Amended in Senate July 8, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1177

Introduced by Assembly Members Gomez, Burke, and Low

February 27, 2015

An act to add, repeal, and add Section 1204.2 of the Health and Safety Code, relating to primary care clinics.

LEGISLATIVE COUNSEL’S DIGEST

AB 1177, as amended, Gomez. Primary care clinics: written transfer agreements.

Existing regulations require primary care clinics to maintain a written transfer agreement with one or more nearby hospitals and other facilities as appropriate to meet medical emergencies. Existing law authorizes certain clinics to request that the State Department of Public Health waive this requirement.

This bill would provide that a begin insert licensed end insert primary care clinic begin delete that is licensed end delete is not required to enter into a written transfer agreement pursuant to those begin delete provisions. end delete begin insert provisions as a condition of licensure, except as provided for a primary care clinic where anesthesia is used in compliance with the community standard of practice, in doses that when administered have the probability of placing a patient at risk for loss of the patient’s life-preserving protective reflexes. The bill would not require a primary care clinic to have a hospital transfer agreement with a nearby hospital if the clinic provides analgesia and sedation services consisting only of local anesthesia, peripheral nerve blocks, a combination thereof, or conscious sedation, as defined. end insert The bill would require the State Department of Public Health to repeal its regulations to conform to these changes.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 1204.2 is added to the Health and Safety
Code, to read:

1204.2.  

(a)  begin insert (1) end insert begin insert   end insert Notwithstanding any other begin delete provision of end delete law,
including, but not limited to, Section 75047 of Title 22 of the
California Code of Regulations, begin insert and except as provided in
paragraph (2), end insert a primary care clinic begin delete licensed pursuant to end delete begin insert described
in end insert subdivision (a) of Section 1204 begin insert that is licensed pursuant to this
chapter end insert shall not be required to enter into a written transfer
agreement with a nearby hospital as a condition of licensure.

begin insert

(2) (A) A primary care clinic where anesthesia is used in
compliance with the community standard of practice, in doses that
when administered have the probability of placing a patient at risk
for loss of the patient’s life-preserving protective reflexes, shall
do one of the following:

end insert begin insert

(i) Have a written transfer agreement with a local accredited
or licensed general acute care hospital.

end insert begin insert

(ii) Permit procedures requiring the doses of anesthesia
described in this subparagraph to be performed only by a licensee
who has admitting privileges at a local accredited or licensed
general acute care hospital, except that a licensee who may be
precluded from having admitting privileges due to his or her
professional classification or other administrative limitations shall
have a written transfer agreement with a licensee who has
admitting privileges at a local accredited or licensed general acute
care hospital.

end insert begin insert

(iii) Submit for approval from an accrediting agency a detailed
procedural plan for handling medical emergencies that shall be
reviewed at the time of accreditation. A reasonable plan shall not
be disapproved by the accrediting agency.

end insert begin insert

(B) A primary care clinic described in subparagraph (A) that
cannot meet any of the criteria listed in clauses (i) to (iii), inclusive,
of subparagraph (A) is exempt from this paragraph if that clinic
submits to the department any competent evidence that
demonstrates to the department that at least one nearby hospital
or other inpatient health facility has elected not to enter into a
transfer agreement with that primary care clinic.

end insert begin insert

(C) For the purposes of this section, the following definitions
shall apply:

end insert begin insert

(i) “Competent evidence” means evidence that is relevant and
of such a nature that it can be received by a court of law, and
includes, but is not limited to, an affidavit of someone with the
legal authority to bind the clinic operation.

end insert begin insert

(ii) “Nearby hospital or other inpatient health facility” means
a hospital or other inpatient health facility that the clinic
corporation has determined is reasonably accessibly by road travel
for purposes of providing patients with medical emergency care.

end insert begin insert

(b) This section does not require a primary care clinic to have
a hospital transfer agreement with a nearby hospital, if that clinic
provides only the following types of analgesia and sedation
services:

end insert begin insert

(1) Local anesthesia.

end insert begin insert

(2) Peripheral nerve blocks.

end insert begin insert

(3) A combination of both local anesthesia and peripheral nerve
blocks.

end insert begin insert

(4) Conscious sedation, as defined in Section 1647.1 of the
Business and Professions Code.

end insert begin delete

(b)

end delete

begin insert (c) end insert  The State Department of Public Health shall, no later than
July 1, 2016, repeal Section 75047 of Chapter 7 of Division 5 of
Title 22 of the California Code of Regulations.

begin delete

(c)

end delete

begin insert (d) end insert  This section shall remain in effect only until January 1, 2018,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2018, deletes or extends that date.

SEC. 2.  

Section 1204.2 is added to the Health and Safety Code,
to read:

1204.2.  

(a)  begin insert (1) end insert begin insert   end insert Notwithstanding any other begin delete provision of end delete law,
begin insert and except as provided in paragraph (2), end insert a primary care clinic
begin delete licensed pursuant to end delete begin insert described in end insert subdivision (a) of Section 1204
begin insert that is licensed pursuant to this chapter end insert shall not be required to
enter into a written transfer agreement with a nearby hospital as a
condition of licensure.

begin insert

(2) (A) A primary care clinic where anesthesia is used in
compliance with the community standard of practice, in doses that
when administered have the probability of placing a patient at risk
for loss of the patient’s life-preserving protective reflexes, shall
do one of the following:

end insert begin insert

(i) Have a written transfer agreement with a local accredited
or licensed acute general care hospital.

end insert begin insert

(ii) Permit procedures requiring the doses of anesthesia
described in this subparagraph to be performed only by a licensee
who has admitting privileges at a local accredited or licensed
general acute care hospital, except that a licensee who may be
precluded from having admitting privileges due to his or her
professional classification or other administrative limitations shall
have a written transfer agreement with a licensee who has
admitting privileges at a local accredited or licensed acute care
hospital.

end insert begin insert

(iii) Submit for approval from an accrediting agency a detailed
procedural plan for handling medical emergencies that shall be
reviewed at the time of accreditation. A reasonable plan shall not
be disapproved by the accrediting agency.

end insert begin insert

(B) A primary care clinic described in subparagraph (A) that
cannot meet any of the criteria listed in clauses (i) to (iii), inclusive,
of subparagraph (A) shall be exempt from this paragraph if it
submits to the department any competent evidence that
demonstrates to the department that at least one nearby hospital
or other inpatient health facility has elected to not enter into a
transfer agreement with that primary care clinic.

end insert begin insert

(C) For the purposes of this section, the following definitions
shall apply:

end insert begin insert

(i) “Competent evidence” means evidence that is relevant and
of such a nature that it can be received by a court of law, and
includes, but is not limited to, an affidavit of someone with the
legal authority to bind the clinic operation.

end insert begin insert

(ii) “Nearby hospital or other inpatient health facility” means
a hospital or other inpatient health facility that the clinic
corporation has determined is reasonably accessibly by road travel
for purposes of providing patients with medical emergency care.

end insert begin insert

(b) This section does not require a primary care clinic to have
a hospital transfer agreement with a nearby hospital, if that clinic
provides only the following types of analgesia and sedation
services:

end insert begin insert

(1) Local anesthesia.

end insert begin insert

(2) Peripheral nerve blocks.

end insert begin insert

(3) A combination of both local anesthesia and peripheral nerve
blocks.

end insert begin insert

(4) Conscious sedation, as defined in Section 1647.1 of the
Business and Professions Code.

end insert begin delete

(b)

end delete

begin insert (c) end insert  This section shall become operative on January 1, 2018.