BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1177|
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THIRD READING
Bill No: AB 1177
Author: Gomez (D), Burke (D), and Low (D), et al.
Amended: 9/4/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 7-2, 7/15/15
AYES: Hernandez, Hall, Mitchell, Monning, Pan, Roth, Wolk
NOES: Nguyen, Nielsen
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 51-28, 5/11/15 - See last page for vote
SUBJECT: Primary care clinics: written transfer agreements
SOURCE: Planned Parenthood Affiliates of California
DIGEST: This bill prohibits a primary care clinic,
notwithstanding current regulations or any other law, from being
required to enter into a written transfer agreement with a
nearby hospital as a condition of licensure.
Senate Floor Amendments of 9/4/15 make technical clarifications
suggested by the Department of Public Health (DPH) to more
accurately reflect the terminology of licensed primary care
clinics that are providing services as an alternative birth
center, and also correct a technical drafting error.
Senate Floor Amendments of 8/24/15:
1)Delete provisions that would have required primary care
clinics using anesthesia in specified doses to either have a
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Page 2
written transfer agreement with a local hospital or document
the clinic's attempt to obtain a written transfer agreement
with at least two local hospitals, and deleted related
provisions.
2)Require primary care clinics 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.
3)Require the medical records specified in 2) above, to the
extent practicable and applicable to the patient's transfer,
to include current medical findings, diagnoses, laboratory
results, medications provided prior to transfer, a brief
summary of the course of treatment provided prior to transfer,
ambulation status, nursing and dietary information, name and
contact information for the treating physician at the clinic,
and as appropriate, pertinent administrative and demographic
information related to the patient, including name and date of
birth.
4)Specify that the requirement in 2) above does not apply if the
primary care clinic has entered into a written transfer
agreement with a local hospital that provides for the transfer
of medical records.
ANALYSIS:
Existing law:
1)Licenses and regulates primary care clinics and specialty
clinics by DPH. Primary care clinics are either "community
clinics" or "free clinics," while specialty clinics include
surgical clinics, chronic dialysis clinics, rehabilitation
clinics, and alternative birth centers.
2)Defines "alternative birth center" as a clinic that is not
part of a hospital and that provides comprehensive perinatal
services and delivery care to pregnant women who remain less
than 24 hours at the facility. Alternative birth centers can
be specifically licensed as a specialty clinic, or can be
provided as a permitted service by a licensed primary care
clinic.
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Existing Title 22 regulations:
1)Requires primary care clinics to maintain written transfer
agreements, which include provisions for communication and
transportation, with one or more nearby hospitals and other
inpatient health facilities as appropriate to meet medical
emergencies. Requires essential personal, health and medical
information to either accompany the patient upon transfer or
be transmitted immediately by telephone to the receiving
facility.
2)Permits primary care clinics, except for those providing
abortion or birthing services, to request that DPH waive the
written transfer agreement requirement above. Requires the
clinic to demonstrate to DPH that all nearby hospitals and
other inpatient health facilities, as appropriate to meet
medical emergencies have refused to enter into transfer
agreements.
This bill:
1)Prohibits primary care clinics, notwithstanding a current
regulation or any other law, from being required to enter into
a written transfer agreement with a nearby hospital as a
condition of licensure.
2)Requires primary care clinics 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.
3)Requires the medical records specified in 2) above, to the
extent practicable and applicable to the patient's transfer,
to include current medical findings, diagnoses, laboratory
results, medications provided prior to transfer, a brief
summary of the course of treatment provided prior to transfer,
ambulation status, nursing and dietary information, name and
contact information for the treating physician at the clinic,
and as appropriate, pertinent administrative and demographic
information related to the patient, including name and date of
birth.
4)Specifies that the requirement in 2) above does not apply if
the primary care clinic has entered into a written transfer
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Page 4
agreement with a local hospital that provides for the transfer
of medical records.
