BILL ANALYSIS Ó
AB 491
Page 1
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 31, |
| | | | | |2012) |
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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 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).
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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
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.
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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
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
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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 cardiac catheterization
procedures per year, and that these new facilities will allow it
to serve patients in a more convenient and accessible way.
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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.
This bill was substantially amended in the Senate and the
Assembly-approved version of this bill was deleted. This bill,
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as amended in the Senate, is inconsistent with Assembly actions.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0005875