BILL NUMBER: AB 1177 AMENDED
BILL TEXT
AMENDED IN SENATE JULY 8, 2015
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 licensed primary care
clinic that is licensed is not required to enter
into a written transfer agreement pursuant to those
provisions. 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. 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) (1) Notwithstanding any other
provision of law, including, but not limited to,
Section 75047 of Title 22 of the California Code of Regulations,
and except as provided in paragraph (2), a primary care clinic
licensed pursuant to described in
subdivision (a) of Section 1204 that is licensed pursuant to
this chapter shall not be required to enter into a written
transfer agreement with a nearby hospital as a condition of
licensure.
(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:
(i) Have a written transfer agreement with a local accredited or
licensed general acute care hospital.
(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.
(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.
(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.
(C) For the purposes of this section, the following definitions
shall apply:
(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.
(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.
(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:
(1) Local anesthesia.
(2) Peripheral nerve blocks.
(3) A combination of both local anesthesia and peripheral nerve
blocks.
(4) Conscious sedation, as defined in Section 1647.1 of the
Business and Professions Code.
(b)
(c) 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.
(c)
(d) 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) (1) Notwithstanding any other
provision of law, and except as provided in
paragraph (2), a primary care clinic licensed pursuant
to described in subdivision (a) of Section 1204
that is licensed pursuant to this chapter shall not be
required to enter into a written transfer agreement with a nearby
hospital as a condition of licensure.
(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:
(i) Have a written transfer agreement with a local accredited or
licensed acute general care hospital.
(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.
(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.
(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.
(C) For the purposes of this section, the following definitions
shall apply:
(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.
(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.
(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:
(1) Local anesthesia.
(2) Peripheral nerve blocks.
(3) A combination of both local anesthesia and peripheral nerve
blocks.
(4) Conscious sedation, as defined in Section 1647.1 of the
Business and Professions Code.
(b)
(c) This section shall become operative on January 1,
2018.