The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy
BILL: CS/SB 1602
INTRODUCER: Health Policy Committee and Senator Harrell
SUBJECT: Health Care Patient Protection
DATE: April 21, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Looke Brown HP Fav/CS
2. Barr McKnight AHS Favorable
3. Looke Siples FP Pre-meeting
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 1602 requires each hospital with an emergency department (ED) to develop and
implement policies and procedures for pediatric patient care in the ED. Additionally, each such
hospital ED must designate a pediatric emergency care coordinator and conduct the National
Pediatric Readiness Assessment (NPRA) within a certain time frame.
The bill also requires the Agency for Health Care Administration to incorporate the needs of
pediatric and neonatal patients in rules requiring an emergency management plan, to adopt rules
that establish minimum standards for pediatric patient care in hospital EDs, and to collect the
results of the NPRA and publish the overall assessment score for each hospital ED and provide a
comparison to the national average score.
The bill has no fiscal impact on state expenditures or revenues. The bill will have an
indeterminate, negative fiscal impact on hospitals with EDs. See Section V., Fiscal Impact
Statement.
The bill takes effect July 1, 2025.
REVISED: BILL: CS/SB 1602 Page 2
II. Present Situation:
Hospital Licensure
Hospitals are regulated by the Agency for Health Care Administration (AHCA) under ch. 395,
F.S., and the general licensure provisions of part II, of ch. 408, F.S. In Florida, emergency
departments (ED) are either located in a hospital or on separate premises of a licensed hospital.
Any licensed hospital which has a dedicated ED may provide emergency services in a location
separate from the hospital’s main premises, known as a hospital-based off-campus emergency
department.
1
Current law requires each hospital with an ED to screen, examine, and evaluate a patient who
presents to the ED to determine if an emergency medical condition exists and, if it does, provide
care, treatment, or surgery to relieve or eliminate the emergency medical condition.
2
Each
hospital with an ED must provide emergency services and care
3
24 hours a day and must have at
least one physician on-call and available within 30 minutes.
4
Inventory of Hospital Emergency Services
Each hospital offering emergency services and care must report to the AHCA the services which
are within the service capability of the hospital.
5
The AHCA is required to maintain an inventory
of hospitals with emergency services, including a list of the services within the service capability
of the hospital, to assist emergency medical services providers and the general public in locating
appropriate emergency medical care.
6
If a hospital determines it is unable to provide a service on
a 24 hour per day, 7 day per week, basis, either directly or indirectly through an arrangement
with another hospital, the hospital must request a service exemption from the AHCA.
7
Policies and Procedures
Each hospital offering emergency services and care is required to maintain written policies and
procedures specifying the scope and conduct of their emergency services. The policies and
procedures must be approved by the organized medical staff, reviewed at least annually, and
must include:
• A process to designate a physician to serve as the director of the ED;
1
Section 395.002(13), F.S.
2
Section 395.1041, F.S.
3
Section 395.002(9), F.S., “emergency services and care” means medical screening, examination, and evaluation by a
physician, or, to the extent permitted by applicable law, by other appropriate personnel under the supervision of a physician,
to determine if an emergency medical condition exists and, if it does, the care, treatment, or surgery by a physician necessary
to relieve or eliminate the emergency medical condition, within the service capability of the facility.
4
Fla. Admin. Code R. 59A-3.255(6)(e)(2014).
5
Section 395.1041(2), F.S.
6
Medical services listed in the inventory include: anesthesia; burn; cardiology; cardiovascular surgery; colon & rectal
surgery; emergency medicine; endocrinology; gastroenterology; general surgery; gynecology; hematology; hyperbaric
medicine; internal medicine; nephrology; neurology; neurosurgery; obstetrics; ophthalmology; oral/maxilla-facial surgery;
orthopedics; otolaryngology; plastic surgery; podiatry; psychiatry; pulmonary medicine; radiology; thoracic surgery; urology;
and vascular surgery.
