BILL ANALYSIS                                                                                                                                                                                                    






                                 SENATE HEALTH
                               COMMITTEE ANALYSIS
                        Senator Elaine K. Alquist, Chair


          BILL NO:       AB 1863                                      
          A
          AUTHOR:        Gaines                                       
          B
          AMENDED:       As Introduced                               
          HEARING DATE:  June 9, 2010
          REFERRAL:      Environmental Quality                        
          1
          CONSULTANT:                                                 
          8
          Hansel/                                                     
          6
                                                                       
                                         3
                                        
                                     SUBJECT
                                         
                      Diesel generators: health facilities

                                     SUMMARY  

          Extends until January 1, 2016 existing requirements that  
          health facilities test diesel backup generators in  
          accordance with standards set by The Joint Commission.


                             CHANGES TO EXISTING LAW  

          Existing law:
          Provides for the licensure of health care facilities,  
          including hospitals, skilled nursing facilities, and  
          intermediate care facilities, by the Department of Public  
          Health (DPH).

          Provides, through regulation, that specified health  
          facilities maintain backup generators to provide emergency  
          lighting and power supplies in case of a power failure.

          Until January 1, 2011, requires health facilities to meet  
          standards that are based on those set by The Joint  
          Commission for testing of backup diesel generators.  These  
                                                         Continued---



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          standards generally require health facilities to test each  
          of their backup generators once per month in accordance  
          with specified procedures.

          Requires health facilities to submit data collected about  
          diesel backup generator operation to DPH, upon request.

          Requires air pollution control districts to enforce rules  
          and regulations necessary to achieve and maintain  
          compliance by emission sources with state and federal  
          ambient air quality standards.

          Limits, under existing regulations, the maximum number of  
          hours emergency backup generators may be operated for  
          purposes of maintenance and testing of the generators.

          This bill:
          Extends until January 1, 2016 existing requirements that  
          health facilities comply with standards set by The Joint  
          Commission for testing diesel backup generators and submit  
          to the Department of Public Health (DPH), upon request,  
          related data collected about generator operation.


                                  FISCAL IMPACT  

          According to the Assembly Appropriations Committee, there  
          would be no direct fiscal impact associated with requiring  
          hospitals to continue to meet current standards for testing  
          of backup generators.

                            BACKGROUND AND DISCUSSION  

          Health facilities are required to maintain backup  
          generators to provide emergency lighting and power supplies  
          in case of a power failure.  In 2003, the California  
          Hospital 
          Association sponsored AB 390 (Montanez), Chapter 676,  
          Statutes of 2003, to address concerns that hospitals were  
          over-testing their diesel backup generators, resulting in  
          unnecessary pollution.  Prior to 2003, the requirements for  
          testing generators in California health facilities were  
          contained in 25-year old regulations, which required a  
          weekly or biweekly one-half hour test of generators.   
          Following hurricane Katrina, The Joint Commission, the  




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          nation's largest health care accrediting entity, revised  
          its diesel testing standards.  The Joint Commission  
          determined that monthly testing under certain specified  
          duration and load conditions was adequate.  

          AB 390 aligned California law with The Joint Commission  
          standards and established a sunset date for the new  
          standards of January 1, 2009.  AB 2216 (Gaines), Chapter  
          232, Statutes of 2008, extended the AB 390 sunset date to  
          January 1, 2011, with the expectation that the Department  
          of Health Services (now DPH) would adopt regulations to  
          update its standards by then.  DPH now indicates it will be  
          2016 before the regulations are adopted. 

          Health facilities subject to testing requirements for  
          backup generators include acute care hospitals, acute  
          psychiatric hospitals, skilled nursing facilities,  
          intermediate care facilities, special hospitals,  
          intermediate care facilities for the developmentally  
          disabled, and nursing facilities.

          Health effects of diesel engine emissions 
          Diesel engines emit a complex mixture of air pollutants,  
          including particulate matter.  In 1998, California Air  
          Resource Board (CARB) identified diesel particulate matter  
          as a toxic air contaminant based on its potential to cause  
          cancer and other adverse health effects.  In addition to  
          particulate matter, emissions from diesel engines include  
          over 40 other cancer-causing substances.

          Diesel exhaust has acute and chronic effects on  
          respiratory, neurological, and immune systems, especially  
          for vulnerable groups such as children and the elderly.   
          People who are ill, including hospital patients, are at  
          higher risk of injury and illness due to exposure to diesel  
          exhaust.
          Regulations of the California Air Resources Board (CARB)  
          limit the maximum number of hours emergency backup  
          generators may be operated for purposes of maintenance and  
          testing.  The number of allowed hours varies based on the  
          age, size, and emission rate of the generator.  Health care  
          facilities are subject to minimum testing requirements as a  
          condition of licensure, but are also subject to the CARB  
          limits on nonemergency operation.





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          Prior legislation
          AB 390 ( Montanez), Chapter 676, Statutes of 2003, required  
          health facilities, until January 1, 2009, to test their  
          diesel backup generators according to standards set by The  
          Joint Commission. Provides that, during a week when the  
          diesel backup generator is not being tested, the generator  
          must be started, with or without a load, at least once and  
          operated for the length of time it takes the coolant  
          temperature to stabilize.

          AB 2216 (Gaines), Chapter 232, Statutes of 2008, extended  
          until January 1, 2011, the requirement that health  
          facilities meet the most recent standards set by The Joint  
          Commission for testing of backup diesel generators.  The  
          bill additionally deleted the requirement that health  
          facility diesel backup generators be started during weeks  
          when the generator is not being tested.

          Arguments in support
          The California Hospital Association (CHA) states that,  
          before the enactment of AB 390 in 2003, testing  
          requirements for backup generators were contained in  
          25-year old regulations that did not adequately address air  
          quality impacts.  Because DPH (formerly the Department of  
          Health Services) had not updated the regulations, hospitals  
          were being fined for air quality violations.  AB 1863  
          merely extends the sunset date on the newer standards for  
          testing, as contained in AB 390 and modified by AB 2216, in  
          order to allow DPH additional time to update its  
          regulations in this area.

          The South Coast Air Quality Management District states that  
          AB 1863 will decrease diesel emissions and reduce the toxic  
          risk in areas surrounding hospitals.


                                  PRIOR ACTIONS

           Assembly Health Committee     18-0
          Assembly Appropriations Committee15-0
          Assembly Floor           74-0
                                         
                                    COMMENTS

           1.  Double referral.  This bill has been double referred to  




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          the Environmental Quality Committee.


                                         



                                   POSITIONS  
                                        
          Support:  California Hospital Association (Sponsor)
                 Bay Area Air Quality Management District 
                  South Coast Air Quality Management District (AQMD)

          Oppose:  None received