Wyoming Peer Review

This information was last updated by Horty, Springer & Mattern on January 3, 2019.

WYOMING

PEER REVIEW

Wyo. Stat. §35-2-910 Quality management functions for health care facilities; confidentiality; immunity; whistle blowing; peer review.

(a) Each licensee shall implement a quality management function to evaluate and improve patient and resident care and services in accordance with rules and regulations promulgated by the division. Quality management information relating to the evaluation or improvement of the quality of health care services is confidential. Any person who in good faith and within the scope of the functions of a quality management program participates in the reporting, collection, evaluation, or use of quality management information or performs other functions as part of a quality management program with regard to a specific circumstance shall be immune from suit in any civil action based on such functions brought by a health care provider or person to whom the quality information pertains. In no event shall this immunity apply to any negligent or intentional act or omission in the provision of care.

(b) Health care facilities subject to or licensed pursuant to this act shall not harass, threaten discipline or in any manner discriminate against any resident, patient or employee of any health care facility for reporting to the division a violation of any state or federal law or rule and regulation. Any employee found to have knowingly made a false report to the division shall be subject to disciplinary action by the employing health care facility, including but not limited to, dismissal.

(c) No hospital shall be issued a license or have its license renewed unless it provides for the review of professional practices in the hospital for the purpose of reducing morbidity and mortality and for the improvement of the care of patients in the hospital. This review shall include, but not be limited to:

(i) The quality and necessity of the care provided to patients as rendered in the hospital;

(ii) The prevention of complications and deaths occurring in the hospital;

(iii) The review of medical treatments and diagnostic and surgical procedures in order to ensure safe and adequate treatment of patients in the hospital; and

(iv) The evaluation of medical and health care services and the qualifications and professional competence of persons performing or seeking to perform those services.

(d) The review required in subsection (c) of this section shall be performed according to the decision of a hospital’s governing board by:

(i) A peer review committee appointed by the organized medical staff of the hospital;

(ii) A state, local or specialty medical society; or

(iii) Any other organization of physicians established pursuant to state or federal law and engaged by the hospital for the purposes of subsection (c) of this section.

§35-2-901 Definitions; applicability of provisions.

(a) As used in this act:

(i) “Acute care” means short term care provided in a hospital;

(ii) “Ambulatory surgical center” means a facility which provides surgical treatment to patients not requiring hospitalization and is not part of a hospital or offices of private physicians, dentists or podiatrists;

(iii) “Birthing center” means a facility which operates for the primary purpose of performing deliveries and is not part of a hospital;

(iv) “Boarding home” means a dwelling or rooming house operated by any person, firm or corporation engaged in the business of operating a home for the purpose of letting rooms for rent and providing meals and personal daily living care, but not habilitative or nursing care, for persons not related to the owner. Boarding home does not include a lodging facility or an apartment in which only room and board is provided;

(v) “Construction area” means thirty (30) highway miles, from any existing nursing care facility or hospital with swing beds to the site of the proposed nursing care facility, as determined by utilizing the state map prepared by the Wyoming department of transportation;

(vi) “Department” means the department of health;

(vii) “Division” means the designated division within the department of health;

(viii) “Freestanding diagnostic testing center” means a mobile or permanent facility which provides diagnostic testing but not treatment and is not part of the private offices of health care professionals operating within the scope of their licenses;

(ix) Repealed By Laws 1999, ch. 119, 2.

(x) “Health care facility” means any ambulatory surgical center, assisted living facility, adult day care facility, adult foster care home, alternative eldercare home, birthing center, boarding home, freestanding diagnostic testing center, home health agency, hospice, hospital, freestanding emergency center, intermediate care facility for the mentally retarded, medical assistance facility, nursing care facility, rehabilitation facility and renal dialysis center;

(xi) “Home health agency” means an agency primarily engaged in arranging and directly providing nursing or other health care services to persons at their residence;

(xii) “Hospice” means a program of care for the terminally ill and their families given in a home or health facility which provides medical, palliative, psychological, spiritual and supportive care and treatment. Hospice care may include short-term respite care for non-hospice patients, if the primary activity of the hospice is the provision of hospice services to terminally ill individuals and provided that the respite care is paid by the patient or by a private third party payor and not through any governmental third party payment program;

(xiii) “Hospital” means an institution or a unit in an institution providing one (1) or more of the following to patients by or under the supervision of an organized medical staff:

(A) Diagnostic and therapeutic services for medical diagnosis, treatment and care of injured, disabled or sick persons;

(B) Rehabilitation services for the rehabilitation of injured, disabled or sick persons;

(C) Acute care;

(D) Psychiatric care;

(E) Swing beds.

