N.Y. Public Health Law Section 2805-J
Medical, dental and podiatric malpractice prevention program

1.

Every hospital shall maintain a coordinated program for the identification and prevention of medical, dental and podiatric malpractice. Such program shall include at least the following:

(a)

The establishment of a quality assurance committee with the responsibility to review the services rendered in the hospital in order to improve the quality of medical, dental and podiatric care of patients and to prevent medical, dental and podiatric malpractice. Such committee shall oversee and coordinate the medical, dental and podiatric malpractice prevention program and shall insure that information gathered pursuant to the program is utilized to review and to revise hospital policies and procedures. At least one member of the committee shall be a member of the governing board of the hospital who is not otherwise affiliated with the hospital in an employment or contractual capacity;

(b)

A medical, dental and podiatric staff privileges sanction procedure through which credentials, physical and mental capacity and competence in delivering health care services are periodically reviewed, and reviewed as otherwise warranted in specific instances and circumstances, as part of an evaluation of staff privileges;

(c)

The periodic review and the review as otherwise warranted in specific instances and circumstances of the credentials, physical and mental capacity and competence in delivering health care services of all persons who are employed or associated with the hospital;

(d)

A procedure for the prompt resolution of grievances by patients or their representatives related to accidents, injuries, treatment and other events that may result in claims of medical, dental or podiatric malpractice;

(e)

The maintenance and continuous collection of information concerning the hospital’s experience with negative health care outcomes and incidents injurious to patients, patient grievances, professional liability premiums, settlements, awards, costs incurred by the hospital for patient injury prevention and safety improvement activities;

(f)

The maintenance of relevant and appropriate information gathered pursuant to paragraphs (a) through (e) of this subdivision concerning individual physicians, dentists and podiatrists within the physician’s, dentist’s or podiatrist’s personnel or credential file maintained by the hospital;

(g)

Education programs dealing with patient safety, injury prevention, staff responsibility to report professional misconduct, the legal aspects of patient care, improved communication with patients and causes of malpractice claims for staff personnel engaged in patient care activities;

(h)

Continuing education programs for medical, dental and podiatric staff in their areas of specialty; and

(i)

Policies to ensure compliance with the reporting requirements of § 2803-E (Residential health care facilities)section twenty-eight hundred three-e of this article and subdivision eleven of § 230 (State board for professional medical conduct)section two hundred thirty of this chapter.

(j)

For the purposes of this section, the term “hospital” shall have the same meaning as is set forth in subdivision ten of § 2801 (Definitions)section twenty-eight hundred one of this article.

2.

Any person who, in good faith and without malice, provides information to further the purposes of the medical, dental and podiatric malpractice prevention program or who, in good faith and without malice, participates on the quality assurance committee shall not be subject to an action for civil damages or other relief as a result of such activity. Any hospital, or any person acting on behalf of such hospital, who, in good faith and without malice, takes or fails to take any action as a result of a review conducted pursuant to paragraph (b) or (c) of subdivision one of this section, shall not be subject to an action for civil damages or other monetary relief as a result of such action or failure to act, provided, however, that nothing in this subdivision shall relieve any hospital of any liability in an action for medical, dental or podiatric malpractice based on an act or failure to act as a result of a review conducted pursuant to paragraph (b) or (c) of subdivision one of this section, and provided further that nothing herein shall affect the authority of the commissioner pursuant to this chapter.

3.

The commissioner shall make, adopt, promulgate and enforce such rules and regulations as he may deem appropriate to effectuate the purposes of this section.

Source: Section 2805-J — Medical, dental and podiatric malpractice prevention program, https://www.­nysenate.­gov/legislation/laws/PBH/2805-J (updated Sep. 22, 2014; accessed Apr. 20, 2024).