7
Fla. Admin. Code R. 59A-3.255(4)(2014). BILL: CS/SB 1602 Page 3
• A written description of the duties and responsibilities of all other health care personnel
providing care within the ED;
• A planned formal training program on emergency access laws for all health care personnel
working in the ED; and
• A control register to identify all persons seeking emergency care.
8
Current law does not require EDs to have pediatric-specific policies and procedures.
Equipment and Supplies
Each hospital ED is required to provide diagnostic radiology services and clinical laboratory
services and must ensure that an adequate supply of blood is available at all times. Hospitals EDs
are also required to have certain equipment available for immediate use at all times, including:
• Oxygen and means of administration;
• Mechanical ventilatory assistance equipment, including airways, manual breathing bags, and
ventilators;
• Cardiac defibrillators with synchronization capability;
• Respiratory and cardiac monitoring equipment;
• Thoracentises and closed thoracotomy sets;
• Tracheostomy or cricothyrotomy sets;
• Tourniquets;
• Vascular cutdown sets;
• Laryngoscopes and endotracheal tubes;
• Urinary catheters with closed volume urinary systems;
• Pleural and pericardial drainage sets;
• Minor surgical instruments;
• Splinting devices;
• Emergency obstetrical packs;
• Standard drugs as determined by the facility;
• Common poison antidotes;
• Syringes, needles, and surgical supplies;
• Parenteral fluids and infusion sets;
• Refrigerated storage for biologicals and other supplies; and
• Stable examination tables.
9
Currently, there are no pediatric-specific equipment or supply standards for EDs.
Comprehensive Emergency Management Plans
All hospitals are required to develop and adopt a comprehensive emergency management plan
for emergency care during an internal or external disaster or an emergency.
10
Each hospital must
review, update, and submit its plans annually to the respective county office of emergency
8
Fla. Admin. Code R. 59A-3.255(6)(e)(2014).
9
Fla. Admin. Code R. 59A-3.255(6)(g)(2014).
10
Section 395.1055(1)(c), F.S. BILL: CS/SB 1602 Page 4
management. A hospital’s comprehensive emergency management plan must include the
following:
• Provisions for the management of staff, including the distribution and assignment of
responsibilities and functions;
• Education and training of personnel in carrying out their responsibilities in accordance with
the adopted plan;
• Information about how the hospital plans to implement specific procedures outlined in the
plan;
• Precautionary measures, including voluntary cessation of hospital admissions, to be taken in
preparation and response to warnings of inclement weather, or other potential emergency
conditions;
• Provisions for the management of patients, including the discharge of patients in the event of
an evacuation order;
• Provisions for coordinating with other hospitals;
• Provisions for the individual identification of patients, including the transfer of patient
records;
• Provisions to ensure that relocated patients arrive at designated hospitals;
• Provisions to ensure that medication needs will be reviewed and advance medication for
relocated patients will be forwarded to the appropriate hospitals;
• Provisions for essential care and services for patients who may be relocated to the facility
during a disaster or an emergency, including staffing, supplies, and identification of patients;
• Provisions for the management of supplies, communications, power, emergency equipment,
and security;
• Provisions for coordination with designated agencies including the Red Cross and the county
emergency management office; and
• Plans for the recovery phase of the operation.
11
Current law does not require hospitals to include any pediatric-specific provisions in their
comprehensive emergency management plans.
Pediatric Care in Hospital Emergency Departments
Children represent approximately 25 percent of all ED visits in the U.S. each year.
12
According
to a recent study conducted to evaluate the association between ED pediatric readiness and in-
hospital mortality, pediatric patient deaths are 60 percent to 76 percent less likely to occur in an
ED with high pediatric readiness. The study included 796,937 pediatric patient visits in 983 EDs
over a six-year period (January 1, 2012, through December 31, 2017).
