Sarah Willson, VP Clinical and Regulatory Affairs, Missouri Hospital Association
Article reprinted with permission of the Missouri Hospital Association
The following legislation impacting EMS and hospitals has been signed into law by Governor Jay Nixon.
Public Safety and Transport (SB 732)
SB 732 modifies numerous provisions related to public safety. Of particular interest to Missouri hospitals are the changes to the TCD system, changes to hospital helipad regulations to eliminate a state role in that area, as well as a number of EMS changes. First responders have been added to the list of mandated reporters of elder abuse, and “bullying” is now a reportable incident. In addition, the legislation gives emergency medical technicians liability protection for transporting a patient for evaluation or treatment under the involuntary commitment laws, or for using physical or chemical restraints during transportation to ensure the safety of an at-risk behavioral health patient or the EMT. To qualify, the EMT must act in good faith and without gross negligence. Nurses, physicians, and other healthcare workers are already afforded this protection.
Senate Bill 732 creates a new law, section 190.240, which directs hospitals and nursing homes to have policies and procedures requiring notification of emergency medical services (EMS) personnel prior to transport of an at-risk behavioral health patient. Affected patients include those who display violent, homicidal, or suicidal ideation or behavior. Hospitals will need to review their policies and procedures related to transport, emergency services, discharge, etc. to ensure compliance regarding transport or discharge of an at-risk behavioral patient by EMS. The new law also addresses the training of EMS personnel related to restraining procedures and non-medical management techniques which can be used prior to and during transport.
There is another significant change regarding the transport of at-risk behavioral patients. A physician treating an at-risk behavioral patient in an emergency situation may place the patient on a temporary involuntary hold for a period of time needed to transport the patient. Physicians must have reasonable cause to believe the patient may cause imminent harm to himself, herself, or others unless the patient is immediately transported to another appropriate facility. During such transport EMS personnel can rely on the physician’s hold order. The order serves as implied consent to treat and transport the patient and negates liability for any claims of negligence, false imprisonment, or invasion of privacy based on the temporary hold, treatment, and transport of the patient. It is important to note this section will not limit the patients’ rights under the federal Mental Health Patient’s Bill of Rights. The process for a civil involuntary commitment must be initiated by either the sending or receiving facility. Additionally, there needs to be a physician order for an involuntary hold including during transport.
In addition to these new state laws, law enforcement personnel, under their police power authority, may detain a person believed to be imminently harmful due to a mental disorder or alcohol or drug abuse, and transport the person to an appropriate facility for evaluation and admission.
Staff of the Access Crisis Intervention (ACI) system, the 24-hour crisis hotline, can also assist with the civil involuntary detention process. By calling the toll-free 24-hour ACI crisis number, the caller will be able to speak to a mental health worker who will evaluate the current situation and assist with the appropriate response.
Facilities that are recognized by the Department of Mental Health to provide civil involuntary detention services have mental health professionals who are designated and approved to initiate on-site civil involuntary detention for individuals in need of emergency evaluation and treatment. These professionals may be psychiatrists, licensed physicians, psychiatric residents, psychologists, nurses or social workers, licensed professional counselors or a qualified substance abuse counselor.
Helipad Safety (SB 988 and SB 635)
Senate Bill 988 and Senate Bill 635 include identical language regarding hospital helipad safety. Specifically, this new legislation makes any previous rules or regulations promulgated by the Department of Health and Senior Services (DHSS) that require fencing or other barriers around hospital helipads null and void. It also prohibits DHSS from promulgating any rules or regulations regarding the operation or construction of a helipad located at a hospital. Finally, it requires that hospitals ensure that helipads are free of obstructions and safe for use by helicopters while on the ground and during approach and takeoff. This legislation was signed with an emergency provision and is effective immediately.
With the new rules in place, it is incumbent upon each hospital to determine the reasonableness of maintaining a fence or any other physical barrier to secure the hospital helipad. Lacking any requirement from state or federal authorities, hospitals that maintain a physical barrier around the helipad that is inconsistent with FAA guidance could be exposed to excess liability should any unfortunate incident occur.
The Missouri Hospital Association strongly recommends that fences that encroach the prescribed safety area around helipads be removed. We encourage hospitals to communicate with their air medical service providers to review the conditions of the helicopter landing area to ensure the safety of patients, air crews and hospital personnel during air transport operations.