Dear OCEP Members,
We are at the midpoint of the long Oregon legislative session and I am happy to report we have not only made significant strides in furthering bills that support our legislative goals but also been successful in preventing the advancement of bills that would make our job even more challenging without providing improved patient outcomes.
Specifically, we are a large step closer to not only have the ability to distribute naloxone to our patients but also the funding to support the undertaking. Additionally, we advocated for a bill to fund a state-wide medical coordination center which identifies available beds and facilitates the transfer of patients requiring higher levels of care. We have successfully worked with nurses to amend proposed legislation that would have decreased the ED nurse-to-patient staffing ratio to a point which would further exacerbate delays in care. Finally, we have lobbied to stop legislation that would require all emergency departments to become virtual full-service social service centers to anyone presenting who is experiencing houselessness. Please take a look below for more information on these efforts as well as others.
As always, please reach out to me with any concerns and any interest in being more involved. Our power comes from our ability to represent you, our members. We want your voice to be heard!
Best,
Alex Skog, MD FACP
President of the Oregon Chapter of the American College of Emergency Physicians
Status of OR-ACEP Priority One Bills
HB 2002 Reproductive health and gender affirming care (Ways and Means 4/13)
OR-ACEP Position: SUPPORT
- The measure declares an individual’s decisions regarding their reproductive health as a fundamental right
- Protection is provided for authorized individuals against malpractice claims or actions on their provider license when providing reproductive or gender-affirming health care services that are legal in Oregon and provides additional direction for insurers and provider boards.
- The measure declares laws in other states that permit civil or criminal action against a person seeking or providing reproductive healthcare or gender-affirming treatment as contrary to the public policy of this state. The measure defines what recourse may be taken for these interstate actions. The measure makes interfering with healthcare facilities with the intent to disrupt operations a Class A misdemeanor and addresses other transgressions.
HB 2395 Omnibus opioid bill (Passed House, Senate hearing on 4/24)
OR-ACEP Position: SUPPORT
House Bill 2395 A makes long-acting opioid antagonist medications more accessible in Oregon and establishes standards for reporting opioid overdose deaths.
- Allows law enforcement officers, firefighters, and emergency medical services providers to distribute and administer short-acting opioid antagonists.
- Allows Oregon Prescription Drug Program administrator to undertake bulk purchases of short-acting opioid antagonists for the purpose of expanding access to short-acting opioid antagonists throughout the state by entities that serve vulnerable populations.
HB 2397 Bulk purchase of naloxone. (Ways and Means)
OR-ACEP Position: SUPPORT
- The measure establishes the Harm Reduction Clearinghouse Project within OHA which is directed to bulk purchase harm reduction supplies for community organizations, first responders and other entities that serve individuals with a high potential for overdose. The measure establishes the Opioid Reversal Medication and Harm Reduction Clearinghouse Bulk Purchasing Fund.
- Permits transfers or donations from the Prescription Drug Purchasing Fund.
- Effective January 1, 2024.
SB 1043 Opioid poisoning medication distribution (Passed Senate 4/13)
OR-ACEP Position: SUPPORT
- Requires hospitals, detoxification facilities, and residential treatment facilities to provide two doses of opioid overdose reversal medication to patients who are treated for opioid use disorder and who are discharged to an unlicensed setting. Does not apply to residents who leave the hospital or facility against advice.
- Exempts providers who fail to meet this requirement from liability if acting in good faith.
- Directs the Oregon Health Authority to facilitate access to opioid overdose reversal medications.
HB 2743 Funding for the Oregon Medical Coordination Center (Ways and Means)
OR-ACEP Position: SUPPORT
The Oregon Medical Coordination Center (OMCC) ensures access to hospital care across the state by facilitating patient transfers. Developed as a voluntary partnership during the COVID-19 pandemic, OMCC has proven to be an effective way to support patients receiving the right level of care as hospitals face evolving capacity challenges.