5)Requires a primary care clinic that provides services as an
alternative birth center to be required to maintain a written
transfer agreement with a local hospital, and requires this
transfer agreement to include provisions for communication and
transportation to meet medical emergencies. Requires essential
personal and medical information to either accompany the
patient upon transfer or be transmitted immediately by
telephone to the receiving facility.
6)Requires DPH to repeal, no later than July 1, 2016, specified
Title 22 regulations that require primary care clinics to have
a written transfer agreement with a hospital.
Comments
1)Author's statement. According to the author, under current
California law, clinics are obliged to obtain a hospital
transfer agreement (HTA) from a nearby hospital as a condition
of licensure in order to begin performing services. DPH
regulations allow clinics who cannot get an HTA from a nearby
hospital to apply for a waiver to this requirement. However,
clinics that provide abortions or birthing services are not
allowed to apply for a waiver, even if a local hospital won't
agree to enter into an HTA. The author states that this
effectively allows a hospital that does not want to enter into
an HTA to prevent an abortion clinic from opening. The author
notes that if this bill is enacted, this regulation will be
repealed and unenforceable, and will give Californians equal
access to reproductive services and the ability to choose.
2)Hospital transfer agreements. The requirement for a written
transfer agreement between primary care clinics and a local
hospital, which is the subject of this bill, is contained in
the Title 22 regulations governing primary care clinics. There
are also a handful of places where written transfer agreements
are statutorily required, and would not be affected by this
bill. For example, a rural general acute care hospital that
does not provide surgical and anesthesia services is required
to maintain a written transfer agreement with one or more
general acute care hospitals that provide surgical and
anesthesia services. A mobile health care services unit
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(generally speaking, a bus outfitted as a mobile clinic that
is operated by a licensed clinic or hospital) is required to
maintain written transfer agreements that include provisions
for communication with, and transportation to, one or more
nearby hospitals as needed to meet medical emergencies.
Finally, an accredited outpatient surgical setting, which uses
general anesthesia, is required to either have a written
transfer agreement with a hospital, only permit surgery by
physicians who have admitting privileges at a hospital, or
have a "detailed procedural plan for handling medical
emergencies" that is approved by the accrediting agency.
While written transfer agreements can vary by hospital, DPH
provides on its website an example of a transfer agreement
that meets its requirements. This form is two pages long, with
11 itemized requirements, such as a requirement that
transferring institutions send with the patient forms that
include information on the medical course of treatment
followed by the transferring institution and other pertinent
medical, administrative, and social information. Other
requirements include ensuring that the hospital make available
its diagnostic and therapeutic services, and to be accountable
for the recognition of need for social services. The form also
specifies that charges for services performed are to be
collected by the institution rendering services, and that
neither facility has any liability to the other for such
charges.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
SUPPORT: (Verified9/4/15)
Planned Parenthood Affiliates of California (source)
California Family Health Council
Community Action Fund of Planned Parenthood Orange and San
Bernardino Counties
Community Clinic Association of Los Angeles County
Planned Parenthood Action Fund of Santa Barbara, Ventura, and
San Luis Obispo Counties
Planned Parenthood Action Fund of the Pacific Southwest
Planned Parenthood Advocacy Project Los Angeles County
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Planned Parenthood Mar Monte
Planned Parenthood Northern California Action Fund
Planned Parenthood Pasadena and San Gabriel Valley
OPPOSITION: (Verified9/4/15)
California Chapter of the American College of Emergency
Physicians
California Right to Life Committee
Concerned Women for America of California
ARGUMENTS IN SUPPORT: This bill is sponsored by Planned
Parenthood Affiliates of California (PPAC), which states that
this bill deletes an obsolete regulation that restricts abortion
clinics from obtaining an exemption if they cannot enter into a
transfer agreement with a local hospital. PPAC states that the
Legislature vested DPH with the authority to regulate and
license clinics, but by requiring HTAs as a condition of
licensure, DPH has essentially delegated some of its licensure
authority to the hospitals. PPAC states that any hospital
corporation with either a moral objection or a desire to secure
a competitive edge can refuse to sign a transfer agreement and
bring a clinic's license application to a halt. PPAC states that
the existing regulations around the HTA acts like a targeted
restriction on abortion providers, or a TRAP law. Community
clinics that provide abortion services, like Planned Parenthood,
are singled-out and in this case are unable to file for an
exemption from the HTA requirement. According to PPAC, although
California's laws and regulations tend to be progressive around
abortion and comprehensive reproductive health care, this bill
will address some of the last remaining policies that single out
abortion providers.
