BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 974
AUTHOR: Hall
AMENDED: April 16, 2013
HEARING DATE: June 26, 2013
CONSULTANT: Marchand
SUBJECT : Patient transfer: nonmedical reasons: notice to
contact person or next of kin.
SUMMARY : Requires a hospital to alert a patient's emergency
contact person prior to transferring the patient from one
hospital to another for nonmedical reasons.
Existing law:
1.Requires hospital emergency departments, under the federal
Emergency Medical Treatment and Active Labor Act as well as
state law, to provide emergency screening and stabilization
services without regard to the patient's insurance status or
ability to pay.
2.Requires a health plan to reimburse providers for emergency
services and care provided to its enrollees until the care
results in stabilization of the enrollee.
3.Prohibits any person needing emergency services and care from
being transferred from a hospital to another hospital for any
nonmedical reason, such as the person's inability to pay for
any emergency service or care, unless specified conditions are
met, including the following:
a. The person is examined and evaluated by a
physician prior to transfer;
b. The person has been provided with emergency
services and care so that it can be determined, within
reasonable medical probability, that the transfer or
delay caused by the transfer will not create a medical
hazard to the person;
c. A physician at the transferring hospital has
notified and obtained the consent to the transfer by a
physician at the receiving hospital;
d. The transferring hospital provides the
appropriate personnel and equipment to effect the
transfer, and all the person's pertinent medical
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records are transferred with the person; and,
e. The records transferred with the person
include a "Transfer Summary," signed by the
transferring physician, containing specified relevant
information, including the reason for the transfer and
a declaration of the signing physician that the
transfer creates no medical hazard to the patient.
4.Prohibits anything in the above provisions of law pertaining
to the nonmedical transfer of a person needing emergency
services and care from prohibiting the transfer or discharge
of a patient when the patient or the patient's representative
requests a transfer or discharge and gives informed consent to
the transfer or discharge against medical advice.
5.Permits a health facility to disclose medical information
about a patient in order to notify a family member or a
personal representative of the patient about the patient's
location, general condition, or death, if specified procedures
are followed.
6.Prohibits, under Title 22 of the California Code of
Regulations, any patient from being transferred or discharged
solely for the purposes of effecting a transfer from a
hospital to another health facility unless certain
requirements have been made, including that the patient or the
person legally responsible for the patient has been notified,
or attempts have been made over the 24-hour period prior to
the patient's transfer and the legally responsible person
cannot be reached.
This bill:
1.Requires a patient needing emergency services and care, prior
to being transferred from one hospital to another for
nonmedical reasons, such as an inability to pay, in addition
to other existing requirements, to be asked if there is a
preferred contact person who should be notified, and requires
the hospital to make a reasonable attempt to contact that
person and alert him or her about the proposed transfer.
2.Requires the hospital, if the patient about to be transferred
for nonmedical reasons is not able to respond, to make a
reasonable effort to ascertain the identity of the preferred
contact person or the next of kin and alert him or her about
the transfer.
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FISCAL EFFECT : According to the Assembly Appropriations
Committee, this bill will result in special fund costs to DPH of
$75,000 in fiscal year 2013-14 and $128,000 in 2014-15 for a
limited term position to develop regulations.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 75- 0
COMMENTS :
1.Author's statement. California hospitals that operate an
emergency department are required to provide care to any
person regardless of the patient's insurance status. Once the
patient has been stabilized and is no longer in immediate
danger, he or she may be transferred from one hospital to
another for nonmedical reasons. Before transferring a patient
for nonmedical reasons, hospitals are required to meet certain
conditions. These conditions include ensuring all pertinent
medical records are transferred with the patient, examination
and evaluation by a physician at the transferring hospital,
and ensuring that the receiving hospital has adequate staff
and equipment to care for the patient. Currently there is no
uniform procedure for alerting a preferred contact person
about a patient's transfer between health facilities. This has
led to situations of confusion and fear among families when a
patient is transferred and no contact person has been alerted.
This bill will bring much needed uniformity to all patient
transfers between hospitals. This bill will also provide
patients and their loved ones vital information, comfort and
peace of mind when being cared for by a hospital.
The author states that this bill is in response to an incident
involving the elderly mother in the care of a constituent, who
suffered a stroke and was brought to the closest emergency
room which happened to be an out of network hospital. The
patient was then stabilized, and once she met all the criteria
to be eligible for transfer, she was transferred to an
in-network hospital. The transferring hospital, however failed
to notify the daughter who had been visiting her mother. When
she arrived at the hospital she was shocked and scared to find
that her mother's room was empty. Her first thought was that
her mother had died. She was eventually able to find someone
who informed her of the transfer.
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2.Support. Health Access states in support that anyone who has
received the call that a loved one is being seen in an
emergency room knows the worry and the fear that accompanies
that journey to the hospital. Imagine arriving to find that
the patient has been transferred to another hospital without
notice. Health Access states that this bill builds on
existing California law regarding transfer of individuals from
one hospital to another by adding a provision that the
hospital should attempt to contact a family member or
emergency contact person prior to the transfer, and that this
seems a simple measure of human dignity. The Consumer
Attorneys of California state in support that hospitals are
not required to notify the patient's next of kin or emergency
contact that the patient is being transferred, and that this
lack of communication creates unnecessary confusion and fear
in an already stressful time for family members and friends.
The California Chapter of the American College of Emergency
Physicians states in support that this bill will reduce the
confusion caused by hospital transfers, and that it supports
ensuring that loved ones are notified when patients are
transferred to another hospital. The Congress of California
Seniors states that this bill aims to end the confusion and
heartache that results when family members do not know where
their relative has gone. California Advocates for Nursing
Home Reform states that for all persons with disabilities and
the elderly, notifying someone about the transfer is essential
to their health and safety. The Alzheimer's Association notes
that without notification of a pending transfer, families of
someone living with Alzheimer's disease could fear that their
loved one has wandered off, when in reality they have been
transferred to another health facility.
3.Conforming to the Confidentiality of Medical Information Act.
Under the Confidentiality of Medical Information Act (CMIA),
health care providers are prohibited from disclosing medical
information regarding a patient without first obtaining
authorization, except under specified conditions. The CMIA
does specifically permit the disclosure of medical information
to notify a family member or personal representative of the
patient about the patient's "location, general condition, or
death." The patient's consent is required for this
notification, but if the patient is incapacitated, the health
care provider is permitted to exercise professional judgment
in determining whether the disclosure is in the best interests
of the patient. The provider is also restricted to disclosing
only the medical information that is directly relevant to the
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person's involvement with the patient's health care.
While this bill does require the patient to first be asked for a
preferred contact, in the event the patient is not able to
respond, this bill requires the hospital to "make a reasonable
effort to ascertain the identity of the preferred contact
person or the next of kin and alert him or her about the
transfer."
Because the CMIA already has provisions of law that specify the
requirements a provider must follow in order to disclose
information about a patient's location to a family member, the
committee may wish to consider whether this bill should be
amended to require the hospital to follow the CMIA
requirements when alerting the preferred contact about the
transfer of the patient.
SUPPORT AND OPPOSITION :
Support: Alzheimer's Association
Brotherhood Crusade
California Advocates for Nursing Home Reform
California Chapter of the American College of
Emergency Physicians
California Senior Legislature
Congress of California Seniors
Consumer Attorneys of California
Health Access California
Oppose: None received
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