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House
File
2593
-
Introduced
HOUSE
FILE
2593
BY
R.
JOHNSON
A
BILL
FOR
An
Act
relating
to
infant
and
maternal
care
at
health
care
1
facilities.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
SHORT
TITLE.
This
Act
shall
be
known
and
may
be
1
cited
as
“The
Amir
Act”.
2
Sec.
2.
NEW
SECTION
.
135E.1
Legislative
findings
and
3
intent.
4
1.
The
general
assembly
finds
all
of
the
following:
5
a.
Infant
and
maternal
mortality
remain
critical
public
6
health
concerns
in
this
state.
7
b.
Preventable
harm
and
death
can
occur
when
patient
and
8
caregiver
concerns,
particularly
concerns
raised
by
mothers,
9
are
dismissed,
delayed,
or
not
adequately
escalated
within
10
medical
settings.
11
c.
Parents
and
guardians
are
often
the
first
to
recognize
12
signs
of
distress
or
decline
in
an
infant.
13
d.
Health
care
systems
must
ensure
that
concerns
raised
14
by
patients,
caregivers,
parents,
and
guardians
are
taken
15
seriously,
documented,
and
promptly
evaluated.
16
2.
The
general
assembly
intends
for
this
chapter
to
17
accomplish
all
of
the
following:
18
a.
Strengthen
protections
for
infants
and
mothers.
19
b.
Ensure
timely
medical
response
when
a
patient,
caregiver,
20
parent,
or
guardian
expresses
concerns
regarding
the
condition
21
of
an
infant
or
the
infant’s
mother.
22
c.
Establish
clear
accountability
and
escalation
protocols
23
in
health
care
facilities.
24
d.
Reduce
preventable
infant
and
maternal
morbidity
and
25
mortality.
26
Sec.
3.
NEW
SECTION
.
135E.2
Definitions.
27
For
purposes
of
this
chapter,
unless
the
context
otherwise
28
requires:
29
1.
“Caregiver”
means
a
parent,
legal
guardian,
legal
30
custodian,
or
primary
caregiver
for
an
infant.
31
2.
“Caregiver
concern”
means
a
verbal
or
written
expression
32
by
a
caregiver
indicating
the
belief
that
an
infant
or
the
33
infant’s
mother
is
experiencing
distress,
deterioration,
or
34
abnormal
symptoms.
35
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3.
“Department”
means
the
department
of
health
and
human
1
services.
2
4.
“Escalation
protocol”
means
a
formal
process
requiring
3
review
by
a
clinician
in
a
supervisory
position
or
a
care
team.
4
5.
“Health
care
facility”
means
any
of
the
following:
5
a.
A
hospital
as
defined
in
section
135B.1.
6
b.
A
birth
center
as
defined
in
section
135.131.
7
c.
A
birthing
hospital
as
defined
in
section
135.131.
8
d.
Other
medical
facilities
licensed
to
provide
infant
or
9
maternal
care
in
this
state.
10
6.
“Infant”
means
a
child
under
one
year
of
age.
11
7.
“Infant
rapid
response
process”
means
a
series
of
actions
12
a
health
care
facility
must
immediately
take
to
evaluate
the
13
condition
of
an
infant,
determine
whether
the
infant’s
care
14
needs
to
be
altered,
and
execute
the
altered
care
if
necessary.
15
Sec.
4.
NEW
SECTION
.
135E.3
Caregiver
concern
——
escalation
16
protocols.
17
1.
Each
health
care
facility
shall
adopt
and
implement
a
18
caregiver
concern
escalation
protocol
for
infant
and
maternal
19
patients.
20
2.
When
a
health
care
facility
receives
a
caregiver
concern,
21
the
health
care
facility
shall
do
all
of
the
following:
22
a.
Provide
the
individual
who
expressed
the
caregiver
23
concern
an
acknowledgment
that
the
health
care
facility
has
24
received
and
will
act
on
the
caregiver
concern
as
soon
as
25
practicable.
26
b.
Document
the
caregiver
concern
in
the
medical
record
for
27
the
infant
or
mother
to
whom
the
caregiver
concern
relates.
28
c.
Conduct
an
assessment
of
the
caregiver
concern
as
soon
29
as
practicable.
30
d.
