Bolstered by a recent “patient dumping” incident in Baltimore that garnered embarrassing national attention, legislation to outline a bill of rights for Maryland hospital patients passed the state Senate on Friday.
But even with the heightened concern, the proposal could be headed for failure. Advocates who originally backed the measure are now begging lawmakers to kill a revised version of it.
Senators approved the bill, 36-7, with little discussion, despite arguments among lawmakers, patient advocates and hospital executives over which rights should be enshrined in state law and which should be the prerogative of caregivers.
The approved version calls for eight broad guarantees backed by hospitals, instead of a list of 22 specific rights contained in the original legislation offered by patient advocates. That revision means the bill now faces a frosty reception in the House of Delegates.
Patient advocates say the proposal has changed so drastically that it now places the concerns of health care organizations above patient safety.
“This is not a compromise — this is a further erosion of our rights,” said Anna Palmisano, coordinator of Marylanders for Patient Rights. “This is the wrong bill.”
But Jim Reiter, a spokesman for the Maryland Hospital Association, said the amended bill “does not remove any rights for patients.” Existing state and federal rules currently impose standards that exceed what the advocates are calling for, he added.
The divide has kept past bills from ever advancing this far. The Senate’s action Friday marks the first time in three attempts that a patients’ bill of rights proposal has even reached the floor of the General Assembly — largely because of concern generated in January when University of Maryland Medical Center staff discharged a woman wearing only a hospital gown onto the street in frigid temperatures in downtown Baltimore.
A psychotherapist who captured a video of the incident that was widely shared on Facebook said the woman appeared disoriented and unable to speak.
The incident prompted leadership changes at medical center’s Midtown hospital and led state health regulators to investigate. UMMC officials have apologized for what they called an isolated case and said they are reviewing discharge policies.
Patient advocates said the rights spelled out in the bills they initially offered in both chambers of the General Assembly could have prevented the patient-dumping incident. They proposed a set of 22 rights that included guaranteeing patients opportunities to request an escort during examinations, to make advanced directives and to participate in their discharge plans.
Palmisano said such rights need to be made explicit in state law because respect, safety and quality of care provided to patients can vary widely at different hospitals. She said Maryland ought to join 27 other states that spell out patient rights in law. Her advocacy group is a coalition of organizations, including Disability Rights Maryland, AARP Maryland and the Mental Health Association of Maryland.
But hospital officials said the advocates’ approach went too far, micromanaging the way care is provided and treading on territory already covered by the Centers for Medicare and Medicaid Services, or CMS, and an industry accrediting organization called the Joint Commission. Hospital officials offered an amendment to the bill rewriting it with a set of eight basic rights that the Joint Commission already requires hospitals to maintain, including certainty of patient privacy, visitation, access to medical records and clear communication.
CMS and the commission already have “pages of standards that we must meet beyond what the bill as introduced requires,” Reiter said.
Under current state law, hospitals must provide patients with an existing “bill of rights” that has been established by the Joint Commission. The law does not specify what those rights should be.
Sen. Ronald Young, a Frederick County Democrat who until Wednesday was the Senate bill’s lead sponsor, said he thinks the legislation no longer reflects his intention to boost patient rights. He is not a member of the committee that amended the bill to reflect what the hospital association was seeking. He voted against it Friday.
But Sen. Thomas “Mac” Middleton, who is now the bill’s lead sponsor, said the hospitals’ concerns are valid because lawmakers should not be dictating the way health care is provided. The Southern Maryland Democrat said the Senate Finance Committee that he chairs has never been willing to approve bills that legislate what he called “a standard of care.”
The bill that passed “doesn’t tell hospitals what they have to do, it gives them guidance,” Middleton said. “What we have here is an attempt to get something meaningful out and get it in statute. It’s a good bill as amended.”
Young was hopeful the legislation would die in the House of Delegates, where a companion bill was introduced and then withdrawn by his wife, Del. Karen Lewis Young.
Lewis Young, also a Frederick County Democrat, has pushed patients’ bill of rights legislation for the past two legislative sessions. She said she pulled this year’s attempt after learning of hospitals’ counter-proposal, and is “highly disappointed” to see their influence on the Senate version.
When legislation reaches her committee later this month, she said she will urge her colleagues to reject what she called “a bad bill.” Del. Eric Bromwell, the committee’s vice chairman and a Baltimore County Democrat, said advocates’ opposition makes the bill unlikely to pass.
“This is a bill for the hospitals association, not for the citizens of Maryland,” Lewis Young said.