BILL NUMBER: AB 648 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Chesbro
(Coauthor: Assembly Member Swanson)
FEBRUARY 25, 2009
An act to add Chapter 6.5 (commencing with Section 124871) to Part
4 of Division 106 of the Health and Safety Code, relating to rural
hospitals.
LEGISLATIVE COUNSEL'S DIGEST
AB 648, as introduced, Chesbro. Rural hospitals: physician
services.
Existing law generally provides for the licensure of health
facilities, including rural general acute care hospitals, by the
State Department of Public Health.
Existing law requires the department to provide expert technical
assistance to strategically located, high-risk rural hospitals, as
defined, to assist the hospitals in carrying out an assessment of
potential business and diversification of service opportunities.
Existing law also requires the department to continue to provide
regulatory relief when appropriate through program flexibility for
such items as staffing, space, and physical plant requirements.
This bill would authorize a rural hospital, as defined, to employ
a physician to provide medical services at the rural hospital or
other health facility that the rural hospital owns or operates and
retain all or part of the income generated by the physician for these
medical services and billed and collected by the rural hospital. It
would require a rural hospital that employs a physician and surgeon
pursuant to this bill to develop and implement a policy regarding the
independent medical judgment of the physician.
The bill would require these physicians to biennially sign a
specified statement.
The bill would impose various duties on the department and the
Medical Board of California.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Many hospitals in the state are having great difficulty
recruiting and retaining physicians.
(b) There is a shortage of physicians in communities across
California, particularly in rural areas, and this shortage limits
access to health care for Californians in these communities.
(c) Allowing rural hospitals to directly employ physicians will
allow rural hospitals to provide economic security adequate for a
physician to relocate and reside in the communities served by the
rural hospitals and will help rural hospitals recruit physicians to
provide medically necessary services in these communities.
(d) Allowing rural hospitals to directly employ physicians will
provide physicians with the opportunity to focus on the delivery of
health services to patients without the burden of administrative,
financial, and operational concerns associated with the establishment
and maintenance of a medical office.
(e) It is the intent of the Legislature by enacting this act to
authorize a rural hospital that meets the conditions set forth in
Chapter 6.5 (commencing with Section 124871) of the Health and Safety
Code to be able to employ physicians directly and to charge for
their professional services.
(f) It is the further intent of the Legislature to prevent a rural
hospital that employs a physician from interfering with,
controlling, or otherwise directing the physician's medical judgment
or medical treatment of patients.
SEC. 2. Chapter 6.5 (commencing with Section 124871) is added to
Part 4 of Division 106 of the Health and Safety Code, to read:
CHAPTER 6.5. RURAL HOSPITAL PHYSICIAN AND SURGEON SERVICES
124871. For purposes of this chapter, a rural hospital means all
of the following:
(a) A general acute care hospital located in an area designated as
nonurban by the United States Census Bureau.
(b) A general acute care hospital located in a rural-urban
commuting area code of 4 or greater as designated by the United
States Department of Agriculture.
(c) A rural general acute care hospital, as defined in subdivision
(a) of Section 1250.
124872. Notwithstanding Article 18 (commencing with Section 2400)
of Chapter 5 of Division 2 of the Business and Professions Code, a
rural hospital may employ a physician and surgeon to provide medical
services at the rural hospital or other health facility, as defined
in Section 1250, that the rural hospital owns or operates. The rural
hospital may retain all or part of the income generated by the
physician and surgeon for these medical services and billed and
collected by the rural hospital.
124873. (a) A rural hospital that employs a physician and surgeon
pursuant to Section 124872 shall develop and implement a written
policy to ensure that each employed physician and surgeon exercises
his or her independent medical judgment in providing care to
patients.
(b) Each physician and surgeon employed by a rural hospital
pursuant to Section 124872 shall sign a statement biennially
indicating that the physician and surgeon:
(1) Voluntarily desires to be employed by the hospital.
(2) Will exercise independent medical judgment in all matters
relating to the provision of medical care to his or her patients.
(3) Will report immediately to the Medical Board of California any
action or event that the physician and surgeon reasonably and in
good faith believes constitutes a compromise of his or her
independent medical judgment in providing care to patients in a rural
hospital or other health care facility owned or operated by the
rural hospital.
(c) The signed statement required by subdivision (b) shall be
retained by the rural hospital for a period of at least three years.
A copy of the signed statement shall be submitted by the rural
hospital to the Medical Board of California within 10 working days
after the statement is signed by the physician and surgeon.
(d) A rural hospital shall not interfere in a physician and
surgeon's exercise of his or her independent medical judgment in
providing medical care to patients. If, pursuant to a report to the
Medical Board of California required by paragraph (3) of subdivision
(a), the Medical Board of California believes that a rural hospital
has violated this prohibition, the Medical Board of California shall
refer the matter to the State Department of Public Health, which
shall investigate the matter. If the department believes that the
rural hospital has violated the prohibition, it shall notify the
rural hospital. The rural hospital shall have 20 working days to
respond in writing to the department's notification, following which
the department shall make a final determination. If the department
finds that the rural hospital violated the prohibition, it shall
assess a civil penalty of five thousand dollars ($5,000) for the
first violation and twenty-five thousand dollars ($25,000) for any
subsequent violation that occurs within three years of the first
violation. If no subsequent violation occurs within three years of
the most recent violation, the next civil penalty, if any, shall be
assessed at the five thousand dollar ($5,000) level. If the rural
hospital disputes a determination by the department regarding a
violation of the prohibition, the rural hospital may request a
hearing pursuant to Section 131071. Penalties, if any, shall be paid
when all appeals have been exhausted and the department's position
has been upheld.