REPRESENTATIVES Jolivette, Gilb, Schuring, Kearns, Roman, McGregor, Raga, Patton, Seitz, Kilbane, Beatty, Hartnett, Schmidt, Faber, Brinkman, Trakas, Setzer, D. Miller, Seaver, Coates, Schneider, Niehaus, Flowers, Distel, Carano, Allen, Sferra, Clancy, Young, Buehrer, Reidelbach, Schaffer, Hughes, Hoops, Rhine, G. Smith

To amend sections 2317.54, 3702.30, 3702.31, 3727.09,

1

3727.10, 4765.01, and 4765.50 and to enact sections

2

3702.32, 3727.101, and 3727.102 of the Revised Code

3

relative to sanctions for a health care facility's

4

violations of licensing requirements and quality

5

standards, injunctions to enjoin such violations,

6

informed consent compliance requirements for

7

ambulatory surgical facility physicians, expanded

8

health care facility rule making authority of the

9

Director of Health, and implementation of

10

requirements applicable to trauma centers.

11

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 2317.54, 3702.30, 3702.31, 3727.09,	12
3727.10, 4765.01, and 4765.50 be amended and sections 3702.32,	13
3727.101, and 3727.102 of the Revised Code be enacted to read as	14
follows:	15

Sec. 2317.54.  No hospital, home health agency, ambulatory	16
surgical facility, or provider of a hospice care program shall be	17
held liable for a physician's failure to obtain an informed	18
consent from histhe physician's patient prior to a surgical or	19
medical procedure or course of procedures, unless the physician is	20
an employee of the hospital, home health agency, ambulatory	21
surgical facility or provider of a hospice care program.	22

Written consent to a surgical or medical procedure or course	23
of procedures shall, to the extent that it fulfills all the	24
requirements in divisions (A), (B), and (C) of this section, be	25
presumed to be valid and effective, in the absence of proof by a	26
preponderance of the evidence that the person who sought such	27
consent was not acting in good faith, or that the execution of the	28
consent was induced by fraudulent misrepresentation of material	29
facts, or that the person executing the consent was not able to	30
communicate effectively in spoken and written English or any other	31
language in which the consent is written. Except as herein	32
provided, no evidence shall be admissible to impeach, modify, or	33
limit the authorization for performance of the procedure or	34
procedures set forth in such written consent.	35

(A) The consent sets forth in general terms the nature and	36
purpose of the procedure or procedures, and what the procedures	37
are expected to accomplish, together with the reasonably known	38
risks, and, except in emergency situations, sets forth the names	39
of the physicians who shall perform the intended surgical	40
procedures.	41

(B) The person making the consent acknowledges that such	42
disclosure of information has been made and that all questions	43
asked about the procedure or procedures have been answered in a	44
satisfactory manner.	45

(C) The consent is signed by the patient for whom the	46
procedure is to be performed, or, if the patient for any reason	47
including, but not limited to, competence, infancy, or the fact	48
that, at the latest time that the consent is needed, the patient	49
is under the influence of alcohol, hallucinogens, or drugs, lacks	50
legal capacity to consent, by a person who has legal authority to	51
consent on behalf of such patient in such circumstances.	52

Any use of a consent form that fulfills the requirements	53
stated in divisions (A), (B), and (C) of this section has no	54
effect on the common law rights and liabilities, including the	55
right of a physician to obtain the oral or implied consent of a	56
patient to a medical procedure, that may exist as between	57
physicians and patients on July 28, 1975.	58

As used in this section the term "hospital" has the meaning	59
set forth in division (D) of section 2305.11 of the Revised Code;	60
"home health agency" has the meaning set forth in division (A) of	61
former section 3701.88 of the Revised Code; "ambulatory surgical	62
facility" has the meaning as in division (A) of section 3702.30 of	63
the Revised Code; and "hospice care program" has the meaning set	64
forth in division (A) of section 3712.01 of the Revised Code. The	65
provisions of this division apply to hospitals, doctors of	66
medicine, doctors of osteopathic medicine, and doctors of	67
podiatric medicine.	68

Sec. 3702.30.  (A) As used in this section:

69

(1) "Ambulatory surgical facility" means a facility, whether	70
or not part of the same organization as a hospital, that is	71
located in a building distinct from another in which inpatient	72
care is provided, and to which any of the following apply:	73

(a) Outpatient surgery is routinely performed in the	74
facility, and the facility functions separately from a hospital's	75
inpatient surgical service and from the offices of private	76
physicians, podiatrists, and dentists;.	77

(b) Anesthesia is administered in the facility by an	78
anesthesiologist or certified registered nurse anesthetist, and	79
the facility functions separately from a hospital's inpatient	80
surgical service and from the offices of private physicians,	81
podiatrists, and dentists;.	82

