Be well. Practice big medicine.

The views expressed here reflect the views of the authors alone, and do not necessarily reflect the views of any of their organizations. In particular, the views expressed here do not necessarily reflect those of Big Medicine, nor any member of Team EMS Inc.

NEWS: POLITICS

1103 Legislation introduced to restore emergency care [Victoria BC]--The Province is taking action to restore full emergency care to protect British Columbians, Minister of Health Services Kevin Falcon announced today in introducing legislation to end the strike by CUPE 873, the union representing BC Ambulance Service (BCAS) paramedics and dispatchers.

“With the H1N1 pandemic impacting the acute care system and winter and the holiday season fast approaching, the public needs certainty that they’ll have the care they need in an emergency,” Falcon said. “The decision to introduce this legislation was a difficult one and certainly not one that we take lightly. But it was clear that after seven months of failed attempts to reach an agreement and with no hope for a negotiated settlement in sight, we had to act.”

Falcon stated while the system is coping, pressure is increasing both in emergency departments and critical care areas across the province. He added health authorities are under further stress from increasing absenteeism, with up to 25 per cent of staff not reporting to work at BC Women’s Hospital last week alone due to illness.

Falcon said despite an essential services order, the dispute has had a profound impact on service delivery.

“In the Lower Mainland, the number of ambulances out of service each month has jumped to 150, compared to just 12 per month before the strike began,” said Falcon. “With the rest of our health care system already operating at full capacity to manage the impact of H1N1, we can’t afford to have the ambulance service operating at less than peak effectiveness.”

He added that every day the strike continues, it increases the risk to patients.

Falcon said the settlement outlined in the Ambulance Service Collective Agreement Act reflects the latest offer made to the union in September. The one-year deal is retroactive to April 1, 2009, and includes a competitive compensation increase of three per cent, in line with wage increases for other public sector workers in 2009.

“We believe this increase is more than generous at a time of global economic uncertainty,” said Falcon. “We are also profoundly aware there is no more room in the BCAS budget to increase compensation without undermining service delivery.”

Since April, the estimated cost impact of the strike is $9.2 million, which represents the cost of putting nine additional ambulances on the road for one year.

He noted the September offer had also included a further 1.2 per cent increase, contingent on both sides finding efficiencies within the collective agreement, which the union flatly refused. As a result this amount was not included as part of the legislation, however, he noted BCAS would still be willing to work collaboratively with the union to achieve the 1.2 per cent if their position changed.

Falcon said he is also calling on the Minister of Labour to appoint an Industrial Inquiry Commissioner as soon as possible to identify options for repairing the broken labour relations structure within the ambulance service.

1030 Hudak calls on Premier to remove H1N1 vax roadblocks [Queen's Park ON]--Today, Ontario PC Leader Tim Hudak presented Premier Dalton McGuinty with a plan to help expedite H1N1 vaccine distribution across the province. The current system in place is not working and the situation especially for high risk groups, is growing more critical.

"I am calling on the Premier to use his authority to ensure vaccines are
distributed as efficiently as possible. It is essential that this government
knocks down any bureaucratic barriers that prevent people from getting this
potentially life-saving vaccine," Hudak said.

Hudak called on the Premier to:

- Extend the hours of the clinics to operate 24 hours a day and on weekends;
- Implement a school-based and work-place vaccination program;
- Establish a reliable and consistent communications protocol between the Ministry, Chief Medical Officer and all of Ontario's Public Health Units;
- Expand the number of clinics in high demand areas;
- Solicit the immediate assistance of retired physicians and nurses to administer the vaccine;
- Establish a system that expedites the delivery of vaccines to physicians.

"I want to express my gratitude to the doctors, nurses and other health care professionals who have been working tirelessly during these extraordinary circumstances," Hudak said.

PC Deputy Leader and Health Critic Christine Eloitt wrote to the Health Minister on Wednesday, October 28, calling on the government to implement immediate measures to expedite vaccine distribution across the province. No response was given.

Tim Hudak and the PC Caucus believe that action must be taken now to end the unacceptable hours long line ups at clinics around the province.

"As a parent of a young child myself, this situation deeply concerns me. Vaccines do not protect anyone if they're left sitting on a shelf after a clinic closes its doors."

1029 Assistance to Shelter Act will protect homeless in extreme weather [British Columbia]--The Province has introduced the Assistance to Shelter Act to keep homeless British Columbians safe from extreme weather by giving police the authority to take people at risk of harm to emergency shelters, announced Housing and Social Development Minister Rich Coleman.