2800
Declaration of policy and statement of purpose 2801
Definitions 2801‑A
Establishment or incorporation of hospitals 2801‑B
Improper practices in hospital staff appointments and extension of professional privileges prohibited 2801‑C
Injunctions 2801‑D
Private actions by patients of residential health care facilities 2801‑E
Voluntary residential health care facility rightsizing demonstration program 2801‑F
Residential health care facility quality incentive payment program 2801‑G
Community forum on hospital closure 2801‑H
Personal caregiving and compassionate caregiving visitors to nursing home residents during declared local or state health emergencies 2802
Approval of construction 2802‑A
Transitional care unit demonstration program 2802‑B
Health equity impact assessments 2803
Commissioner and council 2803‑A
Authority to contract 2803‑AA
Sickle cell disease information distribution 2803‑AA*2
Nursing home infection control competency audit 2803‑B
Uniform reports and accounting systems for hospital costs 2803‑C
Rights of patients in certain medical facilities 2803‑C‑1
Rights of patients in certain medical facilities 2803‑C‑2
Lesbian, gay, bisexual and transgender, and people living with HIV long-term care facility residents’ bill of rights 2803‑D
Reporting abuses of persons receiving care or services in residential health care facilities 2803‑E
Residential health care facilities 2803‑E*2
Reporting incidents of possible professional misconduct 2803‑F
Respite projects 2803‑G
Board of visitors in county owned residential health care facility 2803‑H
Health related facility 2803‑I
General hospital inpatient discharge review program 2803‑J
Information for maternity patients 2803‑J*2
Nursing home nurse aide registry 2803‑K
In-patient nasogastric feeding procedures 2803‑L
Community service plans 2803‑M
Discharge of hospital patients to adult homes 2803‑N
Hospital care for maternity patients 2803‑O
Hospital care for mastectomy, lumpectomy, and lymph node dissection patients 2803‑O‑1
Required protocols for fetal demise 2803‑P
Disclosure of information concerning family violence 2803‑Q
Family councils in residential health care facilities 2803‑R
Dissemination of information about the abandoned infant protection act 2803‑S
Access to product recall information 2803‑T
Preadmission information 2803‑U
Hospital substance use disorder policies and procedures 2803‑V
Lymphedema information distribution 2803‑V*2
Standing orders for newborn care in a hospital 2803‑W
Independent quality monitors for residential health care facilities 2803‑W*2
Disclosure of information concerning pregnancy complications 2803‑X
Requirements related to nursing homes and related assets and operations 2803‑Y
Provision of residency agreement 2803‑Z
Transfer, discharge and voluntary discharge requirements for residential health care facilities 2803‑Z*2
Antimicrobial resistance prevention and education 2804
Units for hospital and health-related affairs 2804‑A
State task force on clinical practice guidelines and medical technology assessment 2805
Approval of hospitals 2805‑A
Disclosure of financial transactions 2805‑B
Admission of patients and emergency treatment of nonadmitted patients 2805‑C
Every private proprietary nursing home having a capacity of eighty patients or more may have a licensed medical doctor in attendance, upo... 2805‑D
Limitation of medical, dental or podiatric malpractice action based on lack of informed consent 2805‑E
Reports of residential health care facilities 2805‑F
Money deposited or advanced for admittance to nursing homes 2805‑G
Maintenance of records 2805‑H
Immunizations 2805‑I
Treatment of sexual offense victims and maintenance of evidence in a sexual offense 2805‑J
Medical, dental and podiatric malpractice prevention program 2805‑K
Investigations prior to granting or renewing privileges 2805‑L
Adverse event reporting 2805‑M
Confidentiality 2805‑N
Child abuse prevention 2805‑O
Identification of veterans and their spouses by nursing homes, residential health care facilities, and adult care facilities 2805‑P
Emergency treatment of rape survivors 2805‑Q
Hospital visitation by domestic partner 2805‑R
Patients unable to verbally communicate 2805‑S
Circulating nurse required 2805‑T
Clinical staffing committees and disclosure of nursing quality indicators 2805‑U
