BILL ANALYSIS Ó
SB 233
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SENATE THIRD READING
SB 233 (Pavley)
As Amended August 25, 2011
Majority vote
SENATE VOTE :37-0
HEALTH 17-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Bonnie Lowenthal, | |Davis, Donnelly, Gatto, |
| |Mansoor, Mitchell, | |Hall, Hill, Lara, |
| |Nestande, Pan, | |Mitchell, Nielsen, Norby, |
| |V. Manuel Pérez, Silva, | |Solorio, Wagner |
| |Williams | | |
| | | | |
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SUMMARY : Clarifies existing law to explicitly permit appropriate
licensed personnel to perform consultations and treatment in an
emergency department (ED) if within their existing scope of
practice. Specifically, this bill :
1)Revises the existing definition of "emergency services and care"
to mean medical screening, examination, and evaluation by a
physician or surgeon, or, to the extent permitted by applicable
law, other appropriate licensed personnel under the supervision
of a physician and surgeon, to determine if an emergency medical
condition or active labor exists.
2)Clarifies that, upon a determination that an emergency medical
condition or active labor exists, "emergency services and care"
also includes the care, treatment, and surgery, if within the
scope of the appropriate licensed personnel's license and
clinical privileges, necessary to relieve or eliminate the
emergency medical condition, within the capability of the
facility.
3)Includes the rendering of a decision regarding hospitalization
or transfer by telephone or other means of communication in the
existing definition of "consultation" and authorizes other
appropriate licensed personnel acting within their scope of
licensure to provide consultation.
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4)Requires the request for consultation to be made by the treating
physician and surgeon, or by other appropriate licensed
personnel acting within their scope of licensure, provided that
it is made with the contemporaneous approval of the treating
physician and surgeon.
5)Permits the treating physician and surgeon to request to
communicate directly with the consulting physician and surgeon,
and requires, when determined to be medically necessary, jointly
by the treating physician and surgeon and the consulting
physician and surgeon, the consulting physician and surgeon to
examine and treat the patient in person.
6)States that the consulting physician and surgeon is ultimately
responsible for providing the necessary consultation to the
patient, regardless of who makes the in-person appearance.
7)Authorizes, in addition to a physician or surgeon, other
appropriate licensed personnel acting within their scope of
licensure to determine when a patient's emergency condition has
been stabilized.
8)Prohibits this bill from being construed to expand the scope of
licensure for licensed personnel providing services in the ED.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, negligible direct state fiscal impact. This bill
clarifies state law and conforms state law to existing federal law
and current practice, and is not likely to significantly change
the delivery of emergency medical care.
COMMENTS : According to the author, this bill is prompted by a
recent situation in which a physician was requested to provide a
consultation in the ED at Mission Hospital in Orange County and
sent his physician assistant (PA) to provide the further
assessment. The PA was subsequently prohibited from providing the
consultation. The author maintains that although these types of
services are routinely authorized by supervising physicians at
hospitals, in this case, the hospital pointed out that existing
law does not explicitly authorize a PA to perform consulting and
treatment services in an ED setting.
The author argues that this bill would make state law consistent
with federal law, which permits PAs to provide consults in the ED.
The author adds that PAs working in specialty practice areas
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provide an essential service to the ED as they can expedite the
admission or surgical preparation of the patient under the
supervision of the physician and surgeon, and, in doing so, vacate
a bed for an incoming ED patient. The author contends that as
long as evaluation, consultation, and treatment is performed
pursuant to a PA's scope of practice, delegation of services
agreement, and under the supervision of a physician and surgeon,
this type of care by a PA is routine and should not be unduly
restricted by omissions and lack of clarity in the current
definition of emergency services and care in state law.
The sponsor of this bill, the California Academy of Physician
Assistants (CAPA), states that existing law allows PAs to perform
a variety of medical services set forth in state regulations 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 and other mid-level practitioners to
perform consultative and treatment services in the hospital ED,
thereby increasing the provision of urgent medical care and
decreasing patient overcrowding.
The California Nurses Association (CNA) objects to this bill and
views it as an expansion of scope of practice and an encroachment
into the practice of medicine. CNA asserts that the law is clear
that physicians may provide emergency consults, care, treatment,
and surgery; and, allowing "other appropriate personnel" to
provide these services raises concerns over whether or not any of
these types of personnel retain the appropriate levels of training
and competence to perform these services. CNA believes this bill
lessens standards of care for patients by promoting the broad
delegation of certain aspects of care, including consultations and
stabilization determinations, to non-physician practitioners.
The California Chapter of the American College of Emergency
Physicians opposes this bill unless it is amended to clarify that
the definitions of emergency services, care, and consultation
include delivery by appropriate licensed personnel to the extent
permitted by hospital by-laws or rules and regulations as provided
under federal law.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097FN:
0002097
SB 233
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