BILL ANALYSIS
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THIRD READING
Bill No: AB 911
Author: Lieu (D), et al
Amended: 9/8/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-1, 7/15/09
AYES: Alquist, Strickland, Cedillo, Cox, DeSaulnier, Leno,
Negrete McLeod, Pavley, Wolk
NOES: Aanestad
NO VOTE RECORDED: Maldonado
SENATE APPROPRIATIONS COMMITTEE : 10-0, 8/17/09
AYES: Kehoe, Cox, Corbett, Denham, Leno, Oropeza, Price,
Runner, Walters, Wolk
NO VOTE RECORDED: Hancock, Wyland, Yee
ASSEMBLY FLOOR : 45-31, 6/3/09 - See last page for vote
SUBJECT : Emergency room crowding
SOURCE : California Chapter of the American College of
Emergency
Physicians
DIGEST : This bill requires all hospitals that operate
emergency departments to assess the condition of its
emergency department by determining a crowding score of one
to six, with one being the least crowded and six being the
most crowded. The bill requires hospitals to develop and
file full capacity protocols that correspond to the
CONTINUED
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crowding score with the Office of Statewide Health Planning
and Development.
Senate Floor Amendments of 9/4/09 (1) adjusted the formula
for determining the rang of overcrowding scores to more
appropriated inputs, according to initial field testing
results of formula, and (2) generalized medical personnel
involved in planned response to levels of overcrowding form
inpatient medical staff and specialty service operations to
organized medical staff for rounds, discharges,
coordination with the emergency department and emergency
consults for emergency department patients.
ANALYSIS :
Existing law:
1. Provides for the licensing and regulation of health
facilities, including general acute care hospitals,
acute psychiatric hospitals, and special hospitals by
the Department of Public Health (DPH).
2. Establishes the Office of Statewide Health Planning and
Development (OSHPD) to analyze California's health care
infrastructure, provide information about health care
outcomes, assure the safety of buildings used in
providing health care, insure loans to encourage the
development of health care facilities, and facilitate
development of sustained capacity for communities to
address local health care issues.
This bill, except as otherwise provided, requires every
licensed general acute care hospital with an emergency
department to calculate and record a crowding score a
minimum of every four hours to assess the crowding
condition of the emergency department.
This bill defines "crowding score" as a score calculated to
measure emergency department and hospital overcrowding,
with an equation, as specified, using the following
variables:
1. Number of patients within the emergency department.
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2. Total number of beds staffed in the emergency
department, not to exceed the number of licensed beds.
3. Total number of admissions waiting in the emergency
department, including patients awaiting transfer.
4. 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.
5. Total number of patients in the emergency department
admitted to the intensive care unit.
6. The longest admit time, in hours, including, transfers.
7. The wait time for the last patient waiting the longest
in the waiting room, in hours.
This bill defines "crowding scale" to mean a range of
crowding scores that are divided into six categories of
which level one will be the lowest level and level six the
highest.
This bill requires every licensed general acute care
hospital, as defined in subdivision (a) or Section 250 of
the Health and Safety Code with an emergency department to
determine the range of crowding scores that constitute each
category of the crowding scale for its emergency
department.
This bill requires by January 1, 2011, every licensed
general acute care hospital to develop and implement, in
consultation with its emergency department staff, a full
capacity protocol for each of the categories of the
crowding scale that addresses the following factors, where
applicable.
1. Notification of hospital administrators, nursing staff,
medical staff, and ancillary services of category
changes on the scale.
2. Hospital operations, including bed utilization,
transfers, elective admissions, discharges, supplies,
and additional staffing.
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3. Emergency department operations, including diversion,
triage, and alternative care sites.
4. Planned response, if the organized medical staff by the
hospital for rounds, discharges, coordination with the
emergency department patients.
The bill provides that any hospital that has an emergency
department census of less than 14,000 visits annually shall
calculate and record the crowding score daily between 4:00
p.m. and 8:00 p.m.
This bill requires every licensed general acute care
hospital with an emergency department to file its
full-capacity protocols with OSHPD, and annually report any
revisions to its protocols.
This bill allows licensed general acute care hospitals with
emergency departments that do not have crowding score in
level four or higher for the pervious 30 days to calculate
and record a crowding score every eight hours instead of
four hours, if the licensed general acute care hospital
calculating a crowding score every eight hours records a
score in level four or higher to again calculate and record
an crowding score every four hours.
This bill sunsets its provisions on January 1, 2014.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11
2011-12 Fund
CDPH inspection Minor and
absorbable Special*
OSHPD file collection Minor and
absorbable Special**
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And storage
Publicly-founded health Unknown,
potentially significant General/
Program impact costs or savingsFederal
*State Department of Public Health Licensing and
Certification Program Fund
**California Health Data and Planning Fund
SUPPORT : (Verified 9/8/09)
CA Chapter of the American College of Emergency Physicians
(source)
California Academy of Physician Assistants
California Medical Association
California Professional Firefighters
ARGUMENTS IN SUPPORT : The American College of Emergency
Physicians, State Chapter of California, sponsor of this
bill states that, in hospitals that have utilized the
approach that this bill proposes, the scoring and assessing
of emergency departments as well as the development of a
plan to best utilize hospital space and personnel at each
level of crowding, has resulted in reduced overcrowding,
decreased wait times, and improved patient care.
The California Medical Association (CMA) states that this
bill establishes plans for times when hospitals reach
capacity, which is essential to providing consistent and
quality emergency care. CMA further states that this bill
also provides a way to increase knowledge of the
overcrowding problems caused by hospital closures and
consolidations.
ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Blumenfield, Brownley,
Buchanan, Charles Calderon, Carter, Chesbro, Coto, Davis,
De La Torre, De Leon, Eng, Evans, Feuer, Fuentes,
Furutani, Hall, Hayashi, Hernandez, Hill, Huffman, Jones,
Krekorian, Lieu, Bonnie Lowenthal, Ma, Mendoza, Monning,
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Nava, John A. Perez, V. Manuel Perez, Portantino, Price,
Ruskin, Salas, Saldana, Skinner, Solorio, Swanson,
Torlakson, Torres, Torrico, Bass
NOES: Adams, Anderson, Bill Berryhill, Tom Berryhill,
Blakeslee, Conway, Cook, DeVore, Duvall, Emmerson,
Fletcher, Fuller, Gaines, Galgiani, Garrick, Gilmore,
Hagman, Harkey, Huber, Jeffries, Knight, Logue, Miller,
Nestande, Niello, Nielsen, Silva, Smyth, Audra
Strickland, Tran, Villines
NO VOTE RECORDED: Block, Caballero, Fong, Yamada
RJG:do 9/8/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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