(c) The facility applies to be certified by the United	83
States health care financing administration as an ambulatory	84
surgical center for purposes of reimbursement under Part B of the	85
medicare program, Part B of Title XVIII of the "Social Security	86
Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended;.	87

(d) The facility applies to be certified by a national	88
accrediting body approved by the health care financing	89
administration for purposes of deemed compliance with the	90
conditions for participating in the medicare program as an	91
ambulatory surgical center;.	92

(e) The facility bills or receives from any third-party	93
payer, governmental health care program, or other person or	94
government entity any ambulatory surgical facility fee that is	95
billed or paid in addition to any fee for professional services;.	96

(f) The facility is held out to any person or government	97
entity as an ambulatory surgical facility or similar facility by	98
means of signage, advertising, or other promotional efforts.	99

"Ambulatory surgical facility" does not include a hospital	100
emergency department.	101

(2) "Ambulatory surgical facility fee" means a fee for	102
certain overhead costs associated with providing surgical services	103
in an outpatient setting. A fee is an ambulatory surgical	104
facility fee only if it directly or indirectly pays for costs	105
associated with any of the following:	106

(a) Use of operating and recovery rooms, preparation areas,	107
and waiting rooms and lounges for patients and relatives;	108

(b) Administrative functions, record keeping, housekeeping,	109
utilities, and rent;	110

(c) Services provided by nurses, orderlies, technical	111
personnel, and others involved in patient care related to	112
providing surgery.	113

"Ambulatory surgical facility fee" does not include any	114
additional payment in excess of a professional fee that is	115
provided to encourage physicians, podiatrists, and dentists to	116
perform certain surgical procedures in their office or their group	117
practice's office rather than a health care facility, if the	118
purpose of the additional fee is to compensate for additional cost	119
incurred in performing office-based surgery.	120

(3) "Governmental health care program" has the same meaning	121
as in section 4731.65 of the Revised Code.	122

(4) "Health care facility" means any of the following:

123

(a) An ambulatory surgical facility;

124

(b) A freestanding dialysis center;

125

(c) A freestanding inpatient rehabilitation facility;

126

(d) A freestanding birthing center;

127

(e) A freestanding radiation therapy center;

128

(f) A freestanding or mobile diagnostic imaging center.

129

(5) "Metropolitan statistical area" has the same meaning as	130
in section 3702.51 of the Revised Code.	131

(6) "Third-party payer" has the same meaning as in section	132
3901.38 of the Revised Code.	133

(B) By rule adopted in accordance with sections 3702.12 and	134
3702.13 of the Revised Code, the director of health shall	135
establish quality standards for health care facilities. The	136
standards may incorporate accreditation standards or other quality	137
standards established by any entity recognized by the director.	138
The rules shall be adopted so as to cause the standards to take	139
effect on March 31, 1996.	140

(C) Every ambulatory surgical facility shall require that	141
each physician who practices at the facility comply with all	142
relevant provisions in the Revised Code that relate to the	143
obtaining of informed consent from a patient.	144

(D) The director shall issue a license to each health care	145
facility that makes application for a license and demonstrates to	146
the director that it meets the quality standards established by	147
the rules adopted under division (B) of this section, except that	148
if a health care facility located in a metropolitan statistical	149
area applies for a license on or after March 31, 1996, and at the	150
time the license is to take effect the quality standards are not	151
yet in effect, the director shall issue the license without a	152
demonstration that the health care facility meets quality	153
standardsand satisfies the informed consent compliance	154
requirements specified in division (C) of this section.	155

(D)(E)(1) No health care facility shall operate without a	156
license issued under this section.	157

(2) If the department of health finds that a physician who	158
practices at a health care facility is not complying with any	159
provision of the Revised Code related to the obtaining of informed	160
consent from a patient, the department shall report its finding to	161
the state medical board, the physician, and the health care	162
facility.	163

(3) This division does not create, and shall not be	164
construed as creating, a new cause of action or substantive legal	165
right against a health care facility and in favor of a patient who	166
allegedly sustains harm as a result of the failure of the	167
patient's physician to obtain informed consent from the patient	168
prior to performing a procedure on or otherwise caring for the	169
patient in the health care facility.	170

(E)(F) The rules adopted under division (B) of this section	171
shall include provisionsall of the following:	172

(1) Provisions governing application for, renewal,	173
suspension, and revocation of licensesa license under this	174
section;	175

(2) Provisions governing orders issued pursuant to section	176
3702.32 of the Revised Code for a health care facility to cease	177
its operations or to prohibit certain types of services provided	178
by a health care facility;	179

