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144.7067 COMMISSIONER DUTIES AND RESPONSIBILITIES.
    Subdivision 1. Establishment of reporting system. (a) The commissioner shall establish an
adverse health event reporting system designed to facilitate quality improvement in the health care
system. The reporting system shall not be designed to punish errors by health care practitioners
or health care facility employees.
(b) The reporting system shall consist of:
(1) mandatory reporting by facilities of 27 adverse health care events;
(2) mandatory completion of a root cause analysis and a corrective action plan by the facility
and reporting of the findings of the analysis and the plan to the commissioner or reporting of
reasons for not taking corrective action;
(3) analysis of reported information by the commissioner to determine patterns of systemic
failure in the health care system and successful methods to correct these failures;
(4) sanctions against facilities for failure to comply with reporting system requirements; and
(5) communication from the commissioner to facilities, health care purchasers, and the
public to maximize the use of the reporting system to improve health care quality.
(c) The commissioner is not authorized to select from or between competing alternate
acceptable medical practices.
    Subd. 2. Duty to analyze reports; communicate findings. The commissioner shall:
(1) analyze adverse event reports, corrective action plans, and findings of the root cause
analyses to determine patterns of systemic failure in the health care system and successful
methods to correct these failures;
(2) communicate to individual facilities the commissioner's conclusions, if any, regarding an
adverse event reported by the facility;
(3) communicate with relevant health care facilities any recommendations for corrective
action resulting from the commissioner's analysis of submissions from facilities; and
(4) publish an annual report:
(i) describing, by institution, adverse events reported;
(ii) outlining, in aggregate, corrective action plans and the findings of root cause analyses; and
(iii) making recommendations for modifications of state health care operations.
    Subd. 3. Sanctions. (a) The commissioner shall take steps necessary to determine if adverse
event reports, the findings of the root cause analyses, and corrective action plans are filed in a
timely manner. The commissioner may sanction a facility for:
(1) failure to file a timely adverse event report under section 144.7065, subdivision 1; or
(2) failure to conduct a root cause analysis, to implement a corrective action plan, or to
provide the findings of a root cause analysis or corrective action plan in a timely fashion under
section 144.7065, subdivision 8.
(b) If a facility fails to develop and implement a corrective action plan or report to the
commissioner why corrective action is not needed, the commissioner may suspend, revoke, fail to
renew, or place conditions on the license under which the facility operates.
History: 2003 c 99 s 4

Official Publication of the State of Minnesota
Revisor of Statutes