“When an extreme weather alert has been issued, we want people at risk off the streets and into safe accommodation,” said Coleman. “This legislation will help to prevent tragedies such as the one that occurred last winter when a woman died trying to keep warm in a makeshift shelter.”

Police will have to be satisfied people are at risk of harm due to the weather conditions before taking them to an emergency shelter. Once at the shelter, they have the right to decide whether or not they want to stay at the shelter. The shelter may provide the opportunity for individuals to connect with outreach workers, who can help them access medical, financial and long-term housing supports.

“The RCMP fully endorses efforts to assist homeless and less fortunate people on our streets,” said Gary Bass, RCMP Deputy Commissioner, Pacific Region. “We recognize that for the most part, these individuals do not commit crimes, but consider it a key pillar of our Crime Reduction Strategy in terms of those people who are on the street and may find themselves in situations where they are committing criminal offences to support themselves. We view this as a positive step forward in terms of assisting not only the homeless but those making efforts to avoid a criminal lifestyle.”

Victoria Police Chief Jamie Graham said, “The terrible dilemma for police officers is when the weather is so extreme and vulnerable people are found who are at very substantial risk. When a mental illness or addiction takes over rational decision making, the only hope is for the police to have supportive legislation allowing them to take people to safety. This is socially relevant policing in its purest form. “When the weather changes for the worse, many of our community's most vulnerable need a helping hand, and many times we are the only ones out there. I welcome any initiative that gets needy people the help they deserve.”

The new legislation will apply to adults age 19 and older when an extreme weather alert has been issued for a community. It is expected that the legislation will be in place this winter. Youth are covered by the Child, Family and Community Service Act, which provides the framework for Child Protection Services.

“What we want to do is show people the supports available to them, including a warm bed and a hot meal,” said Coleman. “Our hope is that once they see these supports, they’ll decide to stay at an emergency shelter, safe from the risks of extreme weather.”

The Province provides annual funding of $56 million for shelter supports and has more than doubled the number of year-round shelter beds across B.C. from just 700 in 2001 to 1,500 today. An additional 1,200 beds are available during extreme weather situations.

1029 Governor issues Executive Order to assist local govts with statewide H1N1 vax campaign [New York]--In response to requests for assistance from local governments across New York State including New York City, Governor David A. Paterson today issued Executive Order 29 declaring a State Disaster Emergency, which will provide additional personnel and flexibility to local governments as they work to implement a statewide vaccination campaign to protect New Yorkers from H1N1 influenza.

“The nationwide H1N1 vaccination campaign represents the first time in 33 years that the United States has attempted to conduct a mass vaccination campaign of this proportion for influenza,” Governor Paterson said. “Local governments are reporting that the current public health workforce is not sufficient to thoroughly execute a vaccination campaign of this magnitude. Those local governments and health care providers specifically requested that we issue this emergency declaration to give them flexibility to use additional personnel and resources in New York’s vaccination campaign.”

Under existing law, physicians, certified nurse practitioners and nurses may administer vaccinations. The Governor’s Executive Order will suspend Section 6902 of the Education Law to permit other health care workers – including physician and specialist assistants, pharmacists, dentists, certain dental hygienists, midwives and emergency medical personnel – to administer vaccinations after they receive training. They will work under the direction of the State or county health departments as part of their sponsored mass vaccination clinics.

To assure local governments’ ability to immunize in the school setting, the Executive Order also authorizes school-based health centers to vaccinate adults and children, and allows hospitals to operate part-time immunization clinics on school campuses.

Governor Paterson’s declaration follows the announcement on Saturday that President Barack Obama has declared a National Emergency related to H1N1 flu. With the President’s declaration in place, the federal government is permitted to waive specific hospital-related legal requirements – allowing hospitals to implement procedures in their emergency disaster plans that allow them to increase their ability, or surge capacity, to triage, treat and care for increased numbers of persons with the flu.

“I commend President Obama for declaring H1N1 a national emergency,” the Governor added. “By doing so, he is providing much-needed federal assistance to states as we respond to this influenza pandemic. Lifting certain legal health care requirements at both the federal and state levels will give local governments and health care facilities the support they need to effectively respond to an influenza pandemic of this magnitude.”

