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HomeMy WebLinkAboutMINUTES - 05051998 - D2 ro: BOARD OF SUPERVISORS Contra Gt VR*M: Supervisor Donna Gerber •� Costa t Cole DATE: May 5, 1998 �`t K SUBJECT. AB 2103.(Gallegos) Emergency Medical Services snewle R1ttlU"T(s);%RECOAt1iMENDA7iOWS)a AACMECiRi'2UMto MID JUETiPICATION RECOMMENDATION: Consider sending a letter to Assemblymember Gallegos expressing a support position on AB 2103 if the bill is amended to prohibit"standby" emergency departments in urban areas and to require signs indicating the location of a hospital to specify that no emergency services are provided if the hospital does not operate at least a"basic" emergency department. BACKGROUND: AB 2103 was introduced earlier this year with a number of provisions intended to improve the provision of hospital emergency medical services. As introduced,this bill would have banned the use of"standby"emergency departments in urban areas. Serious incidents that occurred in Contra Costa County last year led to the Assembly Health Committee holding an informational hearing on problems related to the provision of hospital emergency services and included a particular focus on the use of standby emergency departments. As a result of that hearing and significant input from Contra Costa County, AB 2103 was introduced as a means to address the serious health risks associated with standby facilities. Unfortunately, AB 2103 was recently amended to delete its most important provision that would have banned standby emergency departments in urban areas and instead the bill merely renames standby emergency departments to "Urgent Medical Services." This change in name only will still allow the use of standby emergency departments in areas such as Contra Costa County, which has experienced serious difficulties with standby departments in the past. CONTIN�lONA7TACMMtNT: .�..YtB sIs�NATURE: �syA.� MtRCOMAtENDA'f►OM CMf!rQUMTY At1MtNt8'tMTOR �...RECCI#gEENDATION OF iOARD COM1AtTctE ' .......A: cwE -OTHER ACTION OM"SQRRD ON--- Mair , • . APPWNW AS RECOIM MOM..,X CTM M r..._ 1t0#t or SUPIRYEtM" t MERESY CVM"THAT"a R A TRM ...2L uttmtmous tAsKwr _ _ r _ � ; AND CORRECT CO►Y Of AN ACTION TAM EN AYES: "Oft AND 1NTERZ0 ON TME WNUTU Oi TNR'somv Ai Etta: ASITAK- or St7MVISORS ON THE"n StIOWN. cc= May s, 1998 • PHIL rATOKLOR,C9LFAX OF TME AOtRD Of SUPERVISORS AND GtXAM AWINISTRATOR M382 (10166) i .DE►#14rY Additionally, the bill was recently amended to delete the requirement that signs indicating the location of a hospital specify that no emergency services are provided if the hospital does not operate at least a"basic"emergency department. Instead,the bill now requires the sign to read "urgent medical services." This change will add to the serious confusion that currently exists with the public as to the level of services provided by standby facilities. It is unlikely that people will understand that"urgent medical services"does not include emergency services. AB 2103 also contains numerous other provisions aimed at improving the quality of hospital emergency medical services and should be supported by the County. These provisions include a requirement for a local hearing prior to a hospital closing or downgrading an emergency department and the results being reported to the State Department of Health Services. AB 2103 additionally requires hospitals, prior to closing or downgrading an emergency department,to have an implementation plan regarding the emergency medical service or closure, and have transfer agreements with other health facilities. The bill also includes a requirement that 90 days prior to reducing or eliminating levels of service that the State Department of Health Services and the public be notified. BILL NUMBER: AB 2103 AMENDED BILL TEXT AMENDED IN ASSEMBLY APRIL 28, 1998 AMENDED IN ASSEMBLY APRIL 16, 1998 INTRODUCED BY Assembly Member Gallegos (Coauthor: Assembly Members Alquist, Aroner, Baca, Kuehl,. Martinez, and Ortiz) (Coauthor: Senator Watson) FEBRUARY 18, 1998 An act to amend Sections 1300 and 1797.203 of, and to add Sections 1255.1, 1255.2, 1255.3, and 1369.1 to, the Health and Safety Code, and to add Section 101.91 to the Streets and Highways Code, relating to emergency medical services. LEGISLATIVE COUNSEL'S DIGEST AB 2103, as amended, Gallegos. Emergency medical services. (1) Existing law authorizes general acute care hospitals to provide certain special services, including, but not limited to, emergency services, upon approval by the State Department of Health Services. This bill would require any acute care hospital that provides those services to provide notice of any intended elimination or