Add Art 2 Title 6 S266, Pub Health L; amd S6507, Ed L; amd SS2343, 3436 & 5505, Ins L
Establishes the health care practitioner hygienic dress code program within the department of health to address clothing, jewelry and identification tags worn by health care professionals that may cause infection, disease and bacteria in patients, visitors and the general public.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7845C
SPONSOR: Magnarelli TITLE OF BILL: An act to amend the public health law, the education
law and the insurance law, in relation to establishing a health care
practitioner hygienic dress code; and providing for the repeal of
certain provisions upon expiration thereof
PURPOSE: The purpose of this bill is to help reduce the rate of
patient injury due to the inadvertent spread of infections, bacteria,
and diseases by health care practitioners due to the clothes and other
items that they wear. Further, it is to help reduce the rising cost of
medical malpractice insurance faced by health care practitioners due to
the increased damages from injuries caused by such infections.
SUMMARY OF PROVISIONS:
Section 1: Amends Article 2 of the Public Health Law by adding new title
6, "Health Care Practitioner Hygienic Dress Code". This section creates
a State health care practitioner hygienic dress code council comprised
of twenty-five members appointed by the commissioner of health with the
advice of the commissioner of education and financial services. This
council is to advise the health and education commissioners on (i) the
best practices for mitigating and eliminating the spread of disease and
other infections via practitioner clothing, jewelry, and facility iden-
tification tags (ii) the promotion of better coordinated interdiscipli-
nary policies to ensure hygienic practices, (iii) establish materials
and curricula to be used in continuing education programs related to
hygienic dress codes.
This council also may provide guidance to practitioners and health care
facilities on the best practices to mitigate and eliminate the spread of
infection and disease by vectors related to health care practitioners'
clothes and identification tags.
The council should examine and consider the adoption of rules and regu-
lations including a bare below the elbow policy, no necktie policy,
education and instruction to patients and practitioners, provision of
clean scrubs and uniforms, and prohibition of wearing clothing worn
during treatment of patients outside of the health care facility.
This section also creates Health care practitioner hygienic resource
centers as the commissioner may designate. These centers shall act as a
source of support and information for practitioners in the area of sani-
tary and hygienic conditions for patient treatment. These centers may be
contracted for with not-for-profit organizations at the discretion of
the Health Department and with the council's consultation.
The council, in consultation with the health and education departments,
as well as practitioner professional organizations, is to develop course
materials on sanitary dress code policies and practices and, within two
years, make recommendations for inclusions into the continuing education
curriculum of such policies or practices.
Lastly, every other year, the council shall submit a report on activ-
ities or accomplishments on sanitary and hygienic conditions recommended
by the council in health care facilities, including legislative
proposals.
Section 2: Amends section 6507 of the education law and adds new para-
graph d to subdivision 3. It establishes standards for continuing educa-
tion for health care practitioners on the best practices and approaches
for mitigating and eliminating the spread of disease by health care
practitioners by implementing to the extent practicable the recommenda-
tions of the state health care practitioner hygienic dress code council.
Section 3: Amends 2343 of the insurance law by adding subsection(f)which
instructs the superintendent to approve and implement programs to
encourage health care facilities and practitioners to adopt hygienic
dress codes to obtain better or cheaper medical malpractice coverage.
Such programs can include enhanced coverage levels, lower deductibles,
or an actuarially appropriate premium reduction for facilities and
health care providers which have implemented a successful practitioner
dress code.
Section 4: Amends 3436 of the insurance law by adding subsection (f) to
chapter 266 which instructs insurers to provide for actuarially appro-
priate premium reductions or other medical malpractice insurance
enhancements such as enhanced coverage levels and lower deductibles for
health care providers and facilities which implement a successful prac-
titioner dress code.
Section 5: Amends section 5505 of the insurance law by adding subsection
e which provides for an actuarially appropriate premium discounts or
other medical malpractice insurance enhancements such as enhanced cover-
age levels and lower deductibles by the association for facilities and
practitioners which implement a successful practitioner dress code.
Section 6: This act is effective on the first on January next succeeding
date on which is shall have become law and section one expires January
1, 2021.
JUSTIFICATION: New York is facing a crisis with regard to the avail-
ability and affordability of medical liability insurance coverage. New
York health care providers pay the highest premium rates in the country
for their medical liability insurance and those rates continue to rise.
Approaches to improve patient safety have been increasingly researched
for their effects on curtailing medical malpractice liability costs.
