BILL ANALYSIS �
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UNFINISHED BUSINESS
Bill No: SB 357
Author: Correa (D)
Amended: 6/14/13
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE : 8-0, 4/17/13
AYES: Hernandez, Anderson, Beall, De Le�n, DeSaulnier, Monning,
Nielsen, Wolk
NO VOTE RECORDED: Pavley
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SENATE FLOOR : 35-0, 5/2/13 (Consent)
AYES: Anderson, Beall, Berryhill, Block, Calderon, Cannella,
Corbett, De Le�n, DeSaulnier, Emmerson, Evans, Fuller, Gaines,
Galgiani, Hancock, Hernandez, Hill, Hueso, Huff, Jackson,
Knight, Lara, Leno, Lieu, Liu, Monning, Nielsen, Padilla,
Pavley, Price, Roth, Steinberg, Wright, Wyland, Yee
NO VOTE RECORDED: Correa, Walters, Wolk, Vacancy, Vacancy
ASSEMBLY FLOOR : 77-0, 8/8/13 (Consent) - See last page for vote
SUBJECT : Elective Percutaneous Coronary Intervention Pilot
Program
SOURCE : Author
DIGEST : This bill extends the January 1, 2014, sunset date
for the Elective Percutaneous Coronary Intervention Pilot
Program (PCI Pilot Program) to January 1, 2015, and requires the
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final report by the PCI Pilot Program oversight committee to be
completed by November 30, 2013, rather than at the conclusion of
the pilot program.
Assembly Amendments extend the date the final report by the PCI
Pilot Program oversight committee is due from July 31, 2013 to
November 30, 2013.
ANALYSIS :
Existing law:
1.Licenses and regulates general acute care hospitals by the
Department of Public Health (DPH), and in addition to the
basic services offered under that license, permits general
acute care hospitals to seek approval from DPH to offer
special services, including cardiac surgery and cardiac
catheterization laboratory services.
2.Requires DPH, for cardiac catheterization laboratory services,
to adopt standards and regulations, as specified.
3.Establishes the PCI Pilot Program to allow DPH to authorize up
to six general acute care hospitals, as specified, to perform
scheduled, elective percutaneous transluminal coronary
angioplasty and stent placement for eligible patients without
onsite cardiac surgery.
4.Establishes an advisory oversight committee to oversee,
monitor, and make recommendations to DPH concerning the PCI
Pilot Program.
5.Requires the advisory oversight committee to submit at least
two reports to DPH during the pilot period, and to conduct a
final report at the conclusion of the pilot program.
6.Requires DPH to prepare and submit a report to the Legislature
on the results of the PCI Pilot Program no later than 90 days
after termination of the pilot program. Requires this report
to recommend whether elective PCI without onsite cardiac
surgery should be continued in California, and if so, under
what conditions.
7.Sunsets the provisions of law creating the PCI Pilot Program
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on January 1, 2014.
This bill:
1.Extends the January 1, 2014, sunset date for the PCI Pilot
Program to January 1, 2015.
2.Requires the PCI Pilot Program advisory oversight committee to
conduct a final report by November 30, 2013, rather than at
the conclusion of the pilot program.
3.Requires the report that DPH is required to submit to the
Legislature to be completed within 90 days of receiving the
final report from the advisory oversight committee, rather
than 90 days after termination of the PCI Pilot Program, and
specifies that this report is to be on the initial results of
the pilot program.
Background
Percutaneous transluminal coronary angioplasty . According to
Stanford Medical Center online health library, percutaneous
transluminal coronary angioplasty is performed to open blocked
coronary arteries cause by coronary artery disease and to
restore arterial blood flow to the heart tissue without
open-heart surgery. Once the artery has been opened, a stent is
placed in the artery. A stent is a tiny, expandable metal coil
that is inserted into the newly-opened area of the artery to
help keep the artery from narrowing or closing again.