The study used the results of the 2013 National Pediatric Readiness Project Assessment to
categorize each hospital ED in one of four levels of pediatric readiness (first quartile 0-58,
second quartile 59-72, third quartile 73-87, and fourth quartile 88-100). Hospital EDs with an
11
Fla. Admin. Code R. 59A-3.078(2014).
12
Remick KE, Hewes HA, Ely M, et al. National Assessment of Pediatric Readiness of US Emergency Departments During
the COVID-19 Pandemic. JAMA Netw Open. 2023. available at National Assessment of Pediatric Readiness of US
Emergency Departments During the COVID-19 Pandemic | Pediatrics | JAMA Network Open | JAMA Network, (last visited
Mar. 28, 2025). BILL: CS/SB 1602 Page 5
Assessment score of 88-100 were categorized as having high pediatric readiness. The study also
concluded that if all 983 EDs had high pediatric readiness, an estimated 1,442 pediatric deaths
may have been prevented.
13
General hospital EDs (nonchildren’s hospitals) primarily treat adults and may not be prepared to
treat children because of low pediatric patient volume.
14
More than 97 percent of EDs caring for
children are general hospital EDs, accounting for 82 percent of pediatric ED visits. Most of these
hospitals see less than 15 pediatric patients per day.
15
Therefore, according to a joint policy
statement issued by the American Academy of pediatrics (AAP), the American College of
Emergency Physicians (ACEP), and the Emergency Nurses Association (ENA), “it is imperative
that all hospital EDs have the appropriate resources (medications, equipment, policies, and
education) and staff to provide effective emergency care for children.”
16
The 2009 joint policy statement also included guidelines for care of children in the emergency
department. In 2012, the Emergency Medical Services for Children (EMSC) Program, under the
U.S. Department of Health and Human Services, used the guidelines to launch the National
Pediatric Readiness Project, in partnership with the AAP, ACEP, and ENA.
17
The National Pediatric Readiness Project
The National Pediatric Readiness Project (NPRP) is a quality improvement initiative offering
state partnership grants to state governments and accredited schools of medicine to expand and
improve emergency medical services for children in hospital EDs.
18
The NPRP measures the
performance of hospital EDs based on the following four metrics and includes program goals for
each.
19
• Pediatric Readiness Recognition Programs – Program Goal: To increase the percent of
hospitals with an ED recognized through a statewide, territorial, or regional standardized
program that are able to stabilize and manage pediatric emergencies.
• Pediatric Emergency Care Coordinators – Program Goal: To increase the percent of hospitals
with an ED that have a designated nurse, physician, or both who coordinates pediatric
emergency care.
13
Newgard CD, Lin A, Malveau S, et al. Emergency Department Pediatric Readiness and Short-term and Long-term
Mortality Among Children Receiving Emergency Care. JAMA Network (January, 2023) available at
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800400 (last visited Mar. 28, 2025).
14
Id.
15
The National Pediatric Readiness Project, Pediatric Readiness Saves Lives, available at
https://media.emscimprovement.center/documents/EMS220628_ReadinessByTheNumbers_220830_ZekNYVF.pdf (last
visited Mar. 28, 2025).
16
American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency
Physicians, Pediatric Committee; Emergency Nurses Association, Pediatric Committee. Joint policy statement--guidelines for
care of children in the emergency department (Oct. 2009), available at https://doi.org/10.1542/peds.2009-1807 (last visited
Mar. 28, 2025).
17
Id.
18
The program is also used to improve emergency medical care for children in prehospital settings and to advance family
partnerships and leadership in efforts to improve EMSC systems of care, see https://www.grants.gov/search-results-
detail/340371 (last visited Mar. 28, 2025).
19
EMSC Innovation and Improvement Center, Performance Measures, available at
https://emscimprovement.center/programs/partnerships/performance-measures/ (last visited Mar. 28, 2025). BILL: CS/SB 1602 Page 6
• Disaster Plan Resources – Program Goal: To increase the percent of hospitals with an ED
that have a disaster plan that addresses the needs of children.