The California Family Health Council also supports this bill,
stating that this bill expands access to essential sexual and
reproductive health care by removing barriers to primary clinics
from getting licenses to operate.
The Community Clinic Association of Los Angeles County states in
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Page 7
support that the decision of whether to grant a license to a
clinic should rest exclusively with the state and should not
hinge upon securing an agreement with an independent entity
that, for a variety of reasons, may or may not be cooperative.
ARGUMENTS IN OPPOSITION: This bill is opposed by Concerned
Women for America of California (CWA), which states that
operators of abortion clinics would benefit from the passage of
this bill since abortion facilities would be able to open
without the requirement of having to get a transfer agreement
with a local hospital. CWA states that in El Centro, a Planned
Parenthood recently opened, and that after months of public
outcry by thousands of Imperial County residents to dissolve a
transfer agreement between El Centro Regional Medical Center,
suddenly this bill makes its way through the California
Legislature. CWA states that women will be endangered further if
abortion facilities are not required to have a transfer
agreement with a local hospital, and that loosening the reins on
abortion clinics will lead to serious injury and death for
women. The California Right to Life Committee (CRLC) also
opposes this bill, stating that primary care clinics are a
benefit to their communities, so one would assume that the
medical personnel would want to include transfer agreements as
an important and valid component of licensure. CRLC states that
it has read about serious situations developing when such
facilities have not had such transfer agreements.
The California Chapter of the American College of Emergency
Physicians (California ACEP) states that they are opposed unless
amended to make all clinics equal by allowing community clinics
providing birthing or abortion services to apply for an
exemption from the written transfer agreement requirement.
According to California ACEP, while it supports the goal of
removing barriers to licensing for clinics offering reproductive
services, it is opposed to the solution offered in this bill of
eliminating transfer agreements with a local hospital for all
community clinics as a condition of licensure. California ACEP
states that transfer agreements between community clinics and
one or more nearby hospitals are important to ensuring that
clinics can adequately coordinate care for patients facing
medical emergencies. California ACEP states that while it is of
course true that a patient can always be transported to an
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emergency department by ambulance without accompanying medical
information, it is always better for the patient if the treating
emergency physician has access to personal, health, and medical
information. California ACEP notes that under current law,
clinics may ask DPH to waive the transfer agreement requirement,
as long as those clinics do not provide birthing or abortion
services. Rather than eliminate transfer agreements for all
community clinics, California ACEP states that this bill should
be amended to make all clinics equal by allowing community
clinics providing birthing or abortion services to apply for an
exemption.
ASSEMBLY FLOOR: 51-28, 5/11/15
AYES: Alejo, Bloom, Bonilla, Bonta, Brown, Burke, Calderon,
Campos, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Daly, Dodd,
Eggman, Frazier, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Gray, Roger Hernández,
Holden, Irwin, Jones-Sawyer, Levine, Lopez, Low, Maienschein,
McCarty, Medina, Mullin, Nazarian, O'Donnell, Perea, Quirk,
Rendon, Ridley-Thomas, Rodriguez, Santiago, Mark Stone,
Thurmond, Ting, Weber, Williams, Wood
NOES: Achadjian, Travis Allen, Baker, Bigelow, Brough, Chang,
Chávez, Dahle, Beth Gaines, Gallagher, Grove, Hadley, Harper,
Jones, Kim, Lackey, Linder, Mathis, Mayes, Melendez,
Obernolte, Olsen, Patterson, Salas, Steinorth, Wagner,
Waldron, Wilk
NO VOTE RECORDED: Atkins
Prepared by:Vince Marchand / HEALTH /
9/8/15 16:19:41
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