BILL ANALYSIS Ó
SB 906
Page 1
SENATE THIRD READING
SB 906 (Correa)
As Amended August 18, 2014
Majority vote
SENATE VOTE :36-0
HEALTH 18-0 APPROPRIATIONS 17-0
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|Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bigelow, |
| |Ammiano, Bonilla, Bonta, | |Bocanegra, Bradford, Ian |
| |Chesbro, Gomez, Gonzalez, | |Calderon, Campos, |
| |Roger Hernández, | |Donnelly, Eggman, Gomez, |
| |Lowenthal, Mansoor, | |Holden, Jones, Linder, |
| |Nazarian, Nestande, | |Pan, Quirk, |
| |Patterson, Ridley-Thomas, | |Ridley-Thomas, Wagner, |
| |Rodriguez, Wagner, | |Weber |
| |Wieckowski | | |
| | | | |
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SUMMARY : Creates the Elective Percutaneous Coronary
Intervention (PCI) Program in the Department of Public Health
(DPH) to certify general acute care hospitals that are licensed
to provide urgent and emergent cardiac catheterization
laboratory services in California, to perform scheduled,
elective percutaneous transluminal coronary angioplasty (PTCA)
and stent placement for eligible patients.
EXISTING LAW : Provides for the licensing and regulation of
general acute care hospitals by 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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Approximately $300,000 annually to OSHPD (California Health
Data and Planning Fund) to collect and analyze information
related to PCI procedures, and to produce an annual report.
Costs may be somewhat lower in future years as the data
procedures and analytical methodology is routinized.
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2)One-time costs of about $110,000 for initial licensing of
hospitals by DPH (Licensing and Certification Program Fund).
3)Potential one-time costs for regulations, likely in the range
of $50,000 (Licensing and Certification Program Fund), if DPH
finds any additional criteria beyond those enumerated in the
bill are necessary to ensure patient safety or quality of
care.
4)Ongoing costs to review compliance by participating hospitals
as part of the Department's ongoing licensing enforcement
program would be calculated and charged to hospitals as
allowed by this bill (Licensing and Certification Program
Fund).
COMMENTS : According to the author, until the passage of SB 891
(Correa), Chapter 295, Statues of 2008, only California
hospitals licensed to provide cardiac surgery, such as bypass
surgery, were permitted to perform scheduled, elective PCI
treatment. SB 891 created the Elective PCI Pilot Program, which
allowed six California general acute care hospitals licensed to
provide cardiac catheterization services, that have off-site
cardiac surgery backup, and that met the specified rigorous
selection criteria, to perform scheduled, elective PCI for low
to medium risk patients. The author argues that expanding
access to quality healthcare and addressing health disparities
is important to improving patients' quality of life and this
bill is prompted by studies showing that elective PCI for low to
medium risk patients can be safely and effectively performed in
hospitals without cardiac surgery services so long as they meet
certain requirements, including that they have in place
stringent patient selection criteria and a transfer agreement
that ensures transfer to a hospital with cardiac surgery
services within 60 minutes or less.
PCI encompasses a variety of procedures used to treat patients
with diseased arteries of the heart such as, chest pain caused
by a build-up of fats, cholesterol, and other substances from
the blood (referred to as plaque) that can reduce blood flow to
a near trickle, or a heart attack caused by a large blood clot
that completely blocks the artery. The American Heart
Association reports that PCI is typically performed by PTCA, or
threading a catheter - a slender balloon-tipped tube - from the
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artery in the groin to a trouble spot in an artery of the heart.
The balloon is then inflated, compressing the plaque and
dilating the narrowed coronary artery so that blood can flow
more easily. This is also accompanied by inserting an
expandable metal stent, a wire mesh tube used to prop open
arteries after PTCA. For patients suffering from a heart
attack, science shows that patients benefit from the restoration
of blood flow to the heart muscle within 90 minutes of the
patient's arrival at the hospital. PCI done under emergency
circumstances is referred to as "primary" PCI. Other PCI
procedures, such as those done to unblock an artery before a
heart attack occurs, are referred to as "elective" PCI.
Six hospitals participated in the PCI Pilot Program: 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. All six hospitals maintained their
eligibility to participate throughout the entire program.
Since the beginning of the pilot program in California, there
have been many studies in the United States on PCI without
onsite surgery. Seven studies of primary PCI showed no
difference for in-hospital or 30 day mortality between offsite
or onsite surgery. Additionally there was no difference in the
seven studies in the occurrence of emergency coronary artery
bypass surgery after primary PCI, between onsite or offsite
surgery. There are eight studies that have examined urgent and
elective PCI comparing PCI with onsite surgery and offsite
surgery. There was no difference in mortality or a need for
emergency coronary artery bypass surgery between the two sites,
in these studies.
According to the November 19, 2013, final report from the
California PCI Pilot oversight committee, the PCI Pilot
hospitals demonstrated similar safety and efficacy results for
elective and non-elective PCIs when compared to 116 hospitals
with onsite surgery. The oversight committee recommends that
the pilot program be continued in the six hospitals until
California law is changed to allow elective PCI without on-site
cardiac surgery under the conditions required by the pilot
program.
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Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097
FN: 0004938