BILL NUMBER: AB 1177 AMENDED
BILL TEXT
AMENDED IN SENATE JULY 16, 2015
AMENDED IN SENATE JULY 8, 2015
INTRODUCED BY Assembly Members Gomez, Burke, and Low
FEBRUARY 27, 2015
An act to add, repeal, and add add and
repeal 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 that
that, when administered
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 exempt a primary
care clinic to have a from the
above-referenced hospital transfer agreement with a
nearby hospital requirement if the clinic
provides analgesia and sedation services consisting only of
local anesthesia, peripheral nerve blocks, a combination thereof, or
conscious sedation, as defined. 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. The bill would require the
State Department of Public Health department
to repeal amend 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
that that, when administered
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
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 the requirements of subparagraph (A)
if that clinic submits to the department any competent evidence that
demonstrates to the department that documents
its attempt to obtain a written transfer agreement from at
least one nearby hospital or other inpatient health facility
has two local hospitals that have elected not
to enter into a transfer agreement with that primary care clinic.
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.
(C) For the purposes of this section, the following
definitions shall apply:
(i) "Competent
"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.
(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.
(b) This section does not require a primary care clinic to have a
hospital transfer agreement with a nearby
local 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 Health shall,
Health, no later than July 1, 2016,
repeal shall amend Section 75047 of Chapter 7 of
Division 5 of Title 22 of the California Code of
Regulations. Regulations to be consistent with this
section.
(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
that that, when administered
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
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 is
exempt from this paragraph the requirements
of subparagraph (A) if it submits to the department any
competent evidence that demonstrates to the department that
documents its attempts to obtain a written
transfer agreement from at least one nearby hospital
or other inpatient health facility has two local
hospitals that have elected to not enter into a transfer
agreement with that primary care clinic. 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.
(C) For the purposes of this section, the following
definitions shall apply:
(i) "Competent
"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.
(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.
(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.