Malpractice claims that involve preventable injuries often result in
large jury awards. Information indicates that, rather than increased
frequency of claims, the soaring amount of individual malpractice awards
accounts for increasing malpractice costs. Therefore, it is logical to
reduce, and when possible, eliminate preventable injuries to curtail
medical malpractice costs and accompanying premium rates.
In a report issued by Senator Klein, it was found that while other meth-
ods and avenues for addressing rising medical malpractice costs and
overall health care costs, such as attempting to cap damages in medical
malpractice suits or other methods of tort reform, there were other ways
to address the underlying causes of increased insurance rates. Namely,
that by addressing some of the underlying causes of injury rates in
patients such as the spread of infections, such as nosocomial infections
like methicillin resistant staphylococcus aureus (MRSA), that these
reduced incidence rates would necessarily reduce the number of claims
and thus the rising costs of medical malpractice insurance. One major
way of curtailing the number of these infections involves avoiding
having to treat drug-resistant afflictions altogether and work to miti-
gate their initial spread. That is, mitigating the spread of these
infections is an effective method of combating them. Thus, as research
indicates that the health care practitioners themselves may be unwitting
agents of these infections, examining how they are being spread and then
addressing that cause may be an effective tool.
Exploring and possibly implementing all or some of a health care practi-
tioner dress code may lead to fewer injuries to patients as well as
lowered insurance premiums. Further, this can lessen the practice of
defensive medicine-that is, care tailored toward preventing lawsuits and
not carefully planned to a patient's needs which also drives up the cost
of care.
PRIOR LEGISLATIVE HISTORY: New Bill.
FISCAL IMPLICATIONS: This bill is designed to lower rising medical
malpractice costs by targeting some of the underlying causes such as the
spread of several types of infection. Lowering such rates should also
lead to fewer claims and less time in the hospital, thus alleviating
associated health care costs to all parties involved, including the
state.
EFFECTIVE DATE: This act shall take effect on the first of January
next succeeding the date on which it shall have become law and section
one of this act shall expire and be deemed repealed January 1, 2020.
STATE OF NEW YORK
________________________________________________________________________
7845--C
2011-2012 Regular Sessions
IN ASSEMBLY
May 19, 2011
___________
Introduced by M. of A. MAGNARELLI, JAFFEE, MAISEL, LINARES, SCHIMEL,
MILLMAN, COOK, GIBSON, HOOPER, WEPRIN -- Multi-Sponsored by -- M. of
A. BOYLAND, PERRY, P. RIVERA -- read once and referred to the Commit-
tee on Health -- recommitted to the Committee on Health in accordance
with Assembly Rule 3, sec. 2 -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee --
again reported from said committee with amendments, ordered reprinted
as amended and recommitted to said committee -- again reported from
said committee with amendments, ordered reprinted as amended and
recommitted to said committee
AN ACT to amend the public health law, the education law and the insur-
ance law, in relation to establishing a health care practitioner
hygienic dress code; and providing for the repeal of certain
provisions upon expiration thereof
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Article 2 of the public health law is amended by adding a
2 new title 6 to read as follows:
3 TITLE 6
4 HEALTH CARE PRACTITIONER HYGIENIC
5 DRESS CODE
6 Section 266. Health care practitioner hygienic dress code.
7 § 266. Health care practitioner hygienic dress code. 1. Definitions.
8 The following words or phrases as used in this title shall have the
9 following meanings:
10 (a) "Continuing education" shall mean all professional continuing
11 education programs required either by state law, or by professional
12 associations authorized by the education department to monitor the
13 requirements of licensure or certification and to conduct continuing
14 education required to be completed by a health care practitioner.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD10964-09-2
A. 7845--C 2
1 (b) "Council" shall mean the state health care practitioner hygienic
2 dress code council established by subdivision two of this section.
3 (c) "Health care facility" shall mean and include a hospital and resi-
4 dential health care facility as defined in section twenty-eight hundred
5 one of this chapter, and any setting in which a health care practitioner
6 regularly practices his or her profession.
7 (d) "Health care practitioner" shall mean any person licensed as a
8 physician pursuant to article one hundred thirty-one of the education
9 law, physician assistant or specialist assistant pursuant to article one
10 hundred thirty-one-B of the education law, nurse pursuant to article one
11 hundred thirty-nine of the education law, or midwife pursuant to article
12 one hundred forty of the education law.
