BILL NUMBER: AB 911	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Lieu

                        FEBRUARY 26, 2009

   An act to add Section 1257.10 to the Health and Safety Code,
relating to health facilities.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 911, as introduced, Lieu. Emergency rooms: overcrowding.
   Existing law establishes various programs for the prevention of
disease and the promotion of health to be administered by the State
Department of Public Health, including, but not limited to, the
licensure and regulation of health facilities. Violation of these
provisions is a crime.
   This bill would require every licensed general acute care hospital
to calculate and record a NEDOCS score, as defined, every 3 hours to
assess the crowding condition of its emergency department. The bill
would require, by January 1, 2011, every licensed general acute care
hospital to develop and implement a full-capacity protocol for each
of the categories of the overcrowding scale.
   This bill would require every licensed general acute care hospital
to file its full-capacity protocols with the Office of Statewide
Health Planning and Development, and to annually report revisions to
the protocol.
   By changing the definition of an existing crime, this bill would
impose a state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature hereby finds and declares all of the
following:
   (a) California is last in the nation in the number of emergency
departments available to its residents with 6.16 emergency
departments per 1,000,000 people. Since 1990, this ratio has steadily
declined leading to severe emergency department overcrowding.
   (b) Studies show that the most significant cause of emergency
department overcrowding is the boarding of admitted patients in the
emergency department, not the care of nonurgent patients in the
emergency department.
   (c) Boarding is the practice of keeping patients who require
hospitalization in the emergency department until a hospital bed
becomes available.
   (d) As the emergency department becomes saturated with patients
who no longer require emergency care, the emergency department's
ability to care for all patients, especially those waiting for
evaluation and treatment, is seriously impacted.
   (e) Studies show that patients who were boarded in the emergency
department have a higher overall length of stay and cost of
hospitalization.
   (f) Studies show that patients who are evaluated and treated in
overcrowded emergency departments had higher morbidity and mortality.

   (g) Studies show that critically ill patients boarded in the
emergency department for more than six hours before transfer to an
intensive care unit had an increased hospital length of stay and
higher morbidity and mortality.
   (h) Overcrowded emergency departments have increased ambulance
diversion, which strains emergency medical services and increases
risk to the public health and safety.
   (i) Overcrowded emergency departments have a much reduced capacity
to manage a mass casualty incident or disaster.
  SEC. 2.  Section 1257.10 is added to the Health and Safety Code, to
read:
   1257.10.  (a) For purposes of this section, a "NEDOCS score" means
the score calculated using the equation derived from the National
Emergency Department Overcrowding Study and is as follows: 85.8
(total number of patients within the emergency department/total
number of beds in the emergency department) + 600 (total number of
admissions waiting in the emergency department/total number of
inpatient hospital beds) + 13.4 (total number of patients on
respirators in the emergency department) + .93 (the longest admit
time, in hours) + 5.64 (the wait time for the last patient called
from triage, in hours) - 20.
   (b) For purposes of this section the "overcrowding scale" means
the range of NEDOCS scores that are divided into the following
categories:
   (1) Not busy, which includes NEDOCS scores of 20 and below.
   (2) Busy, which includes NEDOCS scores of 21 to 60, inclusive.
   (3) Extremely busy, which includes NEDOCS scores of 61 to 100,
inclusive.
   (4) Overcrowded, which includes NEDOCS scores of 101 to 140,
inclusive.
   (5) Severely overcrowded, which includes NEDOCS scores of 141 to
180, inclusive.
   (6) Dangerously overcrowded, which includes NEDOCS scores over
180.
   (c) Every licensed general acute care hospital shall calculate,
and record, a NEDOCS score every three hours to assess the crowding
condition of its emergency department.
   (d) Every licensed general acute care hospital shall, by January
1, 2011, develop and implement, in consultation with its emergency
department staff, a full-capacity protocol for each of the categories
of the overcrowding scale that addresses all of the following:
   (1) Notification of hospital administrators, nursing staff,
medical staff, and ancillary services of category changes on the
overcrowding scale.
   (2) Bed utilization.
   (3) Diversion.
   (4) Elective admissions.
   (5) Transfers.
   (6) Triage.
   (7) Responsibilities of inpatient medical staff and specialty
service operations for rounds, discharges, coordination with the
emergency department, and emergency consults for emergency department
patients.
   (8) Hospital unit operations.
   (9) Nursing services.
   (10) Supplies.
   (11) Calling in additional medical, nursing, and ancillary staff.
   (12) Space utilization, including, but not limited to, alternate
care sites.
   (e) Every licensed general acute care hospital shall file its
full-capacity protocols with the Office of Statewide Health Planning
and Development and shall annually report any revisions of those
protocols.
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.