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THE BOARD OF SUPERVISORS OF
CONTRA COSTA COUNTY, CALIFORNIA
Date: February 1, 2000 Matter of Record
On this date, the Board of Supervisors heard a report from the County Administrator on AB 421
(Aroner), which would provide a public forum for considering whether the closure of a hospital
emergency room is in the public interest before a decision is made to implement such a closure,
as recommended by Supervisor Gerber.
THIS IS A MATTER FOR RECORD PURPOSES ONLY
NO BOARD ACTION WAS TAKEN
AMENDED IN ASSEMBLY JUNE 1, 1999
AMENDED 1N ASSEMBLY APRIL 27, 1999
AMENDED IN ASSEMBLY APRIL 6, 1999
CALIFORNIA LEGISLATURE-1999-2000 REGULAR SESSION
ASSEMBLY BILL No. 421
Introduced by Assembly Member Aroner
.February 12, 1999
An act to amend Section 1300 of the Health and Safety Code,
relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
AB 421, as amended, Aroner. Health facilities: license
suspension and revocation: emergency services.
Under 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 specified 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 law provisions relating to health facilities, or
willful or repeated violation of any rule or regulation adopted
thereunder, is a crime.
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AE 421 —2—
This
-2--yThis 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
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
authorize hospitals to appeal a determination that the
downgrade or closure is not in the best interest of the general
public to the Secretary of the California Health and Human
Services Agency. The bill would declare that its provisions
shall not apply to rural general
acute care hospitals located in rural areas, as defined. This bill
would also provide that it does not apply to certain facilities
subject to closure under specified provisions of law, or if the
department makes a specified finding as to a denial of a
permit.
Existing law requires each county or its designated local
emergency medical services agency to develop a policy
specifying the criteria it will consider in conducting an impact
evaluation.
This bill would require that policy to include evaluation of
the economic impact on the owner of the facility.
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 do enact as follows: "
1 SECTION 1. Section 1300 of the Health and Safety
2 Code is amended to read:
3 1300. (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
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1 suspension or cancellation by the state department. Any
2 license or special permit suspended or canceled pursuant
3 to this section may be reinstated by the state department
4 on receipt of an application showing compliance with the
5 requirements of Section 1265.
6 (b) Before approving a downgrade or closure of
7 emergency services pursuant to subdivision (a), the state
8 department shall receive a copy of the impact evaluation
9 of the county to determine impacts, including, but not
10 limited to, an impact evaluation of the downgrade or
11 closure upon the community, including community
12 access to emergency care, and how that downgrade or
13 closure will affect emergency services provided by other
14 entities. Development of the impact evaluation shall
15 incorporate at least one public hearing. The county in
16 which the proposed downgrade or closure will occur shall
17 ensure the completion of the impact evaluation, and shall
18 notify the department of results of an impact evaluation
19 within three days of the completion of that evaluation.
20 The county may designate the local emergency medical
21 services agency as the appropriate agency to conduct the
22 impact evaluation. The impact evaluation and hearing
23 shall be completed within 60 days of the county receiving
24 notification of intent to downgrade or close emergency
25 services. The county or designated local emergency
26 medical services agency shall ensure that all hospital and
27 prehospital health care providers in the geographic area
28 impacted by the service closure or change are consulted
29 with, and local emergency service agencies and planning
30 or zoning authorities are notified, prior to completing an
31 impact evaluation as required in this section. This
32 subdivision shall be implemented on and after the date
33 that the county in which the proposed downgrade or
34 closure will occur, or its designated local emergency
35 medical services agency, has developed a policy
36 specifying the criteria it will consider in conducting an
37 impact evaluation, as required by this subdivision.
38 (c) (1) Notwithstanding subdivision (a), if the county
39 or its designated local emergency services agency
40 concludes that a downgrade to standby emergency
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AB 421 —4-
1 medical services, or the closure of an emergency service,
2 would not be in the best interest of the general public, and
3 includes this conclusion in its impact evaluation, the
4 department shall not approve a special permit for a
5 standby emergency medical service, or shall not permit
6 the closure of the emergency service. However, if the
7 county or its designated local emergency services agency
8 determines that a downgrade or closure would not be in
9 the best interest of the general public, a hospital may
10 appeal to the Secretary of the California Health and
11 Human Services Agency to overturn the determination.
12 The appeal shall be submitted, reviewed, and decided
13 upon in accordance with procedures and timelines
14 recommended by the Licensing and Certification
15 Division of the department.
16 (2) Paragraph (1) shall not apply to a facility or unit
17 within a facility that is subject to closure by the
18 department pursuant to subparagraph (B) of paragraph
19 (2) of subdivision (c) of Section 1280 or if the department
20 makes a finding that the denial of a permit under this
21 section would imperil the financial stability of the hospital
22 corporation.
23 ,
24 as defifted in Seefiett 50801.
25 (3) This subdivision shall not apply to general acute
26 care hospitals located in rural areas as defined in Section
27 70059.1 of Title 22 of the California Code of Regulations.
28 (d) The Emergency Medical Services Authority shall
29 develop guidelines for development of impact evaluation
30 policies. On or before June 30, 1999, each county or its
31 designated local emergency medical services agency
32 shall develop a policy specifying the criteria it will
33 consider in conducting an impact evaluation pursuant to
34 subdivision (b). The policy shall include an evaluation of ;.'
35 the economic impact on the owner of the facility of
36 keeping the emergency room open or not downgrading
37 it to standby status. 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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1 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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