H1N1 flu activity is now considered widespread in New York, with more than 50 percent of counties reporting flu activity. Currently, vaccination in New York and all other states is hindered by a nationwide shortage of the H1N1 flu vaccine due to unexpected delays in vaccine production, according to the federal Centers for Disease Control and Prevention (CDC). The President’s declaration does not increase the pace at which the H1N1 vaccine will become available to the public.

“The next few weeks are critical to countering this H1N1 pandemic,” the Governor said. “While we cannot do anything about the current vaccine shortage, we are doing everything we can to ensure that public health officials around the State can mobilize and vaccinate New Yorkers as more vaccine becomes available. My Executive Order will not only give State and local authorities more access to professionals authorized to administer vaccinations, but it will help significantly increase the number of vaccinators in areas of the State that need them the most.”

Approximately 10 million New Yorkers fall into the priority groups established by the CDC for H1N1 vaccination, including 4.3 million in New York City alone. So far, 460,300 doses of the H1N1 vaccine – the total available to date from the CDC -- have been distributed to clinical sites in New York State outside of New York City, including hospitals, community health centers, physician offices, colleges and universities, and county health departments. Distribution of vaccine within New York City is coordinated by the New York City Department of Health and Mental Hygiene.
The priority groups established by CDC to receive the H1N1 influenza vaccine are:

Pregnant women, who experience four times the rate of hospitalization and six times the rate of death from H1N1 flu compared to the general population;
Persons who live with or provide care for infants under six months of age (infants under 6 months cannot be vaccinated);
Children and young people ages 6 months through 24 years;
Persons age 25 through 64 years old who have medical conditions that put them at higher risk for serious illness and influenza-related complications, including cancer, blood disorders, chronic lung disease (including asthma or heart disease), diabetes, heart disease, kidney disorders, liver disorders, neurological disorders neuromuscular disorders and weakened immune systems; and
Health care workers and emergency medical services personnel.

Due to shortages of both H1N1 and seasonal flu vaccine, Governor Paterson announced last week that State Health Commissioner Richard F. Daines, M.D., has suspended the State Health Department’s requirement that health care workers in certain facilities be vaccinated against the flu.

“The vaccination of health care workers continues to be an important patient safety measure, and I urge hospitals and other health care facilities to continue to encourage employees to be vaccinated against the flu,” Commissioner Daines said. “But with available vaccine in New York State far below the CDC’s original projections, we are adapting to this change in supply so that vaccines can be made available first to individuals in groups at highest risk for serious illness and death.”

With this declaration of a State Disaster Emergency, New York joins nine other states that have already taken emergency action or are in the process of declaring a public health emergency related to the H1N1 outbreak during this fall influenza season. Governor Paterson noted that it is within his power to declare an emergency by Executive Order when a current or imminent threat to public safety hinders local governments’ ability to respond adequately.

Additional information about seasonal and H1N1 flu, including educational resources and direct links to CDC’s website, is available on the New York State Department of Health’s website at www.nyhealth.gov. Read Executive Order Number 29 (PDF, 449KB, 6pg.)

1029 Governor renews Civil Emergency Order to fight flu, facilitate school-based vax [Maine]--Governor John E. Baldacci today renewed a Proclamation of Civil Emergency Due to a Highly Infectious Agent. The original proclamation was signed on Sept. 1 and again on Sept. 30.

The proclamation enables the State to continue to better respond to the potential dangers of H1N1 flu and to facilitate a statewide vaccination campaign.

“Providers in our schools, clinics and other facilities are on the front lines of prevention the spread of H1N1,” said Governor Baldacci. “Aggressive, responsible vaccination and public education are critical as we address the seasonal and H1N1 flu.”

The proclamation protects school districts and other vaccination clinic participants from liability. The proclamation also provides immunity from tort liability for approved health care workers who administer the flu vaccines. The vaccines are voluntary.

The Maine Center for Disease Control, the Department of Education and the Maine Emergency Management Agency continue to coordinate and facilitate the implementation of school supported vaccine clinics for both the seasonal flu and H1N1.

On April 29, Governor Baldacci signed an executive order that activated the State’s H1N1 Response Committee, which includes the Maine Department of Health and Human Services, Maine Center for Disease Control, MEMA, the Department of Education and the Governor’s Office.

