54.1-2400.6 - Hospitals and other health care institutions required to report disciplinary actions against and certain disorders of health professionals; immunity from liability; failure to report.
§ 54.1-2400.6. Hospitals and other health care institutions required toreport disciplinary actions against and certain disorders of healthprofessionals; immunity from liability; failure to report.
A. The chief executive officer and the chief of staff of every hospital orother health care institution in the Commonwealth shall report within 30days, except as provided in subsection B, to the Director of the Departmentof Health Professions the following information regarding any person (i)licensed, certified, or registered by a health regulatory board or (ii)holding a multistate licensure privilege to practice nursing or an applicantfor licensure, certification or registration unless exempted under subsectionE:
1. Any information of which he may become aware in his official capacityindicating that such a health professional is in need of treatment or hasbeen committed or admitted as a patient, either at his institution or anyother health care institution, for treatment of substance abuse or apsychiatric illness that may render the health professional a danger tohimself, the public or his patients.
2. Any information of which he may become aware in his official capacityindicating, after reasonable investigation and consultation as needed withthe appropriate internal boards or committees authorized to imposedisciplinary action on a health professional, that there is a reasonableprobability that such health professional may have engaged in unethical,fraudulent or unprofessional conduct as defined by the pertinent licensingstatutes and regulations. The report required under this section shall besubmitted within 30 days of the date that the chief executive officer orchief of staff determines that a reasonable probability exists.
3. Any disciplinary proceeding begun by the institution as a result ofconduct involving (i) intentional or negligent conduct that causes or islikely to cause injury to a patient or patients, (ii) professional ethics,(iii) professional incompetence, (iv) moral turpitude, or (v) substanceabuse. The report required under this section shall be submitted within 30days of the date of written communication to the health professionalnotifying him of the initiation of a disciplinary proceeding.
4. Any disciplinary action taken during or at the conclusion of disciplinaryproceedings or while under investigation, including but not limited to denialor termination of employment, denial or termination of privileges orrestriction of privileges that results from conduct involving (i) intentionalor negligent conduct that causes or is likely to cause injury to a patient orpatients, (ii) professional ethics, (iii) professional incompetence, (iv)moral turpitude, or (v) substance abuse. The report required under thissection shall be submitted within 30 days of the date of writtencommunication to the health professional notifying him of any disciplinaryaction.
5. The voluntary resignation from the staff of the health care institution orvoluntary restriction or expiration of privileges at the institution of anyhealth professional while such health professional is under investigation oris the subject of disciplinary proceedings taken or begun by the institutionor a committee thereof for any reason related to possible intentional ornegligent conduct that causes or is likely to cause injury to a patient orpatients, medical incompetence, unprofessional conduct, moral turpitude,mental or physical impairment, or substance abuse.
Any report required by this section shall be in writing directed to theDirector of the Department of Health Professions, shall give the name andaddress of the person who is the subject of the report and shall fullydescribe the circumstances surrounding the facts required to be reported. Thereport shall include the names and contact information of individuals withknowledge about the facts required to be reported and the names and contactinformation of individuals from whom the hospital or health care institutionsought information to substantiate the facts required to be reported. Allrelevant medical records shall be attached to the report if patient care orthe health professional's health status is at issue. The reporting hospitalor health care institution shall also provide notice to the Department thatit has submitted a report to the National Practitioner Data Bank under theHealth Care Quality Improvement Act (42 U.S.C. § 11101 et seq.). Thereporting hospital or health care institution shall give the healthprofessional who is the subject of the report an opportunity to review thereport. The health professional may submit a separate report if he disagreeswith the substance of the report.
This section shall not be construed to require the hospital or health careinstitution to submit any proceedings, minutes, records or reports that areprivileged under § 8.01-581.17, except that the provisions of § 8.01-581.17shall not bar (i) any report required by this section or (ii) any requestedmedical records that are necessary to investigate unprofessional conductreported pursuant to this subtitle or unprofessional conduct that should havebeen reported pursuant to this subtitle. Under no circumstances shallcompliance with this section be construed to waive or limit the privilegeprovided in § 8.01-581.17. No person or entity shall be obligated to reportany matter to the Department if the person or entity has actual notice thatthe same matter has already been reported to the Department.
B. Any report required by this section concerning the commitment or admissionof such health professional as a patient shall be made within five days ofwhen the chief administrative officer learns of such commitment or admission.
C. The State Health Commissioner or the Commissioner of the Department ofSocial Services shall report to the Department any information of which theiragencies may become aware in the course of their duties that a healthprofessional may be guilty of fraudulent, unethical or unprofessional conductas defined by the pertinent licensing statutes and regulations.
D. Any person making a report by this section, providing information pursuantto an investigation or testifying in a judicial or administrative proceedingas a result of such report shall be immune from any civil liability allegedto have resulted therefrom unless such person acted in bad faith or withmalicious intent.
E. Medical records or information learned or maintained in connection with analcohol or drug prevention function that is conducted, regulated, or directlyor indirectly assisted by any department or agency of the United States shallbe exempt from the reporting requirements of this section to the extent thatsuch reporting is in violation of 42 U.S.C. § 290dd-2 or regulations adoptedthereunder.
F. Any person who fails to make a report to the Department as required bythis section shall be subject to a civil penalty not to exceed $25,000assessed by the Director. The Director shall report the assessment of suchcivil penalty to the Commissioner of the Department of Health. Any personassessed a civil penalty pursuant to this section shall not receive a licenseor certification or renewal of such unless such penalty has been paidpursuant to § 32.1-125.01. The Medical College of Virginia Hospitals and theUniversity of Virginia Hospitals shall not receive certification pursuant to§ 32.1-137 or Article 1.1 (§ 32.1-102.1 et seq.) of Chapter 4 of Title 32.1unless such penalty has been paid.
(Code 1950, § 32-137.1; 1977, c. 639; 1978, c. 541, § 54-325.1; 1979, cc.720, 727; 1986, cc. 303, 434; 1988, c. 765, § 54.1-2906; 1994, c. 234; 2000,c. 77; 2003, cc. 456, 753, 762; 2004, cc. 49, 64.)