1.1 	A bill for an act
1.2 	relating to health; expanding the Adverse Health Care
1.3 	Events Reporting Act to include facility-acquired
1.4 	infection rates; prohibiting the nontherapeutic use of
1.5 	animal feed containing certain antibiotics;
1.6 	establishing a surcharge on all commercial feeds sold
1.7 	that contain antibiotics; appropriating money;
1.8 	amending Minnesota Statutes 2004, sections 25.33, by
1.9 	adding a subdivision; 25.341, by adding a subdivision;
1.10 	144.7063, by adding a subdivision; 144.7065,
1.11 	subdivisions 1, 6, 8, by adding a subdivision;
1.12 	144.7067; proposing coding for new law in Minnesota
1.13 	Statutes, chapter 25.
1.14 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.15 	Section 1. Minnesota Statutes 2004, section 25.33, is
1.16 	amended by adding a subdivision to read:
1.17 		Subd. 8a.Nontherapeutic use. "Nontherapeutic use" means
1.18 	any use of an antimicrobial drug in animals in the absence of
1.19 	disease, including use for growth promotion, feed efficiency, or
1.20 	disease prevention.

1.21 	Sec. 2. Minnesota Statutes 2004, section 25.341, is
1.22 	amended by adding a subdivision to read:
1.23 		Subd. 2a.Commercial feed containing antibiotics;
1.24 	surcharge. (a) A licensee shall pay an annual surcharge on all
1.25 	commercial feeds sold that contain antibiotics.  The surcharge
1.26 	is one-quarter of one percent of the licensee's annual gross
1.27 	sales of all commercial feeds sold that contain antibiotics and
1.28 	are used in Minnesota.  Notwithstanding section 25.39,
1.29 	subdivision 4, money collected from the surcharge must be
2.1 	deposited in an antibiotics account in the agricultural fund.
2.2 	(b) A portion of the money in the antibiotics account shall
2.3 	be appropriated by law to the commissioner of health to
2.4 	administer the facility-acquired infection reporting provisions
2.5 	of sections 144.706 to 144.7069.
2.6 	(c) The remaining money in the antibiotics account is
2.7 	appropriated to the commissioner for:
2.8 	(1) monitoring antibiotic resistance;
2.9 	(2) surveillance of antimicrobial-resistant salmonella in
2.10 	retail meats;
2.11 	(3) monitoring for bacteria, resistant bacteria, and
2.12 	antibiotic residues in drinking water supplies, including
2.13 	surface water areas downstream from confined animal feeding
2.14 	operations; and 
2.15 	(4) support for on-farm demonstrations of alternatives to
2.16 	antibiotics for growth promotion.

2.17 	Sec. 3. [25.385] PROHIBITION ON THE NONTHERAPEUTIC USE OF
2.18 	FEED CONTAINING CERTAIN ANTIBIOTICS.
2.19 	(a) After January 1, 2006, a person may not sell, buy, or
2.20 	use animal feed, for a nontherapeutic use, containing
2.21 	fluoroquinolones.
2.22 	(b) After January 1, 2007, a person may not sell, buy, or
2.23 	use animal feed, for a nontherapeutic use, containing
2.24 	penicillin, tetracycline, erythromycin, lincomycin, tylosin,
2.25 	virginiamycin, or other antibiotics used in human medicine.
2.26 	(c) The commissioner shall, by rule, prohibit the use of
2.27 	any microbial agents for growth promotion in animals if the
2.28 	agent is used in human therapies or is known to select for
2.29 	cross-resistance to microbial agents used in human medicine.

2.30 	Sec. 4. Minnesota Statutes 2004, section 144.7063, is
2.31 	amended by adding a subdivision to read:
2.32 		Subd. 3a.Facility-acquired infection.
 2.33 	"Facility-acquired infection" means a localized or systemic
2.34 	condition that:
2.35 	(1) results from an adverse reaction to the presence of an
2.36 	infectious agent or its toxin; and 
3.1 	(2) was not present or incubating at the time of the
3.2 	patient's admission to the facility.

