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system oversight (Florida)
It is not permissible
under Florida law to "establish, conduct, or maintain"
a hospital or other care facility without first obtaining
a license (FL Stat chapter 395). Nor
can one practice as a physician, dentist, psychologist or
other clinical professional without a license. (See chapters
458, 459, 461, 464, 466 and 490 among others.)
A large category
of uses and disclosures for health system oversight are related
to the state's duty to monitor the conduct of the organizations
and persons that it has licensed. HIPAA permits these activities
to continue unchanged.
Each licensed facility
is required to have a peer review process for those persons
that delivery clinical services (notably, its physicans).
(See 395.0193.) The proceedings and records of such activities
-- which will include identifiable patient information --
are not open to public inspection (such as under 119.07),
nor subject to discovery in a civil or administrative action.
(Note, however,
that "information, documents, or records otherwise available
from original sources" are not immune from discovery
simply because they were so used.)
Each license facility
must have an internal risk management program -- that investigates
and analyzes adverse events. The program must be under the
supervision of a licensed risk manager, who has access to
all of a facility's health records. Facilities must report
adverse events to the Florida Agency for Health Care Administration
(AHCA), with detail that can include identifiable patient
information.
The timetable for
such reporting varies depending on the incident. Facilities
must also submit an annual report. Moreover, AHCA "shall
have access to all licensed facility records necessary"
to carry out its monitoring responsibilities. (395.0197)
As with peer review,
risk management reports are exempted from state public records
access provisions, as well as civil or administrative discovery.
(395.0198)
Trauma centers
and acute care hospitals must provide trauma registry data
to the state, for monitoring patient outcomes and program
compliance. (395.404) Additional disclosures of data on trauma
care may be required as part of site visits or other quality
assurance activities. (395.4025, 395.50)
DCF and ACHA may
enter and inspect any mental health treatment facility, to
determine if it is in compliance with the relevant statutes
and administrative rules. This right of inspection may include
access to any and all clinical records. (394.90)
In general, information
disclosed for these purposes is, like matters related to peer
review, exempt from the "sunshine" statutes that
otherwise permit "inspection, examination and duplication"
of public records (as per FL Stat 119.07)
See also:
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