BILL ANALYSIS �
SB 233
Page 1
SENATE THIRD READING
SB 233 (Pavley)
As Amended July 14, 2011
Majority vote
SENATE VOTE :37-0
HEALTH 17-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Bonnie Lowenthal, | |Davis, Donnelly, Gatto, |
| |Mansoor, Mitchell, | |Hall, Hill, Lara, |
| |Nestande, Pan, | |Mitchell, Nielsen, Norby, |
| |V. Manuel P�rez, Silva, | |Solorio, Wagner |
| |Williams | | |
| | | | |
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SUMMARY : Clarifies existing law to explicitly permit appropriate
licensed personnel to perform consultations and treatment in an
emergency department (ED) if within their existing scope of
practice. Specifically, this bill :
1)Revises the existing definition of "emergency services and care"
to mean medical screening, examination, and evaluation by a
physician or surgeon, or, to the extent permitted by applicable
law, other appropriate licensed personnel acting within their
scope of licensure under the supervision of a physician and
surgeon, to determine if an emergency medical condition or active
labor exists.
2)Clarifies that, upon a determination that an emergency medical
condition or active labor exists, "emergency services and care"
also includes the care, treatment, and surgery, if within the
scope of the appropriate licensed personnel's license, necessary
to relieve or eliminate the emergency medical condition, within
the capability of the facility.
3)Includes the rendering of a decision regarding hospitalization or
transfer by telephone or other means of communication in the
existing definition of "consultation" and authorizes other
appropriate licensed personnel acting within their scope of
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licensure to provide consultation.
4)Requires the request for consultation to be made by the treating
physician and surgeon, or by other appropriate licensed personnel
acting within their scope of licensure, provided that it is made
with the contemporaneous approval of the treating physician and
surgeon.
5)Permits the treating physician and surgeon to request to
communicate directly with the consulting physician and surgeon,
and requires, when determined to be medically necessary, jointly
by the treating physician and surgeon and the consulting physician
and surgeon, the consulting physician and surgeon to examine and
treat the patient in person.
6)States that the consulting physician and surgeon is ultimately
responsible for providing the necessary consultation to the
patient, regardless of who makes the in-person appearance.
7)Authorizes, in addition to a physician or surgeon, other
appropriate licensed personnel acting within their scope of
licensure to determine when a patient's emergency condition has
been stabilized.
8)Prohibits this bill from being construed to expand the scope of
licensure for licensed personnel providing services in the ED.
FISCAL EFFECT : According to the Assembly Appropriations Committee,
negligible direct state fiscal impact. This bill clarifies state
law and conforms state law to existing federal law and current
practice, and is not likely to significantly change the delivery of
emergency medical care.
COMMENTS : According to the author, this bill is prompted by a
recent situation in which a physician was requested to provide a
consultation in the ED at Mission Hospital in Orange County and sent
his physician assistant (PA) to provide the further assessment. The
PA was subsequently prohibited from providing the consultation. The
author maintains that although these types of services are routinely
authorized by supervising physicians at hospitals, in this case, the
hospital pointed out that existing law does not explicitly authorize
a PA to perform consulting and treatment services in an ED setting.
The author argues that state law is in conflict with federal law,
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which permits PAs to provide consults in the ED, and this bill would
make state law consistent with federal law. The author adds that
PAs working in specialty practice areas provide an essential service
to the ED as they can expedite the admission or surgical preparation
of the patient under the supervision of the physician and surgeon,
and, in doing so, vacate a bed for an incoming ED patient. The
author contends that as long as evaluation, consultation, and
treatment is performed pursuant to a PA's scope of practice,
delegation of services agreement, and under the supervision of a
physician and surgeon, this type of care by a PA is routine and
should not be unduly restricted by omissions and lack of clarity in
the current definition of emergency services and care in state law.
The sponsor of this bill, the California Academy of Physician
Assistants (CAPA), states that existing law allows PAs to perform a
variety of medical services set forth in state regulations when
rendered under the supervision of a physician and surgeon. CAPA
argues that this bill clarifies an inconsistency in state law by
explicitly authorizing PAs and other mid-level practitioners to
perform consultative and treatment services in the hospital ED,
thereby increasing the provision of urgent medical care and
decreasing patient overcrowding.
The California Nurses Association (CNA) objects to this bill and
views it as an expansion of scope of practice and an encroachment
into the practice of medicine. CNA asserts that the law is clear
that physicians may provide emergency consults, care, treatment, and
surgery; and, allowing "other appropriate personnel" to provide
these services raises concerns over whether or not any of these
types of personnel retain the appropriate levels of training and
competence to perform these services. CNA believes this bill
lessens standards of care for patients by promoting the broad
delegation of certain aspects of care, including consultations and
stabilization determinations, to non-physician practitioners.
The California Chapter of the American College of Emergency
Physicians opposes this bill unless it is amended to clarify that
the definitions of emergency services, care, and consultation
include delivery by appropriate licensed personnel to the extent
permitted by hospital by-laws or rules and regulations as provided
under federal law.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097
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