13 2. State health care practitioner hygienic dress code council. (a) The
14 state health care practitioner hygienic dress code council is hereby
15 established in the department to be an expert panel to advise the
16 commissioner and the commissioner of education on: (i) the best prac-
17 tices related to mitigating and eliminating the spread of disease,
18 infection and bacteria to patients, visitors and the general public in
19 health care facilities by means of the unhygienic clothing, jewelry and
20 health care facility identification tags worn by health care practition-
21 ers and the cleaning personnel of such facilities, (ii) the promotion of
22 better and coordinated policies to ensure better hygienic practices in
23 health care facilities, and (iii) the development of guidelines to
24 assist the education department in establishing materials and curricula
25 to be used in providing continuing education programs to health care
26 practitioners on the use of a hygienic dress code to minimize the spread
27 of disease, infection and bacteria to patients, visitors and the general
28 public.
29 (b) The council shall be composed of twenty-five members appointed by
30 the commissioner. The commissioner shall seek recommendations for
31 appointments from the commissioner of education and the superintendent
32 of financial services. The membership of the council shall include
33 representatives of the various professions within the definition of
34 health care practitioner, the various facilities and settings within the
35 definition of health care facility, educators of health care practition-
36 ers, cleaning and sterilization services for health care facilities,
37 pharmaceutical companies, and insurers and corporations providing health
38 care coverage. The chair of the council shall be a member thereof as is
39 so designated by the commissioner.
40 (c) The members of the council shall have expertise in the maintenance
41 and creation of sanitary and hygienic conditions in the treatment of
42 patients by health care practitioners and in health care facilities. The
43 term of office of such members shall be four years. The members of the
44 council shall receive no compensation for their services, but shall be
45 allowed their actual and necessary expenses in the performance of their
46 duties.
47 (d) The council shall meet upon the call of the commissioner or the
48 chair. The council may adopt regulations consistent with this section.
49 (e) The commissioner shall designate such employee and provide for
50 other resources of the department as may be reasonably necessary to
51 provide support and services for the work of the council.
52 (f) The council may provide technical information and guidance to
53 health care practitioners and health care facilities on the latest and
54 best practices and strategies related to mitigating and eliminating the
55 spread of disease, infection and bacteria during the course of treatment
A. 7845--C 3
1 of patients as it relates to the use of hygienic health care practition-
2 er clothing, attire and a dress code.
3 3. Policies to be considered, examined and possibly advanced after
4 evidence-based review by the council. The council shall consider and
5 examine the following policies and guidelines in the adoption of rules
6 and regulations:
7 (a) The provision of education and instruction to patients and health
8 care practitioners on how enhanced sanitary and hygienic policies,
9 including the use of hygienic health care practitioner clothing, attire
10 and a dress code, can help to reduce the risk of cross-infection;
11 (b) Encouraging health care facilities to provide adequate supplies of
12 clean scrubs, other articles of clothing and health care facility iden-
13 tification tags to health care practitioners to ensure frequent changes
14 thereof;
15 (c) Encouraging health care facilities to provide changing rooms, and
16 instruction on how to appropriately wash clothing worn by health care
17 practitioners;
18 (d) The wearing of pathogen-resistant scrubs and coats, aprons or
19 slips made of plastic or wicking materials, and double gloves;
20 (e) The adoption of a prohibition on the wearing outside of a health
21 care facility by health care practitioners of clothing worn during
22 treatment of patients; and
23 (f) Consideration of alterations in Medicaid and private payor
24 reimbursement rates and practices to encourage more optimum sanitary and
25 hygienic conditions in health care facilities.
26 4. Health care practitioner hygienic resource centers. The commission-
27 er, in consultation with the council, may designate a health care prac-
28 titioner hygienic resource center or centers. Such resource center may
29 be statewide or regional, and shall act as a source of technical
30 support, information and guidance for health care practitioners and
31 health care facilities on the latest strategies and best practices with
32 regard to establishing sanitary and hygienic conditions for the treat-
33 ment of patients. The department, in consultation with the council, may
34 contract with not-for-profit organizations or associations to establish
35 and manage such resource centers. Such resource centers may charge a fee
36 to help offset the cost of providing such services.
37 5. Continuing education for health care practitioners. The council, in
38 consultation with the department, the education department and health
39 care practitioner professional organizations, shall develop, compile and
40 publish information and course materials on sanitary and hygienic prac-
41 tices that should be followed by health care practitioners and health
42 care facilities to mitigate and eliminate the spread of disease,
43 infection and bacteria to patients, visitors and the general public by
44 means of the clothing, jewelry and health care facility identification
45 tags worn by health care practitioners and the cleaning personnel of
46 such facilities. In addition, within two years of the effective date of
47 this title, the council shall make recommendations to the education
48 department for the course work, training and curriculum to be included
49 in the continuing education on the best practices, strategies and
50 approaches related to mitigating and eliminating the spread of disease,
51 infection and bacteria to patients, visitors and the general public in
52 health care facilities by means of the clothing, jewelry and health care
53 facility identification tags worn by health care practitioners and the
54 cleaning personnel of such facilities.