(3) Provisions governing the imposition under section	180
3702.32 of the Revised Code of civil penalties for violations of	181
this section or the rules adopted under this section, including a	182
scale for determining the amount of the penalties.	183

Sec. 3702.31.  (A) The quality monitoring and inspection	184
fund is hereby created in the state treasury. The director of	185
health shall use the fund to administer and enforce this section	186
and sections 3702.11 to 3702.20 and, 3702.30, and 3702.32 of the	187
Revised Code and rules adopted pursuant to those sections. The	188
director shall deposit in the fund any moneys collected pursuant	189
to this section or section 3702.32 of the Revised Code. All	190
investment earnings of the fund shall be credited to the fund.	191

(B) The director of health shall adopt rules pursuant to	192
Chapter 119. of the Revised Code establishing fees for both of the	193
following:	194

(1) Initial and renewal license applications submitted under	195
section 3702.30 of the Revised Code. The fees established under	196
division (B)(1) of this section shall not exceed the actual and	197
necessary costs of performing the activities described in division	198
(A) of this section.	199

(2) Inspections conducted under section 3702.15 or 3702.30	200
of the Revised Code. The fees established under division (B)(2)	201
of this section shall not exceed the actual and necessary costs	202
incurred during an inspection, including any indirect costs	203
incurred by the department for staff, salary, or other	204
administrative costs. The director of health shall provide to	205
each health care facility or provider inspected pursuant to	206
section 3702.15 or 3702.30 of the Revised Code a written statement	207
of the fee. The statement shall itemize and total the costs	208
incurred. Within fifteen days after receiving a statement from	209
the director, the facility or provider shall forward the total	210
amount of the fee to the director.	211

(3) The fees described in divisions (B)(1) and (2) of this	212
section shall meet both of the following requirements:	213

(a) For each service described in section 3702.11 of the	214
Revised Code, the fee shall not exceed one thousand dollars two	215
hundred fifty dollars annually, except that the total fees charged	216
to a health care provider under this section shall not exceed five	217
thousand dollars annually.	218

(b) The fee shall exclude any costs reimbursable by the	219
United States health care financing administration as part of the	220
certification process for the medicare program established under	221
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42	222
U.S.C.A. 301, as amended, and the medicaid program established	223
under Title XIX of that act.	224

(4) The director shall not establish a fee for any service	225
for which a licensure or inspection fee is paid by the health care	226
provider to a state agency for the same or similar licensure or	227
inspection.	228

Sec. 3702.32. (A) If the director of health determines that	229
a health care facility is operating without a license in violation	230
of division (E)(1) of section 3702.30 of the Revised Code, the	231
director shall do one or more of the following:	232

(1) Provide an opportunity for the health care facility to	233
apply for a license within a specified time, not exceeding thirty	234
days after the date of the facility's receipt of the order;	235

(2) Issue an order that the health care facility cease its	236
operations;	237

(3) Issue an order that prohibits the health care facility	238
from performing certain types of services;	239

(4) Impose a civil penalty of not less than one thousand	240
dollars and not more than two hundred fifty thousand dollars upon	241
the health care facility for operating without a license;	242

(5) Impose an additional civil penalty of not less than one	243
thousand dollars and not more than ten thousand dollars for each	244
day that the health care facility operates without a license.	245

(B)(1) If a health care facility subject to an order issued	246
under division (A)(1) of this section continues to operate, the	247
director of health may file a petition in the court of common	248
pleas of the county in which the health care facility is located	249
for an injunction enjoining the facility from operating. The	250
court shall grant an injunction upon a showing that the respondent	251
named in the petition is operating without a license.	252

(2) If a health care facility subject to an order issued	253
under division (A)(2) of this section continues to provide the	254
types of services prohibited by the order, the director of health	255
may file a petition in the court of common pleas of the county in	256
which the health care facility is located for an injunction	257
enjoining the facility from performing those types of services.	258
The court shall grant an injunction upon a showing that the	259
respondent named in the petition is providing the types of	260
services prohibited by the director's order.	261

(C) If, after making its reports as provided in division	262
(E)(2) of section 3702.30 of the Revised Code, the department of	263
health finds that a physician has continued to engage at the same	264
health care facility in a pattern of repeating the same violation	265
and that the health care facility has failed to take reasonable	266
steps to ensure that the physician does not continue the same	267
violation at the health care facility, the department may, after	268
providing the health care facility an opportunity for a hearing	269
pursuant to Chapter 119. of the Revised Code, impose a civil	270
penalty on the health care facility. The penalty shall be not	271
less than one thousand dollars and not more than fifty thousand	272
dollars.	273

