BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 491|
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THIRD READING
Bill No: AB 491
Author: Ma (D), et al
Amended: 8/30/12 in Senate
Vote: 27 - Urgency
PRIOR VOTES NOT RELEVANT
SENATE HEALTH COMMITTEE : 5-0, 8/29/12
AYES: Harman, Anderson, Blakeslee, Rubio, Wolk
NO VOTE RECORDED: Hernandez, Alquist, De León, DeSaulnier
(pursuant to Senate Rule 29.10)
SENATE APPROPRIATIONS COMMITTEE : 7-0, 8/30/12
AYES: Kehoe, Walters, Alquist, Dutton, Lieu, Price,
Steinberg
SUBJECT : General acute care hospitals: cardiac
catheterization
SOURCE : California Hospital Association
DIGEST : This bill deletes a requirement that cardiac
catheterization laboratory services be located in a
hospital, as long as the laboratory space is connected to
the general acute care hospital by an enclosed all-weather
passageway, performs no more than 25 percent of its
procedures on hospital inpatients and meets other specified
requirements.
Senate Floor Amendments of 8/24/12 delete the prior version
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of the bill, regarding public roads and fire suppression.
The bill now addresses general acute care hospitals and
cardiac catheterization.
ANALYSIS :
Existing law:
1. Licenses and regulates general acute care hospitals by
the Department of Public Health (DPH).
2. Permits a general acute care hospital to be approved to
offer special services, in addition to the basic
services offered under their license, including cardiac
surgery and cardiac catheterization laboratory services.
3. Requires a cardiac catheterization laboratory service to
be located in a general acute care hospital that is
either licensed to perform cardiovascular procedures
requiring extracorporeal coronary artery bypass, or have
a licensed intensive care service and coronary care
service and maintain a written agreement for the
transfer of patients to a general acute care hospital
that is licensed for cardiac surgery.
4. Prohibits, except as specified, cardiac catheterizations
from being performed outside of a general acute care
hospital or a multispecialty clinic, as defined.
5. Establishes the Alfred E. Alquist Hospital Facilities
Seismic Safety Act of 1983 (Seismic Safety Act), which
establishes requirements for health care facilities
under the jurisdiction of the Office of Statewide Health
Planning and Development (OSHPD).
6. Exempts from the definition of "hospital building," for
purposes of the Seismic Safety Act, any building where
outpatient clinical services of licensed health facility
are provided. Specifies that if any one or more
outpatient clinical services in the building provides
services to inpatients, the building shall not be
included as a "hospital building" if those services
provided to inpatients represent no more than 25 percent
of the total outpatient services provided at the
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building.
7. Permits DPH to license a freestanding cardiac
catheterization laboratory that was part of a Health
Care Pilot Project testing the feasibility of performing
diagnostic catheterization procedures in a freestanding
laboratory. Subjects these freestanding cardiac
catheterization laboratories to the DPH regulations
governing cardiac catheterization laboratories operating
in hospitals without facilities for cardiac surgery.
The bill:
1. Deletes the requirement that a cardiac catheterization
laboratory service be located in a general acute care
hospital.
2. Permits cardiac catheterization laboratory services,
beginning on March 1, 2013, a general acute care
hospital that has applied for program flexibility on or
before July 1, 2012, to expand cardiac catheterization
space that is in conformance with applicable building
code standards, including those promulgated by OSHPD, as
long as all of the following occur:
A. The expanded laboratory space is located in the
building so that the space is connected by an
enclosed all-weather passageway that is accessible
by staff and patients who are accompanied by staff;
B. The service performs no more than 25 percent of
its procedures on hospital inpatients; and,
C. The service complies with all policies and
procedures approved by hospital medical staff, and
all standards and regulations prescribed by DPH,
including applicable nurse-to-patient ratios, and
with all standards and regulations prescribed by
OSHPD.
3. Requires emergency regulations permitting a general
acute care hospital to operate a cardiac catheterization
laboratory service to be adopted by DPH and OSHPD by
February 28, 2013.
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4. Requires cardiac catheterization laboratory services to
be reviewed by OSHPD for compliance with the OSHPD 3
requirements of the most recent version of the
California Building Standards Code.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/30/12)
California Hospital Association (source)
Association of California Healthcare Districts
Cedars-Sinai Medical Center
OPPOSITION : (Verified 8/30/12)
The California Nurses Association
United Nurses Associations of California/Union of Health
Care Professional
ARGUMENTS IN SUPPORT : According to the author, "With the
passage of the Affordable Care Act, California will see an
increase in patients seeking access and care in a health
system with limited resources and already at capacity.
