BILL ANALYSIS Ó
AB 974
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Date of Hearing: April 9, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 974 (Hall) - As Introduced: February 22, 2013
SUBJECT : Patient transfer: non-medical reasons: notice to
contact person or next of kin.
SUMMARY : Establishes a requirement for hospitals seeking to
transfer a person from one facility to another for nonmedical
reasons to first ask for an emergency contact person who should
be notified and informed about any proposed transfer.
Specifically, this bill :
1)Requires hospitals to ask for an emergency contact person who
should be notified of proposed transfers.
2)Requires hospitals to make a reasonable effort to ascertain
the identity of the emergency contact person or the next of
kin if the patient is unable to respond.
3)Requires hospitals to contact the emergency contact person and
alert him or her about any proposed transfers of the patient.
EXISTING LAW :
1)Requires in federal law, under provisions of the federal
Emergency Medical Treatment and Active Labor Act (EMTALA),
hospital emergency departments to provide emergency screening
and stabilization services without regard to the patient's
insurance status or ability to pay. EMTALA requires hospitals
to maintain an on-call roster of specialists in a manner that
best meets the needs of its patients.
2)Requires in state law, licensed hospitals which maintain and
operate an emergency department, to provide emergency care and
services to any person requesting emergency services or care,
or for whom emergency services or care is requested, for any
life-threatening or serious injury or illness, including a
psychiatric emergency medical condition.
3)Prohibits in state law, hospitals from transferring any person
needing emergency services or care for any nonmedical reason
without all of the following conditions being met:
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a) The person is examined by a physician and surgeon as
well as any necessary consultations prior to transfer;
b) The person has been provided with adequate emergency
services and care to ensure that the transfer will not
cause a medical hazard to the person;
c) A physician and surgeon at the transferring hospital has
notified and obtained the consent to transfer by the a
physician and surgeon at the receiving hospital and
received confirmation ensuring that the patient meets the
hospitals admission criteria relating to appropriate bed,
personnel, and equipment needed to treat the patient;
d) The transferring hospital provides for the appropriate
personnel and equipment to effect the transfer;
e) Pertinent medical records and copies of appropriate
tests must be transferred with the patient;
f) Records transferred with the person must include a
"Transfer Summary" signed by the transferring physician and
surgeon. This "Transfer Summary" includes at minimum: the
person's name, address, sex, race, age, insurance status,
and medical condition; the name and address of the
transferring physician and surgeon or emergency department
personnel authorizing the transfer; the time and date the
person was first presented at the transferring hospital;
the name of the physician and surgeon at the receiving
hospital consenting to the transfer and the time and date
of the consent; the time and date of the transfer; the
reason for the transfer; and the declaration of the signor
that the signor is assured, within reasonable medical
probability, that the transfer creates no medical hazard to
the patient. Neither the transferring physician and surgeon
nor transferring hospital shall be required to duplicate,
in the "Transfer Summary," information contained in medical
records transferred with the person; and,
g) The transfer must conform to additional regulations
developed by the California Department of Public Health
(DPH).
4)Prohibits in state law, health facilities from transferring or
discharging patients for purposes of affecting a transfer from
one hospital to another unless arrangements between facilities
have been made in advance, and the person legally responsible
for the patient has been notified or attempts over a 24-hour
period have been made and a responsible person cannot be
reached. Prohibits the transfer or discharge of patients in
the case that the patient's physician deems that the transfer
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or discharge would create a medical hazard for the patient.
5)Requires a health plan that is contacted by a hospital, as
specified to, within 30 minutes of the time the hospital makes
the initial telephone call requesting information, either
authorize post stabilization care or inform the hospital that
it will arrange for the prompt transfer of the enrollee to
another hospital. Requires a health plan that is contacted by
a hospital to reimburse the hospital for post-stabilization
care rendered to the enrollee if any of the following occurs:
a) The health plan authorizes the hospital to provide
post-stabilization care;
b) The health plan does not respond to the hospital's
initial contact or does not make a decision regarding
whether to authorize post-stabilization care or to promptly
transfer the enrollee within the specified timeframe; or,
c) There is an unreasonable delay in the transfer of the
enrollee, and the noncontracting physician and surgeon
determines that the enrollee requires post-stabilization
care.
