BILL NUMBER: AB 271 CHAPTERED 10/10/99 CHAPTER 944 FILED WITH SECRETARY OF STATE OCTOBER 10, 1999 APPROVED BY GOVERNOR OCTOBER 10, 1999 PASSED THE ASSEMBLY SEPTEMBER 10, 1999 PASSED THE SENATE SEPTEMBER 8, 1999 AMENDED IN SENATE SEPTEMBER 3, 1999 AMENDED IN SENATE AUGUST 25, 1999 AMENDED IN SENATE JULY 1, 1999 AMENDED IN SENATE JUNE 23, 1999 AMENDED IN ASSEMBLY MAY 6, 1999 AMENDED IN ASSEMBLY MARCH 17, 1999 INTRODUCED BY Assembly Member Gallegos FEBRUARY 3, 1999 An act to add Sections 2216.1, 2216.2, and 2240 to the Business and Professions Code, and to amend Section 1248.15 of the Health and Safety Code, relating to medical care. LEGISLATIVE COUNSEL'S DIGEST AB 271, Gallegos. Health care. Existing law requires reports regarding personal injury judgments and settlements involving health care providers, and other reports of possible incompetence by health care providers. This bill would enact the Cosmetic and Outpatient Surgery Patient Protection Act. This act would require any physician and surgeon who performs a scheduled medical procedure outside of a general acute care hospital that results in the death or transfer to a hospital or emergency center for medical treatment for a period exceeding 24 hours, of any patient on whom that medical treatment was performed by the physician and surgeon, or by a person acting under the physician and surgeon's orders or supervision, to report, in writing, that occurrence to the Medical Board of California within 15 days after the occurrence, as specified. It would provide that the failure to comply with this requirement constitutes unprofessional conduct. The bill would also provide that, on and after July 1, 2000, it is unprofessional conduct for a physician and surgeon to perform procedures in any outpatient setting unless the setting has a minimum of 2 staff persons on the premises, one of whom is either a licensed physician and surgeon or a licensed health care professional with current certification in advanced cardiac life support, as long as a patient is present who has not been discharged from supervised care. It would further provide that it is unprofessional conduct for a physician and surgeon to fail to provide adequate security by liability insurance or by participation in an interindemnity trust for claims by patients arising out of surgical procedures performed outside of a general acute care hospital. Existing law provides for the licensure and regulation of health facilities. Existing law provides for the accreditation of outpatient facilities subject to the supervision of the Division of Licensing of the Medical Board of California. Existing law regulates those facilities. Existing law requires outpatient facilities to submit an emergency plan to accrediting agencies. This bill would require outpatient settings to post the certificate of accreditation in a location readily visible to patients and staff, and to post the name and telephone number of the accrediting agency with instructions on the submission of complaints in a location readily visible to patients and staff. It would require outpatient settings to have a written discharge criteria. The bill would also require outpatient settings to have a minimum of 2 staff persons on the premises, one of whom shall be either a licensed physician and surgeon or a licensed health care professional with current certification in advanced cardiac life support, as long as a patient is present who has not been discharged from supervised care. It would provide that transfer to an unlicensed setting of a patient who does not meet the discharge criteria shall constitute unprofessional conduct. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. This act shall be known and may be cited as the Cosmetic and Outpatient Surgery Patient Protection Act. SEC. 2. Section 2216.1 is added to the Business and Professions Code, to read: 2216.1. On and after July 1, 2000, it is unprofessional conduct for a physician and surgeon to perform procedures in any outpatient setting except in compliance with Section 2216, unless the setting has a minimum of two staff persons on the premises, one of whom shall either be a licensed physician and surgeon or a licensed health care professional with current certification in advanced cardiac life support (ACLS), as long as a patient is present who has not been discharged from supervised care. SEC. 3. Section 2216.2 is added to the Business and Professions Code, to read: 2216.2. (a) It is unprofessional conduct for a physician and surgeon to fail to provide adequate security by liability insurance, or by participation in an interindemnity trust, for claims by patients arising out of surgical procedures performed outside of a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code. (b) For purposes of this section, the board shall determine what constitutes adequate security. (c) Nothing in this section shall require an insurer admitted