Friday, 26 June 2020 11:12

Watered-down patient visitation bill passes House but not Senate

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Watered-down patient visitation bill passes House but not Senate Pixabay

RALEIGH — A Senate bill to ensure visitation rights for hospital patients passed the House unanimously Thursday, June 25. But the new version is stripped, the bill’s sponsor says, leaving hospitals to block visitors under COVID-19 restrictions. The Senate rejected the watered-down version.

Senate Bill 730, The No Patient Left Alone Act, originally overrode hospital rules that keep patients isolated to prevent virus spread. The Senate’s version of the bill, led by Sen. Warren Daniel, R-Burke, would’ve let patients choose one visitor during hospitalization. That companion would be tested for infection. Wear a face mask. Stay quarantined in the patient’s room.

But House members substituted the bill’s language Wednesday, subjecting visitation rights to hospitals’ existing policies. On Thursday, the bill was hastily amended to include $100 million in small business grants through the N.C. Department of Commerce. Another portion, added by House lawmakers Wednesday, would appropriate several million dollars for virus testing, tracking, and tracing across the state.

The bill went to the Senate for concurrence. Daniel said Wednesday he doesn’t approve the House revisions. Late Thursday night, 40 of the 46 senators voting rejected the House version. The bill died.

The Senate version of S.B. 730 didn’t align with federal rules, N.C. Health and Human Services Secretary Mandy Cohen told the House Health Committee last week. S.B. 730 was inconsistent with “conditions of participation” from the Centers for Medicaid and Medicare Services, the health department said. CMS rules allow hospitals to “adopt policies that restrict or limit visitors when clinically necessary and reasonable.” That includes infection control.

The new version brings the bill into compliance, House Republicans and Democrats said Wednesday during floor debate.

But Daniel says the changes “merely codify the current hospital practice of having unilateral control over patient visitation.”

“It won’t fix the tragic problem of patients being forced to be left alone in hospitals,” he told CJ.

Daniel has many letters, phone messages, and emails from families desperate to visit hospitalized loved ones.

Last week, Cohen told House lawmakers the stories keep her awake at night, but repeatedly pointed to concerns over risk of infection and compliance with federal rules. When CJ reached out to Cohen for clarification June 18, health department spokeswoman Amy Ellis sent a link to the CMS manual, pointing again to “conditions of participation.” Hospitals are allowed to set restrictive visitation policies “when clinically necessary and reasonable,” Ellis said.

That’s true, CJ found in its own reading of the manual, but the rules also allow some flexibility for doctors to exercise clinical judgment “when determining when visitation is, and is not, appropriate.”

That judgment accounts for “all aspects of patient health and safety, including the benefits of visitation on a patient’s care as well as potential negative impacts that visitors may have on other patients in the hospital.”

Cohen’s concerns are valid, said David Balat, director of the Right on Healthcare initiative at the Texas Public Policy Foundation. But CMS rules only apply to Medicare and Medicaid patients.

“CMS cannot mandate for private insurance patients,” Balat told CJ.

Cohen is “hiding behind rhetoric,” Rep. Hugh Blackwell, R-Burke, told CJ June 19, just after the Senate passed the original version of S.B. 730. The health secretary isn’t taking a sophisticated approach to dealing with the virus, he said.

“From my perspective, we have to try to be safe, but we also have to protect patients who are in facilities. And that means they need to have contact with family,” Blackwell said.

Mental health is as important as physical health, he said. In some cases, patients need advocates. People in the room who know the patient’s needs.

“If somebody is impaired in some manner they’re not necessarily in a position to be able to take care of their own best interests. They can’t necessarily get out of the bed and [talk to] a nurse.”

One such story came from Kenda Carpenter, a registered nurse who wrote to Daniel about her great grandmother’s recent hospitalization in Charlotte. The older woman suffered a serious head injury, but the family wasn’t allowed to visit. They couldn’t advocate for the “spry, active lady,” Carpenter wrote. After several days in isolation, after conflicting messages from doctors and nurses, Carpenter’s great grandmother was discharged. But she’d been given too many medications, sedated for days. She was incoherent. In pain.

"We all can’t help but wonder, how much better could she have been right now if she had been allowed one family member,” Carpenter wrote. “One advocate. One person to watch over her.”

“Please help us. Please help future patients.”

Outside the legislature, some help is offered. But in minute doses.

A few hospital systems are easing visitor restrictions. In late May, Atrium Health allowed surgery patients to bring a companion to some procedures. On June 12, Wake Forest Baptist Health reinstated limited visitation hours. On June 22, UNC Health Care announced it would let patients at its Triangle hospitals have one visitor. In all cases, COVID-19 screenings apply.

But many hospitals remain in quarantine. People are alone during major surgeries. Cancer treatments. Even death. Meanwhile, parents, husbands, wives, and children wait in hospital parking lots, hoping to get a few minutes, even an hour, to visit their loved ones.

Sen. Joyce Krawiec, R-Forsyth, is another primary sponsor of S.B. 730. The mother of a girl with Crohn’s Disease, Krawiec has passionately argued that the General Assembly can’t sit by and watch families suffer.

“If that were my loved one, the hospital would be calling the police,” Krawiec said before a Senate committee June 11. “Because I would be going in.”

The intent is good, but the application is problematic, Balat said.

“The hospital would no longer be able determine their own policies and procedures with regard to visitation and would be open to exposure legally for something they no longer have control over,” he said.