Amended in Senate July 16, 2015

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 begin delete add, repeal, and add end delete begin insert add and repeal end insert 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 is not required to enter into a written transfer agreement pursuant to those 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 begin delete that end delete begin insert that, end insert when begin delete administered end delete begin insert administered, end insert have the probability of placing a patient at risk for loss of the patient’s life-preserving protective reflexes. The bill would begin delete not require end delete begin insert exempt end insert a primary care clinic begin delete to have a end delete begin insert from the above-referenced end insert hospital transfer agreement begin delete with a nearby hospital end delete begin insert requirement end insert if the clinic begin delete provides analgesia and sedation services consisting only of local anesthesia, peripheral nerve blocks, a combination thereof, or conscious sedation, as defined. end delete begin insert submits to the State Department of Public Health competent evidence, as defined, that documents its attempt to obtain a written transfer agreement from at least 2 local hospitals, except as provided. The bill would impose similar requirements upon an alternative birth center licensed as a primary care clinic, as specified. end insert The bill would require the begin delete State Department of Public Health end delete begin insert department end insert to begin delete repeal end delete begin insert amend end insert 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 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 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 begin delete that end delete
begin insert that, end insert when begin delete administered end delete begin insert administered, end insert have the probability of
placing a patient at risk for loss of the patient’s life-preserving
protective reflexes, shall begin delete do one of the following: end delete

begin delete (i) end delete begin delete   end delete begin delete Have end delete begin insert have end insert a written transfer agreement with a local
accredited or licensed general acute care hospital.

begin delete

(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 delete begin delete

(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 delete

(B) A primary care clinic described in subparagraph (A) begin delete that
cannot meet any of the criteria listed in clauses (i) to (iii), inclusive,
of subparagraph (A) end delete is exempt from begin delete this paragraph end delete begin insert the
requirements of subparagraph (A) end insert if that clinic submits to the
department any competent evidence that begin delete demonstrates to the
department that end delete begin insert documents its attempt to obtain a written transfer
agreement from end insert at least begin delete one nearby hospital or other inpatient
health facility has end delete begin insert two local hospitals that have end insert elected not to enter
into a transfer agreement with that primary care clinic. begin insert If the
primary care clinic determines that there are not two hospitals
that are reasonably accessible by road travel for purposes of
providing patients with emergency medical care, the primary care
clinic shall only be required to submit competent evidence to the
department that documents its attempt to obtain a written transfer
agreement from one local hospital. end insert

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

begin delete (i) end delete begin delete   end delete begin delete “Competent end delete begin insert “competent end insert 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.

begin delete

(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 delete begin insert

(D) An alternative birth center that is licensed under this chapter
as a primary care clinic, as a condition of licensure, shall be
required to maintain a written transfer agreement with a local
hospital. The transfer agreement shall include provisions for
communication and transportation to meet medical emergencies.
Essential personal, health, and medical information shall either
accompany the patient upon transfer or be transmitted immediately
by telephone to the receiving facility. This section does not modify
or supersede the requirements imposed on alternative birth centers
described in Section 1204.3.

end insert

(b) This section does not require a primary care clinic to have
a hospital transfer agreement with a begin delete nearby end delete begin insert local end insert 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.

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

(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 law, and except as
provided in paragraph (2), a primary care clinic 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 begin delete that end delete
begin insert that, end insert when begin delete administered end delete begin insert administered, end insert have the probability of
placing a patient at risk for loss of the patient’s life-preserving
protective reflexes, shall begin delete do one of the following: end delete

begin delete (i) end delete begin delete   end delete begin delete Have end delete begin insert have end insert a written transfer agreement with a local
accredited or licensed acute general care hospital.

begin delete

(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 delete begin delete

(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 delete

(B) A primary care clinic described in subparagraph (A) begin delete that
cannot meet any of the criteria listed in clauses (i) to (iii), inclusive,
of subparagraph (A) shall be end delete begin insert is end insert exempt from begin delete this paragraph end delete begin insert the
requirements of subparagraph (A) end insert if it submits to the department
any competent evidence that begin delete demonstrates to the department that end delete
begin insert documents its attempts to obtain a written transfer agreement from end insert
at least begin delete one nearby hospital or other inpatient health facility has end delete
begin insert two local hospitals that have end insert elected to not enter into a transfer
agreement with that primary care clinic. begin insert If the primary care clinic
determines that there are not two hospitals that are reasonably
accessible by road travel for purposes of providing patients with
emergency medical care, the primary care clinic shall only be
required to submit competent evidence to the department that
documents its attempt to obtain a written transfer agreement from
one local hospital. end insert

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

begin delete (i) end delete begin delete   end delete begin delete “Competent end delete begin insert “competent end insert 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.

begin delete

(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 delete begin insert

(D) An alternative birth center that is licensed under this chapter
as a primary care clinic, as a condition of licensure, shall be
required to maintain a written transfer agreement with a local
hospital. The transfer agreement shall include provisions for
communication and transportation to meet medical emergencies.
Essential personal, health, and medical information shall either
accompany the patient upon transfer or be transmitted immediately
by telephone to the receiving facility. This section does not modify
or supersede the requirements imposed on alternative birth centers
described in Section 1204.3.

end 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:

(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.

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