BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 630|
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UNFINISHED BUSINESS
Bill No: SB 630
Author: Alquist (D), et al.
Amended: 5/29/12
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE : 5-0, 01/11/12
AYES: Hernandez, Alquist, De León, DeSaulnier, Wolk
NO VOTE RECORDED: Strickland, Anderson, Blakeslee, Rubio
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SENATE FLOOR : 36-0, 1/19/12
AYES: Alquist, Anderson, Blakeslee, Cannella, Corbett,
Correa, De León, DeSaulnier, Dutton, Emmerson, Fuller,
Gaines, Hancock, Harman, Hernandez, Huff, Kehoe, La
Malfa, Leno, Lieu, Liu, Lowenthal, Negrete McLeod,
Padilla, Pavley, Price, Rubio, Simitian, Steinberg,
Strickland, Vargas, Walters, Wolk, Wright, Wyland, Yee
NO VOTE RECORDED: Berryhill, Calderon, Evans, Runner
ASSEMBLY FLOOR : 74-0, 5/31/12 - See last page for vote
SUBJECT : Hospitals: licensure
SOURCE : Stanford Hospital and Clinics
DIGEST : This bill allows, for purposes of providing
emergency services and care to patients with conditions
related to active labor presenting in the emergency
department (ED) of Stanford Hospital and Clinics (SHC) and
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Lucile Packard Children's Hospital (LPCH), SHC and LPCH to
be treated as a single licensed facility if the two
hospitals have signed an agreement under which LPCH will
accept and provide emergency services and care to all
patients presenting to the ED of SHC without regard to
insurance, financial status or any other non-clinical
factor.
Assembly Amendments were technical in nature.
ANALYSIS : Existing law:
1.Provides for the licensure of health facilities,
including general acute care hospitals, by the Department
of Public Health (DPH).
2.Establishes the federal 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.
3.Prohibits the transfer of a person needing emergency
services and care from one hospital to another for any
nonmedical reason, unless specified conditions are met,
including that the person is examined and evaluated by a
physician.
4.Defines "emergency services and care" as requiring
screening, examination, and evaluation by a physician to
determine if active labor exists, and if it does, the
care, treatment, and surgery by a physician necessary to
relieve eliminate the emergency medical condition.
5.Defines "active labor" to mean labor in which there is
either inadequate time to safely transfer to another
hospital prior to delivery or a transfer may pose a
threat to the health and safety of the patient or the
unborn child.
This bill:
1.Allows, for purposes of the provision of emergency
services and care to patients with conditions related to
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active labor presenting in the ED of SHC and LPCH, to be
treated as a single licensed facility if the two
hospitals have signed an agreement under which LPCH will
accept and provide emergency services and care to all
patients presenting to the ED of SHC without regard to
insurance, financial status or any other non-clinical
factor.
2.Makes legislative findings and declarations.
Background
SHC and LPCH are separately licensed and accredited acute
care hospitals located on the same campus of Stanford
University. While each hospital has a dedicated main
entrance, internal corridors connect the two hospitals
seamlessly. SHC maintains an ED but does not have a labor
and delivery (L&D) unit. LPCH does not maintain an ED but
does provide an L&D unit along with post-partum, newborn
nursery and neonatal intensive care services.
The two hospitals have developed a Memorandum of
Understanding (MOU) to permit a process of transferring
patients in active labor directly from SHC's ED to LPCH's
L&D unit. The MOU would apply to all pregnant patients
estimated to be 20 weeks gestation or greater and requires
an initial triage assessment by a qualified ED registered
nurse (RN). The MOU states LPCH agrees to accept all
pregnant patients without discriminating against any
patient on the basis of payor type or other non-clinical
factor.
The Centers for Medicare and Medicaid Services (CMS) has
found the MOU "appears to pose no negative outcome to
beneficiaries and no potential violation of the Emergency
Medical Treatment and Labor Act." However, CMS does not
have the authority to approve the MOU. SHC and LPCH are
licensed by DPH and therefore only DPH has the authority to
approve the MOU.
On June 29, 2011, DPH found the MOU does not meet the
requirements established under current state law.
Specifically, DPH found that current law requires
screening, examination, and evaluation by a physician prior
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to any transfer from the ED. The MOU agreement requires a
triage assessment by a qualified ED RN, but not by a
physician.
EMTALA was passed as part of the Consolidated Omnibus
Budget Reconciliation Act of 1986. Under EMTALA, a patient
who comes to, or is brought to the ED 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.
EMTALA allows 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
be based on the individual's medical need, the capacities
of the hospital, the applicable state's scope of practice
laws, and the hospital bylaws and rules and regulations.
The designated on-call physician is ultimately responsible
for providing the necessary services to the individual
regardless of who makes the in-person appearance.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 6/4/12)
Stanford Hospital and Clinics (source)
California Children's Hospital Association
California Hospital Association
California Medical Association
Lucile Packard Children's Hospital
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ARGUMENTS IN SUPPORT : SHC states that this bill will
address a unique situation for pregnant woman presenting at
SHC's ED with labor-related conditions. Enactment of this
bill will enable women to be transferred without delay to
the L&D unit of LPCH thereby best meeting the immediate
health and safety needs of the mother and her unborn child.
SHC contends that in most hospitals that provide both
emergency and L&D services, women presenting to the ED are
re-directed to the L&D unit for services. This bill will
allow SHC and LPCH to be treated as a single hospital
solely for women presenting to the SHC ED with
labor-related conditions. LPCH writes that this bill will
enable women to be transferred without delay in order to
meet the health and safety needs of women and children.
ASSEMBLY FLOOR : 74-0, 5/31/12
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,
Donnelly, Eng, Feuer, Fong, Fuentes, Furutani, Beth
Gaines, Galgiani, Garrick, Gatto, Gordon, Gorell, Grove,
Hagman, Halderman, Hall, Harkey, Hayashi, Hill, Huber,
Hueso, Huffman, Jeffries, Jones, Knight, Lara, Logue,
Bonnie Lowenthal, Ma, Miller, Mitchell, Monning, Morrell,
Nestande, Nielsen, Olsen, Pan, Perea, V. Manuel Pérez,
Portantino, Silva, Skinner, Smyth, Solorio, Swanson,
Torres, Wagner, Wieckowski, Williams, Yamada, John A.
Pérez
NO VOTE RECORDED: Fletcher, Roger Hernández, Mansoor,
Mendoza, Norby, Valadao
CTW:nl 6/6/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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