Bill Text: CA AB235 | 2009-2010 | Regular Session | Chaptered
Bill Title: Emergency services and care.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2009-10-11 - Chaptered by Secretary of State - Chapter 423, Statutes of 2009. [AB235 Detail]
Download: California-2009-AB235-Chaptered.html
BILL NUMBER: AB 235 CHAPTERED
BILL TEXT
CHAPTER 423
FILED WITH SECRETARY OF STATE OCTOBER 11, 2009
APPROVED BY GOVERNOR OCTOBER 11, 2009
PASSED THE SENATE AUGUST 27, 2009
PASSED THE ASSEMBLY AUGUST 31, 2009
AMENDED IN SENATE JUNE 11, 2009
AMENDED IN ASSEMBLY APRIL 14, 2009
INTRODUCED BY Assembly Member Hayashi
FEBRUARY 6, 2009
An act to amend Section 1317.1 of, and to add Section 1317.4a to,
the Health and Safety Code, relating to emergency services.
LEGISLATIVE COUNSEL'S DIGEST
AB 235, Hayashi. Emergency services and care.
(1) Existing law provides for the regulation of health facilities,
including general acute care hospitals and acute psychiatric
hospitals. A violation of these provisions is a crime. Existing law
requires emergency services and care to be provided to any person
requesting the services or care for any condition in which the person
is in danger of loss of life. For purposes of these provisions,
existing law defines emergency services and care to include
additional screening, examination, and evaluation by a physician, or
other personnel to the extent permitted by applicable law and within
the scope of their licensure and clinical privileges, to determine if
a psychiatric emergency medical condition exists, as provided.
This bill would define psychiatric emergency medical condition,
and would, for this purpose, include admission or transfer to a
psychiatric unit within a general acute care hospital or to an acute
psychiatric hospital within the care and treatment of this condition.
This bill would, consistent with provisions of law relating to
involuntary mental health services, also allow the transfer of a
patient to a psychiatric unit within a general acute care hospital or
to an acute psychiatric hospital for the purpose of providing care
and treatment that is solely necessary to relieve or eliminate a
psychiatric emergency medical condition if, in the opinion of the
treating provider, the patient's psychiatric emergency medical
condition is such that, within a reasonable medical probability, no
material deterioration of the patient's condition is likely to result
from, or occur during, the transfer of the patient. The bill would
require a provider to notify the patient's health care service plan,
or the health plan's contracting medical provider, of the need for
the transfer, as provided. The bill would require a hospital that
transfers a patient pursuant to these provisions to seek to obtain
the name and contact information of the patient's health care service
plan, would require the hospital to document its attempt to
ascertain this information, and would require the hospital to notify
the health care service plan or the health plan's contracting medical
provider of specified information related to the transfer, as
provided. The bill would also require a health care service plan to
provide noncontracting hospitals with its contact information, as
provided, and would require health care service plans to update this
information as necessary, but no less than once a year. The bill
would further require the hospital to which a patient is transferred
pursuant to these provisions to notify the patient's health care
service plan of the transfer, as provided. By creating new crimes,
this bill would impose a state-mandated local program.
(2) The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1317.1 of the Health and Safety Code is amended
to read:
1317.1. Unless the context otherwise requires, the following
definitions shall control the construction of this article and
Section 1371.4:
(a) (1) "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 or active labor exists and, if it does, the care,
treatment, and surgery by a physician necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
(2) (A) "Emergency services and care" also means an additional
screening, examination, and evaluation by a physician, or other
personnel to the extent permitted by applicable law and within the
scope of their licensure and clinical privileges, to determine if a
psychiatric emergency medical condition exists, and the care and
treatment necessary to relieve or eliminate the psychiatric emergency
medical condition, within the capability of the facility.
(B) The care and treatment necessary to relieve or eliminate a
psychiatric emergency medical condition may include admission or
transfer to a psychiatric unit within a general acute care hospital,
as defined in subdivision (a) of Section 1250, or to an acute
psychiatric hospital, as defined in subdivision (b) of Section 1250,
pursuant to subdivision (k). Nothing in this subparagraph shall be
construed to permit a transfer that is in conflict with the
Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of
Division 5 of the Welfare and Institutions Code).
(C) For the purposes of Section 1371.4, emergency services and
care as defined in subparagraph (A) shall not apply to Medi-Cal
managed care plan contracts entered into with the State Department of
Health Care Services pursuant to Chapter 7 (commencing with Section
14000), Chapter 8 (commencing with Section 14200), and Chapter 8.75
(commencing with Section 14590) of Part 3 of Division 9 of the
Welfare and Institutions Code, to the extent that those services are
excluded from coverage under those contracts.
(D) This paragraph does not expand, restrict, or otherwise affect
the scope of licensure or clinical privileges for clinical
psychologists or other medical personnel.
(b) "Emergency medical condition" means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in any of the
following:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of any bodily organ or part.
(c) "Active labor" means a labor at a time at which either of the
following would occur:
(1) There is inadequate time to effect safe transfer to another
hospital prior to delivery.
(2) A transfer may pose a threat to the health and safety of the
patient or the unborn child.
(d) "Hospital" means all hospitals with an emergency department
licensed by the state department.
(e) "State department" means the State Department of Public
Health.
(f) "Medical hazard" means a material deterioration in medical
condition in, or jeopardy to, a patient's medical condition or
expected chances for recovery.
(g) "Board" means the Medical Board of California.
