BILL NUMBER: AB 911	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 23, 2009
	AMENDED IN SENATE  JULY 2, 2009
	AMENDED IN ASSEMBLY  JUNE 1, 2009

INTRODUCED BY   Assembly Member Lieu
   (Coauthors: Assembly Members Eng and Price)

                        FEBRUARY 26, 2009

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


	LEGISLATIVE COUNSEL'S DIGEST


   AB 911, as amended, Lieu. Emergency  rooms: overcrowding.
  room crowding. 
   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
with an emergency department to determine the range of 
overcrowding   crowding  scores, as defined, that
constitute each category of the  overcrowding  
crowding  scale, as  determined by the bill 
 provided  , for its emergency department. The bill would
require every licensed general acute care hospital with an emergency
department to calculate and record  an overcrowding 
 a crowding  score every 4 hours, except as specified, to
assess the crowding condition of its emergency department. The bill
would require, by January 1, 2011, every licensed general acute care
hospital with an emergency department to develop and implement a
full-capacity protocol for each of the categories of the 
overcrowding   crowding  scale.
   This bill would require every licensed general acute care hospital
with an emergency department to file its full-capacity protocol with
the Office of Statewide Health Planning and Development, and to
annually report revisions to its protocol.
   The bill would repeal its provisions on January 1, 2014.
   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.  Section 1257.10 is added to the Health and Safety Code,
to read:
   1257.10.  (a) For purposes of this section,  an
"overcrowding score"  a "crowding score"  means the
score calculated using the equation as follows: 85.8 (total number
of patients within the emergency department/total number of staffed
beds in the emergency department, not to exceed the number of
licensed beds) + 600 (total number of admissions waiting in the
emergency department, including patients awaiting transfer/total
number of acute inpatient hospital beds routinely in use by the
hospital, excluding beds in the newborn nursery, neonatal intensive
care unit, and obstetrics) + 13.4 (total number of patients in the
emergency department admitted to the intensive care unit  , with
a maximum of two  ) + .93 (the longest admit time, in hours,
including transfers) + 5.64 (the wait time for the last patient
waiting the longest in the waiting room, in hours) - 20.  No
crowding scores shall exceed 200 for calculation purposes. 
   (b) For purposes of this section the  "overcrowding
  "crowding  scale" means a range of 
overcrowding   crowding  scores that are divided
into  the following categories:   six categories
of which level one will be the lowest level of crowding and level
six will be the highest.  
   (1) Not busy.  
   (2) Busy.  
   (3) Extremely busy.  
   (4) Overcrowded.  
   (5) Severely overcrowded.  
   (6) Dangerously overcrowded. 
   (c) Every licensed general acute care hospital with an emergency
department shall determine the range of  overcrowding
  crowding  scores that constitute each category of
the  overcrowding   crowding  scale for
its emergency department.
   (d)  Every   (1)     Except
as otherwise provided in this subdivision, every  licensed
general acute care hospital with an emergency department shall
calculate, and record,  an overcrowding score  
a crowding score a minimum of  every four hours to assess the
crowding condition of its emergency department. 
   (e) (1) 
    (2)    If, after calculating and recording
 an overcrowding score pursuant to subdivision (d) 
 a crowding score  , a licensed general acute care hospital
does not have  an overcrowding score over 60   a
crowding score in level four or higher  for the previous 30
days, it may calculate and record  an overcrowding 
 a crowding  score every eight hours rather than every four
 hours. 
    (2)     If a licensed
general acute care hospital calculating and   hours. If
the licensed general acute care hospital calculating and 
recording  an overcrowding   a crowding 
score every eight hours  pursuant to this subdivision scores
over 60   records a score in level four or higher 
, it shall again calculate  and record an overcrowding score
every four hours pursuant to subdivision (d).   and
record a crowding score every four hours.  
   (3) Any hospital that has an emergency department census of less
than 12,000 visits annually shall calculate and record the crowding
score daily between 4 p.m. and 8 p.m.  
   (f) 
    (e)  Every licensed general acute care hospital with an
emergency department 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   crowding  scale that addresses all
of the following factors,  except that if any of these
factors do not occur at the hospital, the hospital may state in its
protocol that the factor is not applicable:   as
applicable: 
   (1) Notification of hospital administrators, nursing staff,
medical staff, and ancillary services of category changes on the
 overcrowding   crowding  scale. 
   (2) Bed utilization.  
   (3) Diversion.  
   (4) Elective admissions.  
   (5) Transfers.  
   (6) Triage.  
   (7) Responsibilities of inpatient medical staff and specialty
 
   (2) Hospital operations, including bed utilization, transfers,
elective admissions, discharges, supplies, and additional staffing.
 
   (3) Emergency department operations, including diversion, triage,
and alternative care sites. 
    (4)     Planned response, whether the
response can be enforced by the hospital or not, 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.  
   (g) 
    (f)  Every licensed general acute care hospital 
with an emergency department  shall file its full-capacity
protocol with the Office of Statewide Health Planning and Development
and shall annually report any revisions to its protocol. 
   (h) 
    (g)  This section shall remain in effect only until
January 1, 2014, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2014, deletes or
extends that date.
  SEC. 2.  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.