There is also a national trend toward wellness and early
intervention by treating problems before they require
hospitalization. This is good not only for patients but
also for managing the overall cost of healthcare. In order
to provide increased services to these newly covered
patients, plus those seeking earlier intervention,
California hospitals will need to utilize all resources
available in order to treat patients in a timely manner.
"Cardiac services are in great demand and hospitals can
better serve some of these patients in an outpatient
setting. Under current law, DPH has no authority to allow
cardiac catheterization services to be performed in an
outpatient setting. This bill seeks to resolve this
dilemma by amending the law to allow qualified hospitals to
perform cardiac catheterization services in an outpatient
setting. This bill will allow no more than 25 percent of
cardiac catheterization laboratory inpatient services to be
performed in an appropriately equipped and staffed
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outpatient setting. Should an emergency arise that
requires cardiac surgery service support, the bill requires
the outpatient cardiac catheterization space be located in
a building connected by an enclosed all weather passageway
to a general acute care hospital. The cardiac
catheterization physician will determine which patients
will be treated in the outpatient cardiac catheterization
laboratory setting based on the type of procedure and
condition of the patient. In order to improve access to
health care for patients requiring cardiac catheterization
services at the earliest possible time."
This bill is sponsored by the California Hospital
Association (CHA), which states that with the passage of
the Affordable Care Act, California will see an increase in
patients seeking access and care in a health system that is
already challenged with limited resources and capacity.
According to CHA, in order to provide increased services to
these newly covered patients, California hospitals will
need to utilize all resources available in order to treat
patients in a timely efficient manner. CHA states that
OSHPD currently allows up to 25 percent of procedures on
inpatients to be performed in an outpatient setting, and
that this legislation is necessary to conform DPH authority
that currently restricts inpatient cardiac catheterization
services to an acute care setting. According to CHA, this
bill would allow no more than 25 percent of cardiac
catheterization laboratory inpatient services to be
performed in an appropriately equipped and staff outpatient
setting. CHA notes that should an emergency arise that
requires cardiac surgery service support, this bill
requires the outpatient cardiac catheterization space to be
located in a building connected by an enclosed all-weather
patient passageway to a general acute care hospital.
Cedars-Sinai Medical Center (Cedars) states in support that
it is constructing a new 800,000 square foot building on
the campus called the Advanced Health Science Pavilion
(AHSP). Cedars states that the AHSP will primarily house
outpatient services and advanced clinical research
activities. According to Cedars, one full floor will be
devoted to outpatient surgery, including surgery and
interventional radiology suites, and two cardiac
catheterization laboratories. Cedars states that the AHSP
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is immediately adjacent to the seismically compliant main
hospital building and will be connected to the hospital at
the fifth floor surgery level by a fully approved and
enclosed OSHPD Level 1 bridge. Cedars states that it is
one of the largest cardiac care providers in California,
providing 5,000 cardiac catheterization procedures per
year, and that these new facilities will allow it to serve
patients in a more convenient and accessible way.
ARGUMENTS IN OPPOSITION : The California Nurses
Association (CNA) opposes this bill, stating that it is an
end-of-session "gut and amend" that would completely alter
the settings in which cardiovascular procedures are
performed in California and would significantly and
negatively impact patient care in California. CNA states
that this bill would take catheterization laboratories into
an outpatient clinic-like setting where hospital inpatients
would have cardiac catheterization procedures performed in
buildings that skirt seismic requirements by being licensed
under clinic building standards rather than standards and
regulations for hospitals. CNA also opposes the use of the
emergency regulations, which are required to be adopted by
February of 2013, to implement this change in the provision
of cardiac catheterization services. Rapidly implementing
regulations would deny DPH the immediate benefit of public
input into a significant change in the manner in which care
is provided to consumers. If these proposed changes have
any merit, they need to be considered during the regular
full session to allow the public and Legislature more time
to consider this major change in the provision of high risk
health care services.
This bill is also opposed by the United Nurses Associations
of California/Union of Health Care Professionals
(UNAC/UHCP), stating that it is their view that conducting
cardiac catheterization procedures on an outpatient basis,
even on the campus of a hospital, is unsafe. UNAC/UHCP
states that if something goes wrong during the procedure,
the patient will need care within seconds or minutes,
minutes that do not allow a patient to be transported from
an outpatient facility to an inpatient facility. The
hospital campuses where such procedures might be conducted
are generally very large physical plants where a patient
could be literally a block or more from the inpatient
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facility.
CTW:RJG:d 8/30/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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