited to
determining the identities of the volunteer healthcare practitioners
who
and
whether they are registered and in good standing with a the system
described in subsection (a) or approved pursuant to subsection (b)..
(d) The [name
of appropriate agency or agencies] shall may establish
procedures in advance for the efficient
confirmation of volunteer healthcare practitioners during the period of an
emergency declaration or other invocation of this [act].pursuant
to subsection (c).
SECTION 5. INTERSTATE
LICENSURE RECOGNITION FOR VOLUNTEER HEALTHCARE PRACTITIONERS.
(a) If While
an emergency declaration is in effect, a volunteer healthcare
practitioner authorized to provide healthcare services in this
state by this [act] is licensed and in good standing in another
state, may practice in this
state as if the person had been licensed in this state shall
recognize the out-.
(b) This [act] does not affect credentialing
and privileging standards of-state license as if the
license had been issued by this state during the period of an emergency
declaration or other invocation of this [act].
(b) This [act] does not affect
any requirement that a healthcare entity may have concerning
credentialing and privileging standards, nor does it preclude a
healthcare entity from waiving or modifying such standards during the period ofwhile
an emergency declaration or other invocation of this [act]. is in
effect.
(a) [Subject to subsection
(d), a] [A] volunteer healthcare practitioner,
including a practitioner licensed in another state and authorized to provide
healthcare or veterinary services in this state
pursuant to this [act], must adhere to the normal scope
of practice and standard of care established by
the licensing provisions, practice acts, or other laws or
policies of this state.
(b)
The [name
of appropriate agency or agencies] may modify, or restrict or enlarge the
normal
scope of practice or standard of care for volunteer
healthcare practitioners practicing in this state pursuant to this [act.] while
an emergency declaration is in effect.
(c) A host entity may limit, restrict, or
modify the types of services that a volunteer healthcare
practitioner may provide pursuant to this [act] as long as the
limitation, restriction, or modification is consistent with the scope of
practice or standard of care as provided in subsections (a) and (b).while
an emergency declaration is in effect.
[(d)
Nothing
in this [act] authorizes a volunteer healthcare practitioner to provide
healthcare or veterinary services that are outside the practitioner’s scope of
practice in any of the other states in which the practitioner is licensed and
in good standing.]
(e) A volunteer healthcare practitioner who in
good faith provides healthcare or veterinary services consistent with
subsections (a), (b), [and] (c)[, and (c)d)]
shall not be subject to administrative sanctions for unauthorized
practice.
(ef)
A volunteer healthcare practitioner who
is licensed in another state, is unaware of a limitation modification
or restriction on the scope of practice in this state, and who in
good faith provides healthcare or veterinary services consistent with
the practitioner’s normal scope of practice in
another state shall not be subject to administrative sanctions for
unauthorized practice.
(f) In determining whether to
impose administrative sanctions for conduct outside the scope of practice and
for which the volunteer healthcare practitioner is not subject to
administrative sanctions under subsections (d) and (e), a licensing board or
other disciplinary authority shall consider the nature of the exigent
circumstances in which the actions took place.
[SECTION
7. CIVIL IMMUNITY FOR VOLUNTEER
HEALTHCARE PRACTITIONERS; NO VICARIOUS LIABILITY.
(a) Subject to
subsections (d) and (e), volunteer healthcare practitioners authorized to
provide healthcare services by this [act] are not liable for civil damages
arising out of such services provided during the period of the emergency
declaration or other invocation of this [act].
(b) Subject to subsections (d) and (e),
volunteer healthcare practitioners authorized to provide healthcare services by
this [act] are not liable for civil damages for nonhealthcare-related acts
performed within the scope of their activities as volunteer healthcare
practitioners during the period of the emergency declaration or other invocation
of this [act].
(c) Source, coordinating, and host entities
are not vicariously liable for damages arising out of actions for which
volunteer healthcare practitioners are not liable under subsections (a), (b)
and (c).
(d) Subsections (a), (b), and (c) shall not
apply to (1) the willful, wanton, grossly negligent, reckless, or criminal
conduct of a volunteer healthcare practitioner during the period of an
emergency declaration or other invocation of this [act]; and (2) an action (A)
for damages for breach of contract, or (B) brought against the practitioner by
a source or host entity.]
[SECTION
8. WORKERS’ COMPENSATION COVERAGE.
Option A
Unless the volunteer
healthcare practitioner is covered by workers’ compensation insurance (or other
insurance providing comparable benefits) provided by a coordinating, host, or
source entity, or other person, a practitioner who resides in this state and
who provides healthcare services in this or another state during the period of
an emergency declaration or other invocation of this [act] or another state’s
similar [act] shall be considered an employee of this state for purposes of
workers’ compensation coverage.
Option B
Unless the volunteer
healthcare practitioner is covered by workers’ compensation insurance (or other
insurance providing comparable benefits) provided by a coordinating, host, or
source entity, or other person, a practitioner who provides healthcare services
in this state during the period of an emergency declaration or other invocation
of this [act] shall be considered an employee of this state for purposes of
workers’ compensation coverage.
