BILL NUMBER: SB 233	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 18, 2011
	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 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  , in regards to   recast
 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  
to include other appropriate licensed persons acting within their
  scope of  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   licensed persons acting
within their scope of  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   appropriate licensed persons acting within their
scope of  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 
 licensed persons acting within their scope of  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  , if within the scope of that
person's license,  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,
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  
licensed persons acting within their scope of  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  , or by other
appropriate licensed persons acting within their scope of licensure
under the supervision of a 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
  licensed persons acting within their scope of 
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 physician and surgeon, or other
appropriate  personnel acting pursuant to their scope of
practice and   licensed persons acting within their
scope of  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. 
   (l) This section shall not be construed to expand the scope of
licensure for licensed persons providing services pursuant to this
section. 
  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.