Credentialing and privileging of health care practitioners providing telemedicine services 2805‑V
Observation services 2805‑W
Patient notice of observation services 2805‑X
Hospital-home care-physician collaboration program 2805‑Y
Identification and assessment of human trafficking victims 2805‑Z
Hospital domestic violence policies and procedures 2806
Hospital operating certificates 2806‑A
Temporary operator 2806‑B
Residential health care facilities 2807
Hospital reimbursement provisions 2807‑A
General hospital nineteen hundred eighty-six and nineteen hundred eighty-seven inpatient rates and charges 2807‑AA
Nurse loan repayment program 2807‑B
Outstanding payments and reports due under subdivision eighteen of section twenty-eight hundred seven-c, sections twenty-eight hundred se... 2807‑C
General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight 2807‑D
Hospital assessments 2807‑D‑1
Hospital quality contributions 2807‑DD
Temporary nursing home stability contributions 2807‑E
Uniform bills 2807‑F
Health maintenance organization payment factor 2807‑I
Service and quality improvement grants 2807‑J
Patient services payments 2807‑K
General hospital indigent care pool 2807‑L
Health care initiatives pool distributions 2807‑M
Distribution of the professional education pools 2807‑N
Palliative care education and training 2807‑O
Early intervention services pool 2807‑P
Comprehensive diagnostic and treatment centers indigent care program 2807‑R
Funding for expansion of cancer services 2807‑S
Professional education pool funding 2807‑T
Assessments on covered lives 2807‑U
Transfers for tax credits 2807‑V
Tobacco control and insurance initiatives pool distributions 2807‑W
High need indigent care adjustment pool 2807‑X
Grants for long term care demonstration projects 2807‑Y
Pool administration 2807‑Z
Review of eligible federally qualified health center capital projects 2808
Residential health care facilities 2808‑A
Liability of certain persons 2808‑B
Certification of financial statements and financial information 2808‑C
Reimbursement of general hospital inpatient services 2808‑D
Nursing home quality improvement demonstration program 2808‑E
Residential health care for children with medical fragility in transition to young adults and young adults with medical fragility demonst... 2808‑E*2
Nursing home ratings 2809
Residential health care facilities 2810
Residential health care facilities 2811
Discounts and splitting fees with medical referral services 2812
Construction 2813
Separability 2814
Health networks, global budgeting, and health care demonstrations 2815
Health facility restructuring program 2815‑A
Community health care revolving capital fund 2816
Statewide planning and research cooperative system 2816‑A
Cardiac services information 2817
Community health centers capital program 2818
Health care efficiency and affordability law of New Yorkers (HEAL NY) capital grant program 2819
Hospital acquired infection reporting 2820
Home based primary care for the elderly demonstration project 2821
State electronic health records (EHR) loan program 2822
Residential care off-site facility demonstration project 2823
Supportive housing development program 2824
Central service technicians 2824*2
Surgical technology and surgical technologists 2825
Capital restructuring financing program 2825‑A
Health care facility transformation program: Kings county project 2825‑B
Oneida county health care facility transformation program: Oneida county project 2825‑C
Essential health care provider support program 2825‑D
Health care facility transformation program: statewide 2825‑E
Health care facility transformation program: statewide II 2825‑F
Health care facility transformation program: statewide III 2825‑G
Health care facility transformation program: statewide IV 2825‑H
Health care facility transformation program: statewide V 2826
Temporary adjustment to reimbursement rates 2827
Plant-based food options 2828
Residential health care facilities 2828*2
Essential support persons allowed for individuals with disabilities during a state of emergency 2829
Nursing homes 2830
Surgical smoke evacuation 2830*2
Regulation of the billing of facility fees
Green check means up to date. Up to date

Accessed:
Apr. 20, 2024

Last modified:
Sep. 22, 2014

§ 2805-J’s source at nysenate​.gov

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