to transact liability insurance in this state to provide coverage to a physician and surgeon. (d) The security required by this section shall be acceptable only if provided by any one of the following: (1) An insurer admitted pursuant to Section 700 of the Insurance Code to transact liability insurance in this state. (2) An insurer that appears on the list of eligible surplus line insurers pursuant to subdivision (f) of Section 1765.1 of the Insurance Code. (3) A cooperative corporation authorized by Section 1280.7 of the Insurance Code. SEC. 4. Section 2240 is added to the Business and Professions Code, to read: 2240. (a) Any physician and surgeon who performs a scheduled medical procedure outside of a general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, that results in the death of any patient on whom that medical treatment was performed by the physician and surgeon, or by a person acting under the physician and surgeon's orders or supervision, shall report, in writing on a form prescribed by the board, that occurrence to the board within 15 days after the occurrence. (b) Any physician and surgeon who performs a scheduled medical procedure outside of a general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, that results in the transfer to a hospital or emergency center for medical treatment for a period exceeding 24 hours, of any patient on whom that medical treatment was performed by the physician and surgeon, or by a person acting under the physician and surgeon's orders or supervision, shall report, in writing, on a form prescribed by the board that occurrence, within 15 days after the occurrence. The form shall contain all of the following information: (1) Name of the patient's physician in the outpatient setting. (2) Name of the physician with hospital privileges. (3) Name of the patient and patient identifying information. (4) Name of the hospital or emergency center where the patient was transferred. (5) Type of outpatient procedures being performed. (6) Events triggering the transfer. (7) Duration of the hospital stay. (8) Final disposition or status, if not released from the hospital, of the patient. (9) Physician's practice specialty and ABMS certification, if applicable. (c) The form described in subdivision (b) shall be constructed in a format to enable the physician and surgeon to transmit the information in paragraphs (5) to (9), inclusive, to the board in a manner that the physician and surgeon and the patient are anonymous and their identifying information is not transmitted to the board. The entire form containing information described in paragraphs (1) to (9), inclusive, shall be placed in the patient's medical record. (d) The board shall aggregate the data and publish an annual report on the information collected pursuant to subdivisions (a) and (b). (e) On and after January 1, 2002, the data required in subdivision (b) shall be sent to the Office of Statewide Health Planning and Development (OSHPD) instead of the board. OSHPD may revise the reporting requirements to fit state and national standards, as applicable. The board shall work with OSHPD in developing the reporting mechanism to satisfy the data collection requirements of this section. (f) The failure to comply with this section constitutes unprofessional conduct. SEC. 5. Section 1248.15 of the Health and Safety Code is amended to read: 1248.15. (a) The division shall adopt standards for accreditation and, in approving accreditation agencies to perform accreditation of outpatient settings, shall ensure that the certification program shall, at a minimum, include standards for the following aspects of the settings' operations: (1) Outpatient setting allied health staff shall be licensed or certified to the extent required by state or federal law. (2) (A) Outpatient settings shall have a system for facility safety and emergency training requirements. (B) There shall be onsite equipment, medication, and trained personnel to facilitate handling of services sought or provided and to facilitate handling of any medical emergency that may arise in connection with services sought or provided. (C) In order for procedures to be performed in an outpatient setting as defined in Section 1248, the outpatient setting shall do one of the following: (i) Have a written transfer agreement with a local accredited or licensed acute care hospital, approved by the facility's medical staff. (ii) Permit surgery only by a licensee who has admitting privileges at a local accredited or licensed acute care hospital, with the exception that licensees who may be precluded from having admitting privileges by their professional classification or other administrative limitations, shall have a written transfer agreement with licensees who have admitting privileges at local accredited or licensed acute care hospitals. (iii) Submit for approval by an accrediting agency a detailed procedural