BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 336|
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UNFINISHED BUSINESS
Bill No: SB 336
Author: Lieu (D) and De Leon (D), et al.
Amended: 8/21/12
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 03/23/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De León, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 9-0, 05/02/11
AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley,
Price, Runner, Steinberg
SENATE FLOOR : 38-0, 5/27/11
AYES: Alquist, Anderson, Berryhill, Blakeslee, Calderon,
Cannella, Corbett, Correa, De León, DeSaulnier, Dutton,
Evans, Fuller, Gaines, Hancock, Harman, Hernandez, Huff,
Kehoe, La Malfa, Leno, Lieu, Liu, Lowenthal, Negrete
McLeod, Padilla, Pavley, Price, Rubio, Runner, Steinberg,
Strickland, Vargas, Walters, Wolk, Wright, Wyland, Yee
NO VOTE RECORDED: Emmerson, Simitian
ASSEMBLY FLOOR : 77-2, 8/23/12 - See last page for vote
SUBJECT : Emergency room crowding
SOURCE : The American College of Emergency Physicians,
California
State Chapter
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DIGEST : This bill requires, until January 1, 2016, every
licensed general acute care hospital to assess the
condition of its emergency department (ED), using a
crowding score, every four or eight hours, and to develop
and implement capacity protocols for overcrowding, and
requires every licensed general acute care hospital that
operates an ED to develop and implement full capacity
protocols, and requires these protocols to be filed with
the Office of Statewide Health Planning and Development
(OSHPD).
Assembly Amendments change the date requirement regarding
the development of full-capacity protocol by a year, and
extends the sunset date by a year.
Senate Floor Amendments of 5/16/11 are technical and add
co-authors.
ANALYSIS : Existing law:
1.Provides for the licensing and regulation of health
facilities, including general acute care hospitals, acute
psychiatric hospitals, and special hospitals by the
Department of Public Health.
2.Defines a general acute care hospital as a health
facility having a duly constituted governing body with
overall administrative and professional responsibility
and an organized medical staff that provides 24-hour
inpatient care, including medical, nursing, surgical,
anesthesia, laboratory, radiology, pharmacy and dietary
services.
3.Permits hospitals to provide emergency medical services,
under specified circumstances.
4.Establishes OSHPD to analyze California's health care
infrastructure, provide information about health care
outcomes, assure the safety of buildings used in
providing health care, insure loans to encourage the
development of health care facilities, and facilitate
development of sustained capacity for communities to
address local health care issues.
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This bill:
1.Defines "crowding score" as the score calculated to
measure EDs and hospital overcrowding, with an equation,
as specified, using the following variables:
A. Total number of patients within the ED;
B. Total number of staffed beds in the ED, not to
exceed the number of licensed beds;
C. Total number of admissions waiting in the ED,
including patients awaiting transfer;
D. Total number of acute inpatient hospital beds
routinely in use by the hospital, excluding beds in
the newborn nursery, neonatal intensive care unit, and
obstetrics;
E. Total number of patients in the ED admitted to the
intensive care-critical care unit;
F. The longest admit time, in hours, including
transfers; and,
G. The wait time for the last patient waiting the
longest in the waiting room, in hours.
1.Defines "crowding scale" as the range of crowding scores
that are divided into six categories of which level one
represents the lowest level of crowding and level six
represents the highest.
2.Requires every licensed general acute care hospital that
operates an ED to determine a range of crowding scores
that constitutes each category of the crowding scale for
its ED.
3.Requires every licensed general acute care hospital that
operates an ED to assess the condition of its ED by
calculating and recording a crowding score a minimum of
every four hours or, if after calculating and recording a
crowding score less than level four for the previous 30
days, calculating and recording a crowding score a
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minimum of every eight hours.
4.Requires that every licensed general acute care hospital
that has an ED and a census of 14,000 visits annually to
calculate and record the crowding score daily between
4:00 p.m. and 8:00 p.m.
