HomeMy WebLinkAboutMINUTES - 02231999 - D4 D4
TO. BOARD Lei' SUPERVISORS Contra
SUPERVISOR DONNA GERBER o;ta
FROM- ry,
County
February 16, 1999
DATE,
SUBJECT: LEGISLATION: AB 421 (ARONER) -
STANDBY EMERGENCY ROOM DESIGNATION
SPECIFIC REOUEST(S)OR RECOMMENDATIONS)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ACKNOWLEDGE that the Board of Supervisors is the SPONSOR of AB 421 by
Assemblywoman Cion Aroner, which, as Introduced, would permit the county or Its
designated local emergency medical services agency, if they conclude that the
downgrade of an emergency room to standby status or the closure of an emergency
room would not be in the best interests of the general public, to advise the State
Department of Health Services of this fact and thereby prevent the State Department
of Health Services from approving a special permit for standby emergency room
status or permitting the closure of the emergency room.
BACKGROUND:
Under current law,the State Department of Health Services must receive an impact
evaluation from the County before approving the downgrade of an emergency room
to standby status or closing an emergency room. The impact evaluation has to
include an evaluation of the impact of the downgrade or closure on the community,
Including community access to emergency care and how the downgrade or closure
will affect emergency services provided by other entities. At least one public hearing
must be held as a part of developing the impact evaluation.
CONTINUED ON ATTACHMENT: YES S; <NAI'URE�
RECOMMENDATION OF COUNTY ADM INISTi ATOR _RECOMMENDATION OF BOARD COMMITTE
APPROVE OTHER
SIGNATURE s. DONNA GERBER
ACTION OF BOARD ON February 23, 1999 APPROVED AS RECOMMENDED �� OTHER
On this date, the Board of Supervisors considered the above entitled matter. Lynn Baskett,
Hospital Council, commented on the matter.No one else desiring to speak, the Board took the
following action: ADOPTED the staff's recommendation as stated above.
VOTE OF SUPERVISORS
__________-___ IHERESY CERTIFY THASTHISISATRUE
UNANIMOUS(ABSENT } AND CORRECT COPY OF AN ACTION TAKEN
AYES:T�.TT, �T: NOES: �. AND ENTERED ON THE MINUTESOF THE BOARD
ABSENT; ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
ATTESTED F e b r.0 a r V 23 . 1999
Ci7i]taPHIL BATCHELOR,CLE8K OF THE BOARD OF
cc: ee Page 3 SUPERVISORS AND$,OUNTY ADMINISTRATOR
¢ r
BY ? .6` $ Il Y DEPUTY
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The impact evaluation must be completed within 60 days of receiving notification of
the hospital's intent to downgrade or close the emergency service. The County must
ensure that all hospital and prehospital providers in the geographic area impacted
by the service closure or change are consulted with prior to completing the impact
evaluation. In addition, local emergency service agencies and planning or zoning
authorities must be notified prior to completing the impact evaluation.
Prior to implementing the impact evaluation procedure, the County must develop a
policy specifying the criteria it will consider in conducting an impact evaluation.
AB 421 would, notwithstanding the requirement for an impact evaluation, permit the
County to conclude that a downgrade of an emergency room to standby status or
closure of an emergency room would not be in the best interests of the general
public. If that conclusion is included in the County's impact evaluation, the State
Department of Health Services would be prohibited from approving a special permit
for a standby emergency medical service, or from permitting the closure of the
emergency room.
This latter procedure would only be available in urban counties, which would be
defined as counties with a population of more than 200,000.
AB 421 places in the hands of local officials the ability to evaluate the local
circumstances in terms of the availability of emergency medical care and prevent the
downgrade or closure of an emergency room when it is judged that the downgrade
or closure would not be in the best interests of the general public. This is where the
decision should be made. Local elected officials know the circumstances in their
jurisdiction and should be allowed to judge what is and is not in the best interests of
the general public. This is not guaranteed under current law. The County may
prepare an impact evaluation which the State Department of health Services can
then totally ignore if it wishes to do so.
