BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 233|
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THIRD READING
Bill No: SB 233
Author: Pavley (D)
Amended: 5/18/11
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 4/27/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De León, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Emergency services and care
SOURCE : California Academy of Physician Assistants
DIGEST : This bill revises the definition of "emergency
services and care," "consultation," and "stabilized" to
clarify which medical professionals may provide medical
screening, examination, evaluation, and treatment within an
emergency department.
ANALYSIS :
Existing federal law:
1. Establishes the Emergency Medical Treatment and Active
Labor Act (EMTALA), which governs when and how a patient
may be refused treatment or transferred from one
hospital to another when the patient is in an unstable
medical condition.
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2. Permits, under the EMTALA, an on-call physician, under
hospital
policies, the option to direct a non-physician
practitioner or his/her representative to appear at a
hospital and provide further assessment or stabilizing
treatment to an individual.
Existing state law:
1. Contains requirements similar to EMTALA which require
emergency services to be provided to any person
requesting the services or care, or for whom services or
care is requested, for any condition in which the person
is in danger of loss of life, or serious injury or
illness, at any licensed health facility that maintains
and operates an emergency department to provide
emergency services to the public when the health
facility has appropriate facilities and qualified
personnel available to provide the services or care.
2. Defines "emergency services" as the 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
capacity of the facility.
3. Establishes the Physician Assistant Practice Act
administered by the Physician Assistant Committee
(Committee) of the Medical Board of California (MBC) to
regulate physician assistants.
4. Provides that a physician assistant (PA) may perform
those medical services as set forth by the regulations
of MBC when the services are rendered under the
supervision of a licensed physician and surgeon approved
by MBC, except as otherwise provided.
5. Requires a PA and his/her supervising physician and
surgeon to establish written guidelines for the adequate
supervision of the PA, which may be satisfied by the
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adoption of protocols for some or all of the tasks
performed by the PA.
6. Requires the protocol to meet specified requirements.
7. Authorizes a PA to administer or provide medication to a
patient, or transmit orally or in writing on a patient's
record or in a drug order, an order to a person who may
lawfully furnish the medication or medical device, as
specified.
8. Authorizes a PA, pursuant to a Delegation of Services
Agreement (DSA), to order durable medical equipment,
certify unemployment insurance disability, and after
consultation with the supervising physician, approve,
sign, modify, or add to a plan of treatment or plan of
care for individuals receiving home health services or
personal care services.
9. Authorizes PAs to conduct specified medical examinations
and sign corresponding medical certificates for various
individuals.
10.Authorizes a PA to conduct specified medical
examinations and sign corresponding medical certificates
for various individuals.
This bill:
1. Clarifies that "emergency services and care" means
medical screening, examination, and evaluation by a
physician or surgeon and would also specify that other
appropriate personnel rendering these services do so
pursuant to their scope of practice and licensure.
2. Adds "decision regarding hospitalization or transfer" to
the definition of "consultation" and would provide that
other appropriate personnel acting pursuant to their
scope of practice and licensure under the supervision of
a physician and surgeon may provide "consultation".
3. Permits appropriate personnel, in addition to a
physician or surgeon, acting pursuant to the scope of
practice and licensure under the supervision of a
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physician or surgeon, to determine when a patient's
emergency condition has been "stabilized".
4. States that the bill does not expand the scope of
licensure for personnel providing services in the
emergency department.
Background
EMTALA was passed as part of the Consolidated Omnibus
Budget Reconciliation Act of 1986 (COBRA). Under EMTALA, a
patient who comes to, or is brought to the emergency
department must be provided with an appropriate medical
screening examination to determine if an emergency medical
condition exists. If an emergency situation is determined,
the hospital is obligated to either provide treatment until
the patient is stable, or transfer the patient to another
hospital in conformance with the statute's directives.
The purpose of EMTALA is to prevent hospitals from
rejecting patients, refusing to treat them, or transferring
them to charity hospitals or county hospitals because they
are unable to pay or are covered under the Medicare or
Medicaid programs. This purpose, however, does not limit
the coverage of its provisions.
EMTALA applies only to participating hospitals, i.e.,
hospitals that have entered into provider agreements under
which they will accept payment from the Department of
Health and Human Services, Centers for Medicare and
Medicaid Services (CMS) under the Medicare program for
services provided to beneficiaries of that program. In
practical terms, this means that it applies to virtually
all hospitals in the United States, with the exception of
the Shriners' Hospital for Crippled Children and many
military hospitals. Its provisions apply to all patients
and not just to Medicare patients.
EMTALA permits an on-call physician, under hospital
policies, the option of sending a representative, i.e.,
directing a non-physician practitioner or his/her
representative to appear at the hospital and provide
further assessment or stabilizing treatment to an
individual. According to EMTALA, this determination should
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be based on the individual's medical need and the
capacities of the hospital, and the applicable state's
scope of practice laws, and hospital by-laws and rules and
regulations. There are some instances in which the
non-physician practitioner can provide the specialty
treatment more expeditiously than the physician on-call.
It is important to note, however, that the designated
on-call physician is ultimately responsible for providing
the necessary services to the individual regardless of who
makes the in-person appearance. Furthermore, in the event
that the treating physician disagrees with the on-call
physician's decision to send a representative and requests
the actual appearance of the on-call physician, then the
on-call physician is required by EMTALA to appear in
person.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
DPH oversight no fiscal impact
Special*
* Department of Public Health Licensing and Certification
Program Fund
SUPPORT : (Verified 5/18/11)
California Academy of Physician Assistants (source)
United Nurses Associations of California/Union of
Healthcare Professionals
OPPOSITION : (Verified 5/18/11)
American College of Emergency Physicians
California Nurses Association
ARGUMENTS IN SUPPORT : The California Academy of
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Physician Assistants (CAPA), the bill's sponsor, states
that existing law allows PAs to perform a variety of
medical services set forth by regulations adopted by the
MBC when rendered under the supervision of a physician and
surgeon. CAPA argues that this bill clarifies an
inconsistency in state law by explicitly authorizing PAs to
perform consultative and treatment services in the hospital
emergency room, providing an increase in to urgent medical
care and a decrease in patient overcrowding.
ARGUMENTS IN OPPOSITION : The California Nurses
Association writes: "As currently written, the law is
clear that physicians may provide emergency consults, care,
treatment and surgery. As such, SB 233 was initially
introduced in order to provide a simple clarification that
PAs may also perform such care under physician supervision.
However, in taking the bill beyond PAs, the proposed
amendments raise questions about potential expansions of
scope of practice and whether or not other practitioner
types are lawfully able to provide these services."
CTW:mw 5/18/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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