PCI Pilot Program background. According to the Senate Health
Committee analysis of SB 891 (Correa, Chapter 295, Statutes of
2008), which created the PCI Pilot Program, legislation was
prompted by studies showing that elective PCI for low- to
medium-risk patients can be safely and effectively performed at
hospitals without cardiac surgery services if they meet certain
requirements. The current limitation on hospitals performing
interventional cardiac procedures, if they are not also licensed
to perform cardiac surgery, was enacted over 25 years ago. Since
that time, there have been great technological and
methodological advances in interventional cardiology that have
significantly improved patient outcomes and reduced incidents of
emergency cardiac surgery.
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The six hospitals selected by DPH for the pilot program are: Los
Alamitos Medical Center; Sutter Roseville Medical Center; Kaiser
Permanente Walnut Creek Medical Center; Doctors Medical
Center-San Pablo; Clovis Community Medical Center; and St. Rose
Hospital in Hayward.
The most recent update from the PCI Pilot Program Advisory
Oversight Committee, dated January 17, 2013, found no
significant outcome differences between the six hospitals in the
pilot program, and the control group of hospitals performing
these procedures with onsite cardiac surgery services.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/13/13)
California Chapter of the American College of Cardiology
California Hospital Association
Clovis Community Medical Center
Doctors Medical Center
Kaiser Permanente Walnut Creek Medical Center
Los Alamitos Medical Center
Placer County Water Agency
St. Rose Hospital
Sutter Roseville Medical Center
ARGUMENTS IN SUPPORT : According the author, the intent of SB
891 (Correa), Chapter 295, Statutes of 2008, which created the
PCI Pilot Program allowing six acute care hospitals to provide
cardiac catheterization services without on-site surgery
services, was to have a report with the recommendations from the
advisory committee to be submitted to DPH prior to the end of
the pilot program, but there was a drafting error. The author
states that this bill corrects the drafting error, allowing the
pilot hospitals to continue with the PCI Pilot Program while DPH
reviews the data from the advisory committee, and allows the
Legislature an opportunity to take action after reviewing the
report on the pilot project.
The California Hospital Association (CHA) states in support that
the PCI Pilot Program expanded patients' access to care,
particularly benefitting underinsured and poor patients who are
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often the least likely to undergo PCI due to barriers accessing
specialized cardiac services such as geography, distance,
culture, race, language, poverty and lack of education.
However, CHA states that there was a drafting error in the
original legislation that requires the program to end prior to
the Legislature making a determination whether or not to extend
the program. CHA states that there is very good evidence at
this time that the program should be extended, and that
interruption in the program would mean the patients relying on
the program could not receive the services.
The California Chapter of the American College of Cardiology
(ACC) also supports this bill, stating that the intent of the
prior legislation was to have a report with the recommendations
of the advisory committee be submitted to DPH prior to the end
of the pilot program, however there was a drafting error. The
ACC states that this bill addresses the drafting error by
enabling the pilot hospitals to continue with the pilot program
while DPH reviews the data from the advisory committee and makes
a recommendation to the Legislature on whether the program
should continue and if so under what circumstances.
All six pilot hospitals also wrote in support, pointing to the
safe outcomes, and also pointing out that the increased volume
of patients has led to the hiring of additional staff, and that
returning to the previous process would be a disservice to
staff, patients and their families.
ASSEMBLY FLOOR : 77-0, 08/08/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chesbro, Conway, Cooley, Dahle, Daly,
Dickinson, Donnelly, Eggman, Fong, Fox, Frazier, Beth Gaines,
Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray, Grove,
Hagman, Hall, Harkey, Roger Hern�ndez, Holden, Jones,
Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein,
Mansoor, Medina, Melendez, Mitchell, Morrell, Mullin,
Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea,
V. Manuel P�rez, Quirk, Quirk-Silva, Rendon, Salas, Skinner,
Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, John A. P�rez
NO VOTE RECORDED: Ch�vez, Vacancy, Vacancy
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JL:nl 8/13/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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