BILL NUMBER: SB 233	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Pavley

                        FEBRUARY 9, 2011

   An act to amend Section 1317.1 of the Health and Safety Code,
relating to emergency services.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 233, as introduced, Pavley. Emergency services and care.
   Existing law provides for the licensure and regulation of health
facilities. A violation of these provisions is a crime. Existing law
requires emergency services and care to be provided to any person
requesting the services or care for any condition in which the person
is in danger of loss of life, or serious injury or illness. For the
purposes of these provisions, emergency services and care is defined
to include medical screening, examination, and evaluation by a
physician, or, to the extent permitted by applicable law, by other
appropriate personnel under the supervision of a physician, to
determine the care, treatment, and surgery by a physician necessary
to relieve or eliminate the emergency medical condition or active
labor, within the capability of the facility. Existing law also
defines consultation as the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and specialty
physicians, includes review of the patient's record, examination, and
treatment of the patient in person by a specialty physician who is
qualified to give an opinion or render the necessary treatment in
order to stabilize the patient.
   This bill would expand the definition of emergency services and
care to include care, treatment, and surgery by a physician assistant
in compliance with prescribed provisions. This bill would also
expand the definition of consultation to authorize physician
assistants to provide a consultation.
   By expanding the definition of a crime, 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 no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1317.1 of the Health and Safety Code, as
amended by Section 1 of Chapter 423 of the Statutes of 2009, is
amended to read:
   1317.1.  Unless the context otherwise requires, the following
definitions shall control the construction of this article and
Section 1371.4:
   (a) (1) "Emergency services and care" means medical screening,
examination, and evaluation by a physician, or, to the extent
permitted by applicable law, by other appropriate personnel under the
supervision of a physician, to determine if an emergency medical
condition or active labor exists and, if it does, the care,
treatment, and surgery by a physician  and surgeon, or  
physician assistant practicing in compliance with Chapter 7.7
(commencing with   Section 3500) of Division 2 of the
Business and Professions Code,  necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
   (2) (A) "Emergency services and care" also means an additional
screening, examination, and evaluation by a physician, or other
personnel to the extent permitted by applicable law and within the
scope of their licensure and clinical privileges, to determine if a
psychiatric emergency medical condition exists, and the care and
treatment necessary to relieve or eliminate the psychiatric emergency
medical condition, within the capability of the facility.
   (B) The care and treatment necessary to relieve or eliminate a
psychiatric emergency medical condition may include admission or
transfer to a psychiatric unit within a general acute care hospital,
as defined in subdivision (a) of Section 1250, or to an acute
psychiatric hospital, as defined in subdivision (b) of Section 1250,
pursuant to subdivision (k). Nothing in this subparagraph shall be
construed to permit a transfer that is in conflict with the
Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of
Division 5 of the Welfare and Institutions Code).
   (C) For the purposes of Section 1371.4, emergency services and
care as defined in subparagraph (A) shall not apply to Medi-Cal
managed care plan contracts entered into with the State Department of
Health Care Services pursuant to Chapter 7 (commencing with Section
14000), Chapter 8 (commencing with Section 14200), and Chapter 8.75
(commencing with Section 14590) of Part 3 of Division 9 of the
Welfare and Institutions Code, to the extent that those services are
excluded from coverage under those contracts.
   (D) This paragraph does not expand, restrict, or otherwise affect
the scope of licensure or clinical privileges for clinical
psychologists or other medical personnel.
   (b) "Emergency medical condition" means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in any of the
following:
   (1) Placing the patient's health in serious jeopardy.
   (2) Serious impairment to bodily functions.
   (3) Serious dysfunction of any bodily organ or part.
   (c) "Active labor" means a labor at a time at which either of the
following would occur:
   (1) There is inadequate time to effect safe transfer to another
hospital prior to delivery.
   (2) A transfer may pose a threat to the health and safety of the
patient or the unborn child.
   (d) "Hospital" means all hospitals with an emergency department
licensed by the state department.
   (e) "State department" means the State Department of Public
Health.
   (f) "Medical hazard" means a material deterioration in medical
condition in, or jeopardy to, a patient's medical condition or
expected chances for recovery.
   (g) "Board" means the Medical Board of California.
   (h) "Within the capability of the facility" means those
capabilities that the hospital is required to have as a condition of
its emergency medical services permit and services specified on
Services Inventory Form 7041 filed by the hospital with the Office of
Statewide Health Planning and Development.
   (i) "Consultation" means the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and specialty physicians
 ,   and surgeons, or physician assistants
practicing in compliance with Chapter 7.7 (commencing with Section
3500) of Division 2 of the Business and Professions Code, 
includes review of the patient's medical record, examination, and
treatment of the patient in person by a specialty physician  and
surgeon, or   physician assistant practicing in compliance
with Chapter 7.7 (commencing with Section 3500) of Division 2 of the
Business and Professions Code,  who is qualified to give an
opinion or render the necessary treatment in order to stabilize the
patient.
   (j) A patient is "stabilized" or "stabilization" has occurred
when, in the opinion of the treating provider, the patient's medical
condition is such that, within reasonable medical probability, no
material deterioration of the patient's condition is likely to result
from, or occur during, the release or transfer of the patient as
provided for in Section 1317.2, Section 1317.2a, or other pertinent
statute.
   (k) (1) "Psychiatric emergency medical condition" means a mental
disorder that manifests itself by acute symptoms of sufficient
severity that it renders the patient as being either of the
following:
   (A) An immediate danger to himself or herself or to others.
   (B) Immediately unable to provide for, or utilize, food, shelter,
or clothing, due to the mental disorder.
   (2) This subdivision does not expand, restrict, or otherwise
affect the scope of licensure or clinical privileges for clinical
psychologists or medical personnel.
  SEC. 2.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.