The text of the proclamation follows:

Proclamation of Civil Emergency Due to a Highly Infectious Agent

Pursuant to the authority vested in the Office of the Governor of the State of Maine, and pursuant to the relevant provisions of 37-B M.R.S.A. �� 703, 741, 742, 743 (2) 784-A and 822, I, John Elias Baldacci, Governor of the State of Maine, renew my Proclamation of Civil Emergency dated September 30, 2009 as follows:

1. Background and Need

On June 11, 2009 the World Health Organization declared a global pandemic of the 2009 Influenza A (H1N1) virus and raised the pandemic alert level to Phase 6. Since the initial detection of the virus in March and April, 2009, it has rapidly spread throughout the United States and the world. The 2009 Influenza A (H1N1) virus is the predominant influenza virus in circulation worldwide and the U.S. Centers for Disease Control and Prevention has predicted a significant increase in cases in the fall of 2009 and winter of 2010. The virus is responsible for nearly 5,000 deaths worldwide, including more than 1,000 deaths in the United States. On October 1, 2009, 2009 U.S. Department of Health and Human Services Secretary Kathleen Sebelius, acting pursuant to her authority under section 319 of the Public Health Service Act, 42 U.S.C. �247-d-6, renewed prior April 26, 2009 and July 24, 2009 Departmental determinations that a public health emergency exists nationwide involving 2009 Influenza A (H1N1) which affects or has significant potential to affect national security. Forty-six states, including Maine, are reporting widespread influenza activity at this time. Almost all of the influenza viruses presently circulating have been identified as 2009 H1N1 Influenza A viruses. On October 24, 2009 President Obama declared a national emergency with respect to the 2009 H1N1 Influenza A pandemic. Manufacturing delays in the production of 2009 H1N1 Influenza A vaccine have delayed distribution and administration of the vaccine.

To prevent the incidence and severity of seasonal influenza and 2009 Influenza A (H1N1), the federal Centers for Disease Control and Prevention have established guidance for the vaccination of at risk populations, based upon the recommendations of the Advisory Committee on Immunization Practices. With respect to seasonal influenza, it is recommended that all children between the ages of 6 months and 19 years be vaccinated for seasonal influenza. With respect to 2009 Influenza A (H1N1), it is recommended that the entire U.S. population be vaccinated, with initial vaccination afforded to high risk groups defined by the federal Centers for Disease Control and Prevention. Funding for the seasonal influenza vaccination is provided through the American Recovery and Reinvestment Act of 2009 and the Fund for a Healthy Maine. Funding for the 2009 Influenza A (H1N1) vaccine is provided by the federal government.

Several state agencies are involved in the administration of statewide seasonal influenza and 2009 Influenza A (H1N1) vaccinations. The Maine Center for Disease Control and Prevention and Maine Department of Education are organizing a statewide campaign to provide seasonal influenza and 2009 Influenza A (H1N1) vaccination to children and the general public in school based clinics and other public vaccination sites. As the 2009 Influenza A (H1N1) vaccine has become available, the Maine Center for Disease Control is coordinating and facilitating the distribution and administration of the vaccine throughout the State of Maine in accordance with the guidance of the federal Centers for Disease Control and Prevention. Vaccine production delays will necessitate an intensive effort to distribute and administer the vaccine in Maine once adequate supplies are available.

The availability of statewide vaccination clinics for seasonal influenza and 2009 Influenza A (H1N1) is threatened due to concerns about potential liability relating to the administration of the vaccines. These current conditions, including the imminent threat of influenza pandemic, constitute a threat to the safety and welfare of the people of the State of Maine and constitute a civil emergency or disaster within the meaning of the relevant emergency management statutes.

1. Mission and Scope

To respond to the current public health emergency, I order and declare the following:

A. Civil emergency is imminent, caused by the public health emergency.

B. The Department of Health and Human Services, Maine Center for Disease Control and Prevention and Maine Department of Education shall coordinate with the Department of Defense, Veterans and Emergency Management, Maine Emergency Management Agency to identify those health care workers duly licensed and authorized to administer influenza vaccines in the State of Maine who are able and available to participate in the planned vaccinations for seasonal influenza and 2009 Influenza A (H1N1).

C. The Maine Center for Disease Control, Department of Education and Maine Emergency Management Agency shall coordinate and facilitate the establishment, implementation, administration and operation of vaccination clinics in school-based settings and other publicly accessible sites in a manner consistent with the recommendations of the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices.

D. The relevant provisions of the Maine Pandemic Influenza Plan will be activated to facilitate the distribution and administration of seasonal influenza and 2009 Influenza A (H1N1) vaccines.