Refer
the
caregiver
concern
to
a
physician
in
a
31
supervisory
position,
a
neonatal
specialist,
or
a
rapid
32
response
team
if
any
of
the
following
occurs:
33
(1)
The
caregiver
that
expressed
the
caregiver
concern
34
believes
the
issue
that
gave
rise
to
the
caregiver
concern
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remains
unresolved
after
the
health
care
facility
assessed
the
1
infant
or
mother.
2
(2)
Upon
request
by
the
caregiver
that
expressed
the
3
caregiver
concern.
4
3.
A
health
care
facility
or
health
care
provider
shall
not
5
do
any
of
the
following
in
response
to
a
caregiver
concern:
6
a.
Retaliate
against
the
caregiver,
the
caregiver’s
infant,
7
or
the
mother
who
is
the
subject
of
the
caregiver
concern.
8
b.
Discharge
the
caregiver’s
infant
or
the
mother
who
is
the
9
subject
of
the
caregiver
concern
from
the
health
care
facility
10
or
the
health
care
provider’s
care.
11
c.
Dismiss
the
caregiver
concern
without
taking
action.
12
Sec.
5.
NEW
SECTION
.
135E.4
Infant
rapid
response
process.
13
1.
A
health
care
facility
that
provides
care
to
infants
14
shall
maintain
an
infant
rapid
response
process
that
may
be
15
initiated
by
any
of
the
following:
16
a.
Medical
staff
attending
an
infant.
17
b.
A
caregiver
when
the
caregiver
believes
the
condition
of
18
the
caregiver’s
infant
is
worsening.
19
2.
When
the
infant
rapid
response
process
is
initiated,
20
a
physician
shall
immediately
evaluate
the
condition
of
the
21
infant
who
is
the
subject
of
the
infant
rapid
response
process.
22
Sec.
6.
NEW
SECTION
.
135E.5
Family
and
patient
advocacy
23
notice.
24
1.
Each
health
care
facility
shall
provide
a
written
and
25
verbal
notice
to
an
infant’s
caregivers
when
the
infant
is
26
brought
to
the
health
care
facility
to
receive
treatment.
27
The
written
and
verbal
notice
shall
include
a
statement
that
28
the
caregiver
is
entitled
to
the
following
rights
under
this
29
chapter:
30
a.
The
right
to
make
and
have
caregiver
concerns
documented.
31
b.
The
right
to
request
a
higher
acuity
of
care
for
the
32
caregiver’s
infant
or
the
infant’s
mother,
as
applicable.
33
c.
The
right
to
initiate
an
infant
rapid
response
process.
34
2.
Each
health
care
facility
where
infants
receive
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treatment
shall
display
a
written
notice
that
contains
the
1
information
in
subsection
1,
paragraphs
“a”
through
“c”
,
in
a
2
prominent
location.
3
Sec.
7.
NEW
SECTION
.
135E.6
Training
requirements.
4
All
health
care
facility
staff
who
provide,
or
assist
in
5
the
provision
of,
infant
or
maternal
care
shall
receive
annual
6
training
on
all
of
the
following:
7
1.
Implicit
bias
and
patient
communication.
8
2.
Recognizing
caregiver-reported
warning
signs.
9
3.
Proper
use
of
escalation
protocols
and
infant
rapid
10
response
processes.
11
Sec.
8.
NEW
SECTION
.
135E.7
Rules.
12
1.
The
department
shall
adopt
rules
pursuant
to
chapter
17A
13
to
do
all
of
the
following:
14
a.
Implement
and
administer
section
135E.5,
including
but
15
not
limited
to
all
of
the
following:
16
(1)
Rules
establishing
minimum
hours
of
annual
training.
17
(2)
Rules
establishing
which
classes
and
training
programs
18
qualify
for
credit.
19
(3)
Other
rules
related
to
training
that
the
department
20
deems
relevant
to
effectuate
the
intent
of
this
chapter.
21
b.
Require
each
health
care
facility
to
provide
data
22
relating
to
all
incidents
with
adverse
outcomes
when
a
23
caregiver
requested
a
higher
acuity
of
care
for
the
caregiver’s
24
infant
or
when
an
infant
rapid
response
process
was
initiated.
25
2.
The
department
of
inspections,
appeals,
and
licensing
26
shall
adopt
rules
pursuant
to
chapter
17A
to
implement,
27
administer,
and
enforce
this
chapter.