(D) If the director of health determines that a health care	274
facility has violated any provision of section 3702.30 of the	275
Revised Code, other than a violation of division (E)(1) or (2) of	276
that section, any provision of Chapter 3701-83 of the	277
Administrative Code, or any other rule adopted by the director of	278
health under section 3702.30 of the Revised Code, the director may	279
do any or all of the following:	280

(1) Provide an opportunity for the health care facility to	281
correct the violation within a specified period of time;	282

(2) Revoke, suspend, or refuse to renew the health care	283
facility's license;	284

(3) Prior to or during the pendency of an administrative	285
hearing under Chapter 119. of the Revised Code, issue an order	286
that prohibits the health care facility from performing certain	287
types of services;	288

(4) Provide an opportunity for the health care facility to	289
correct the violation;	290

(5) Impose a civil penalty of not less than one thousand	291
dollars and not more than two hundred fifty thousand dollars upon	292
the health care facility for the violation;	293

(6) Impose an additional civil penalty of not less than five	294
hundred dollars and not more than ten thousand dollars for each	295
day that the health care facility fails to correct the violation.	296

(E) If a health care facility subject to an order issued	297
under division (C)(2) of this section continues to provide the	298
types of services prohibited by the order, the director of health	299
may file a petition in the court of common pleas of the county in	300
which the facility is located for an injunction enjoining the	301
facility from performing those types of services. The court shall	302
grant an injunction upon a showing that the respondent named in	303
the petition is providing the types of services prohibited by the	304
director's order.	305

(F) The director shall deposit all moneys collected as civil	306
penalties under this section into the quality monitoring and	307
inspection fund created under section 3702.31 of the Revised Code	308
for use in accordance with that section.	309

Sec. 3727.09.  (A) As used in this section and section	310
sections 3727.10 and 3727.101 of the Revised Code:	311

(1) "Trauma," "trauma care," and "trauma center," "trauma	312
patient," "pediatric," and "adult" have the same meanings as in	313
section 4765.01 of the Revised Code.	314

(2) "Stabilize" and "transfer" have the same meanings as in	315
section 1753.28 of the Revised Code.	316

(B) Not later than two yearsOn and after the effective date	317
of this sectionNovember 3, 2002, each hospital in this state that	318
is not a trauma center shall adopt protocols for adult and	319
pediatric trauma care provided in or by that hospital; each	320
hospital in this state that is an adult trauma center and not a	321
level I or level II pediatric trauma center shall adopt protocols	322
for pediatric trauma care provided in or by that hospital; each	323
hospital in this state that is a pediatric trauma center and not a	324
level I and II adult trauma center shall adopt protocols for adult	325
trauma care provided in or by that hospital. In developing its	326
trauma care protocols, each hospital shall consider the guidelines	327
for trauma care established by the American college of surgeons,	328
the American college of emergency physicians, and the American	329
academy of pediatrics. Trauma care protocols shall be written,	330
comply with applicable federal and state laws, and include	331
policies and procedures with respect to all of the following:	332

(1) Evaluation of trauma patients, including criteria for	333
prompt identification of trauma patients who require a level of	334
adult or pediatric trauma care that exceeds the hospital's	335
capabilities;	336

(2) Emergency treatment and stabilization of trauma patients	337
prior to transfer to an appropriate adult or pediatric trauma	338
center;	339

(3) Timely transfer of trauma patients to appropriate adult	340
or pediatric trauma centers based on a patient's medical needs.	341
Trauma patient transfer protocols shall specify all of the	342
following:	343

(a) Confirmation of the ability of the receiving trauma	344
center to provide prompt adult or pediatric trauma care	345
appropriate to a patient's medical needs;	346

(b) Procedures for selecting an appropriate alternative	347
adult or pediatric trauma center to receive a patient when it is	348
not feasible or safe to transport the patient to a particular	349
trauma center;	350

(c) Advance notification and appropriate medical	351
consultation with the trauma center to which a trauma patient is	352
being, or will be, transferred;	353

(d) Procedures for selecting an appropriate method of	354
transportation and the hospital responsible for arranging or	355
providing the transportation;	356

(e) Confirmation of the ability of the persons and vehicle	357
that will transport a trauma patient to provide appropriate adult	358
or pediatric trauma care;	359

(f) Assured communication with, and appropriate medical	360
direction of, the persons transporting a trauma patient to a	361
trauma center;	362

(g) Identification and timely transfer of appropriate	363
medical records of the trauma patient being transferred;	364

(h) The hospital responsible for care of a patient in	365
transit;	366

(i) The responsibilities of the physician attending a	367
patient and, if different, the physician who authorizes a transfer	368
of the patient;	369

(j) Procedures for determining, in consultation with an	370
appropriate adult or pediatric trauma center and the persons who	371
will transport a trauma patient, when transportation of the	372
patient to a trauma center may be delayed for either of the	373
following reasons:	374