(xiv) “Intermediate care facility for people with intellectual disability” means a facility which provides on a regular basis health related care and training to persons with intellectual disabilities or persons with related conditions, who do not require the degree of care and treatment of a hospital or nursing facility and services above the need of a boarding home. The term also means “intermediate care facility for the mentally retarded” or “ICFMR” or “ICFs/MR” as those terms are used in federal law and in other laws, rules and regulations;

(xv) “Medical assistance facility” means a facility which provides inpatient care to ill or injured persons prior to their transportation to a hospital or provides inpatient care to persons needing that care for a period of no longer than sixty (60) hours and is located more than thirty (30) miles from the nearest Wyoming hospital;

(xvi) “Nursing care facility” means a facility providing assisted living care, nursing care, rehabilitative and other related services;

(xvii) “Physician” means a doctor of medicine or osteopathy licensed to practice medicine or surgery under state law;

(xviii) “Psychiatric care” means the in-patient care and treatment of persons with a mental diagnosis;

(xix) “Rehabilitation facility” means an outpatient residential facility which is operated for the primary purpose of assisting the rehabilitation of disabled persons including persons with acquired brain injury by providing comprehensive medical evaluations and services, psychological and social services, or vocational evaluations and training or any combination of these services and in which the major portion of the services is furnished within the facility;

(xx) “Renal dialysis center” means a freestanding facility for treatment of kidney diseases;

(xxi) “Swing bed” means a special designation for a hospital which has a program to provide specialized in-patient long term care. Any medical-surgical bed in a hospital can be designated as a swing bed;

(xxii) “Assisted living facility” means a dwelling operated by any person, firm or corporation engaged in providing limited nursing care, personal care and boarding home care, but not habilitative care, for persons not related to the owner of the facility. This definition may include facilities with secured units and facilities dedicated to the special care and services for people with Alzheimer’s disease or other dementia conditions;

(xxiii) “Adult day care facility” means any facility not otherwise certified by the department of health, engaged in the business of providing activities of daily living support and supervision services programming based on a social model, to four (4) or more persons eighteen (18) years of age or older with physical or mental disabilities;

(xxiv) “Adult foster care home” means a home where care is provided for up to five (5) adults who are not related to the provider by blood, marriage or adoption, except in special circumstances, in need of long term care in a home like atmosphere. “Adult foster care home” does not include any residential facility otherwise licensed or funded by the state of Wyoming. The homes shall be regulated in accordance with this act and with the Wyoming Long Term Care Choices Act, which shall govern in case of conflict with this act;

(xxv) “Alternative eldercare home” means a facility as defined in W.S. 42-6- 102(a)(iii). the homes shall be regulated in accordance with this act and with the Wyoming Long Term Care Choices Act which shall govern in case of conflict with this act;

(xxvi) “Freestanding emergency center” means a facility that provides services twenty-four (24) hours a day, seven (7) days a week for life threatening emergency medical conditions and is at a location separate from a hospital;

(xxvii) “This act” means W.S. 35-2-901 through 35-2-913.

(b) This act does not apply to hospitals or any other facility or agency operated by the federal government which would otherwise be required to be licensed under this act or to any person providing health care services within the scope of his license in a private office.

§35-2-605 Definitions.

(a) As used in this act, unless the context otherwise requires:

(i) “Audit” means an assessment, evaluation, determination or investigation of a hospital or a health care provider by a person not employed by or affiliated with the provider to determine compliance with:

(A) Statutory, regulatory, fiscal, medical or scientific standards;

(B) A private or public program of payments to a hospital or health care provider; or

(C) Requirements for licensing, accreditation or certification.

