BILL NUMBER: AB 1862 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 17, 2012
INTRODUCED BY Assembly Member Logue
FEBRUARY 22, 2012
An act to add Section and repeal Sections
1250.9 to and 1797.134 of the
Health and Safety Code, relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
AB 1862, as amended, Logue. Health facilities: licensure.
Existing law provides for the licensure and regulation of health
facilities, including general acute care hospitals, by the State
Department of Public Health. Existing law requires the department,
when an applicant for a general acute care hospital license meets the
applicable requirements of licensure, to issue a single consolidated
general acute care hospital license that includes more than one
physical plant maintained and operated on separate premises or that
has multiple licenses for a single health facility on the same
premises, if any of certain criteria are met. One of these criteria
is that the physical plants maintained and operated by the licensee
that are to be covered by the single consolidated license are located
not more than 15 miles apart.
This bill would , until January 1, 2015,
require the department to issue a single consolidated license to
certain general acute care hospitals that include more than one
physical plant maintained and operated on separate premises, if one
of the physical plants is used as an a
freestanding emergency center
department that provides service 24 hours a day, 7 days a week,
and other specified conditions are met. The bill would authorize the
transfer of ownership of a freestanding emergency center
department if specified conditions are met.
The bill would require, on or before May 1, 2014, the department to
prepare and provide a report to the Legislature on the implementation
of this bill and its effect upon the quality of emergency health
care services provided to the community served by the freestanding
emergency departments. It would also require the department to
establish a committee to evaluate the quality and efficiency of
services and improvement in patient access provided by freestanding
emergency centers departments and
provide a specified report to the Legislature and the Governor.
Existing law, the Emergency Medical Services System and the
Prehospital Emergency Medical Care Personnel Act, which governs local
emergency medical service systems, establishes the Emergency Medical
Services Authority (EMSA), which is responsible for the coordination
and integration of all state agencies concerning emergency medical
services.
This bill would, until January 1, 2015, require the authority, in
conjunction with the department and local emergency medical services
(EMS) agencies, to develop and adopt triage criteria for the
transportation of patients to freestanding emergency departments, as
specified, and would require each local EMS agency to prepare and
submit to the authority triage protocols to ensure that the use of a
freestanding emergency department is in the best interests of patient
care, consistent with the local plan. By increasing the duties of
local officials, this bill would impose a state-mandated local
program.
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, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature hereby finds and declares all of the
following:
(a) There are currently 241 approximately
222 freestanding emergency departments (FSEDS)
in the United States 16 states
.
(b) FSEDS Freestanding emergency
departments are regulated by state licensing requirements and
federal certification requirements.
(c) Many emergency departments in the state are overcrowded ,
as evidenced by the increased number of high severity cases admitted
and the increased number of emergency visits resulting in admission
.
(d) Eighteen hospitals in the state and their respective emergency
departments have closed in the last 10 years.
(e) FSEDS Freestanding emergency
departments have the ability to provide services to patients
who may not otherwise have timely access to emergency
services.
(f) Historically, freestanding emergency departments filled a need
in rural or underserved regions where emergency departments were
separated by long distances. More recently, freestanding emergency
departments are serving highly congested urban areas that are 15-20
miles from the nearest hospital for easier access and prompt care
delivery.
(g) Present freestanding emergency departments report faster
throughput times as a majority of the higher acuity patients who
might require admission are diverted. Some freestanding emergency
departments report a door-to-doctor time of 30 minutes or less
compared with a hospital emergency department door-to-doctor time of
55.8 minutes. In addition, freestanding emergency departments report
door-to-discharge times of less than 90 minutes in contrast to 180
minutes for hospital emergency departments.
(h) Freestanding emergency departments have reported an average
hospital admission rate of 5%, which is much lower than the average
hospital emergency department admission rate of 12.8%. In addition,
freestanding emergency departments can reduce the time it takes for
patients to be placed in inpatient beds because of faster
door-to-doctor times equating to faster stabilization and triage
combined with the ability to immediately transfer patients to
hospitals with available beds.
SEC. 2. Section 1250.9 is added to the Health and Safety Code, to
read:
1250.9. (a) Notwithstanding Section 1250.8 OR
or any other law, upon application of a general acute care
hospital that meets all the criteria of paragraphs (1) to (3),
inclusive, of subdivision (b) of Section 1250.8, other applicable
requirements of licensure, and is approved to provide emergency
center special services, the department shall issue a single
consolidated license where that hospital includes more than one
physical plant maintained and operated on separate , non
contiguous premises if one of the physical plants is used
as an a freestanding emergency
center department that provides service 24
hours a day, seven days a week, and either
all of the following conditions is are
met:
(1) The general acute care hospital meets either one of the
following geographic requirements: is
(A) Is a rural general acute care
hospital and the freestanding emergency center
department is located within the same
county as, and within 30 miles of , the primary
physical plant of the hospital and at least 20 miles from an
emergency center owned or operated by another general acute care
hospital.
(2) The general acute care hospital is
(B) Is not a rural general acute
care hospital and the freestanding emergency
center department is located within the
same county as, and within 15 miles of , the primary
physical plant of the hospital and at least seven miles from an
emergency center owned or operated by another general acute care
hospital.