Rules
relating
to
28
enforcement
shall
include
the
corrective
action
plans,
29
administrative
penalties,
or
licensure
review
for
a
person
30
found
in
violation
of
this
chapter.
31
EXPLANATION
32
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
33
the
explanation’s
substance
by
the
members
of
the
general
assembly.
34
This
bill
relates
to
infant
and
maternal
care
at
a
health
35
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2593
care
facility
(facility).
1
The
bill
shall
be
known
and
may
be
cited
as
“The
Amir
Act”.
2
The
bill
states
several
legislative
findings
and
the
intent
of
3
the
bill.
4
The
bill
defines
“caregiver”
as
a
parent,
legal
guardian,
5
legal
custodian,
or
primary
caregiver
for
an
infant.
6
The
bill
defines
“caregiver
concern”
as
a
verbal
or
written
7
expression
by
a
caregiver
indicating
the
belief
that
an
infant
8
or
the
infant’s
mother
is
experiencing
distress,
deterioration,
9
or
abnormal
symptoms.
10
The
bill
defines
“escalation
protocol”
as
a
formal
process
11
requiring
review
by
a
clinician
in
a
supervisory
position
or
a
12
care
team.
13
The
bill
defines
“health
care
facility”
(facility)
as
a
14
hospital,
a
birth
center,
a
birthing
hospital,
or
other
medical
15
facilities
licensed
to
provide
infant
or
maternal
care
in
this
16
state.
17
The
bill
defines
“infant
rapid
response
process”
as
a
series
18
of
actions
a
facility
must
immediately
take
to
evaluate
the
19
condition
of
an
infant,
determine
whether
the
infant’s
care
20
needs
to
be
altered,
and
execute
the
altered
care
if
necessary.
21
The
bill
also
defines
“department”
and
“infant”.
22
The
bill
requires
each
facility
to
adopt
and
implement
a
23
caregiver
concern
escalation
protocol
for
infant
and
maternal
24
patients,
and
requires
a
facility
to
take
certain
actions
25
specified
in
the
bill
when
the
facility
receives
a
caregiver
26
concern.
27
The
bill
prohibits
a
facility
or
health
care
provider
from
28
retaliating
against
a
caregiver,
an
infant,
or
a
mother,
or
29
discharging
an
infant
or
a
mother,
due
to
the
fact
a
caregiver
30
expressed
a
caregiver
concern.
The
bill
also
prohibits
a
31
facility
from
dismissing
a
caregiver
concern
without
taking
32
action.
33
The
bill
requires
a
facility
that
provides
care
to
infants
to
34
maintain
an
infant
rapid
response
process
that
may
be
initiated
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by
medical
staff
attending
an
infant,
or
a
caregiver
when
the
1
caregiver
believes
the
condition
of
the
caregiver’s
infant
is
2
worsening.
When
an
infant
rapid
response
process
is
initiated,
3
a
physician
shall
immediately
evaluate
the
infant’s
condition.
4
The
bill
requires
a
facility
to
provide
written
and
verbal
5
notice
to
an
infant’s
caregivers
when
the
infant
is
brought
6
to
the
facility
to
receive
treatment.
The
written
and
verbal
7
notice
shall
include
a
statement
that
the
caregiver
is
entitled
8
to
certain
rights
under
the
bill,
and
the
written
notice
must
9
be
displayed
in
a
prominent
location
where
infants
receive
10
treatment.
11
The
bill
requires
all
facility
staff
who
provide,
or
assist
12
in
the
provision
of,
infant
or
maternal
care
to
receive
annual
13
training
as
specified
in
the
bill.
14
The
bill
requires
the
department
of
health
and
human
15
services
to
adopt
rules
relating
to
facility
staff
training
16
and
requiring
each
facility
to
provide
data
relating
to
all
17
incidents
with
adverse
outcomes
when
a
caregiver
requested
a
18
higher
acuity
of
care
for
the
caregiver’s
infant,
or
when
an
19
infant
rapid
response
process
was
initiated.
20
The
bill
requires
the
department
of
inspections,
appeals,
21
and
licensing
to
adopt
rules
to
implement,
administer,
and
22
enforce
the
bill.
Rules
relating
to
enforcement
must
include
23
corrective
action
plans,
administrative
penalties,
or
licensure
24
review
for
a
person
found
in
violation
of
the
bill.
25
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