BILL NUMBER: SB 233	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 4, 2011
	AMENDED IN SENATE  MARCH 31, 2011

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 amended, 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  , at
any licensed health facility  . 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.  Existing law also defines when
stabilization of a patient has occurred.  
   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.  
   This bill would, in regards to the definition of emergency
services and care, require that the other appropriate personnel
permitted by applicable law be acting pursuant to their scope of
practice and licensure under the supervision of a physician and
surgeon. This bill would expand the definition of consultation to
also mean the rendering of a decision regarding hospitalization or
transfer and would provide that consultation includes review of the
patient's medical record, examination, and treatment of the patient
in person by a specialty physician and surgeon when determined to be
medically necessary jointly by the treating physician and surgeon and
the consulting physician and surgeon, or by other appropriate
personnel acting pursuant to their scope of practice and licensure
under the supervision of a physician and surgeon. This bill would
expand the definition of when stabilization of a patient has occurred
to include the opinion of other personnel acting pursuant to their
scope of practice and licensure under the supervision of a physician
and surgeon. 
   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  and surgeon  ,
or, to the extent permitted by applicable law, by other appropriate
personnel  acting pursuant to their scope of practice and
licensure  under the supervision of a physician  and 
 surgeon  , 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 and who
practices under the supervision of a qualified physician and surgeon,
pursuant to Division 13.8 (commencing with Section 1399.502) of
Title 16 of the California Code of Regulations, necessary to relieve
or eliminate the emergency medical condition, within the capability
of the facility.   treatment, and surgery 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 and who practices under the supervision
of a qualified physician and surgeon, pursuant to Division 13.8
(commencing with Section 1399.502) of Title 16 of the California Code
of Regulations, 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 and who practices
under the supervision of a qualified physician and surgeon, pursuant
to Division 13.8 (commencing with Section 1399.502) of Title 16 of
the California Code of Regulations, who is qualified to give an
opinion or render the necessary treatment in order to stabilize the
patient.  
   (i) "Consultation" means the rendering of an opinion, advice,
prescribing treatment, or decision regarding hospitalization or
transfer by telephone and, when determined to be medically necessary,
jointly by the treating physician and surgeon and the consulting
physician and surgeon, or by other appropriate personnel acting
pursuant to their scope of practice and licensure under the
supervision of a physician and surgeon, includes review of the
patient's medical record, examination, and treatment of the patient
in person by a specialty physician and surgeon who is qualified to
give an opinion or render the necessary treatment in order to
stabilize the patient. A request for consultation shall be made by
the treating physician and surgeon, or by other appropriate personnel
acting pursuant to their scope of practice and licensure under the
supervision of a physician and surgeon, provided the request is made
with the contemporaneous approval of the treating physician and
surgeon. 
   (j) A patient is "stabilized" or "stabilization" has occurred
when, in the opinion of the treating  provider, 
 physician and surgeon, or other appropriate personnel acting
pursuant to their scope of practice and licensure under the
supervision of a physician and surgeon,  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.