BILL NUMBER: SB 233	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JULY 14, 2011
	AMENDED IN ASSEMBLY  JULY 11, 2011
	AMENDED IN ASSEMBLY  JUNE 28, 2011
	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  repeal and  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 recast the definition of emergency services and
care 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 consulting 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 within their scope of  practice or 
licensure under the supervision of a treating physician and surgeon.
The bill would authorize the treating physician and surgeon to
request to communicate directly with the consulting physician and
surgeon, and would require the consulting physician and surgeon to
examine and treat the patient in person when it is determined to be
medically necessary, as specified. This bill would expand the
definition of when stabilization of a patient has occurred to include
the opinion of other appropriate licensed persons acting within
their scope of licensure under the supervision of a treating
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 91 of
Chapter 886 of the Statutes of 1989, is repealed.  
   1317.1.  Unless the context otherwise requires, the following
definitions shall control the construction of this article:
   (a) "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 necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
   (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 Health
Services.
   (f) "Medical hazard" means a material deterioration 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 which 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 the specialty
physicians, includes review of the patient's medical 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. 
   SECTION 1.   SEC. 2.   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 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 or other means of communication. When
determined to be medically necessary, jointly 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, and the consulting physician and
surgeon, "consultation" includes review of the patient's medical
record, examination, and treatment of the patient in person by a
consulting physician and surgeon, or by other appropriate licensed
persons acting within their scope of licensure under the supervision
of a consulting 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 licensed persons
acting within their scope of licensure under the supervision of a
treating physician and surgeon, provided the request is made with the
contemporaneous approval of the treating physician and surgeon. The
treating physician and surgeon may request to communicate directly
with the consulting physician and surgeon, and when determined to be
medically necessary, jointly by the treating physician and surgeon
and the consulting physician and surgeon, the consulting physician
and surgeon shall examine and treat the patient in person. The
consulting physician and surgeon is ultimately responsible for
providing the necessary consultation to the patient, regardless of
who makes the in-person appearance.
   (j) A patient is "stabilized" or "stabilization" has occurred
when, in the opinion of the treating physician and surgeon, or other
appropriate licensed persons acting within their scope of licensure
under the supervision of a treating 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.   SEC. 3.   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.