The Board of Supervisors included in its 1999 Legislative Program sponsorship of
legislation "authorizing the boards of supervisors in urban counties, following public
hearings, to prohibit the use of the designation "Standby Emergency Room" in their
county." AB 421 is consistent with the Board's Legislative Program. It is, therefore,
appropriate for the Board to acknowledge its sponsorship of this legislation.
RECENT HISTORY:
Due to changes in financing, technology and mergers/acquisitions in the health care
industry, acute care hospitals and emergency rooms have been closing throughout
the State over the past decade. For example, Alameda County once had 23
hospitals and now has 12, while Contra Costa County numbers 3 compared to 11
a decade ago. Hospitals also began to reduce emergency rooms to "standby" as
was done in Richmond and Martinez by Kaiser and considered by Tenet for its
hospital in Pinole.
In 1997, Contra Costa County (as well as counties throughout the State) began to
experience tragic patient outcomes coupled with signs of capacity strain. Several
of the patient incidents involved standby ERs and problems with staffing and timely
transfer to acute settings. A Los Angeles study conducted by the Lewin Croup
demonstrated that L.A. was seriously underbedded in Emergency rooms and other
areas due to closures and consolidations and the elimination of emergency rooms.
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Multiple discussions and public hearings have occurred to order to understand this
phenomena and possible solutions. The loss of critical services to communities
without local authority to regulate impact has been highlighted as a significant
problem.
Under current Mate law, acute care hospitals are not required to provide emergency
services, making it possible for existing hospitals to eliminate emergency rooms, In
addition, "Standby ERs"were originally intended to apply to rural areas that needed
to have ER physicians on"standbyy'due to lack of physicians, but the State does not
prohibit the "standby" designation in urban areas and has reported that they never
denied a permit for"standby" status.
AB 421 would provide the County with local authority to assess impact and regulate
outcome should any hospitals or Healthcare Corporations propose to eliminate
further the County's "stock" of emergency services. This would also further assist
the County in providing a coordinated EMS system that can meet the needs of
County residents for emergency care.
cc: County Administrator
Health Services Director
Director, Emergency Medical Services
Assemblywoman Dion Aroner
14th Assembly District
Room 2163 State Capitol
Sacramento, CA 95614
Les Spahnn
Heim, Noack, belly & Spahnn
1121 L Street, Suite 196
Sacramento, CA 95614
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CALIFORNIA LEGISLA TJRE-1999-2000 REGULAR SESSION
ASSEMBLY BILL No. 4221
Introduced by Assembly Member Aroner
February 12, 1999
An act to amend Section 1300 of the Health and. Safety Code,
relating to health facilities.
LEGTSLA'171VE COUNSEUS DIGEST
AE 421, as introduced, Aroner. Health facilities: license
suspension and revocation: emergency services.
Linder existing law, a special permit may be issued by the
State Department of Health Services to a health facility, in
addition to a license, authorizing the facility to offer one or
more of a variety of special services, including emergency
services. Existing law provides that a licensee or holder of a
special permit may surrender his or her license or special
permit for suspension or .revocation, with the approval of the
department. Existing law places specifies) restrictions,
including departmental review of the county impact
evaluation, on approval of the downgrade or closure of
emergency services pursuant to these provisions. Violation of
the existing lava provisions relating to health facilities, or
willful or repeated violation of any rale or regulation adopted
thereunder,is a crime,
This bill would additionally provide that, notwithstanding
the above provisions, if the county or its designated local
emergency services agency concludes that a downgrade to
standby emergency medical services, or the closure of an
emergency service, would not be in the best interest of the
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AIB 421 —2—
general
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general public, the department shall not approve a special
permit for a standby emergency medical service or shall not
permit the closure of the emergency service. The bill would
declare that its provisions shall only apply in urban counties,
as defined,
The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated
by the state, Statutory provisions establish procedures for
making that reimbursement,
This bill would provide that no reimbursement is required
by this act for a specified reason.