(ii) “Data” means all reports, notes, findings, opinions or records of any hospital medical staff committee, including its consultants, advisors and assistants;

(iii) “Directory information” means information disclosing the presence and the general health condition of a particular patient who is an inpatient in a hospital or who is currently receiving emergency health care in a hospital;

(iv) “General health condition” means the patient’s health status described in terms of “critical,” “poor,” “fair,” “good,” “excellent” or terms denoting similar conditions;

(v) “Health care” means any care, service or procedure provided in a hospital licensed under the laws of this state:

(A) To diagnose, treat or maintain a patient’s physical or mental condition; or

(B) That affects the structure or any function of the human body.

(vi) “Health care facility” means a hospital, clinic or nursing home where a health care provider provides health care to patients;

(vii) “Health care information” means any information, whether oral or recorded in any form or medium, that identifies or can readily be associated with the identity of a patient and relates to the patient’s health care, and includes any record of disclosures of that information;

(viii) “Health care provider” means a person who is licensed, certified or otherwise authorized by the law of this state to provide health care in the ordinary course of business or practice of a profession, but does not include a person who provides health care solely through the sale or dispensing of drugs or medical devices;

(ix) “Hospital” means establishments with organized medical staffs, with permanent facilities that include inpatient beds, and with medical services, including physician services and continuous nursing services, to provide diagnosis, treatment and continuity of care for patients;

(x) “Hospital medical staff committee” means any committee within a hospital, consisting of medical staff members or hospital personnel, which is engaged in supervision, discipline, admission, privileges or control of members of the hospital’s medical staff, evaluation and review of medical care, utilization of the hospital facilities or professional training.

(xi) “Institutional review board” means any board, committee or other group formally designated by an institution, or authorized under federal or state law, to review, approve the initiation of, or conduct periodic review of research programs to assure the protection of the rights and welfare of human research subjects;

(xii) “Maintain,” as related to health care information, means to hold, possess, preserve, retain, store or control that information;

(xiii) “Patient” means an individual who receives or has received health care and includes a deceased individual who has received health care;

(xiv) “This act” means W.S. 35-2-605 through 35-2-617.

§35-2-609 Disclosure without patient’s authorization.

(a) A hospital may disclose health care information about a patient without the patient’s authorization to the extent a recipient needs to know the information, if the disclosure is:

(i) To a person who is providing health care to the patient;

(ii) To any other person who requires health care information for health care education or to provide planning, quality assurance, peer review or administrative, legal, financial or actuarial services to the hospital or to assist the hospital in the delivery of health care and the hospital reasonably believes that the person:

(A) Will not use or disclose the health care information for any purpose other than that for which it is disclosed; and

(B) Will use reasonable care to protect the confidentiality of the health care information.

(iii) To any health care provider who has previously provided health care to the patient, to the extent necessary to provide health care to the patient, unless the patient has instructed the hospital not to make the disclosure;

(iv) To any person if the hospital reasonably believes that the disclosure will avoid or minimize an imminent danger to the health or safety of the patient or any other individual;

(v) To immediate family members of the patient, or any other individual with whom the patient is known to have a close personal relationship, if made in accordance with good medical or other professional practice, unless the patient has instructed the hospital not to make the disclosure;

(vi) To a health care facility who is the successor in interest to the hospital maintaining the health care information;

(vii) For use in a research project that an institutional review board has determined:

(A) Is of sufficient importance to outweigh the intrusion into the privacy of the patient that would result from the disclosure;

(B) Is impracticable without the use or disclosure of the health care information in individually identifiably form;

(C) Contains reasonable safeguards to protect the information from redisclosure;

(D) Contains reasonable safeguards to protect against identifying, directly or indirectly, any patient in any report of the research project; and

(E) Contains procedures to remove or destroy at the earliest possible opportunity, consistent with the purposes of the project, information that would enable the patient to be identified, unless an institutional review board authorizes retention of identifying information for purposes of another research project.

(viii) To a person who obtains information for purposes of an audit, if that person agrees in writing to:

(A) Remove or destroy, at the earliest opportunity consistent with the purpose of the audit, information that would enable the patient to be identified; and

(B) Not to disclose the information further, except to accomplish the audit or report unlawful or improper conduct involving fraud in payment for health care, or other unlawful conduct by a health care provider, health care facility or patient.

(ix) To an official of a penal or other custodial institution in which the patient is detained.