For example:
- Critical Access Hospitals, which serve rural areas of the state, have reported significant benefits in using the OMCC to transfer patients who need a higher level of care.
- During the recent pediatric respiratory virus surge, the OMCC focused on maximizing pediatric ICU bed capacity and was able to find in-state placements for most infants and children who needed care.
- Most patients transferred through the OMCC process have been able to remain in or near their region, closer to loved ones and their communities than they otherwise may have been.
HB 3126 Establishes Emergency Behavioral Health Services for Children program in OHA. (Ways and Means)
OR-ACEP Position: SUPPORT
- House Bill 3126 A creates a pilot to bring system-level coordination similar to the state’s Trauma Program by establishing the Emergency Behavioral Health Services for Children program in the Oregon Health Authority. The pilot will promote the timely delivery of behavioral health services to children who present to hospital emergency departments in behavioral health crises.
Nurse Staffing
HB 2697 Nurse Staffing
OR-ACEP Position: WATCH
Board leadership and lobbyist Katy King met with ONA prior to session to express support for adequate staffing but concerns over ratios in the ED. We advocated for flexibility in staffing ratios for the ED and for patients waiting for discharge. The agreement negotiated between ONA, unions and OAHHS included the requested provision regarding patients waiting for discharge and allowances for emergency events.
- The compromise included a cap on how many patients can be assigned to a nurse or certified nursing assistant, support for an workforce exemption from the Health Cost Growth Target regulations (HB 2045), funding for nursing workforce initiatives and a legislative task force (SB 1079) to address medical surge and boarding in hospitals.
- Violations of the proposed law would be complaint-driven and subject to discretion from the health care provider.
- The proposal allows flexibility for emergency departments (up to 12 hours for emergency events such as a mass casualty) psychiatry, and for situations where flexibility is needed (and there’s capacity) because “it’s the right thing to do” to provide access for patient care.
Proposed staffing ratios for ED
- ED: Trauma: 1 RN :1 patient
- ED: non-trauma: 1 RN:4 patients averaged in the unit over the shift. 1 RN: 5 patients max.
- Ratios do not apply for emergency department patients who are in critical condition, until they are stable; patients (including ED) who are located in rooms near one another in the hospital and who are ready for discharge, but who face a barrier to discharge. The hospital nurse staffing committee will have the discretion to establish ratios.
SB 1079 Gut and stuff vehicle for task force to address post-acute health care and discharge. The bill is on the Senate President’s Desk for referral to Senate Rules.
OR-ACEP Position: WATCH
Note: This was part of the OAHHS, ONA labor negotiations.
Not moving forward
HB 2141 Expands crime of assault against HCW in hospitals (Died in Committee)
OR-ACEP Position: SUPPORT
The chapter supported bills in 2015, 2017, 2021, 22 and 23 to make it a felony to assault a healthcare worker. Rep. Shelly Boshart-Davis, R-Albany, convened a meeting in February that included Rep. Travis Nelson, D-Portland, Rep. Jason Kropf, D-Bend and Sen. Sara Gelser Blouin, D-Corvallis, OR-ACEP, OENA, ONA, OMA, DAs, Trial Lawyers and Disability Rights Oregon to review proposals but we were unable to reach agreement.
SB 563 Expands crime of assault and excludes anyone under the influence (Died in Committee)
OR-ACEP Position: OPPOSE unless amended.
Note: There may be an interim workgroup including emergency physicians and nurses, on bills to address violence in the workplace. OR-ACEP has worked very closely with OENA and ONA on this issue.
SB 1076 Hospital discharge policies for homeless patients (Died in Committee)
OR-ACEP Position: OPPOSE
Sen. Deb Patterson, D-Salem, chair of the Senate Health Care Committee and chief sponsor, will convene a local workgroup during the interim to develop recommendations for her community.
Questions about the legislative process? Contact Katy King: KatyKing01@gmail.com