E. To the extent necessary to assure the timely provision of seasonal influenza and 2009 Influenza A (H1N1) vaccination in accordance with the guidance of the federal Centers for Disease Control and Prevention, the Maine Center for Disease Control and the Department of Education, the Maine Emergency Management Agency will exercise its authority pursuant to 37-B M.R.S.A. �784-A to designate appropriate health care workers licensed in this State and authorized to administer influenza vaccines to participate in vaccination clinics in accordance with the requirements of this Proclamation.

F. All persons designated by the Maine Emergency Management Agency to participate in vaccine administration pursuant to Paragraph E shall, pursuant to 37-B M.R.S.A. �784-A, be deemed to be an employee of the State and entitled to immunity pursuant to 37-B M.R.S.A. �822.

G. All State departments and agencies shall take whatever actions may be required and requested by the Maine Emergency Management Agency, Maine Center for Disease Control and Prevention, and Department of Education to respond to this public health emergency. A record of such actions, if any, shall be compiled and presented to me by the heads of the affected departments and agencies on a reasonable and timely basis throughout the duration of this Emergency Proclamation.

H. The Maine Center for Disease Control, the Department of Education and the Maine Emergency Management Agency shall coordinate with the federal government to secure all appropriate influenza vaccines related to this public health emergency provided for by the American Recovery and Reinvestment Act of 2009 and other federal funds.

1. Duration

Pursuant to 37-B M.R.S.A. �743, this Emergency Proclamation shall expire thirty (30) days from the date of its signature, unless earlier rescinded by the Executive or upon joint resolution of the Legislature terminating the Emergency Proclamation, or unless extended by subsequent action of the Executive.

Given under my hand this 29th day of

October, 2009.

John E. Baldacci

Governor

1027 Good Neighbor Protocol to be signed [Nova Scotia]--An agreement signed today, Oct. 27, between health-care unions and the province will help ensure patients receive good care during an emergency by making it easier for health-care providers to go where they are most needed.

The Good Neighbor Protocol confirms how health human resources will be shared across the province and how health-care providers will be compensated and protected while responding to an emergency that impacts the health-care system. The protocol will apply to workers from within the province, from other jurisdictions and to volunteers.

"By developing and agreeing to this protocol, unions, health-care workers and district health authorities have demonstrated leadership and commitment to the health and well-being of Nova Scotians," said Premier Darrell Dexter. "I feel confident that, in the case of an emergency, health-care workers will be able to provide a high level of care to Nova Scotians in every community across the province."

The protocol will be part of the province's planning and response to the H1N1 influenza pandemic, and will be applicable during other declared emergencies. The signing of the protocol also fulfills one of the recommendations recently made by the auditor general in his report on pandemic planning in Nova Scotia released in July.

"Having the right mix of health-care providers in the right place when we need them is the foundation of this agreement," said Health Minister Maureen MacDonald. "The knowledge, skill and caring that health professionals bring to their jobs makes the difference in how patients and families feel about their experience with the system. It may also make a difference in how patients physically respond to the treatments and services they receive."

"I think what the health-care unions have done is wonderful," said Rick Clarke, president of the Nova Scotia Federation of Labour. "They've shown tremendous leadership during a challenging time."

The agreement was signed by Premier Dexter, Ms. MacDonald, Mr. Clarke, Nova Scotia Government and General Employees Union president Joan Jessome, Canadian Union of Public Employees president Danny Cavanagh, Nova Scotia Nurses Union president Janet Hazelton, Canadian Auto Workers Union national representative Susan Burrows, Canadian Union of Postal Workers national director, Atlantic region Jeff Callaghan, Service Employees International Union Local 902 business agent Gerard Higgins and International Union of Operating Engineers Local 727 president Dwayne Fitzgerald.

1024 President Obama signs emergency declaration for H1N1 flu [Washington DC]--

Authority

Section 1135 of the Social Security Act [42 USC §1320b–5] permits the Secretary of Health and Human Services to waive certain regulatory requirements for healthcare facilities in response to emergencies. Two conditions must be met for the Secretary to be able to issue such "1135 waivers": first, the Secretary must have declared a Public Health Emergency; second, the President must have declared a National Emergency either through a Stafford Act Declaration or National Emergencies act Declaration. If these conditions are met, then healthcare facilities may petition for 1135 waivers in response to particular needs, and only within the geographic and temporal limits of the emergency declarations.