(i) Immediate transfer of the patient is unsafe due to	375
adverse weather or ground conditions.	376

(ii) No trauma center is able to provide appropriate adult	377
or pediatric trauma care to the patient without undue delay.	378

(4) Peer review and quality assurance procedures for adult	379
and pediatric trauma care provided in or by the hospital.	380

(C)(1) Not later than two yearsOn and after the effective	381
date of this sectionNovember 3, 2002, each hospital shall enter	382
into all of the following written agreements unless otherwise	383
provided in division (C)(2) of this section:	384

(a) An agreement with one or more adult trauma centers in	385
each level of categorization as a trauma center higher than the	386
hospital that governs the transfer of adult trauma patients from	387
the hospital to those trauma centers;	388

(b) An agreement with one or more pediatric trauma centers	389
in each level of categorization as a trauma center higher than the	390
hospital that governs the transfer of pediatric trauma patients	391
from the hospital to those trauma centers.	392

(2) A level I or level II adult trauma center is not	393
required to enter into an adult trauma patient transfer agreement	394
with another hospital. A level I or level II pediatric trauma	395
center is not required to enter into a pediatric trauma patient	396
transfer agreement with another hospital. A hospital is not	397
required to enter into an adult trauma patient transfer agreement	398
with a level III or level IV adult trauma center, or enter into a	399
pediatric trauma patient transfer agreement with a level III or	400
level IV pediatric trauma center, if no trauma center of that type	401
is reasonably available to receive trauma patients transferred	402
from the hospital.	403

(3) A trauma patient transfer agreement entered into by a	404
hospital under division (C)(1) of this section shall comply with	405
applicable federal and state laws and contain provisions	406
conforming to the requirements for trauma care protocols set forth	407
in division (B) of this section.	408

(D) A hospital shall make trauma care protocols it adopts	409
under division (B) of this section and trauma patient transfer	410
agreements it adopts under division (C) of this section available	411
for public inspection during normal working hours. A hospital	412
shall furnish a copy of such documents upon request and may charge	413
a reasonable and necessary fee for doing so, provided that upon	414
request it shall furnish a copy of such documents to the director	415
of health free of charge.	416

(E) A hospital that ceases to operate as an adult or	417
pediatric trauma center under provisional status is not in	418
violation of divisions (B) and (C) of this section during the time	419
it develops different trauma care protocols and enters into	420
different patient transfer agreements pursuant to division	421
(D)(2)(c) of section 3727.101 of the Revised Code.	422

Sec. 3727.10. Beginning two yearsOn and after the effective	423
date of this sectionNovember 3, 2002, no hospital in this state	424
shall knowingly do any of the following:	425

(A) Represent that it is able to provide adult or pediatric	426
trauma care to a severely injured patient that is inconsistent	427
with its level of categorization as an adult or pediatric trauma	428
center, provided that a hospital that operates an emergency	429
facility may represent that it provides emergency care;	430

(B) Provide adult or pediatric trauma care to a severely	431
injured patient that is inconsistent with applicable federal laws,	432
state laws, and trauma care protocols and patient transfer	433
agreements the hospital has adopted under section 3727.09 of the	434
Revised Code;	435

(C) Transfer a severely injured adult or pediatric trauma	436
patient to a hospital that is not a trauma center with an	437
appropriate level of adult or pediatric categorization or	438
otherwise transfer a severely injured adult or pediatric trauma	439
patient in a manner inconsistent with any applicable trauma	440
patient transfer agreement adopted by the hospital under section	441
3727.09 of the Revised Code.	442

Sec. 3727.101. (A) If a hospital is seeking initial	443
verification as an adult or pediatric trauma center, verification	444
at a different level, or reverification after having ceased to be	445
verified for one year or longer, the hospital shall submit an	446
application to the American college of surgeons for a consultation	447
visit. If a hospital is seeking reverification after having	448
ceased to be verified for less than one year, the hospital shall	449
submit an application for either a consultation visit or a	450
reverification visit, except when operating pursuant to division	451
(C)(1)(b) of this section.	452

The hospital shall undergo the visit and obtain a written	453
report of the results of the visit. If the report is not obtained	454
by the date that occurs one year after the application for the	455
visit is submitted, the hospital shall submit a new application.	456

(B) Not later than one year after obtaining a report under	457
division (A) of this section, a hospital may apply to the American	458
college of surgeons for verification or reverification as an adult	459
or pediatric trauma center if, based on the report, all of the	460
following occur:	461

(1) The hospital's chief medical officer and chief	462
executive officer certify in writing to the hospital's governing	463
board that the hospital is committed and able to provide adult or	464
pediatric trauma care consistent with the level of verification or	465
reverification being sought.	466