plan for handling medical emergencies that shall be reviewed at the time of accreditation. No reasonable plan shall be disapproved by the accrediting agency. (D) All physicians and surgeons transferring patients from an outpatient setting shall agree to cooperate with the medical staff peer review process on the transferred case, the results of which shall be referred back to the outpatient setting, if deemed appropriate by the medical staff peer review committee. If the medical staff of the acute care facility determines that inappropriate care was delivered at the outpatient setting, the acute care facility's peer review outcome shall be reported, as appropriate, to the accrediting body, the Health Care Financing Administration, the State Department of Health Services, and the appropriate licensing authority. (3) The outpatient setting shall permit surgery by a dentist acting within his or her scope of practice under Chapter 4 (commencing with Section 1600) of the Business and Professions Code or physician and surgeon, osteopathic physician and surgeon, or podiatrist acting within his or her scope of practice under Chapter 5 (commencing with Section 2000) of the Business and Professions Code or the Osteopathic Initiative Act. The outpatient setting may, in its discretion, permit anesthesia service by a certified registered nurse anesthetist acting within his or her scope of practice under Article 7 (commencing with Section 2825) of Chapter 6 of the Business and Professions Code. (4) Outpatient settings shall have a system for maintaining clinical records. (5) Outpatient settings shall have a system for patient care and monitoring procedures. (6) (A) Outpatient settings shall have a system for quality assessment and improvement. (B) Members of the medical staff and other practitioners who are granted clinical privileges shall be professionally qualified and appropriately credentialed for the performance of privileges granted. The outpatient setting shall grant privileges in accordance with recommendations from qualified health professionals, and credentialing standards established by the outpatient setting. (C) Clinical privileges shall be periodically reappraised by the outpatient setting. The scope of procedures performed in the outpatient setting shall be periodically reviewed and amended as appropriate. (7) Outpatient settings regulated by this chapter that have multiple service locations governed by the same standards may elect to have all service sites surveyed on any accreditation survey. Organizations that do not elect to have all sites surveyed shall have a sample, not to exceed 20 percent of all service sites, surveyed. The actual sample size shall be determined by the division. The accreditation agency shall determine the location of the sites to be surveyed. Outpatient settings that have five or fewer sites shall have at least one site surveyed. When an organization that elects to have a sample of sites surveyed is approved for accreditation, all of the organizations' sites shall be automatically accredited. (8) Outpatient settings shall post the certificate of accreditation in a location readily visible to patients and staff. (9) Outpatient settings shall post the name and telephone number of the accrediting agency with instructions on the submission of complaints in a location readily visible to patients and staff. (10) Outpatient settings shall have a written discharge criteria. (b) Outpatient settings shall have a minimum of two staff persons on the premises, one of whom shall either be a licensed physician and surgeon or a licensed health care professional with current certification in advanced cardiac life support (ACLS), as long as a patient is present who has not been discharged from supervised care. Transfer to an unlicensed setting of a patient who does not meet the discharge criteria adopted pursuant to paragraph (10) of subdivision (a) shall constitute unprofessional conduct. (c) An accreditation agency may include additional standards in its determination to accredit outpatient settings if these are approved by the division to protect the public health and safety. (d) No accreditation standard adopted or approved by the division, and no standard included in any certification program of any accreditation agency approved by the division, shall serve to limit the ability of any allied health care practitioner to provide services within his or her full scope of practice. Notwithstanding this or any other provision of law, each outpatient setting may limit the privileges, or determine the privileges, within the appropriate scope of practice, that will be afforded to physicians and allied health care practitioners who practice at the facility, in accordance with credentialing standards established by the outpatient setting in compliance with this chapter. Privileges may not be arbitrarily restricted based on category of licensure.