FISCAL EFFECT : This bill has not been analyzed yet by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, existing law
does not regulate the procedure for alerting an emergency
contact or next of kin of a patient's transfer between health
facilities. The author asserts that this has resulted in a
statewide patchwork of procedures that vary from one transfer
agreement to another, which can lead to situations of
confusion and fear among families whenever a patient is
transferred and no emergency contact has been alerted. The
author states that California hospitals that operate an
emergency department are required to provide care to any
person regardless of that patient's insurance status.
However, once the patient has been stabilized and is no longer
in immediate danger, he or she can be transferred from one
hospital to another for nonmedical reasons. The author
proposes that existing law be amended to require hospitals to
obtain an emergency or next of kin contact and notify the
contact prior to the patient's transfer. If the patient is
not able to respond, the hospital must make a reasonable
effort to identify an emergency contact or next of kin and
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alert them. Further, the author believes this additional
requirement will bring uniformity to patient transfers between
hospitals and provide patients and their loved ones vital
information, comfort, and peace of mind
2)BACKGROUND . Title 22 of the Californian Code of Regulations
states that a patient shall not be transferred to another
health facility unless certain conditions are met, including
that the patient or the person legally responsible for the
patient has been notified, or attempts have been made over a
24 hour period prior to the transfer and the patient's
responsible person cannot be reached.
According to DPH, 1309 complaints related to "Admission,
Transfer and Discharge Rights" were received between July 1,
2010 and June 30, 2012; however, only five of these complaints
resulted in citations being issued for violation of admission,
transfer, and discharge requirements. Upon review, none of
these citations were related to the transfer of unconscious
patients without informing emergency contacts or next of kin.
3)SUPPORT IF AMENDED . The California Chapter of the American
College of Emergency Physicians (Cal/ACEP) states that this
bill, as drafted, may have unintended consequences for
Emergency Department patients. Cal/ACEP states that a
requirement to actually make contact with an appointed contact
person may result in delays of transfers and suggests that the
language reflect that a "reasonable effort" to contact be
made. Additionally, Cal/ACEP claims that the term "emergency
contact person" may be taken to mean the person listed on a
patient's record, which may not be the person the patient
wants contacted. Cal/ACEP suggests the language is changed to
reflect the patient's choice of whom and whether to contact an
emergency contact or next of kin.
4)SUPPORT . Health Access California writes in support of this
bill, that requiring hospitals to notify an emergency contact
person before transferring a patient who has been stabilized
is a simple measure of human dignity and beneficial for
healthcare consumers. California Advocates for Nursing Home
and Reform states that informing the next of kin or other
emergency contact is essential for the health and safety of
the elderly and people with disabilities. These groups are
often given little information or no options about their
transfers, and involving their next of kin or emergency
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contact will help them make an informed decision.
5)SUGGESTED AMENDMENTS .
a) This bill requires hospitals to obtain an emergency
contact person who should be notified prior to the
patient's transfer. As suggested by Cal/ACEP, there may be
unintended confusion regarding whether or not this
individual is the contact that the patient wants notified.
The author may wish to amend this bill to address this
issue.
b) As currently drafted, this bill may unintentionally
delay or prevent transfers if there is difficulty in
establishing contact with the listed contact person or next
of kin. To address both of these issues, the author may
wish to amend this bill as follows:
i) Section 1317.2 (h) The patient is first asked if
there is a preferred emergency contact person who should
be notified, and prior to the transfer, the hospital
makes a reasonable attempt to contact that person and
alert him or her about the proposed transfer. If the
patient is not able to respond, the hospital shall make a
reasonable effort to ascertain the identity of the
emergency contact person or the next of kin and alert him
or her about the transfer.
REGISTERED SUPPORT / OPPOSITION :
Support
Alzheimer's Association
Brotherhood Crusade
California Advocates for Nursing Home Reform
Consumer Attorneys of California
Health Access California
Opposition
None on file.
Analysis Prepared by : Hammad Khan / HEALTH / (916) 319-2097
AB 974
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