(2) The hospital's governing board adopts a resolution	467
stating that the hospital is committed and able to provide adult	468
or pediatric trauma care consistent with the level of verification	469
or reverification being sought.	470

(3) The hospital's governing board approves a written plan	471
and timetable for obtaining the level of verification or	472
reverification being sought, including provisions for correcting	473
at the earliest practicable date any deficiencies identified in	474
the report obtained pursuant to division (A) of this section.	475

(C)(1) A hospital may operate as an adult or pediatric	476
trauma center under provisional status, as follows:	477

(a) On submission of an application under division (B) of	478
this section;	479

(b) Until it receives the final result of its reverification	480
if the application was submitted within one year before it ceased	481
to be verified.	482

(2) A hospital operating as an adult or pediatric trauma	483
care center under provisional status is subject to both of the	484
following:	485

(a) The hospital shall limit its provisional status	486
activities to those activities authorized by the level of	487
verification or reverification being sought.	488

(b) The hospital shall make a reasonable, good faith effort	489
to comply with all requirements established by the American	490
college of surgeons that must be met for the level of verification	491
or reverification being sought.	492

(D)(1) A hospital shall cease to operate as an adult or	493
pediatric trauma center under provisional status if any of the	494
following applies:	495

(a) The application for verification or reverification is	496
denied, suspended, terminated, or withdrawn.	497

(b) In the case of a hospital seeking initial verification,	498
verification at a different level, or reverification after having	499
ceased to be verified for one year or longer, the hospital has not	500
obtained verification or reverification by the date that occurs	501
eighteen months after commencing to operate under provisional	502
status.	503

(c) In the case of a hospital seeking reverification after	504
having ceased to be verified for less than one year, the hospital	505
has not obtained reverification by the date that occurs one year	506
after commencing to operate under provisional status.	507

(2) A hospital that ceases to operate as an adult or	508
pediatric trauma center under provisional status pursuant to	509
division (D)(1) of this section shall do all of the following:	510

(a) Except as otherwise provided by federal law, at the	511
earliest practicable date transfer to one or more appropriate	512
trauma centers all trauma patients in the hospital to whom the	513
hospital is not permitted to provide trauma care.	514

(b) Promptly comply with section 3727.10 of the Revised	515
Code according to its current status.	516

(c) Not later than one hundred eighty days after ceasing to	517
operate under provisional status, comply with section 3727.09 of	518
the Revised Code according to its current status.	519

(3) A hospital that ceases to operate as an adult or	520
pediatric trauma center under provisional status may not operate	521
as an adult or pediatric trauma center under provisional status	522
until two years have elapsed since it ceased to operate under that	523
status.	524

(E) With respect to the availability of documents and other	525
information prepared pursuant to this section, an adult or	526
pediatric trauma center operating under provisional status is	527
subject to both of the following:	528

(1) The trauma center shall make available for public	529
inspection during normal working hours a copy of the	530
certification, resolution, and application prepared pursuant to	531
division (B) of this section. On request, the trauma center shall	532
provide a copy of the documents. A reasonable fee may be charged	533
to cover the necessary expenses incurred in furnishing the copies,	534
except that no fee shall be charged if the copies are being	535
furnished to the director of health.	536

(2) On request, the trauma center shall furnish to the	537
director of health a copy of the report of the consultative or	538
reverification visit obtained from the American college of	539
surgeons pursuant to division (A) of this section and a copy of	540
the plan and timetable approved pursuant to division (B)(3) of	541
this section for obtaining verification or reverification. The	542
documents provided may omit patient-identifying information.	543
Submission of the documents to the director does not waive any	544
privilege or right of confidentiality that otherwise applies to	545
the documents and the information in them.	546

The documents and the information in them are not public	547
records and shall not be disclosed to any person except employees	548
of the department of health who are expressly authorized by the	549
director of health to examine the copies and information in them.	550
The documents and information in them are not subject to discovery	551
or introduction into evidence in a civil action, except an action	552
brought by the director against the trauma center or a person that	553
authorized, approved, or created the original documents and the	554
information in them.	555

(F) Notwithstanding any provision of this section regarding	556
the receipt of a report of the results of a consultation visit or	557
reverification visit from the American college of surgeons, if a	558
hospital submitted an application for a consultation visit or	559
reverification visit as an adult or pediatric trauma center on or	560
before May 20, 2002, the hospital may operate as an adult or	561
pediatric trauma center under provisional status. The hospital	562
shall do all of the following:	563

(1) Comply with divisions (B)(1) and (2) of this section as	564
though the report has been received;	565