Under Section 1135:

The Secretary may tailor authorities granted under Section 1135 waivers to match the specific situational needs, but the requirements that may be waived include those related to Medicare, Medicaid or the Children’s Health Insurance Program (CHIP), the Emergency Medical Treatment and Active Labor Act (EMTALA), and the Health Insurance Portability and Accountability Act (HIPAA). These requirements provide important protections for patients during normal day-to-day operations, but they may impede the ability of healthcare facilities to fully implement disaster operations plans that enable appropriate care during emergencies. For example, requirements under the Emergency Medical Treatment and Active Labor Act (EMTALA) would prohibit hospitals from certain rapid triage or sorting activities and prevent the establishment of off-site, alternate care facilities that could off-load emergency department demand.

• Waivers are permitted only to the extent they ensure that sufficient health care items and services are available to meet the needs of Medicare, Medicaid, and CHIP beneficiaries in the emergency area during the emergency period. The "emergency area" and the "emergency period" are the geographic area, in which, and the time period, during which, the dual declarations exist.

• Permitted actions include the waiver or modification of conditions of participation, other certification requirements, program participation requirements, pre-approval requirements for health care providers; waiver of sanctions for certain directions or relocations and transfers that otherwise would violate the Emergency Medical Treatment and Labor Act (EMTALA); waiver of sanctions related to Stark self-referral prohibitions; modifications to deadlines and timetables for the performance of required activities; and waiver of sanctions and penalties arising from noncompliance with certain Health Insurance Portability and Accountability Act (HIPAA) privacy regulations.

Examples of use of waivers:

• Hospitals request to set up an alternative screening location for patients away from the hospital’s main campus (requiring waiver of the Emergency Medical Treatment and Labor Act-EMTALA)

• Hospitals request to facilitate transfer of patients between ERs and inpatient wards between hospitals (requiring waiver of both EMTALA and HIPAA regulations)

• Critical Access Hospitals requesting waiver of 42 CFR 485.620, which requires a 25-bed limit and average patient stays less than 96 hours

• Skilled Nursing Facilities requesting a waiver of 42 CFR 483.5, which requires CMS approval prior to increasing the number of certified beds in a distinct part

Past instances where authority to grant Section 1135 waivers was enabled for recent disaster events include

• Hurricane Katrina (2005)

• 56th Presidential Inauguration (2009)

• Hurricanes Ike and Gustav (2008)

• North Dakota flooding (2009)

Q: Why do this now; why can’t we wait until a hospital or region needs these 1135 Waivers?

A: The H1N1 epidemic is moving rapidly. By the time regions or healthcare systems recognize they are becoming overburdened, they need to implement disaster plans quickly. 1135 Waivers still require specific requests be submitted to HHS and processed, and some State laws may need to be addressed as well. Adding a potential delay while waiting for a National Emergency Declaration is not in the best interest of the public, particularly if this step can be done proactively as the President has done today.

Q: Has the authority to grant 1135 waivers been granted before?

A: Yes, there are several instances where 1135 Waiver authority has been granted under the Stafford Disaster Relief and Emergency Assistance Act (vice National Emergencies Act) to help healthcare facilities cope with large patient burdens. Recent examples include Hurricane Katrina (2005), Hurricanes Ike and Gustav (2008), and the North Dakota flooding (2009). In addition, 1135 waiver authority has been granted previously as a precautionary measure, as in the case of the recent 56th Presidential Inauguration (2009).

Q: Specifically, what will this NEA Declaration enable and what will this allow hospitals to do, if a waiver is requested and granted?

A: An NEA Declaration fulfills the second of the two conditions required for the Secretary of HHS to be able to grant 1135 waivers. If requested, and HHS grants an 1135 waiver, healthcare facilities will be able to utilize alternate care sites, modified patient triage protocols, patient transfer procedures, and other actions that occur when they fully implement disaster operations plans.

Q: Is the HIPAA Privacy Rule suspended during a national or public health emergency?

A (from the HHS Office for Civil Rights website): No; however, the Secretary of HHS may waive certain provisions of the Rule under the Project Bioshield Act of 2004 (PL 108-276) and section 1135(b)(7) of the Social Security Act.