(b) A hospital may disclose health care information about a patient without the patient’s authorization if the disclosure is:

(i) Directory information, unless the patient has instructed the hospital not to make the disclosure;

(ii) To federal, state or local public health authorities, to the extent the hospital is required by law to report healthcare information or when needed to protect the public health;

(iii) To federal, state or local law enforcement authorities to the extent required by law;

(iv) Pursuant to W.S. 35-2-610; or

(v) Pursuant to W.S. 35-2-912.

(c) Subject to bylaws and control by the hospital governing body, the medical staff committees of any hospital shall have access to the records, data and other information relating to the condition and treatment of patients in that hospital for the purposes of:

(i) Supervision, discipline, admission, privileges or control of members of that hospital’s medical staff;

(ii) Evaluating, studying and reporting on matters relating to the care and treatment of patients;

(iii) Research, reducing mortality, prevention and treatment of diseases, illnesses and injuries; and

(iv) Determining if a hospital and extended care facilities are being properly utilized.

(d) All reports, findings, proceedings and data of medical staff committees shall be confidential and privileged. No claim or action shall accrue against any hospital, medical staff member or any employee of either arising out of the denial of staff privileges to any applicant or out of the suspension of, expulsion of or any other restrictive or disciplinary action against any medical staff member or hospital employee unless the action is arbitrary, capricious and without foundation in fact.

§35-17-101 Definition.

(a) As used in this act [ 35-17-101 through 35-17-103]:

(i) “Professional standard review organizations” means:

(A) Any medical, dental, optometric, nursing, osteopathic, emergency medical or pharmacy organization or a local, county, or state medical, dental, optometric, nursing, osteopathic and pharmacy society and any such society itself when such organization or society is performing any medical, dental, nursing, optometric, osteopathic, emergency medical and pharmacy review function or involving any controversy or dispute between a physician, dentist, optometrist, nurse, osteopath, emergency medical technician and pharmacist and a patient concerning the diagnosis, treatment, or care of such patient or the fees or charges therefor, or a physician, dentist, optometrist, nurse, osteopath, emergency medical technician or pharmacist and a provider of medical, dental, optometric, nursing, osteopathic, emergency medical and pharmacy benefits concerning any medical, dental, nursing, optometric, osteopathic, emergency medical, pharmacy or other health charges or fees of such physician, dentist, optometrist, nurse, osteopath, emergency medical technician or pharmacist;

(B) A committee of a medical staff in a hospital having the responsibility of evaluation and improvement of the quality of care rendered in the hospital;

(C) A committee functioning to review, pursuant to federal or state laws, the operation of hospital or extensive care facilities; or

(D) A committee having the responsibility of evaluation and improvement of the quality of care rendered in a long-term care facility.

§35-17-103 Exemption from liability; exception.

Any professional standard review organization or a society or person rendering services as a member of a professional standard review organization functioning pursuant to this act [§§ 35-17-101 through 35-17-106] is not liable either independently or jointly for any civil damages as a result of acts or omissions in his capacity as a member of any such organization or society. Such persons or organizations or societies are not immune from liability for intentional or malicious acts or omissions resulting in harm or any grossly negligent acts or omissions resulting in harm.

§35-17-104 Exemption from liability for witnesses.

(a) Notwithstanding any other provision of law, no person providing information to any professional standard review organization shall be held, by reason of having provided such information, to have violated any criminal law, or to be civilly liable under any law unless:

(i) The information is unrelated to the performance of the duties and functions of the professional standard review organization; or

(ii) The information is false and the person providing the information knew or had reason to know that the information was false.

§ 35-17-105 Information of review organizations to be confidential and privileged.

All reports, findings, proceedings and data of the professional standard review organizations is confidential and privileged, and is not subject to discovery or introduction into evidence in any civil action, and no person who is in attendance at a meeting of the organization shall be permitted or required to testify in any civil action as to any evidence or other matters produced or presented during the proceedings of the organization or as to any findings, recommendations, evaluations, opinions or other actions of the organization or any members thereof. However, information, documents or other records otherwise available from original sources are not to be construed as immune from discovery or use in any civil action merely because they were presented during proceedings of the organization, nor should any person who testifies before the organization or who is a member of the organization be prevented from testifying as to matters within his knowledge, but that witness cannot be asked about his testimony before the organization or opinions formed by him as a result of proceedings of the organization.