(2) The freestanding emergency department otherwise meets the
requirements for providing basic emergency service, except for the
requirements that the emergency department be located within the
primary physical plant of the hospital and that the emergency
department provide on-site surgical or postanesthesia recovery
service immediately available for life-threatening situations. The
requirements for providing basic emergency service shall include all
of the following:
(A) A laboratory service capable of performing blood gas analysis
and electrolyte determinations.
(B) A radiological service capable of providing necessary
radiology services.
(C) Licensed physicians and surgeons on staff who have medical
staff privileges at the primary physical plant of the hospital and
access to the hospital's on-call panel.
(D) Licensed nurses on staff in compliance with Section 1276.4.
(E) The capability of transferring patients in need of a higher
level of care to an appropriate general acute care hospital,
including standby critical care transport at all times.
(3) The freestanding emergency department publishes and posts the
schedule of charges for medical services offered by the emergency
department. This schedule shall include charges for the 25 most
frequently provided medical services and shall be posted in a
conspicuous place in the reception area by signage or through an
electronic messaging board. The freestanding emergency department
shall also provide a patient with notice that the patient may receive
a separate bill for a facility charge in addition to the fee for
medical services.
(4) The local emergency medical services agency that has
jurisdiction over the area in which the hospital is located prepares
a letter of support for the consolidated license and this letter is
attached to the application.
(b) The department shall issue not more than 12
four consolidated licenses pursuant to this section
and , of which not more than
six two consolidated licenses may be issued
to rural general acute care hospitals. Not more than two
freestanding emergency departments located i n the
northern portion of the state and not more than two
freestanding emergency departments located in the southern part of
the state may operate pursuant to a consolidated license issued
pursuant to this section.
(c) Subject to any other state or federal requirements, a
freestanding emergency department that operates pursuant to a single,
consolidated general acute care hospital license shall be considered
the equivalent of an emergency department that is within the primary
physical plant of the general acute care hospital.
(c)
(d) A general acute care hospital, including a rural
general acute care hospital, that continuously operates for at least
three years an approved freestanding emergency
center department at a physical plant that is
separate from the primary physical plant of the hospital may transfer
ownership of the emergency center to another general acute care
hospital that is approved to provide emergency center special
services, if the conditions of subdivisions (a) and (b) will be met
subsequent to the transfer and the appropriate suppleme
ntal or change -of -ownership filings are
made .
(e) This section shall not be construed to authorize the transfer
of a health facility license.
(f) (1) The department, in cooperation with the Emergency Medical
Services Authority, shall measure the success of the freestanding
hospital departments by collecting data on all of the following:
(A) The acuity levels of patients.
(B) Patient transfer times to higher levels of care, as measured
by the time of the decision to transfer a patient to the time when
the patient is in route to the receiving hospital.
(C) The number of higher level of care transfers conducted through
the 911 system.
(D) The number of patient visits per location.
(2) The department shall, on or before May 1, 2014, prepare and
provide a report to the Legislature in accordance with Section 9795
of the Government Code on the implementation of this section and its
effect upon the quality of emergency health care services provided to
the community served by the freestanding emergency departments.
(g) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.
SEC. 3. Section 1797.134 is added to the
Health and Safety Code , to read:
1797.134. (a) The authority, in conjunction with the State
Department of Public Health and local EMS agencies, shall develop and
adopt triage criteria for the transportation of patients to
freestanding emergency departments licensed pursuant to Section
1250.9 that considers all essential variables to ensuring safe
patient care, including the patient's condition, the necessary
equipment and services, and distance and travel times. The triage
criteria shall provide that patients in need of emergency medical
services, including trauma, stroke, and cardiac patients bypass a
freestanding emergency department for the nearest specialty facility,
unless immediate stabilization of the patient is necessary for
lifesaving measures before transfer.
(b) Subject to the triage criteria adopted pursuant to subdivision
(a), each local EMS agency shall prepare and submit to the authority
triage protocols to ensure that the use of a freestanding emergency
department is in the best interests of patient care, consistent with
the local plan.
(c) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.
SEC. 3. SEC. 4. (a)
The State Department of Public Health shall establish a
committee to evaluate the quality and efficiency of services and
improvement in patient access provided by freestanding emergency
centers departments established
pursuant to a consolidated license issued pursuant to Section 1250.9
of the Health and Safety Code. The membership of the committee shall
include a physician and surgeon who has experience providing medical
services within a rural freestanding emergency department, a
physician and surgeon who has experience providing medical services
within an urban freestanding emergency department, a nurse who has
experience working within a rural freestanding emergency department,
a nurse who has experience working within an urban freestanding
emergency department, a patient who was treated within an urban
freestanding emergency department, a patient who was treated within a
rural freestanding emergency department, a representative from a
rural general acute care hospital with a freestanding emergency
center, and a representative from an urban general acute care
hospital with a freestanding emergency center. The
department.
(b) The committee shall be
established within five years after the first freestanding
emergency center department is
established pursuant to a consolidated license issued pursuant to
Section 1250.9 of the Health and Safety Code. The committee shall
prepare and submit its evaluation to the Legislature and the Governor
in accordance with Section 9795 of the Government Code
within six months of the first meeting of the committee.
SEC. 5. If the Commission on State Mandates
determines that this act contains costs mandated by the state,
reimbursement to local agencies and school districts for those costs
shall be made pursuant to Part 7 (commencing with Section 17500) of
Division 4 of Title 2 of the Government Code.