BILL ANALYSIS                                                                                                                                                                                                    �




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                          SB 233 (Pavley)
          
          Hearing Date: 5/16/2011         Amended: 5/4/2011
          Consultant: Katie Johnson       Policy Vote: Health 9-0
          _________________________________________________________________
          ____
          BILL SUMMARY: SB 233 would revise the definition of "emergency 
          services and care," "consultation," and "stabilized" to clarify 
          which medical professionals may provide medical screening, 
          examination, evaluation, and treatment within an emergency 
          department.
          _________________________________________________________________
          ____
                            Fiscal Impact (in thousands)

           Major Provisions         2011-12      2012-13       2013-14     Fund
           
          CDPH oversight         no fiscal impact                 Special*

          *State Department of Public Health Licensing and Certification 
          Program Fund
          _________________________________________________________________
          ____

          STAFF COMMENTS: 
          
          This bill would have no fiscal effect on the California 
          Department of Public Health (CDPH) to continue to oversee 
          hospital licensing and certification.

          Existing statute and regulations provide that physician 
          assistants, nurse practitioners, and registered nurses may 
          perform various duties under the supervision of a physician. 
          This bill would not alter those provisions nor would it permit 
          these medical personnel to provide new services. Additionally, 
          if any other "appropriate professional" were to perform duties 
          within the emergency department, then they would have to do so 
          within their current scope of practice; therefore, there would 
          be no change from existing law since the duties one would 
          perform would already be within his/her scope of practice.

          Existing state law defines "emergency services and care" as 
          medical screening, examination and evaluation by a physician, 








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          or, to the extent permitted by applicable law, by other 
          appropriate personnel under the supervision of a physician to 
          determine if an emergency medical condition or active labor 
          exists, and if it does, the care, treatment, and surgery 
          necessary to relieve or eliminate the emergency medical 
          condition.

          This bill would clarify that "emergency services and care" means 
          medical screening, examination, and evaluation by a physician or 
          surgeon and would also specify that other appropriate personnel 
          rendering these services do so pursuant to their scope of 
          practice and licensure.

          Existing state law defines "consultation" as the rendering of an 
          opinion, advice, or prescribing treatment by telephone and, when 
          determined to be medically necessary jointly by the emergency 
          and specialty physicians. It includes review of the patient's 
          medical record, examination, and treatment of the patient in 
          person by a specialty physician who is qualified to give an 
          opinion or render the necessary treatment in order to stabilize 
          the patient. 

          This bill would add "decision regarding hospitalization or 
          transfer" to the definition of "consultation" and would provide 
          that other appropriate personnel acting pursuant to their scope 
          of practice and licensure under the supervision of a physician 
          and surgeon may provide "consultation".

          Existing law permits a treating provider to determine whether or 
          not a patient is "stabilized" during emergency care.

          This bill would also permit appropriate personnel, in addition 
          to a physician or surgeon, acting pursuant to the scope of 
          practice and licensure under the supervision of a physician or 
          surgeon, to determine when a patient's emergency condition has 
          been "stabilized". 

          Staff recommends that the bill be amended to clarify that 
          nothing in this bill would be meant to expand the scope of 
          licensure for personnel providing services in the emergency 
          department.











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