BILL ANALYSIS Ó SB 145 Page 1 SENATE THIRD READING SB 145 (Pan) As Amended May 5, 2015 Majority vote SENATE VOTE: 21-15 ------------------------------------------------------------------ |Committee |Votes|Ayes |Noes | | | | | | | | | | | | | | | | |----------------+-----+----------------------+--------------------| |Health |13-5 |Bonta, Maienschein, |Chávez, Lackey, | | | |Bonilla, Burke, Chiu, |Patterson, | | | |Gomez, Gonzalez, |Steinorth, Waldron | | | |Roger Hernández, | | | | |Nazarian, Rodriguez, | | | | |Santiago, Thurmond, | | | | |Wood | | | | | | | |----------------+-----+----------------------+--------------------| |Judiciary |8-2 |Mark Stone, Weber, |Wagner, Gallagher | | | |Alejo, Chau, Chiu, | | | | |Cristina Garcia, | | | | |Maienschein, Thurmond | | | | | | | |----------------+-----+----------------------+--------------------| |Appropriations |12-5 |Gomez, Bloom, Bonta, |Bigelow, Chang, | | | |Calderon, Gordon, |Gallagher, Jones, | SB 145 Page 2 | | |Eggman, Eduardo |Wagner | | | |Garcia, Holden, | | | | |Quirk, Rendon, Weber, | | | | |Wood | | | | | | | | | | | | ------------------------------------------------------------------ SUMMARY: Prohibits a general acute care hospital, acute psychiatric hospital, or special hospital from transporting a patient, who in the judgment of the attending physician or other licensed health care professional is at risk of serious injury or death as a result of clinical alcohol intoxication, to any other location including but not limited to, police custody, a correctional facility, or a county jail, unless the patient is medically stable or appropriately transferred to another licensed health facility. Allows the State Department of Public Health (DPH) to determine if a violation of this bill constitutes an immediate jeopardy violation and if so, to assess penalties accordingly. Prohibits anything in this bill from being construed to contradict any other law related to workplace violence prevention, including, but not limited to, workplace violence standards adopted by the Occupational Safety and Health Standards Board. FISCAL EFFECT: According to the Assembly Appropriations Committee, minor and absorbable fiscal impact to DPH, if any. COMMENTS: According to the author, certain hospitals are transferring patients admitted to their ER for acute alcohol poisoning to police departments, corrections facilities, and county jails by calling 911. The author states this bill stops a practice that poses a risk to patient safety, prevents the cost and liabilities of the treating hospitals' emergency patients from being wrongly shifted to the police and correction facilities, and preserves 911 calls for true emergencies. SB 145 Page 3 Blood alcohol concentration. The amount of alcohol in a person's body is measured by the weight of the alcohol in a certain volume of blood. This is called the blood alcohol concentration (BAC). It is illegal to drive with a BAC of 0.08 or higher. A driver also can be arrested with a BAC below 0.08 when a law enforcement officer has probable cause, based on the driver's behavior. BAC may be affected by age, gender, physical condition, amount of food consumed, and any drugs or medication. According to information provided by the author and the Service Employees International Union - United Healthcare Workers West (SEIU-UHW), for the first three months of 2014, 124 emergency calls came from Shasta Regional Medical Center, a Prime Healthcare hospital in Redding, California, which averages to about 41 such calls per month. In comparison, a hospital operated by Dignity Health, about two miles away from Shasta Regional Medical Center, only made 53 emergency calls in the first nine months of 2014, or about six per month. Emergency Medical Treatment and Active Labor Act (EMTALA). EMTALA is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act. It requires hospitals that accept payments from Medicare to provide emergency health care treatment to anyone needing it regardless of citizenship, legal status, or ability to pay. There are no reimbursement provisions. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment. EMTALA applies to "participating hospitals." The statute defines participating hospitals as those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services under the Medicare program. Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals. SB 145 Page 4 EMTALA was passed to address the problem of hospitals refusing to treat indigent, uninsured, or Medicaid patients, or "dumping" these patients by transferring them to county hospitals or other charity hospitals. SEIU-UHW writes there is substantial evidence that one of California's largest hospital chains - Prime Healthcare Services - is inappropriately and dangerously transferring patients admitted to the ER for acute alcohol poisoning to police departments, corrections facilities, and county jails by calling 911. SEIU-UHW states this practice by a for-profit health care provider poses a risk to patient safety and improperly shifts costs and liabilities to the police and corrections facilities. United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP) states that discharging patients with high blood alcohol levels and transferring them to jail in a police car is dangerous to patients. Hospitals are required to provide stabilizing treatment for patients experiencing an emergency medical condition, and in the case of patients who require emergency services because of very high BAC levels, the hospital must stabilize the patient before attempting to make any transfer. UNAC/UHCP concludes any practice or policy of transferring patients prior to stabilization is unconscionable. The California Hospital Association (CHA) is opposed to this bill and states the current version of this bill restates a prohibition that is already in both state and federal law. CHA notes that, initially, this bill would have established prescriptive clinical criteria that would have overridden the judgment of physicians, nurses and other medical staff in California's emergency departments. CHA concludes that the current version of this bill now creates a duplicative mandate on hospitals and authorizes DPH to issue penalties it already SB 145 Page 5 has the authority to impose. Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001559