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Certificate of Need Bills Draw Big Crowd
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On Thursday, a Senate Medical Affairs subcommittee met to discuss bills S.494, S.990, S.1077, and S.1093 - four bills related to the Certificate of Need (CON) program in South Carolina. S.990 would repeal the CON program completely while S.1093 would scale back the program and make significant reform to the existing requirements. S.1077 would not repeal or reform the entire CON program, but would remove the requirement to have a CON for moving from a Level II perinatal hospital to a Level III perinatal hospital. SCHA supports S.1093 to reform the program.
Gressette 308 was filled to the brim, with thirty individuals signed up to speak on the issues. The big question of the day was whether to repeal or reform CON. Speaking in favor of S.1093, reform, was Donna Isgett, Chief Operating Officer of McLeod Health System and Chair for the Board of the South Carolina Hospital Association (SCHA). She urged the subcommittee to reform, not repeal CON, stating that all 63 hospitals and board members of SCHA are unified in this notion. The hospitals agree that the current time it takes for approval, on average 3.6 years, is too long and the dollar threshold that currently triggers the need for a CON is outdated. The Chief Executive Officers of Orangeburg Regional Medical Center, Charles Williams, and Prisma Health, Mark O'Halla, both spoke in favor of reform, arguing that CON saves hospitals, specifically rural ones. Repealing CON will have unintended consequences and will hit the rural communities the hardest with closing facilities and increased prices. Mark O'Halla reiterated the point that all the hospitals are united in reform and stating, "we (the hospitals) are the safety net," asking the subcommittee to keep this in mind when arriving at a decision.
While the hospitals were in agreement on reform, many physicians testified in favor of repeal. One doctor speaking on behalf of the Charleston Medical Society argued that reforming CON does not include or address the needs of patients. According to his testimony, CON can restrict access for patients, increase costs, and lower quality. He went on to say that, in examining states without CON, there has been increased access for African Americans, lowering social disparities and also lowering costs because the free market is able to regulate price. Members of the South Carolina Medical Association support repeal because currently applying for CON is costly and expensive. One doctor who wishes to open a cardiovascular facility was told that he would have to spend half a million dollars and wait two years before anything can be done. Other physicians made similar points, emphasizing that they believe access and quality would improve if CON is repealed.
Several individuals shared comments on S.1077, a bill to remove the CON requirement for a Level II NICU to become a Level III NICU. Todd Gallati, the CEO from Trident Health, argued that allowing Level II care centers to establish Level III unites will save lives. Trident Health System sees a large volume of pre- and post-natal women and the system does not have to capability to care for women and newborns if anything were to happen. He said that passing this bill would increase geographic access and further regulate the market as transportation of a newborn and mother can be upwards of $12,000. In opposition of the bill was a representative from the Medical University of South Carolina (MUSC) and McLeod Health stating that 20 out of every 100,000 births result in the death of the mother and that is because Level II and below are not equipped to handle the emergencies. Multiple doctors also spoke in opposition of the bill, telling their different, negative experiences with level II hospitals and patient safety.
The subcommittee adjourned at 11:00am to go to their legislative session and indicated they would hold another subcommittee meeting on the issue to finish taking testimony and debate the issue amongst the members. SCHA will continue to support reform of the CON program and passage of S. 1093.
The subcommittee was broadcast live and is available to watch here.
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House Panel Hears Testimony on Implicit Bias Training Requirements for Perinatal Providers
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A subcommittee of the House 3M Committee heard emotional testimony Thursday morning on H.4712, a bill to require hospitals, birthing centers, and other community care providers who offer perinatal services to provide implicit bias training for their perinatal care providers. The bill defines what an implicit bias program looks like and requires an annual refresher course be given to all providers.
Dr. Kari Claudia-Allen spoke in favor of the bill and mentioned several names of black women who died during childbirth, noting that the maternal mortality rate for black women is between two and four times higher than the rate for white women. Rozalynn Goodwin spoke on behalf of the South Carolina Hospital Association to highlight the work our member hospitals have done in the area of maternal and infant mortality and efforts to specifically address racial inequity in this area. SCHA is currently involved in the Alliance for a Healthier South Carolina; SC Birth Outcomes Initiative, which recently formed a birth equity council; the SCHA Board-chartered Equity, Diversity, and Inclusion Council; and the Maternal Mortality Review Committee. She discussed the impressive outcomes that have happened with the public-private partnerships we have worked on in the past and noted that mandates do not usually have the same impact, with the same enthusiasm and energy behind them as partnership groups.
Several individuals shared their own personal stories with near-death or otherwise traumatizing experiences during childbirth and expressed support for the legislation. After some discussion, the bill passed out of the subcommittee by a vote of 4-1.
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Committee Action
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- Use of Restraints on Inmates in Childbirth: A bill to lessen the requirements for using restraints on inmates during childbirth was polled out of the Senate Corrections and Penology committee this week after a subcommittee gave the bill a favorable report last week. The bill will be put on the Senate calendar for consideration on the floor.
- Military Spouse Licensure: The conference committee on S. 455 met this week agreed on language to improve professional licensure for military spouses relocating to South Carolina while their spouse in stationed here. The conference committee report states that the licensing board for a professional shall issue a temporary license for a military spouse to continue to work in their professional upon relocation to South Carolina. The bill also includes an unrelated section that would change the statute related to the education requirements for CRNAs to say, "a minimum of" a master's degree. The report was adopted by the Senate.
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February 28, 2020
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