What provisions may be waived

If the President declares an emergency or disaster and the Secretary declares a public health emergency, the Secretary may waive sanctions and penalties against a covered hospital that does not comply with certain provisions of the HIPAA Privacy Rule:

1. the requirements to obtain a patient's agreement to speak with family members or friends involved in the patient’s care (45 CFR 164.510(b))

2. the requirement to honor a request to opt out of the facility directory (45 CFR 164.510(a))

3. the requirement to distribute a notice of privacy practices (45 CFR 164.520)

4. the patient's right to request privacy restrictions (45 CFR 164.522(a))

5. the patient's right to request confidential communications (45 CFR 164.522(b))

When and to what entities does the waiver apply

If the Secretary issues such a waiver, it only applies:

1. In the emergency area and for the emergency period identified in the public health emergency declaration.

2. To hospitals that have instituted a disaster protocol. The waiver would apply to all patients at such hospitals.

3. For up to 72 hours from the time the hospital implements its disaster protocol.

When the Presidential or Secretarial declaration terminates, a hospital must then comply with all the requirements of the Privacy Rule for any patient still under its care, even if 72 hours has not elapsed since implementation of its disaster protocol.

Regardless of the activation of an emergency waiver, the HIPAA Privacy Rule permits disclosures for treatment purposes and certain disclosures to disaster relief organizations. For instance, the Privacy Rule allows covered entities to share patient information with the American Red Cross so it can notify family members of the patient’s location. See 45 CFR 164.510(b)(4).

1013 The increasing phenomena of homelessness - Shelters want to hear mayoral candidates' positions [Montreal Quebec]--During the municipal election campaigns, the three large shelters serving the homeless population of Greater Montreal (the Old Brewery Mission, Welcome Hall Mission and La Maison du Père) want to know the mayoral candidates' positions and intentions regarding the phenomenon of the growth of homeless in the city.

"There are approximately 25,000 homeless Montrealers which is greater than the capacity of the Bell Centre. The average age of a homeless person has dropped to 37 and there are more women falling into homelessness. Consequently, it seems to me that it would be important to hear the candidates explain what they intend to do to help shelters to deal with this critical social dilemma." declared Matthew Pearce, Director General of the Old Brewery Mission.

Clearly, periods of financial crisis or set backs have a significant impact of citizens already in great difficulty, often those suffering from mental Illness, alcoholism or drug and gaming dependencies which have, as a result, led then into the spiral of homelessness. To date, no mayoral candidate has spoken publicly on the matter which, according to the large shelters, merits their attention and comment.

According to Cyril Morgan, Director General of the Welcome Hall Mission, "We are convinced that the candidates are already sufficiently preoccupied by the magnitude of the problem of homelessness to provide their position and action plan right away."

The large Montreal shelters of today are no longer solely centers for the provision of emergency food and lodging. Though these services remain a critical need and are a priority, shelters now also run effective programs aimed at the social reintegration and permanent affordable housing helping homeless individuals to leave the streets. Still, the three large shelters currently receive between $1.24 and $2.36 per person per night from the municipality for emergency services. The actual costs are in the order of $55 to $57 per person per night.

1009 Changes to Emergency Management Act makes communities stronger [Nova Scotia]--Nova Scotia took another important step towards stronger, safer communities yesterday, with the introduction of changes to the provincial Emergency Management Act.

"There is no greater priority than the safety and well being of Nova Scotian families," said Ramona Jennex, Minister of Emergency Management. "Nova Scotia has a robust emergency management system; these updates will reinforce the system and how its parts work together."

The amendments update the act to reflect practices that ensure that provincial emergency response is co-ordinated at a high level. They document and enhance the existing provincial leadership structure for emergencies and the processes for the flow of information.

"The Emergency Management Office and our partners never rest when it comes to preparing the province to respond to emergencies," said Craig MacLaughlan, CEO and deputy head of EMO. "We are constantly evaluating and adapting to ensure Nova Scotians receive the prompt and effective response they deserve."

The executive emergency management committee and its members, role and mandate will be permanently added to the legislation. The legislation will clarify that the Emergency Management Act takes precedence over other provincial legislation for emergencies.

The proposed amendments will help responding organizations communicate better before and during an emergency. The rules and ways information is shared about municipal states of readiness and major events will be formalized.

The Emergency Management Office's authority to make rules for municipalities' duties, planning, evaluation and reporting for non-governmental essential service providers will be strengthened. Non-governmental agencies have the expertise to develop, train and exercise their internal business continuity plans. The Emergency Management Office works with these organizations to ensure plans align with the provincial emergency response. The proposed changes to the act provide the province with a means to compel a non-government entity to provide its plan if requested during a crisis.