5.Requires, by January 1, 2014, every licensed general
acute care hospital that operates an ED, to develop and
implement, in consultation with its ED staff, a
full-capacity protocol for each of the categories of the
crowding scale that addresses all of the following
factors:
A. Notification of hospital administrators, nursing
staff, medical staff, and ancillary services of
category changes on the scale;
B. Hospital operations, including bed utilization,
transfers, elective admissions, discharges, supplies,
and additional staffing;
C. ED operations, including diversion, triage, and
alternative care sites; and,
D. Planned response, if the organized medical staff by
the hospital for rounds discharges, coordination with
the ED and emergency consults for ED patients.
1.Requires every licensed general acute care hospital that
operates an ED to file its full-capacity protocols with
the OSHPD, and annually report any revisions to its
protocols.
2.Sunsets the provisions of this bill on January 1, 2017.
Background
According to a 2007 Institute of Medicine report,
"Hospital-Based Emergency Care: At the Breaking Point"
(IOM report), despite the lifesaving feats performed every
day by EDs and ambulance services, the nation's emergency
medical system as a whole is overburdened, underfunded, and
highly fragmented. As a result, according to the IOM
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report, ambulances are turned away from emergency
departments once every minute on average, and patients in
many areas may wait hours or even days for a hospital bed.
Moreover, the IOM report maintains, the system is ill
prepared to handle surges from disasters such as
hurricanes, terrorist attacks, or disease outbreaks. The
IOM report called for the strengthening of the Joint
Commission standards that address emergency department
overcrowding, boarding, and diversion.
Information posted on the American Academy of Emergency
Medicine website states that the Joint Commission issued an
important guideline on ED overcrowding in 2004. The
website states that the Joint Commission guidelines
recognize the link between overcrowding and quality. While
the guidelines do not call for hospitals to have explicit
policies to alleviate overcrowding, they do call for
hospitals to have a plan for surge capacity in place, and
to provide a level of service to boarded patients
comparable to that which they would receive in an inpatient
unit.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Assembly Appropriations Committee this
bill will result in the following costs:
Minor fee-supported costs to DPH, in the range of $20,000
annually, to verify compliance with this bill's
provisions in the course of conducting regular licensing
surveys of the state's 344 hospitals with emergency
departments.
Minor, absorbable costs to OSHPD to receive and file
full-capacity protocols from hospitals.
One-time cost pressure to University of California
medical centers, estimated in the range of $300,000, to
implement this bill's provisions.
Indirect cost pressure to the state and other purchasers
of health care related to hospital costs to implement
this bill's provisions, likely in the range of millions
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of dollars in total one-time costs statewide.
SUPPORT : (Verified 8/24/12)
The American College of Emergency Physicians, California
State
Chapter (source)
California Medical Association
OPPOSITION : (Verified 8/24/12)
Association of California Healthcare Districts
San Bernardino County
ARGUMENTS IN SUPPORT : The American College of Emergency
Physicians, California State Chapter (CAL/ACEP), sponsor of
this bill, states that SB 336 provides an opportunity to
relieve ED overcrowding that is simple, has a proven,
successful track record, and doesn't require additional
funding from the state or hospitals. CAL/ACEP notes that
LA County/USC hospital, with the largest ED in the state,
implemented this approach at no additional cost and
experienced a dramatic reduction in ED overcrowding.
ARGUMENTS IN OPPOSITION : The Association of California
Healthcare Districts argues that the solution to easing
demands on existing EDs does not lie in adding an
administrative burden to an already overtaxed system, but
rather in addressing the reasons for non-emergent use, or
emergent use that could have been avoided by early
intervention.
ASSEMBLY FLOOR : 77-2, 8/23/12
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
Bill Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson,
Eng, Feuer, Fletcher, Fong, Fuentes, Furutani, Beth
Gaines, Galgiani, Garrick, Gatto, Gordon, Gorell, Grove,
Hagman, Hall, Harkey, Hayashi, Hill, Huber, Hueso,
Huffman, Jeffries, Jones, Knight, Lara, Logue, Bonnie
Lowenthal, Ma, Mansoor, Mendoza, Miller, Mitchell,
Monning, Morrell, Nestande, Nielsen, Norby, Olsen, Pan,
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Perea, V. Manuel Pérez, Portantino, Silva, Skinner,
Smyth, Solorio, Swanson, Torres, Valadao, Wagner,
Wieckowski, Williams, Yamada, John A. Pérez
NOES: Donnelly, Halderman
NO VOTE RECORDED: Roger Hernández
CTW:n 8/24/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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