Amended in Senate August 24, 2015

Amended in Senate July 16, 2015

Amended in Senate July 8, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 1177


Introduced by Assembly Members Gomez, Burke, and Low

February 27, 2015


An act to 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 forbegin delete 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 exempt a primary care clinic from the above-referenced hospital transfer agreement requirement if the clinic 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 uponend delete an alternative birth center licensed as a primary care clinic, as specified.begin insert The bill would require a primary care clinic, except as specified, to send with each patient at the time of transfer, or in the case of an emergency, as promptly as possible, copies of all medical records related to the patient’s transfer, and would require the medical records to incluend insertbegin insertde, among other things, current medical findings and a brief summary of the course of treatment provided prior to the patient’s transfer.end insert The bill would require the department tobegin delete amendend deletebegin insert repealend 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:

P2    1

SECTION 1.  

Section 1204.2 is added to the Health and Safety
2Code
, to read:

3

1204.2.  

(a) begin delete(1)end deletebegin deleteend deleteNotwithstanding any other law, including, but
4not limited to, Section 75047 of Title 22 of the California Code of
5Regulations, and except as provided inbegin delete paragraph (2),end deletebegin insert subdivision
6(c),end insert
a primary care clinic described in subdivision (a) of Section
71204 that is licensed pursuant to this chapter shall not be required
8to enter into a written transfer agreement with a nearby hospital
9as a condition of licensure.

begin delete

10(2) (A) A primary care clinic where anesthesia is used in
11compliance with the community standard of practice, in doses that,
12when administered, have the probability of placing a patient at risk
13for loss of the patient’s life-preserving protective reflexes, shall
14have a written transfer agreement with a local accredited or licensed
15general acute care hospital.

16(B) A primary care clinic described in subparagraph (A) is
17exempt from the requirements of subparagraph (A) if that clinic
18submits to the department any competent evidence that documents
19its attempt to obtain a written transfer agreement from at least two
20local hospitals that have elected not to enter into a transfer
21agreement with that primary care clinic. If the primary care clinic
22determines that there are not two hospitals that are reasonably
23accessible by road travel for purposes of providing patients with
24emergency medical care, the primary care clinic shall only be
P3    1required to submit competent evidence to the department that
2documents its attempt to obtain a written transfer agreement from
3one local hospital.

4(C) For the purposes of this section, “competent evidence”
5means evidence that is relevant and of such a nature that it can be
6received by a court of law, and includes, but is not limited to, an
7affidavit of someone with the legal authority to bind the clinic
8operation.

end delete
begin insert

9(b) (1) A primary care clinic shall send with each patient at
10the time of transfer, or in the case of an emergency, as promptly
11as possible, copies of all medical records related to the patient’s
12transfer. To the extent practicable and applicable to the patient’s
13transfer, the medical records shall include current medical
14findings, diagnoses, laboratory results, medications provided prior
15to transfer, a brief summary of the course of treatment provided
16prior to transfer, ambulation status, nursing and dietary
17information, name and contact information for the treating
18physician at the clinic, and as appropriate, pertinent administrative
19and demographic information related to the patient, including
20name and date of birth.

end insert
begin insert

21(2) The requirements in paragraph (1) shall not apply if the
22primary care clinic has entered into a written transfer agreement
23with a local hospital that provides for the transfer of medical
24records.

end insert
begin delete

26 25(D)

end delete

26begin insert(c)end insert An alternative birth center that is licensed under this chapter
27as a primary care clinic, as a condition of licensure, shall be
28required to maintain a written transfer agreement with a local
29hospital. The transfer agreement shall include provisions for
30communication and transportation to meet medical emergencies.
31Essential personal, health, and medical information shall either
32accompany the patient upon transfer or be transmitted immediately
33by telephone to the receiving facility. This section does not modify
34or supersede the requirements imposed on alternative birth centers
35described in Section 1204.3.

begin delete

36(b) This section does not require a primary care clinic to have
37a hospital transfer agreement with a local hospital, if that clinic
38provides only the following types of analgesia and sedation
39services:

40(1) Local anesthesia.

P4    1(2) Peripheral nerve blocks.

2(3) A combination of both local anesthesia and peripheral nerve
3blocks.