[(g) In the case of conduct of a volunteer
healthcare practitioner for which the practitioner is not protected under
subsections [(e) and (f)] [(d) and (e)], a licensing board or other
disciplinary authority in this state:
(1) may
impose administrative sanctions if the practitioner is licensed in this state
without regard to the state in which the conduct occurs;
(2) may
impose administrative sanctions if the practitioner is not licensed in this
state and the conduct occurs in this state; and
(3) must
report any administrative sanctions to the appropriate licensing board or other
disciplinary authority in any other state in which the practitioner is known to
be licensed.]
(h) In determining whether to
impose administrative sanctions under subsection (g), a licensing board or
other disciplinary authority shall consider the nature of the exigent circumstances
in which the conduct took place and the practitioner’s education, training, experience,
and specialized judgment.
[Reporter’s
Note: Sections 6(d) and 6(g) are
bracketed to signify the need for policy decisions for the drafting committee.]
SECTION 7. NO
LIABILITY FOR VOLUNTEER HEALTHCARE PRACTITIONERS; EXCEPTIONS; NO VICARIOUS
LIABILITY.
(a) Subject
to subsection (b), volunteer healthcare practitioners authorized to provide
healthcare or veterinary services pursuant to this [act] while an emergency
declaration is in effect are not liable for civil damages for acts or omissions
within the scope of their responsibilities as volunteer healthcare
practitioners.
(b) Subsection
(a) does not apply to: (1) willful, wanton, grossly negligent, reckless, or
criminal conduct of, or an intentional tort committed by, a volunteer
healthcare practitioner; (2) an action brought against a volunteer healthcare practitioner
(A) for damages for breach of contract, (B) by a source or host entity, or (C)
the operation of a motor vehicle, vessel, aircraft, or other vehicle by a
volunteer healthcare practitioner for which this state requires the operator to
have a valid operator’s license or to maintain liability insurance.
(c) Source,
coordinating, and host entities are not vicariously liable for the acts or
omissions of volunteer healthcare practitioners while an emergency declaration
is in effect.
SECTION 8.
WORKERS’ COMPENSATION COVERAGE. If a volunteer healthcare
practitioner who is deployed to this state while an emergency declaration is in
effect is not covered by workers’ compensation insurance provided by a source, coordinating,
or host entity, or by another person, or the practitioner is not covered by
other insurance providing comparable benefits, the practitioner shall be
considered an employee of this state for purposes of workers’ compensation
coverage.
(a) A The prospective,
concurrent, or retroactive provision of monetary or any other compensation
to a healthcare practitioner by any person for providing the
provision of healthcare or veterinary services
during
the period of while an emergency declaration or other
invocation of this [act] is in effect does
not preclude the practitioner from being considered a
volunteer healthcare practitioner under this [act], ] unless
such the compensation is provided pursuant
to thea
preexisting employment relationship with the host entity that requires the
practitioner to provide healthcare or veterinary services in this state.
[(b)
The prohibition upon a preexisting employment
relationship in subsection (a) shall not This section does not apply
to (1)
a healthcare practitioner who is not a resident of this state and who is
employed by a disaster relief organization providing services in this state pursuant
to this act; or (2) a healthcare practitioner who is not a resident of this
state who volunteers for deployment to this state to provide healthcare
services at a healthcare facility or organization affiliated with the
healthcare practitioner’s place of employment during an emergency or period of
time in which this [act] is invoked, provided the healthcare practitioner’s
compensation does not exceed the practitioner’s customary and usual compensation.]
while an emergency declaration is in effect.
[Reporter’s Note: Subsection (b) needs additional work. The major idea is
SECTION 10. RELATION TO OTHER LAWS.
[(a)]
This [act] does not limit protections from liability or other benefits provided
to neatly distinguish between volunteer
healthcare practitioners and existing employees of
healthcare or other entities with certain exceptions. Subsection (b) provides 2 exceptions in
response to comments from participants at the first Drafting Committee, but
these remain tentative based on additional
input and guidance].
SECTION
10. RELATION TO OTHER LAWS. Nothing in this [act] is
intended to limit additional protections from liability or other benefits for
volunteer healthcare practitioners provided by laws other than
this [act] or to ], nor does it establish
requirements for the use of volunteer healthcare practitioners used in
this state pursuant to EMAC.
[(b) The [name
of appropriate agency or agencies] may incorporate into state forces used
to respond to emergencies through EMAC a volunteer healthcare practitioner who
is not an employee of this state, a political subdivision of this state, or a
municipality or other local government within this state.]
Legislative
Note: References to other emergency
assistance compacts to which the state is a party should be added.
SECTION 11. REGULATORY
AUTHORITY. The [name of appropriate state agency or agencies] [is] [are] authorized
to promulgate regulations to implement the provisions of this [act]. In doing so, the [name of appropriate state agency or agencies] shall consult with,
and consider the recommendations of, the entity
established to coordinate the implementation of EMAC and shall also consult
with, and consider the regulations promulgated by, similarly empowered agencies
in other states in order to promote uniformity of
application of this act and thereby make the emergency response systems in the
various states reasonably compatible.
SECTION 12. UNIFORMITY
OF APPLICATION AND CONSTRUCTION.
In applying
and construing the provisions of this [act], consideration must be given to the
need to promote uniformity of the law with respect to its subject matter among
states that enact it.
SECTION 13. SEVERABILITY.
The
provisions of this [act] are severable.
If any provision of this [act] or its application to any person or
circumstance is held invalid, such does not affect other provisions or
applications of this [act] which can be given effect without the invalid
provision or application.