BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 630
AUTHOR: Alquist
AMENDED: January 4, 2012
HEARING DATE: January 11, 2012
CONSULTANT: Trueworthy
SUBJECT : Hospitals: licensure.
SUMMARY : SB 630 allows, for purposes of providing
emergency services and care to patients with conditions
related to active labor presenting in the emergency
department (ED) of Stanford Hospital and Clinics (SHC) and
Lucile Packard Children's Hospital (LPCH), SHC and LPCH to
be treated as a single licensed facility if the two
hospitals have signed an agreement under which LPCH will
accept and provide emergency services and care to all
patients presenting to the ED of SHC without regard to
insurance, financial status or any other non-clinical
factor.
Existing law:
1.Provides for the licensure of health facilities,
including general acute care hospitals, by the Department
of Public Health (DPH).
2.Establishes the federal Emergency Medical Treatment and
Active Labor Act (EMTALA), which governs when and how a
patient may be refused treatment or transferred from one
hospital to another when the patient is in an unstable
medical condition.
3.Prohibits the transfer of a person needing emergency
services and care from one hospital to another for any
nonmedical reason, unless specified conditions are met,
including that the person is examined and evaluated by a
physician.
4.Defines "emergency services and care" as requiring
screening, examination, and evaluation by a physician to
determine if active labor exists, and if it does, the
care, treatment, and surgery by a physician necessary to
relieve eliminate the emergency medical condition.
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5.Defines "active labor" to mean labor in which there is
either inadequate time to safely transfer to another
hospital prior to delivery or a transfer may pose a
threat to the health and safety of the patient or the
unborn child.
This bill:
1.Allows, for purposes of the provision of emergency
services and care to patients with conditions related to
active labor presenting in the ED of SHC and LPCH, to be
treated as a single licensed facility if the two
hospitals have signed an agreement under which LPCH will
accept and provide emergency services and care to all
patients presenting to the ED of SHC without regard to
insurance, financial status or any other non-clinical
factor.
2.Makes legislative findings and declarations.
3.Contains an urgency clause that will make this bill
effective upon enactment
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, this bill is
intended to improve the safety of patients in active
labor who arrive at SHC's emergency department. The goal
of SB 630 is to speed up the transfer of these patients
from SHC's emergency department to LPCH, which has a
dedicated labor and delivery department. Because SHC and
LPCH are physically attached, the transfer of a patient
in active labor would take about five minutes and would
be done through an interior corridor that connects the
two hospitals.
Under existing law, it can take up to 90 minutes to
transfer a patient in active labor, which potentially can
deny a higher level of care to the expectant mother and
baby. This is because existing law requires an emergency
room physician to complete a full examination and
accompanying paperwork before transferring the expectant
mother. By exempting the transferring hospital from
current law in this very specific instance, this bill
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would allow SHC and LPCH to quickly provide the best care
to the patient in labor.
Since September 2009, an average of at least 29 patients
a month arrive at Stanford's emergency department in
active labor. SB 630 will allow SHC and LPCH to implement
a medically-appropriate protocol to expedite labor and
delivery services for expectant mothers and their unborn
children."
2.Background. SHC and LPCH are separately licensed and
accredited acute care hospitals located on the same
campus of Stanford University. While each hospital has a
dedicated main entrance, internal corridors connect the
two hospitals seamlessly. SHC maintains an ED but does
not have a labor and delivery (L&D) unit. LPCH does not
maintain an ED but does provide an L&D unit along with
post-partum, newborn nursery and neonatal intensive care
services.
The two hospitals have developed a Memorandum of
Understanding (MOU) to permit a process of transferring
patients in active labor directly from SHC's ED to LPCH's
L&D unit. The MOU would apply to all pregnant patients
estimated to be 20 weeks gestation or greater and
requires an initial triage assessment by a qualified ED
registered nurse (RN). The MOU states LPCH agrees to
accept all pregnant patients without discriminating
against any patient on the basis of payor type or other
non-clinical factor.
The Centers for Medicare and Medicaid Services (CMS) has
found the MOU "appears to pose no negative outcome to
beneficiaries and no potential violation of the Emergency
Medical Treatment and Labor Act." However, CMS does not
have the authority to approve the MOU. SHC and LPCH are
licensed by DPH and therefore only DPH has the authority
to approve the MOU.
On June 29, 2011, DPH found the MOU does not meet the
requirements established under current state law.
Specifically, DPH found that current law requires
screening, examination, and evaluation by a physician
prior to any transfer from the ED. The MOU agreement
requires a triage assessment by a qualified ED RN, but
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not by a physician.
EMTALA was passed as part of the Consolidated Omnibus
Budget Reconciliation Act of 1986. Under EMTALA, a
patient who comes to, or is brought to the ED must be
provided with an appropriate medical screening
examination to determine if an emergency medical
condition exists. If an emergency situation is
determined, the hospital is obligated to either provide
treatment until the patient is stable, or transfer the
patient to another hospital in conformance with the
statute's directives.
The purpose of EMTALA is to prevent hospitals from
rejecting patients, refusing to treat them, or
transferring them to charity hospitals or county
hospitals because they are unable to pay or are covered
under the Medicare or Medicaid Programs.
EMTALA allows an on-call physician, under hospital
policies, the option of sending a representative, i.e.,
directing a non-physician practitioner or his/her
representative to appear at the hospital and provide
further assessment or stabilizing treatment to an
individual. According to EMTALA, this determination
should be based on the individual's medical need, the
capacities of the hospital, the applicable state's scope
of practice laws, and the hospital bylaws and rules and
regulations. The designated on-call physician is
ultimately responsible for providing the necessary
services to the individual regardless of who makes the
in-person appearance.
3.Support. SHC writes in support of SB 630 that this bill
will address a unique situation for pregnant woman
presenting at SHC's ED with labor-related conditions.
Enactment of SB 630 will enable women to be transferred
without delay to the L&D unit of LPCH thereby best
meeting the immediate health and safety needs of the
mother and her unborn child. SHC contends that in most
hospitals that provide both emergency and L&D services,
women presenting to the ED are re-directed to the L&D
unit for services. SB 630 will allow SHC and LPCH to be
treated as a single hospital solely for women presenting
to the SHC ED with labor-related conditions. LPCH writes
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SB 630 will enable women to be transferred without delay
in order to meet the health and safety needs of women and
children.
4.Policy question: transfer requirements. While SB 630
requires an agreement to accept and provide emergency
services and care to all patients without regard to
insurance, financial status or any other non-clinical
factor the author may wish to add additional patient
protection language as follows:
a. Require an initial triage to be performed by a
qualified ED RN to determine if the patient has signs
and/or symptoms suggestive of active labor, can be
safely transported from the ED to L&D, and is not
suffering from a condition, illness or injury more
appropriately treated in the ED.
b. Allow a patient to decline the transfer.
c. Require an organized plan to promptly transport the
patient from the ED to L&D accompanied by an employee
who has received specialized training on the
transportation of women in labor.
SUPPORT AND OPPOSITION :
Support: Stanford Hospital & Clinics (sponsor)
California Children's Hospital Association
Lucile Packard Children's Hospital
Oppose: None received.
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