Otis Warren, MD
RI ACEP President-Elect
In 2017, New York enacted a law requiring hospitals to publicly report their sepsis performance metrics. “Rory’s Law” was named for Rory Staunton, a boy who died of an overwhelming beta-hemolytic strep infection. This law specifically mentions fluid boluses, pressors and antibiotics amongst other components.
This year, similar bills were introduced in RI. While the intention of this type of legislation seems well meaning- to improve care of patients, this is not something that should be legislated.
We are seeing more and more legislative attempts that direct specific components of the way we care for patients every day. This began in the 1970s with laws that decriminalized public intoxication and mandating the care of these patients in the ED. Recently, a comprehensive opiate treatment bill was passed, legislating the way we treat opiate overdose patients in the ED. The sepsis bills are the next iteration.
Our opposition to these bills is multifaceted. On one hand, hospitals already report sepsis data to CMS, so these bills wouldn’t do anything different except to codify this into law. The data on sepsis bundles is evolving rapidly and hotly debated. Laws like this are hard to change with new evidence. The alcohol laws are a great example; they refer to non-existent resources and treatment protocols from 1972.
However, more concerning is the precedent of legislating bedside care. We believe that our current system of checks and accreditation (CMS, JACHO, board certification, medical licensure, maintenance of certification) should manage clinical protocols and that providers and hospitals should not have comply with complicated and rigid state laws.
So where are these bills coming from? Unfortunately most come from a tragic story, a young person’s death in most cases that touches the hearts of our lawmakers. Well meaning legislators become motivated to “do something” and “save lives” without a nuanced and detailed understanding about medicine and hospitals. It is our job to inform them of the complexities and problems that arise when the practice of medicine changes from an art to a law.
Towards that end, a house bill modeled after the New York law was removed by its sponsor after some lobbying on our behalf with the above concerns. A more simplified “resolution” passed the house asking the DOH to create sepsis protocols. This is a much more palatable outcome, there is no mention of pressors or antibiotics, and it is not a law dictating care. It also gives the legislators the opportunity to “have done something” about this problem.
As we more forward, we expect to see more of this type of legislation. Your donations to our PAC helps our voice get heard. Please consider donating at: https://squareup.com/store/RIEMPAC.