(2) Approve through its governing board a written plan and	566
timetable for obtaining the level of verification or	567
reverification being sought, including provisions for correcting	568
at the earliest practicable date any deficiencies identified in	569
the exit interview following the consultation or reverification	570
visit and any subsequent report received;	571

(3) Comply with all other provisions of this section	572
applicable to the operation of a trauma center under provisional	573
status, including the requirements of division (D) of this section	574
regarding the ceasing of operation under provisional status.	575

Sec. 3727.102. A hospital shall promptly notify in writing	576
the director of health, the emergency medical services division of	577
the department of public safety, and the appropriate regional	578
directors and regional advisory boards appointed under section	579
4765.05 of the Revised Code if any of the following occurs:	580

(A) The hospital ceases to be an adult or pediatric trauma	581
center verified by the American college of surgeons.	582

(B) The hospital changes its level of verification as an	583
adult or pediatric trauma center verified by the American college	584
of surgeons.	585

(C) The hospital commences to operate as an adult or	586
pediatric trauma center under provisional status pursuant to	587
section 3727.101 of the Revised Code.	588

(D) The hospital changes the level of verification or	589
reverification it is seeking under its provisional status.	590

(E) The hospital ceases to operate under its provisional	591
status.	592

(F) The hospital receives verification or reverification in	593
place of its provisional status.	594

Sec. 4765.01.  As used in this chapter:

595

(A) "First responder" means an individual who holds a	596
current, valid certificate issued under section 4765.30 of the	597
Revised Code to practice as a first responder.	598

(B) "Emergency medical technician-basic" or "EMT-basic"	599
means an individual who holds a current, valid certificate issued	600
under section 4765.30 of the Revised Code to practice as an	601
emergency medical technician-basic.	602

(C) "Emergency medical technician-intermediate" or "EMT-I"	603
means an individual who holds a current, valid certificate issued	604
under section 4765.30 of the Revised Code to practice as an	605
emergency medical technician-intermediate.	606

(D) "Emergency medical technician-paramedic" or "paramedic"	607
means an individual who holds a current, valid certificate issued	608
under section 4765.30 of the Revised Code to practice as an	609
emergency medical technician-paramedic.	610

(E) "Ambulance" means any motor vehicle that is used, or is	611
intended to be used, for the purpose of responding to emergency	612
medical situations, transporting emergency patients, and	613
administering emergency medical service to patients before,	614
during, or after transportation.	615

(F) "Cardiac monitoring" means a procedure used for the	616
purpose of observing and documenting the rate and rhythm of a	617
patient's heart by attaching electrical leads from an	618
electrocardiograph monitor to certain points on the patient's body	619
surface.	620

(G) "Emergency medical service" means any of the services	621
described in sections 4765.35, 4765.37, 4765.38, and 4765.39 of	622
the Revised Code that are performed by first responders, emergency	623
medical technicians-basic, emergency medical	624
technicians-intermediate, and paramedics. "Emergency medical	625
service" includes such services performed before or during any	626
transport of a patient, including transports between hospitals and	627
transports to and from helicopters.	628

(H) "Emergency medical service organization" means a public	629
or private organization using first responders, EMTs-basic,	630
EMTs-I, or paramedics, or a combination of first responders,	631
EMTs-basic, EMTs-I, and paramedics, to provide emergency medical	632
services.	633

(I) "Physician" means an individual who holds a current,	634
valid certificate issued under Chapter 4731. of the Revised Code	635
authorizing the practice of medicine and surgery or osteopathic	636
medicine and surgery.	637

(J) "Registered nurse" means an individual who holds a	638
current, valid license issued under Chapter 4723. of the Revised	639
Code authorizing the practice of nursing as a registered nurse.	640

(K) "Volunteer" means a person who provides services either	641
for no compensation or for compensation that does not exceed the	642
actual expenses incurred in providing the services or in training	643
to provide the services.	644

(l)(L) "Emergency medical service personnel" means first	645
responders, emergency medical service technicians-basic, emergency	646
medical service technicians-intermediate, emergency medical	647
service technicians-paramedic, and persons who provide medical	648
direction to such persons.	649

(M) "Hospital" has the same meaning as in section 3727.01 of	650
the Revised Code.	651

(N) "Trauma" or "traumatic injury" means severe damage to or	652
destruction of tissue that satisfies both of the following	653
conditions:	654

(1) It creates a significant risk of any of the following:

655

(a) Loss of life;

656

(b) Loss of a limb;

657

(c) Significant, permanent disfigurement;

658

(d) Significant, permanent disability.

659

(2) It is caused by any of the following:

660

(a) Blunt or penetrating injury;

661

(b) Exposure to electtomagneticelectromagnetic, chemical,	662
or rodioactiveradioactive energy;	663

(c) Drowning, suffocation, or stangulationstrangulation;

664

(d) A dificitdeficit or excess of heat.

