BILL ANALYSIS Ó
AB 491
Page 1
( Without Reference to File)
CONCURRENCE IN SENATE AMENDMENTS
AB 491 (Ma)
As Amended August 30, 2012
2/3 vote. Urgency
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|ASSEMBLY: | |(May 31, 2011) |SENATE: |29-3 |(August 30, |
| | | | | |2012) |
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(vote not relevant)
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|COMMITTEE VOTE: |10-1 |(August 31, 2012) |RECOMMENDATION: |concur |
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Original Committee Reference: HEALTH
SUMMARY : Authorizes two general acute care hospitals to provide
cardiac catheterization services in a connected outpatient
facility.
The Senate amendments :
1)Permit, beginning on March 1, 2013, no more than two general
acute care hospitals that have applied for program flexibility on
or before July 1, 2012, to expand cardiac catheterization
laboratory services and utilize cardiac catheterization space
outside an acute care general hospital if the following
conditions are met:
a) The expanded cardiac catheterization laboratory space is
located in the building so that the space is connected to the
general acute care hospital by an enclosed all-weather
passageway that is accessible by staff and patients who are
accompanied by staff;
b) The service performs cardiac catheterization services on no
more than 25% of the general acute care hospital's inpatients
who need cardiac catheterizations; and,
c) The service complies with the same policies and procedures
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approved by hospital medical staff for cardiac catheterization
laboratories that are located within the general acute care
hospital, and the same standards and regulations prescribed by
the Department of Public Health (DPH), for cardiac
catheterization laboratories located inside general acute care
hospitals. Those standards include appropriate
nurse-to-patient ratios, and all standards and regulations
prescribed by Office of Statewide Health Planning and
Development (OSHPD).
2)Require emergency regulations permitting a general acute care
hospital to operate expanded cardiac catheterization laboratory
services to be adopted by DPH and OSHPD by February 28, 2013.
3)Require, by March 1, 2014, DPH and OSHPD to promulgate formal
regulations that provide adequate protection to patient health
and safety.
4)Require 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.
5)Add and urgency clause requiring the provisions of this bill to
go into immediate effect.
EXISTING LAW :
1)Licenses and regulates general acute care hospitals by 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
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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
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% of the total outpatient
services provided at the 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.
AS PASSED BY THE ASSEMBLY , this bill revised existing law that sets
forth requirements for medical providers in clinical settings, at
the time a test for Human immunodeficiency virus (HIV) is
administered, to include HIV counselors in nonclinical settings, to
require informed consent, as specified, and to specify information
that must be shared.
FISCAL EFFECT : According to the Senate Appropriations Committee,
this bill will result in the following fiscal impact:
1)One-time costs up to $150,000 to the Hospital Building Fund for
OSHPD to adopt regulations.
2)One-time costs up to $150,000 to the Licensing and Certification
Program Fund for DPH to adopt regulations.
COMMENTS : According to the American College of Cardiology (ACC)
and the American Heart Association (AHA), during the past four
decades an evolution in cardiac catheterization has taken place.
The ACC and AHA indicate that the role of the cardiac
catheterization laboratory has progressed from study of cardiac
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function and anatomy for purposes of diagnosis to evaluation of
candidates for surgery and finally to providing catheter-based,
nonsurgical interventional treatment. According to the National
Heart Lung and Blood Institute, cardiac catheterization is a common
procedure used to diagnose and treat a wide variety of heart
problems in adults and children. During a cardiac catheterization,
the cardiologist inserts a small, hollow tube (catheter), into an
artery or vein, and then guides it into the heart using an X-ray.
The cardiologist injects contrast (X-ray dye) through the catheter
to outline the arteries and to show any blockages or a narrowing
that may exist. A cardiac catheterization laboratory is equipped
with digital imaging equipment and computers for fluoroscopy and
cineangiogram (movies of the heart) that allow for precise
quantitative evaluation of heart problems.
Existing law specifies that a cardiac catheterization laboratory
must be located in a general acute care hospital. OSHPD
administrative regulations specify that cardiac catheterization
laboratories located within a general acute care hospital must be
in a building built to the OSHPD-1 building standards. OSHPD-1
buildings must comply with the Seismic Safety Act and fall under
the auspices of OSHPD.
The building adjacent to the hospital where cardiac catheterization
services will be provided, as proposed by this bill, would be built
to the OSHPD-3 standards. OSHPD-3 buildings are built to the same
structural requirements of any commercial building. They are not
under the jurisdiction of OSHPD but, instead, are under the
jurisdiction of the local building department. OSHPD-3 buildings
are also exempt from the Seismic Safety Act.
The provisions in this bill would apply to two general acute
hospitals, Cedars-Sinai Medical Center (Cedars) and Scripps Health
(Scripps). Cedars states 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 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
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cardiac catheterization procedures per year, and that these new
facilities will allow it to serve patients in a more convenient and
accessible way.
Scripps Health indicates that it is in the planning stages of
building a Scripps Clinic Medical Office Building (MOB) that would
offer cardiac catheterization services. The MOB would be located
in a building that is adjacent to the Scripps Prebys Cardiovascular
Institute currently under construction; both which will be located
on the campus of Scripps Memorial Hospital.
The California Hospital Association (CHA) writes in support of this
bill that with the passage of the federal Patient Protection and
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 maintains that OSHPD currently allows up to 25% 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% 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.
The California Nurses Association (CNA) writes that they are
strongly opposed to this bill. CNA asserts that there is no real
urgency to this measure and they are opposed to the end of session
"gut and amend" which circumvents the full vetting of a legislative
session. CNA argues that this bill skirts the seismic requirements
and the existing hospital regulations for cardiac catheterization
laboratories by being licensed under OSHPD-3 building standards as
opposed to OSHPD-1 building standards. CNA also states that they
are opposed to the use of the emergency regulation process for the
adoption of regulations for such high risk procedures and that the
emergency regulation process denies DPH the benefit of consumer
input.
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This bill was substantially amended in the Senate and the
Assembly-approved version of this bill was deleted. This bill, as
amended in the Senate, is inconsistent with Assembly actions.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0005906