• Weigh and Record Children’s Weight in Kilograms – Program Goal: To increase the percent
of hospitals with an ED that weigh and record children in kilograms.
The NPRP particularly focuses on weighing and recording children’s weight in kilograms to
avoid medication errors. Product labeling for medications with weight-based dosing utilize the
metric system. Converting from pounds to kilograms is an error-prone process and can double
the number of dosing errors made. Pediatric and neonatal patients are at greater risk for adverse
drug events because they are more vulnerable to the effects of an error.
20
The National Pediatric Readiness Assessment
Emergency department performance is measured based on the NPRA,
21
a voluntary survey
accessed via invitation from the NPRP. The NPRP has conducted two nationwide assessments.
The first NPRA occurred in 2013 and the second was in 2021. According to current Program
plans, the expectation is that the NPRA will occur every five years, so the next assessment will
be in 2026.
22
Not all hospitals choose to participate in the NPRA. Florida participation rates (58 percent) are
below the national average (71 percent), and dropped from 2013 to 2021 (from 61 to 58 percent).
Additionally, while over the national average, Florida hospital readiness scores dropped on
average between 2013 (78) and 2021 (75).
23, 24
Florida Emergency Medical Services for Children State Partnership Program
The Florida Emergency Medical Services for Children (EMSC) State Partnership Program
25
(program) is a quality improvement initiative administered by the University of Florida College
of Medicine — Jacksonville, and is funded by a state partnership grant from the national EMSC
20
Emergency Nurses Association, Weighing all Patients in Kilograms (2020), available at
https://www.pedsnurses.org/assets/docs/Engage/Position-
Statements/Weighing%20All%20Patients%20in%20Kilograms%20Final%20Web.pdf see also National Coordinating
Council for Medication Error Reporting and Prevention, Recommendations to Weigh Patients and Document Metric Weights
to Ensure Accurate Medication Dosing (Oct. 2018), available at https://www.nccmerp.org/recommendations-weigh-patients-
and-document-metric-weights-ensure-accurate-medication-dosing-adopted (both last visited Mar. 28, 2025).
21
National Pediatric Readiness Project, Pediatric Readiness Assessment, available at
https://www.pedsready.org/home_docs/PedsReady%20Survey-OA%20Assessment.pdf (last visited Mar. 28, 2025).
22
Emergency Medical Services for Children, National Pediatric Readiness Project Assessment, available at
https://emscdatacenter.org/sp/pediatric-readiness/national-pediatric-readiness-project-nprp-assessment/ (last visited
Mar. 28, 2025).
23
Florida versus National Pediatric Readiness Project Results from 2013 Survey, available at
https://www.floridahealth.gov/provider-and-partner-resources/emsc-program/_documents/fl-pediatricreadiness-
summary091013.pdf (last visited Mar. 28, 2025).
24
Florida Versus National Pediatric Readiness Project Results from 2021 Survey, available at https://emlrc.org/wp-
content/uploads/National-Pediatric-Readiness-Assessment-2021-Results_07.19.2023_Final.pdf (last visited Mar. 28, 2025).
25
Florida Emergency Medical Services for Children State Partnership Program (Florida PEDREADY), available at
https://flemsc.emergency.med.jax.ufl.edu/ (last visited Mar. 28, 2025). BILL: CS/SB 1602 Page 7
Program.
26
The purpose of the program is to expand and improve emergency medical services
for children who need treatment for trauma or critical care by partnering with EDs, emergency
medical service agencies, and disaster preparedness organizations to enhance pediatric readiness.
The program provides outreach and information to hospital EDs to help improve their pediatric
readiness by, among other things, increasing awareness of, and participation in, the NPRP
Assessment.
III. Effect of Proposed Changes:
Section 1 amends s. 395.1012, F.S., to require each hospital with an emergency department (ED)
to:
• Develop and implement policies and procedures for pediatric patient care in the ED which
reflect evidence-based best practices relating to, at a minimum:
o Triage.
o Measuring and recording vital signs.
o Weighing and recording weights in kilograms.
o Calculating medication dosages.
o Use of pediatric instruments.