Vote: majority, Appropriation: no. Fiscal committee: yes.
State-mandated local program.: yes.
The People of the State of California dry enact as,follows:
I SECTION 1, Section 1300 of the Health and Safety
2 Code is amended to read:
3 133, (a) Any licensee or holder of a special permit
4 may, with the approval of the state department,
5 surrender his or her license or special permit for
6 suspension or cancellation by the state department. Any
7 license or special permit suspended or canceled pursuant
8 to this section may be reinstated by the state department
9 on receipt of an application showing compliance with the
10 requirements of Section 1265.
11 (b) Before approving a downgrade or closure of
12 emergency services pursuant to subdivision. (a), the state
13 department shall receive a copy of the impact evaluation
14 of the county to determine impacts, 'including, but not
15 limited to, an impact evaluation of the downgrade or
16 closure upon the community, including community
17 access to emergency care, and how that downgrade or
18 closure will affect emergency services provided by other
19 entities. Development of the impact evaluation shall
20 incorporate at least one public hearing. The county in
21 which the proposed downgrade or closure will occur shall
22 ensure the completion of the impact evaluation, and shall
23 notify the department of results of an impact evaluation
24 within three days of the completion of that evaluation.
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-3— AB 421
1 The county may designate the local emergency medical
2 services agency as the appropriate agency to conduct the
3 impact evaluation. The impact evaluation and hearing
4 shall be completed within 60 days of the county receiving
5 notification of intent to downgrade or close emergency
6 services. The county or designated local emergency
7 medical services agency shall ensure that all hospital and
8 prehospital health care providers in the geographic area
9 impacted by the service closure or change are consulted
ltd with, and local emergency service agencies and planning
11 or zoning authorities are notified, prior to completing an
12 impact evaluation as required in this section, This
13 subdivision shall be implemented on and after the date
14 that the county in which the proposed downgrade or
15 closure will occur, or its designated local emergency
16 medical services agency, has developed a policy
17 specifying the criteria it will consider in conducting an
18 impact evaluation, as required by subdivision-- this
19 subdivision.
20 (c) (1) Notwithstanding subdivision (a), if the county
21 or its designated local emergency services agency
22 concludes that a downgrade to standby emergency
23 medical services, or the closure of an emergency service,
24 would not be in the best interest of the general public, and
25 includes this conclusion in its impact evaluation, the
26 department shall not approve a special permit for a
27 standby emergency medical service, or shall not permit
28 the closure of the emergency service.
29 (2) This subdivision shall only apply in urban counties,
30 as defined in rection 50801.
31 (d) The Emergency Medical Services Authority shall
32 develop guidelines for development of impact evaluation
33 policies. On or before June 30, 1999, each county or its
34 designated local emergency medical services agency
35 shall develop a policy specifying the criteria it will
36 consider in conducting an impact evaluation pursuant to
37 subdivision (b). Each county or its designated local
38 emergency medical services agency shall submit its
39 impact evaluation policy to the department and the
40 Emergency Medical Services Authority within three days
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AB 421 —4—
I of completion of the policy. The Emergency Medical
2 Services Authority shall provide technical assistance
3 upon request to a county or its designated local
4 emergency medical services agency,
5 SEC. 2. No reimbursement is required by this act
6 pursuant to Section 6 of Article XIII B of the California
7 Constitution because the only costs that may be incurred
8 by a local agency or school district will be incurred
9 because this act creates a new crime or infraction,
10 eliminates a crime or infraction, or changes the penalty
11 for a crime or infraction, within the meaning of Section
12 17556 of the Government Code, or changes the definition
13 of a crime within the meaning of Section 6 of Article
14 XIII B of the California Constitution.
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