Changes to the act will also allow the province to impose greater penalties for emergency management legislation offences. Given the seriousness of such offences, the penalties will be significantly increased to up to $10,000 for individuals and $100,000 for corporations. Courts will also have the power to increase fines by the amount a person gained by committing the offence.

1003 Fifty-nine percent support Massachusetts' landmark 2006 health reform law [Boston]--A new poll by the Harvard School of Public Health and The Boston Globe finds 59% of Massachusetts residents who are aware of the state's health reform legislation, which was enacted in 2006, support it. A little more than one in four oppose it (28%), and 13% are not sure.

The level of public support for the law has declined somewhat in the last year, from 69% saying they support the law in 2008 to 59% in the current poll. The current number is similar to the 61% found in 2006. Support for the law varied by party affiliation, with 76% of Democrats, 56% of Independents, and just 35% of Republicans saying they support the legislation. The poll was conducted September 14-16, 2009.

Massachusetts is currently facing the impact of a severe recession, state budgetary and fiscal problems, and continued rising health care costs. Despite this difficult environment, the poll found that 79% want the law to continue, with 57% favoring continuing it with some changes and 22% continuing it as is. Only 11% of state residents favored repealing the health reform law. There has been no change in the last year in those supporting repeal of the legislation--12% in 2008 versus 11% in 2009.

"The implication of this poll for the national debate is that it is possible to get continuing public support for a program that leads to nearly everyone in the population having health insurance coverage," said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

Impact of the law

The principal intent of the Massachusetts legislation was to provide health coverage for nearly all of the state's residents and, as a result of the widely discussed measure, Massachusetts is the only state where nearly all of the population has health insurance coverage. The poll found that 64% thought the health reform law was successful in reducing the number of uninsured in the state, 22% thought it was not successful, and 14% were unsure.

The poll also asked respondents about the impact of the health reform law on their own health care in terms of quality, costs, and their ability to pay medical bills. On all these measures, about half reported that the law did not have much of an impact on them. Of those who reported an impact, more thought it helped than thought it hurt their quality of care (23% versus 14%), and their ability to pay their medical bills (24% versus 14%). However, on the cost of their own care, the results were not statistically different (24% saying hurt versus 19% helped).

Views about the future

Though the legislation is currently popular, the poll found concerns about the future. The Massachusetts public is divided on whether the state can afford to continue with this law as it currently stands. Forty-three percent said it could not, 40% said it could, and 16% were unsure. Nearly six out of ten (57%) wanted some changes in the law. Those who said this were asked to state in their own words what was the most important change that needed to be made. The responses fell into three categories: lower future costs (30%), increase the coverage and benefits of the current program (23%), and limit the eligibility for subsidies in the future (11%).

"The clear message for state government leaders is that the public wants some action to address the long-term affordability of this program," said Blendon.

The poll also asked about an issue of recent controversy in the state. To help balance the state budget, the Massachusetts government cut 70% of the funding for subsidized health insurance for certain low-income legal immigrants. Respondents were asked their views about this policy in the future. Forty-three percent said the funding for health insurance coverage for low-income legal immigrants should be fully restored, 28% thought the reduced funding should be left as is, and 19% thought the funding should be entirely eliminated.

Methodology

The Massachusetts Health Reform Poll was conducted by the Harvard School of Public Health and The Boston Globe. Representatives of the two organizations worked closely to develop the survey questionnaire and analyze the results of the poll. The Boston Globe and the Harvard School of Public Health are publishing independent summaries of the poll's findings, and each organization bears sole responsibility for the work that appears under its name. The Harvard School of Public Health and The Boston Globe paid for the survey and related expenses.

The project team was lead by Robert J. Blendon, a professor who holds joint appointments in the Harvard School of Public Health and the Harvard Kennedy School, and Gideon Gil, Health and Science editor of The Boston Globe. The Harvard research team also included Gillian SteelFisher, John Benson and Kathleen Weldon.

Interviews were conducted with 506 randomly selected Massachusetts state residents, age 18 and older, via telephone by Social Science Research Solutions of Media, Pennsylvania. The interviewing period was September 14-16, 2009. The data were weighted to accurately reflect the demographics of the state's adult population as described by the U.S. Census.

When interpreting these findings, one should recognize that all surveys are subject to sampling error. Results may differ from what would be obtained if the whole Massachusetts adult population had been interviewed. The size of this error varies with the number of persons surveyed and the magnitude of difference in responses to each question. The sampling error for surveys of 506 respondents is ±5.5 percentage points at the 95% confidence level.

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