665

(o)(O) "Trauma victim" or "trauma patient" means a person	666
who has sustained a traumatic injury.	667

(p)(P) "Trauma care" means the assessment, diagnosis,	668
transportation, treatment, or rehabilitation of a trauma victim by	669
emergency medical service personnel or by a physician, nurse,	670
physician assistant, respiratory therapist, physical therapist,	671
chiropractor, occupational therapist, speech-language pathologist,	672
audiologist, or psychologist licensed to practice as such in this	673
state or another jurisdiction.	674

(Q) "Trauma center" means all of the following:

675

(1) Any hospital that is verified by the American college of	676
surgeons as an adult or pediatric trauma center;	677

(2) Any hospital that is operating as an adult or pediatric	678
trauma center under provisional status pursuant to section	679
3727.101 of the Revised Code;	680

(3) Until December 31, 2004, any hospital in this state that	681
is designated by the director of health as a level II pediatric	682
trauma center under section 3727.081 of the Revised Code;	683

(3)(4) Any hospital in another state that is licensed or	684
designated under the laws of that state as capable of providing	685
specialized trauma care appropriate to the medical needs of the	686
trauma patient.	687

(R) "Pediatric" means involving a patient who is less than	688
sixteen years of age.	689

(S) "Adult" means involving a patient who is not a pediatric	690
patient.	691

(T) "Geriatric" means involving a patient who is at least	692
seventy years old or exhibits significant anatomical or	693
physiological characteristics associated with advanced aging.	694

(U) "Air medical organization" means an organization that	695
provides emergency medical services, or transports emergency	696
victims, by means of fixed or rotary wing aircraft.	697

(V) "Emergency care" and "emergency facility" have the same	698
meanings as in section 3727.01 of the Revised Code.	699

(W) "Stabilize," except as it is used in division (B) of	700
section 4765.35 of the Revised Code with respect to the manual	701
stabilization of fractures, has the same meaning as in section	702
1753.28 of the Revised Code.	703

(X) "Transfer" has the same meaning as in section 1753.28 of	704
the Revised Code.	705

Sec. 4765.50.  (A) Except as provided in division (D) of	706
this section, no person shall represent that the person is a first	707
responder, an emergency medical technician-basic or EMT-basic, an	708
emergency medical technician-intermediate or EMT-I, or an	709
emergency medical technician-paramedic or paramedic unless	710
appropriately certified under section 4765.30 of the Revised Code.	711

(B)(1) No person shall operate an emergency medical services	712
training program without a certificate of accreditation issued	713
under section 4765.17 of the Revised Code.	714

(2) No person shall operate an emergency medical services	715
continuing education program without a certificate of approval	716
issued under section 4765.17 of the Revised Code.	717

(C) No public or private entity shall advertise or	718
disseminate information leading the public to believe that the	719
entity is an emergency medical service organization, unless that	720
entity actually provides emergency medical services.	721

(D) A person who is performing the functions of a first	722
responder, EMT-basic, EMT-I, or paramedic under the authority of	723
the laws of a jurisdiction other than this state, who is employed	724
by or serves as a volunteer with an emergency medical service	725
organization based in that state, and provides emergency medical	726
services to or transportation of a patient in this state is not in	727
violation of division (A) of this section.	728

A person who is performing the functions of a first	729
responder, EMT-basic, EMT-I, or paramedic under a reciprocal	730
agreement authorized by section 4765.10 of the Revised Code is not	731
in violation of division (A) of this section.	732

(E) Beginning two yearsOn and after the effective date of	733
this amendmentNovember 3, 2002, no physician shall purposefully	734
do any of the following:	735

(1) Admit an adult trauma patient to a hospital that is not	736
an adult trauma center for the purpose of providing adult trauma	737
care;	738

(2) Admit a pediatric trauma patient to a hospital that is	739
not a pediatric trauma center for the purpose of providing	740
pediatric trauma care;	741

(3) Fail to transfer an adult or pediatric trauma patient to	742
an adult or pediatric trauma center in accordance with applicable	743
federal law, state law, and adult or pediatric trauma protocols	744
and patient transfer agreements adopted under section 3727.09 of	745
the Revised Code.	746

Section 2. That existing sections 2317.54, 3702.30, 3702.31,	747
3727.09, 3727.10, 4765.01, and 4765.50 of the Revised Code are	748
hereby repealed.	749

Section 3. Sections 3727.101 and 3727.102 of the Revised	750
Code, as enacted by this act, shall take effect on November 3,	751
2002, or the earliest time permitted by law, whichever is later.	752