3.3 	Sec. 5. Minnesota Statutes 2004, section 144.7065,
3.4 	subdivision 1, is amended to read:
3.5 		Subdivision 1.Reports of adverse health care events
3.6 	required. (a) Each facility shall report to the commissioner
3.7 	the occurrence of any of the adverse health care events
3.8 	described in subdivisions 2 to 7 as soon as is reasonably and
3.9 	practically possible, but no later than 15 working days after
3.10 	discovery of the event.
3.11 	(b) Each facility shall collect the data described under
3.12 	subdivision 7a and submit quarterly reports to the commissioner
3.13 	by April 30, July 31, October 31, and January 31 each year for
3.14 	the previous quarter.  Data in the quarterly reports must cover
3.15 	a period ending no earlier than one month prior to submission of
3.16 	the report.
3.17 	(c) The ~~report~~ reports shall be filed in a format specified
3.18 	by the commissioner and shall identify the facility but shall
3.19 	not include any identifying information for any of the health
3.20 	care professionals, facility employees, or patients involved.
3.21 	The commissioner may consult with experts and organizations
3.22 	familiar with patient safety when developing the format for
3.23 	reporting and in further defining events in order to be
3.24 	consistent with industry standards.

3.25 	Sec. 6. Minnesota Statutes 2004, section 144.7065,
3.26 	subdivision 6, is amended to read:
3.27 		Subd. 6.Environmental events.  Events reportable under
3.28 	this subdivision are:
3.29 	(1) patient death or serious disability associated with an
3.30 	electric shock while being cared for in a facility, excluding
3.31 	events involving planned treatments such as electric
3.32 	countershock;
3.33 	(2) any incident in which a line designated for oxygen or
3.34 	other gas to be delivered to a patient contains the wrong gas or
3.35 	is contaminated by toxic substances;
3.36 	(3) patient death or serious disability associated with a
4.1 	burn incurred from any source while being cared for in a
4.2 	facility;
4.3 	(4) patient death associated with a fall while being cared
4.4 	for in a facility; ~~and~~ 
4.5 	(5) patient death or serious disability associated with the
4.6 	use or lack of restraints or bedrails while being cared for in a
4.7 	facility; and 
4.8 	(6) patient death or serious disability associated with a
4.9 	facility-acquired infection.

4.10 	Sec. 7. Minnesota Statutes 2004, section 144.7065, is
4.11 	amended by adding a subdivision to read:
4.12 		Subd. 7a.Facility-acquired infection rates. Each
4.13 	facility shall collect data on facility-acquired infection rates
4.14 	for clinical procedures determined by the commissioner and shall
4.15 	include the following categories:
4.16 	(1) surgical site infections;
4.17 	(2) ventilator-associated pneumonia;
4.18 	(3) central line-related bloodstream infections; and 
4.19 	(4) urinary tract infections.
4.20 	The commissioner may require facilities to collect data for
4.21 	additional categories.

4.22 	Sec. 8. Minnesota Statutes 2004, section 144.7065,
4.23 	subdivision 8, is amended to read:
4.24 		Subd. 8.Root cause analysis; corrective action plan.
 4.25 	Following the occurrence of an adverse health care
4.26 	event described in subdivisions 2 to 7, the facility must
4.27 	conduct a root cause analysis of the event.  Following the
4.28 	analysis, the facility must:  (1) implement a corrective action
4.29 	plan to implement the findings of the analysis or (2) report to
4.30 	the commissioner any reasons for not taking corrective action.
4.31 	If the root cause analysis and the implementation of a
4.32 	corrective action plan are complete at the time an event must be
4.33 	reported, the findings of the analysis and the corrective action
4.34 	plan must be included in the report of the event.  The findings
4.35 	of the root cause analysis and a copy of the corrective action
4.36 	plan must otherwise be filed with the commissioner within 60
5.1 	days of the event.

