BILL ANALYSIS �
SB 630
Page 1
Date of Hearing: April 17, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 630 (Alquist) - As Amended: January 18, 2012
SENATE VOTE : 36-0
SUBJECT : Hospital: licensure.
SUMMARY : Permits Stanford Hospital and Clinics (SHC) and Lucile
Packard Children's Hospital at Stanford (LPCH), for the purposes
of providing emergency services and care to patients with
conditions related to active labor presenting in the emergency
department (ED) of SHC, to be treated as a single licensed
facility if the two hospitals have entered into a specified
agreement. Specifically, this bill :
1)Permits, SHC and LPCH to be treated as a single licensed
facility for purposes of providing emergency services and care
to patients with conditions related to active labor presenting
to the ED at SHC if all of the following conditions are met:
a) The two hospitals have entered into an agreement in
which LPCH accepts and provides emergency services and care
to all patients who are in active labor presenting to the
ED at SHC, without regard to insurance status, financial
status, or other nonclincal factors;
b) A physician and surgeon, qualified ED registered nurse,
or other appropriate personnel under the supervision of a
physician and surgeon determines, prior to the transfer,
that the patient has signs or symptoms or both suggestive
of active labor, the patient can be safely transferred from
the ED at SHC to the Labor and Delivery unit of LPCH, and
that the patient does not have a condition, illness, or
injury more appropriately treated in the ED;
c) The patient has the right to refuse the transfer; and,
d) Each hospital has a prepared plan to promptly transport
the patient with an employee escort who has specialized
training in transporting women in labor.
2)Makes findings and declarations regarding the unique
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circumstances of SHC and LPCH and the justification regarding
the need for a special law.
3)Contains an urgency clause that will make this bill effective
immediately upon enactment.
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 or eliminate the
emergency medical condition.
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.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible costs.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is a
narrowly tailored patient safety bill to help expectant
mothers obtain optimal care when they arrive in active labor
at SHC's ED. SHC, which is physically connected via an
interior hallway to LPCH, has an ED but does not have a Labor
and Delivery unit, so it uses LPCH's Labor and Delivery unit,
which is approximately 600 feet away. The author maintains
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that, unfortunately, existing law, while well intended,
requires an expectant mother who arrives at SHC's ED to be
subjected to a full medical screening by a physician before
she can be transferred to the dedicated Labor and Delivery
unit at LPCH. This screening and coordination of SHC and LPCH
physicians can delay optimal care for the expectant mother and
child by up to 90 minutes. This bill, the author argues, will
improve the safety of patient's in active labor who arrive at
SHC's ED by speeding up the transfer process for patients from
SHC's ED to LPCH.
2)BACKGROUND . According to SHC, SHC and LPCH are separately
licensed and accredited acute care hospitals located in Palo
Alto, California on the campus of Stanford University. The
main inpatient facilities of the two hospitals are located in
the same hospital building. While each hospital has a
dedicated main entrance, internal corridors in the building
connect the two hospitals, allowing easy access by patients,
visitors, and personnel at both facilities. According to SHC,
SHC maintains an ED that meets the definition of a "dedicated
ED" under federal EMTALA obligations. However, SHC does not
provide labor and delivery, post-partum, newborn nursery, or
neonatal intensive care services. Alternatively, LPCH does
not maintain a basic ED, or hold out the provision of a
"dedicated ED" for pediatric emergency services. Instead, SHC
and LPCH have coordinated providing pediatric emergency
services in the SHC ED.
SHC and LPCH have developed a Memorandum of Understanding (MOU)
that expresses the terms and conditions under which laboring
patients that present to the SHC ED will be transferred to the
LPCH Labor and Delivery unit. The MOU would apply to all
pregnant patients estimated to be 20 weeks of gestation or
greater and requires an initial triage assessment by a
qualified ED registered nurse to determine if the patient: a)
has signs and/or symptoms suggestive of active labor; b) can
be safely transported from the ED to the Labor and Delivery
unit; and, c) is not suffering from a condition, illness or
injury more appropriately treated with the ED. 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.
According to a letter dated April 27, 2011 from the federal
Centers for Medicare and Medicaid Services (CMS), CMS has
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found the MOU between SHC and LPCH to appear to pose no
negative outcome to beneficiaries and no potential violation
of EMTALA. The letter indicated, however, that SHC and LPCH
were also licensed by DPH and DPH might have regulations which
could conflict with the hospitals' proposed joint facility
transfer procedure. The letter instructed that the hospitals
contact DPH directly to assess compliance with State
regulations.
On June 29, 2011, DPH communicated to SHC that the department
had reviewed the MOU and determined that it did 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 registered nurse, but not a
physician.
3)EMTALA . EMTALA was passed as part of the Consolidated Omnibus
Budget Reconciliation Act of 1986 and requires hospitals to
provide care to anyone needing emergency health care treatment
regardless of citizenship, legal status or ability to pay.
Hospitals may only transfer or discharge patients needing
emergency treatment under their own informed consent, after
stabilization, or when their condition requires transfer to a
hospital better equipped to administer the treatment.
Congress passed EMTALA to combat the practice of "patient
dumping," i.e., refusal to treat people because of inability
to pay or insufficient insurance, or transferring or
discharging emergency patients on the basis of high
anticipated diagnosis and treatment costs.
EMTALA allows an on-call physician, under hospital policies, the
option of sending a representative, such as 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.
4)SUPPORT . SHC and LPCH both write in support that this bill
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will provide statutory language to allow SHC and LPCH to
implement a MOU to enable the two hospitals to be treated as a
single consolidated license solely for women presenting to the
SHC ED with labor-related conditions. SHC maintains that from
September 1, 2010 to August 31, 2011, an average of 23 women
per month were delayed in the SHC's ED on average for 54
minutes before they could be transferred to LPCH's Labor and
Deliver unit. The hospitals explain that they have cooperated
to encourage women with labor-related conditions to go
directly to LPCH, but many women present to the SHC ED. SHC
asserts that in most hospitals that provide emergency and
obstetric services, women presenting to the ED are re-directed
to the Labor and Delivery unit for examination and
labor-related services. This bill ensures that expectant
mothers and their unborn children can receive prompt and
appropriate care eliminating undesirable delays
REGISTERED SUPPORT / OPPOSITION :
Support
Stanford Hospital and Clinics (sponsor)
California Hospital Association
Lucile Packard Children's Hospital
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097