(h) "Within the capability of the facility" means those
capabilities that the hospital is required to have as a condition of
its emergency medical services permit and services specified on
Services Inventory Form 7041 filed by the hospital with the Office of
Statewide Health Planning and Development.
(i) "Consultation" means the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and specialty
physicians, includes review of the patient's medical record,
examination, and treatment of the patient in person by a specialty
physician who is qualified to give an opinion or render the necessary
treatment in order to stabilize the patient.
(j) A patient is "stabilized" or "stabilization" has occurred
when, in the opinion of the treating provider, the patient's medical
condition is such that, within reasonable medical probability, no
material deterioration of the patient's condition is likely to result
from, or occur during, the release or transfer of the patient as
provided for in Section 1317.2, Section 1317.2a, or other pertinent
statute.
(k) (1) "Psychiatric emergency medical condition" means a mental
disorder that manifests itself by acute symptoms of sufficient
severity that it renders the patient as being either of the
following:
(A) An immediate danger to himself or herself or to others.
(B) Immediately unable to provide for, or utilize, food, shelter,
or clothing, due to the mental disorder.
(2) This subdivision does not expand, restrict, or otherwise
affect the scope of licensure or clinical privileges for clinical
psychologists or medical personnel.
SEC. 2. Section 1317.4a is added to the Health and Safety Code, to
read:
1317.4a. (a) Notwithstanding subdivision (j) of Section 1317.1, a
patient may be transferred for admission to a psychiatric unit
within a general acute care hospital, as defined in subdivision (a)
of Section 1250, or an acute psychiatric hospital, as defined in
subdivision (b) of Section 1250, for care and treatment that is
solely necessary to relieve or eliminate a psychiatric emergency
medical condition, as defined in subdivision (k) of Section 1317.1,
provided that, in the opinion of the treating provider, the patient's
psychiatric emergency medical condition is such that, within
reasonable medical probability, no material deterioration of the
patient's psychiatric emergency medical condition is likely to result
from, or occur during, a transfer of the patient. A provider shall
notify the patient's health care service plan, or the health plan's
contracting medical provider of the need for the transfer if
identification of the plan is obtained pursuant to paragraph (1) of
subdivision (b).
(b) A hospital that transfers a patient pursuant to subdivision
(a) shall do both of the following:
(1) Seek to obtain the name and contact information of the patient'
s health care service plan. The hospital shall document its attempt
to ascertain this information in the patient's medical record. The
hospital's attempt to ascertain the information shall include
requesting the patient's health care service plan member card, asking
the patient, the patient's family member, or other person
accompanying the patient if he or she can identify the patient's
health care service plan, or using other means known to the hospital
to accurately identify the patient's health care service plan.
(2) Notify the patient's health care service plan or the health
plan's contracting medical provider of the transfer, provided that
the identification of the plan was obtained pursuant to paragraph
(1). The hospital shall provide the plan or its contracting medical
provider with the name of the patient, the patient's member
identification number, if known, the location and contact
information, including a telephone number, for the location where the
patient will be admitted, and the preliminary diagnosis.
(c) (1) A hospital shall make the notification described in
paragraph (2) of subdivision (b) by either following the instructions
on the patient's health care service plan member card or by using
the contact information provided by the patient's health care service
plan. A health care service plan shall provide all noncontracting
hospitals in the state to which one of its members would be
transferred pursuant to paragraph (1) of subdivision (b) with
specific contact information needed to make the contact required by
this section. The contact information provided to hospitals shall be
updated as necessary, but no less than once a year.
(2) A hospital making the transfer pursuant to subdivision (a)
shall not be required to make more than one telephone call to the
health care service plan, or its contracting medical provider,
provided that in all cases the health care service plan, or its
contracting medical provider, shall be able to reach a representative
of the provider upon returning the call, should the plan, or its
contracting medical provider, need to call back. The representative
of the hospital who makes the telephone call may be, but is not
required to be, a physician and surgeon.
(d) If a transfer made pursuant to subdivision (a) is made to a
facility that does not have a contract with the patient's health care
service plan, the plan may subsequently require and make provision
for the transfer of the patient receiving services pursuant to this
section and subdivision (a) of Section 1317.1 from the noncontracting
facility to a general acute care hospital, as defined in subdivision
(a) of Section 1250, or an acute psychiatric hospital, as defined in
subdivision (b) of Section 1250, that has a contract with the plan
or its delegated payer, provided that in the opinion of the treating
provider the patient's psychiatric emergency medical condition is
such that, within reasonable medical probability, no material
deterioration of the patient's psychiatric emergency medical
condition is likely to result from, or occur during, the transfer of
the patient.
(e) Upon admission, the hospital to which the patient was
transferred shall notify the health care service plan of the
transfer, provided that the facility has the name and contact
information of the patient's health care service plan. The facility
shall not be required to make more than one telephone call to the
health care service plan, or its contracting medical provider,
provided that in all cases the health care service plan, or its
contracting medical provider, shall be able to reach a representative
of the facility upon returning the call, should the plan, or its
contracting medical provider, need to call back. The representative
of the facility who makes the telephone call may be, but is not
required to be, a physician and surgeon.
(f) Nothing in this subdivision shall be construed to require
providers to seek authorization to provide emergency services and
care, as defined in paragraph (2) of subdivision (a) of Section
1317.1, to a patient who has a psychiatric emergency medical
condition, as defined in subdivision (k) of Section 1317.1, that is
not otherwise required by law.
SEC. 3. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