5.2 	Sec. 9. Minnesota Statutes 2004, section 144.7067, is
5.3 	amended to read:
5.4 	144.7067 COMMISSIONER DUTIES AND RESPONSIBILITIES.
5.5 		Subdivision 1.Establishment of reporting system. (a)
5.6 	The commissioner shall establish an adverse health event
5.7 	reporting system designed to facilitate quality improvement in
5.8 	the health care system.  The reporting system shall not be
5.9 	designed to punish errors by health care practitioners or health
5.10 	care facility employees.
5.11 	(b) The reporting system shall consist of:
5.12 	(1) mandatory reporting by facilities of 27 adverse health
5.13 	care events and of facility-acquired infection rates;
5.14 	(2) mandatory completion of a root cause analysis and a
5.15 	corrective action plan by the facility and reporting of the
5.16 	findings of the analysis and the plan to the commissioner or
5.17 	reporting of reasons for not taking corrective action;
5.18 	(3) analysis of reported information by the commissioner to
5.19 	determine patterns of systemic failure in the health care system
5.20 	and successful methods to correct these failures;
5.21 	(4) sanctions against facilities for failure to comply with
5.22 	reporting system requirements; and
5.23 	(5) communication from the commissioner to facilities,
5.24 	health care purchasers, and the public to maximize the use of
5.25 	the reporting system to improve health care quality.
5.26 	(c) The commissioner is not authorized to select from or
5.27 	between competing alternate acceptable medical practices.
5.28 		Subd. 2.Duty to analyze reports; communicate findings.
 5.29 	The commissioner shall:
5.30 	(1) analyze adverse event reports, corrective action plans,
5.31 	and findings of the root cause analyses to determine patterns of
5.32 	systemic failure in the health care system and successful
5.33 	methods to correct these failures;
5.34 	(2) communicate to individual facilities the commissioner's
5.35 	conclusions, if any, regarding an adverse event reported by the
5.36 	facility;
6.1 	(3) communicate with relevant health care facilities any
6.2 	recommendations for corrective action resulting from the
6.3 	commissioner's analysis of submissions from facilities; and
6.4 	(4) publish an annual report:
6.5 	(i) describing, by ~~institution~~ facility, adverse events
6.6 	reported;
6.7 	(ii) outlining, in aggregate, corrective action plans and
6.8 	the findings of root cause analyses; ~~and~~ 
6.9 	(iii) comparing the risk-adjusted facility infection rates
6.10 	for each facility describing findings, conclusions, and trends
6.11 	concerning the overall prevalence of facility-acquired
6.12 	infections in the state, including a comparison to prior years;
6.13 	and 
6.14 	(iv) making recommendations for modifications of state
6.15 	health care operations.
6.16 		Subd. 3.Sanctions. (a) The commissioner shall take
6.17 	steps necessary to determine if adverse event reports, the
6.18 	findings of the root cause analyses, and corrective action plans
6.19 	are filed in a timely manner.  The commissioner may sanction a
6.20 	facility for:
6.21 	(1) failure to file a timely adverse event report under
6.22 	section 144.7065, subdivision 1, paragraph (a), or a timely
6.23 	facility-acquired infection data report under section 144.7065,
6.24 	subdivision 1, paragraph (b); or
6.25 	(2) failure to conduct a root cause analysis, to implement
6.26 	a corrective action plan, or to provide the findings of a root
6.27 	cause analysis or corrective action plan in a timely fashion
6.28 	under section 144.7065, subdivision 8.
6.29 	(b) If a facility fails to develop and implement a
6.30 	corrective action plan or report to the commissioner why
6.31 	corrective action is not needed, the commissioner may suspend,
6.32 	revoke, fail to renew, or place conditions on the license under
6.33 	which the facility operates.

6.34 	Sec. 10. APPROPRIATION.
 6.35 	$....... is appropriated in fiscal year 2006 to the
6.36 	commissioner of health from the antibiotics account in the
7.1 	agricultural fund for purposes of Minnesota Statutes, sections
7.2 	144.706 to 144.7069.

7.3 	Sec. 11. EFFECTIVE DATE.
 7.4 	Sections 4 to 9 are effective January 1, 2006.