BILL ANALYSIS                                                                                                                                                                                                    Ó

                                                                     SB 145

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          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,   |


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          |                |     |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.


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          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.


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          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  


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          has the authority to impose.

          Analysis Prepared by:                                             
                          Lara Flynn / HEALTH / (916) 319-2097  FN: