BILL ANALYSIS �
SB 630
Page 1
SENATE THIRD READING
SB 630 (Alquist)
As Amended January 18, 2012
2/3 vote. Urgency
SENATE VOTE : 36-0
HEALTH 19-0 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, |
| |Roger Hern�ndez, | |Davis, Donnelly, Gatto, |
| |Bonnie Lowenthal, | |Hall, Hill, Lara, |
| |Mansoor, Mitchell, | |Mitchell, Nielsen, Norby, |
| |Nestande, Pan, | |Solorio, Wagner |
| |V. Manuel P�rez, Silva, | | |
| |Smyth, Williams | | |
| | | | |
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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 appropriately licensed 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
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at SHC to the Labor and Delivery unit of LPCH, and 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 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.
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FISCAL EFFECT : According to the Assembly Appropriations Committee,
negligible state costs.
COMMENTS : 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 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.
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
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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 found the MOU
between SHC and LPCH 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.
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 or 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.
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SHC and LPCH both write in support that this bill 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
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097 FN:
0003750