• Conduct training at least annually on the policies and procedures developed under this
subsection. The training must include, at a minimum:
o The use of pediatric instruments, as applicable to each licensure type, using clinical
simulation as defined in s. 464.003, F.S.
o Drills that simulate emergency situations. Each ED must conduct drills at least annually.
• Designate a pediatric emergency care coordinator. The pediatric emergency care coordinator
must be a physician or a physician assistant licensed under ch. 458 or ch. 459, F.S., a nurse
licensed under ch. 464, F.S., or a paramedic licensed under ch. 401, F.S. The pediatric
emergency care coordinator is responsible for implementation of and ensuring fidelity to the
policies and procedures adopted as required above.
• Conduct the National Pediatric Readiness Assessment (NPRA) developed by the National
Pediatric Readiness Project (NPRP), in accordance with timelines established by the NPRP.
The bill also authorizes each hospital with an ED to conduct the NPRP’s Open Assessment
during a year in which the NPRA is not conducted.
Section 2 amends s. 395.1055, F.S., to require the Agency for Health Care Administration
(AHCA) to:
• Incorporate the needs of pediatric and neonatal patients in rules requiring an emergency
management plan for hospitals and ambulatory surgical centers; and
• Adopt rules, in consultation with the Florida Emergency Medical Services for Children State
Partnership Program, that establish minimum standards for pediatric patient care in hospital
EDs, including, but not limited to, availability and immediate access to pediatric specific
equipment and supplies.
Section 3 amends s. 408.05, F.S., to require the AHCA to:
26
EMSC Innovation and Improvement Center, EMSC State Partnership Grants Database, Florida – State Partnership,
April 1, 2023 – March 31, 2027, available at https://emscimprovement.center/programs/grants/236/florida-state-partnership-
20230401-20270331-emsc-state-partnership/ (last visited Mar. 28, 2025). BILL: CS/SB 1602 Page 8
• Collect the results of the NPRA from the Florida Emergency Medical Services for Children
State Partnership Program by December 31, 2026, and each December 31 during a year in
which the NPRA is conducted; and
• By April 1, 2027, and each April 1 following a year in which the NPRA is conducted,
publish the overall assessment score for each hospital ED and provide a comparison to the
national average score when it becomes available. The bill specifies that only one overall
assessment score per hospital, per year, may be collected and published and the comparison
must be to the most recently published score.
Section 4 provides that the bill takes effect July 1, 2025.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
The bill will have an indeterminate, negative fiscal impact on hospitals related to
incorporating additional requirements specific to pediatric readiness in the hospitals’
emergency departments.
27
27
Agency for Health Care Administration, Senate Bill 1602 Analysis (Mar. 5, 2025) (on file with the Senate Appropriations
Committee on Health and Human Services). BILL: CS/SB 1602 Page 9
C. Government Sector Impact:
The bill requires the Agency for Health Care Administration to collect and publish online
specific data collected from hospitals. These requirements will be managed within
existing contracts and resources.
28
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 395.1012, 395.1055,
and 408.05.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Health Policy on April 1, 2025:
The CS no longer requires emergency departments (ED) to submit results of the National
Pediatric Readiness Assessment (NPRA) to the Agency for Health Care Administration
(AHCA) and instead requires the AHCA to obtain the results from the Florida
Emergency Medical Services for Children State Partnership Program. Additionally, the
bill authorizes EDs to conduct the National Pediatric Readiness Programs’ Open
Assessment during years when the NPRA is not conducted and prohibits the AHCA from
collecting and publishing more than one assessment score per year for comparison
purposes.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.
28
Agency for Health Care Administration, Senate Bill 1602 Analysis (Mar. 5, 2025) (on file with the Senate Appropriations
Committee on Health and Human Services).