55 6. Report. On or before March first of each even numbered year, the
56 council shall submit to the governor, the commissioner, the commissioner
A. 7845--C 4
1 of education, the temporary president of the senate, the speaker of the
2 assembly, the minority leader of the senate, the minority leader of the
3 assembly, and the chairs of the senate and assembly committees on health
4 a report on its activities and accomplishments pursuant to this article
5 relating to sanitary and hygienic conditions in health care facilities.
6 Such report may also include such legislative proposals as it deems
7 necessary to more effectively implement the provisions of this title.
8 § 2. Paragraphs b and c of subdivision 3 of section 6507 of the educa-
9 tion law, as added by chapter 987 of the laws of 1971, are amended and a
10 new paragraph d is added to read as follows:
11 b. Review qualifications in connection with licensing requirements;
12 [and]
13 c. Provide for licensing examinations and reexaminations[.]; and
14 d. (i) Establish standards for continuing education for health care
15 practitioners on the best practices, strategies and approaches related
16 to mitigating and eliminating the spread of disease, infection and
17 bacteria to patients, visitors and the general public in health care
18 facilities by means of the clothing, jewelry and health care facility
19 identification tags worn by health care practitioners and the cleaning
20 personnel of such facilities. In promulgation of such standards, the
21 department and the appropriate board of each such profession shall
22 consider and, to the extent practicable, implement the recommendations
23 of the state health care practitioner hygienic dress code council.
24 (ii) For the purposes of this paragraph:
25 (A) "Health care facility" shall mean and include a hospital and a
26 residential health care facility as defined in section twenty-eight
27 hundred one of the public health law, and any setting in which a health
28 care practitioner regularly practices his or her profession.
29 (B) "Health care practitioner" shall mean any person licensed as a
30 physician pursuant to article one hundred thirty-one of this title,
31 physician assistant or specialist assistant pursuant to article one
32 hundred thirty-one-B of this title, nurse pursuant to article one
33 hundred thirty-nine of this title, or midwife pursuant to article one
34 hundred forty of this title.
35 § 3. Section 2343 of the insurance law is amended by adding a new
36 subsection (f) to read as follows:
37 (f) The superintendent shall approve and implement programs to encour-
38 age health care providers, health care facilities and medical malprac-
39 tice insurers to participate in health care provider hygienic dress code
40 programs. Such programs may include, but shall be limited to, enhanced
41 coverage levels, reductions in deductible levels or actuarially appro-
42 priate premium reduction for insured health care providers and health
43 care facilities which have implemented a successful health care practi-
44 tioner dress code program, pursuant to title six of article two of the
45 public health law, which is approved by the commissioner of health.
46 § 4. Section 3436 of the insurance law, as added by chapter 266 of the
47 laws of 1986, is amended by adding a new subsection (f) to read as
48 follows:
49 (f) An insurer which issues policies for primary levels of medical
50 malpractice insurance shall upon the issuance or renewal thereof,
51 provide for programs to encourage health care providers, health care
52 facilities and medical malpractice insurers to participate in health
53 care provider hygienic dress code programs. Such programs may include,
54 but shall be limited to, enhanced coverage levels, reductions in deduct-
55 ible levels or actuarially appropriate premium reduction for insured
56 health care providers and health care facilities which have implemented
A. 7845--C 5
1 a successful health care practitioner dress code program, pursuant to
2 title six of article two of the public health law, which is approved by
3 the commissioner of health.
4 § 5. Section 5505 of the insurance law is amended by adding a new
5 subsection (e) to read as follows:
6 (e) The association's rates, rating plans and rating classifications
7 shall provide for programs to encourage health care providers, health
8 care facilities and medical malpractice insurers to participate in
9 health care provider hygienic dress code programs. Such programs may
10 include, but shall be limited to, enhanced coverage levels, reductions
11 in deductible levels or actuarially appropriate premium discounts for
12 health care providers and health care facilities which have implemented
13 a successful health care practitioner dress code program, pursuant to
14 title six of article two of the public health law, which is approved by
15 the commissioner of health.
16 § 6. This act shall take effect on the first of January next succeed-
17 ing the date on which it shall have become a law and section one of this
18 act shall expire and be deemed repealed January 1, 2021.