4(4) Conscious sedation, as defined in Section 1647.1 of the
5Business and Professions Code.

end delete
begin delete

6 6(c)

end delete

7begin insert(d)end insert The State Department of Public Health, no later than July
81, 2016, shallbegin delete amendend deletebegin insert repealend insert Section 75047 of Chapter 7 of Division
95 of Title 22 of the California Code ofbegin delete Regulations to be consistent
10with this section.end delete
begin insert Regulations.end insert

begin delete

10 11(d)

end delete

12begin insert(e)end insert This section shall remain in effect only until January 1, 2018,
13and as of that date is repealed, unless a later enacted statute, that
14is enacted before January 1, 2018, deletes or extends that date.

15

SEC. 2.  

Section 1204.2 is added to the Health and Safety Code,
16to read:

17

1204.2.  

(a) begin delete(1)end deletebegin deleteend deleteNotwithstanding any other law, and except as
18provided inbegin delete paragraph (2),end deletebegin insert subdivision (c),end insert a primary care clinic
19described in subdivision (a) of Section 1204 that is licensed
20pursuant to this chapter shall not be required to enter into a written
21transfer agreement with a nearby hospital as a condition of
22licensure.

begin delete

23(2) (A) A primary care clinic where anesthesia is used in
24compliance with the community standard of practice, in doses that,
25when administered, have the probability of placing a patient at risk
26for loss of the patient’s life-preserving protective reflexes, shall
27 have a written transfer agreement with a local accredited or licensed
28acute general care hospital.

29(B) A primary care clinic described in subparagraph (A) is
30exempt from the requirements of subparagraph (A) if it submits
31to the department any competent evidence that documents its
32attempts to obtain a written transfer agreement from at least two
33local hospitals that have elected to not enter into a transfer
34agreement with that primary care clinic. If the primary care clinic
35determines that there are not two hospitals that are reasonably
36accessible by road travel for purposes of providing patients with
37emergency medical care, the primary care clinic shall only be
38required to submit competent evidence to the department that
39documents its attempt to obtain a written transfer agreement from
40one local hospital.

P5    1(C) For the purposes of this section, “competent evidence”
2means evidence that is relevant and of such a nature that it can be
3received by a court of law, and includes, but is not limited to, an
4affidavit of someone with the legal authority to bind the clinic
5operation.

end delete
begin insert

6(b) (1) A primary care clinic shall send with each patient at
7the time of transfer, or in the case of an emergency, as promptly
8as possible, copies of all medical records related to the patient’s
9transfer. To the extent practicable and applicable to the patient’s
10transfer, the medical records shall include current medical
11findings, diagnoses, laboratory results, medications provided prior
12to transfer, a brief summary of the course of treatment provided
13prior to transfer, ambulation status, nursing and dietary
14information, name and contact information for the treating
15physician at the clinic, and as appropriate, pertinent administrative
16and demographic information related to the patient, including
17name and date of birth.

end insert
begin insert

18(2) The requirements in paragraph (1) shall not apply if the
19primary care clinic has entered into a written transfer agreement
20with a local hospital that provides for the transfer of medical
21records.

end insert
begin delete

24 22(D)

end delete

23begin insert(c)end insert An alternative birth center that is licensed under this chapter
24as a primary care clinic, as a condition of licensure, shall be
25required to maintain a written transfer agreement with a local
26hospital. The transfer agreement shall include provisions for
27communication and transportation to meet medical emergencies.
28Essential personal, health, and medical information shall either
29accompany the patient upon transfer or be transmitted immediately
30by telephone to the receiving facility. This section does not modify
31or supersede the requirements imposed on alternative birth centers
32described in Section 1204.3.

begin delete

33(b) This section does not require a primary care clinic to have
34a hospital transfer agreement with a nearby hospital, if that clinic
35provides only the following types of analgesia and sedation
36services:

end delete
begin delete

37(1) Local anesthesia.

end delete
begin delete

38(2) Peripheral nerve blocks.

end delete
begin delete

39(3) A combination of both local anesthesia and peripheral nerve
40blocks.

end delete
begin delete

P6    1(4) Conscious sedation, as defined in Section 1647.1 of the
2Business and Professions Code.

end delete
begin delete

5 3(c) This section shall become operative on January 1, 2018.

end delete
begin insert

4(d)

end insert

CORRECTIONS:

Text--Page 6.




O

Corrected 8-25-15—See last page.     96