BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2153|
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THIRD READING
Bill No: AB 2153
Author: Lieu (D)
Amended: As introduced
Vote: 21
SENATE HEALTH COMMITTEE : 7-1, 6/16/10
AYES: Alquist, Strickland, Cedillo, Leno, Negrete McLeod,
Pavley, Romero
NOES: Aanestad
NO VOTE RECORDED: Cox
SENATE APPROPRIATIONS COMMITTEE : 7-3, 6/28/10
AYES: Kehoe, Alquist, Corbett, Leno, Price, Wolk, Yee
NOES: Cox, Denham, Walters
NO VOTE RECORDED: Wyland
ASSEMBLY FLOOR : 68-2, 4/26/10 - See last page for vote
SUBJECT : Emergency room crowding
SOURCE : American College of Emergency Physicians, CA
Chapter
DIGEST : This bill requires every licensed general acute
care hospital with an emergency department (ED) to assess
ED overcrowding every four or eight hours, as well as
develop and implement full-capacity protocols that address
staffing, procedures, and operations when an ED is
overcrowded.
CONTINUED
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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. Defines a general acute care hospital as a health
facility having a duly constituted governing body with
overall administrative and professional responsibility
and an organized medical staff that provides 24-hour
inpatient care, including the following basic services:
a) medical; b) nursing; c) surgical; d) anesthesia; e)
laboratory; f) radiology; g) pharmacy; and, h) dietary
services.
3. Permits hospitals to provide emergency medical services,
under specified circumstances.
4. 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:
1. Defines "crowding score" as the score calculated to
measure ED and hospital overcrowding, with an equation,
as specified, using the following variables:
A. Total number of patients within the ED.
B. Total number of staffed beds in the ED, not to
exceed the number of licensed beds.
C. Total number of admissions waiting in the ED,
including patients awaiting transfer.
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D. 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.
E. Total number of patients in the ED admitted to
the intensive care-critical care unit.
F. The longest admit time, in hours, including
transfers.
G. The wait time for the last patient waiting the
longest in the waiting room, in hours.
2. Defines "crowding scale" as the range of crowding scores
that are divided into six categories of which level one
represents the lowest level of crowding and level six
represents the highest.
3. Requires every licensed general acute care hospital that
operates an ED to determine a range of crowding scores
that constitutes each category of the crowding scale for
its ED.
4. Requires every licensed general acute care hospital that
operates an ED to assess the condition of its ED by
calculating and recording a crowding score a minimum of
every four hours or, if after calculating and recording
a crowding score less than level four for the previous
30 days, calculating and recording a crowding score a
minimum of every eight hours.
5. Provides that every licensed general acute care hospital
that has an ED and a census of 14,000 visits annually to
calculate and record the crowding score daily between
4:00 p.m. and 8:00 p.m.
6. Requires, by January 1, 2012, every licensed general
acute care hospital that operates an ED, to develop and
implement, in consultation with its ED staff, a
full-capacity protocol for each of the categories of the
crowding scale that addresses all of the following
factors:
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A. Notification of hospital administrators, nursing
staff, medical staff, and ancillary services of
category changes on the scale.
B. Hospital operations, including bed utilization,
transfers, elective admissions, discharges,
supplies, and additional staffing.
C. Emergency department operations, including
diversion, triage, and alternative care sites.
D. Planned response, if the organized medical staff
by the hospital for rounds discharges, coordination
with the ED and emergency consults for ED patients.
7. Requires every licensed general acute care hospital that
operates an ED to file its full-capacity protocols with
the OSHPD, and annually report any revisions to its
protocols.
8. Sunsets the provisions of this bill on January 1, 2015.
Background
According to a 2007 Institute of Medicine report,
"Hospital-Based Emergency Care: At the Breaking Point"
(IOM report), despite the lifesaving feats performed every
day by EDs and ambulance services, the nation's emergency
medical system as a whole is overburdened, underfunded, and
highly fragmented. As a result, according to the IOM
report, ambulances are turned away from EDs or diverted
once every minute on average and patients in many areas may
wait hours or even days for a hospital bed. Moreover, the
IOM report maintains, the system is ill prepared to handle
surges from disasters such as hurricanes, terrorist
attacks, or disease outbreaks.
Comments
Research also suggests that the use of ED services will
continue to rise due to demographic factors, such as the
increasing age of the population. The U.S. population is
growing and life expectancies are increasing, leading to
more people living longer with complex and chronic
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debilitating diseases such as diabetes, cancer, and renal
failure. According to CHCF, research also shows that
adults with chronic conditions are disproportionately
represented among recent ED users. While 32 percent of the
California adult population suffers from hypertension,
heart disease, diabetes, and/or chronic lung problems, 44
percent of recent ED users fit this description.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
Impact on publicly- unknown,
potentially significant General/*
funded health programs, costs and
savingsFederal/
including Medi-Cal Local
and Healthy Families
*Medi-Cal costs shared 50 percent General Fund, 50 percent
federal funds ongoing; Healthy Families Program shared 35
percent General Fund, 65 percent federal funds; the state
General Fund portion may include local funds
SUPPORT : (Verified 6/25/10)
American College of Emergency Physicians, California
Chapter (source)
California Ambulance Association
California Medical Association
OPPOSITION : (Verified 6/25/10)
San Bernardino county Board of Supervisors
San Joaquin county Health Care Services
ARGUMENTS IN SUPPORT : According to California College of
Emergency Physicians (Cal/ACEP), the sponsors of this bill,
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California's EDs have become the healthcare safety net and
are the front lines of any public health emergency.
Cal/ACEP maintains that ED overcrowding is no longer simply
an uncomfortable and time consuming endeavor for patients,
but waits can be so long they put the lives of Californians
in peril. According to Cal/ACEP, in addition to being a
rapid and practical solution to measuring the changing
conditions in the ED, this bill provides that each hospital
develop an individualized plan that allows for flexibility
in the design that suits each specific hospital. Cal/ACEP
maintains that this bill is a common-sense approach to
improving California's healthcare system using existing
resources.
ARGUMENTS IN OPPOSITION : The San Bernardino County Board
of Supervisors (SBCBS) is opposed to this bill stating that
there is no evidence that using a scoring tool is effective
and would work for California. The SBCBS notes that
overcrowding assessments in EDs are already conducted and
that there is insufficient evidence to show that using a
scoring tool would have any impact on improving ED
overcrowding. According to SBCBS, Arrowhead Regional
Medical Center, San Bernardino County's public hospital,
already employs an effective system to avoid ED
overcrowding, and feels the mandated tool in this bill
would impose an unnecessary and unfunded state mandate.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Beall, Bill Berryhill, Tom
Berryhill, Blakeslee, Block, Blumenfield, Bradford,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Coto, Davis, De La Torre, De Leon,
DeVore, Eng, Evans, Feuer, Fletcher, Fong, Fuentes,
Gaines, Galgiani, Garrick, Gilmore, Hagman, Hall, Harkey,
Hayashi, Hernandez, Hill, Huber, Huffman, Jeffries,
Jones, Lieu, Logue, Bonnie Lowenthal, Ma, Mendoza,
Miller, Monning, Nava, Nestande, Niello, Nielsen, Norby,
Portantino, Ruskin, Saldana, Silva, Skinner, Smyth,
Solorio, Audra Strickland, Swanson, Torlakson, Torres,
Torrico, Tran, Villines, Yamada
NOES: Anderson, Knight
NO VOTE RECORDED: Arambula, Bass, Cook, Emmerson, Fuller,
Furutani, V. Manuel Perez, Salas, John A. Perez, Vacancy
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CTW:do 6/29/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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