reduction of emergency services at least 90 days prior to the intended elimination or reduction in services to the State Department of Health Services, the local government agency in charge of health services, and specified entities under contract with the hospital to provide the services, and to provide public notice in a manner likely to reach a significant number of residents of the community serviced by that facility. This bill would require a health facility, prior to the date on which it implements an emergency medical service closure or change, to have an implementation plan, to have transfer agreements with other health facilities, and to make reasonable efforts to ensure that the community served by the facility is informed. This bill would also require the State Department of Health Services to receive a needs assessment to determine impacts, including an impact evaluation of the downgrade or closure of emergency or critical care services upon the community and how the downgrade or closure will affect emergency services provided by other entities. The bill would require the county in which the proposed downgrade or closure will occur to ensure the completion of, and timely notification to the department of the results of, the impact evaluation, thereby imposing a state-mandated local program. This bill would authorize a county to designate the local emergency medical services agency as the agency to conduct the impact evaluation. The bill would require each local emergency medical services agency to develop a policy specifying the criteria it will consider in conducting an impact evaluation, on or before June 30, AB 2103 Assembly Bitl-AMENDED 1999, thereby imposing a state-mandated local program. (2) Existing law requires the Emergency Medical Service Authority to develop planning and implementation guidelines for emergency medical services Systems that address specified components. This bill would revise these components and include additional guidelines, as specified. (3) Existing law provides for the licensing and certification of health facilities. Existing law authorizes a general acute care hospital, to offer various special services, including emergency center services pursuant to specified requirements. In addition, existing law separately sets forth requirements for the provision of standby emergency medical services in a specifically designated area of a hospital. A violation of existing provisions of law relating to the licensing and certification of health facilities constitutes a misdemeanor. This bill would require a health facility holding a special permit for a standby emergency medical service to post signs clearly. stating that the facility offers "Urgent Medical Services. " Because it would change the definition of an existing crime, this bill would create a state-mandated local program. (4) Existing law provides for the licensure and regulation of health care service plans and requires health care service plans to disclose information to plan enrollees. Willful violation of the law regulating health care service plans is a crime. This bill would require a health care service plan to notify plan enrollees who are affected by a downgrade or closure of a hospital 's emergency services in writing no less than 30 days pricer to a reduction in emergency services at h ;t.,, under eentr-aec with the plan . By changing the definition of a crime, the bill would impose a state-mandated local program. (5) Existing law provides for the placement of signs on state highways by the Department of Transportation. This bill would require the department to ensure that every sign that indicates the location of a hospital shall also indicate "Ne Emevgeney- a lees Previded" "Urgent Medical Services" if the hospital operates standby emergency services and does not operate at least a basic emergency department and would require the sign to state tk...t there is no h. p t , f _t ",Text Emergency Care" and the appropriate number of miles, if the nearest hospital with a basic emergency department is 30 miles or more from the location of the hospital. (6) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory previsions establish procedures for making that reimbursement, including the creation of a State Mandates Claims Fund to pay the costs of mandates that do not exceed $1, 000,000 statewide and other procedures for claims whose statewide costs exceed $1,000,000. This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason. With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1255.1 is added to the Health and Safety Code, to read: y :AB 2103 Assembly Bill-AMENDED 1255.1. (a) Any hospital that operates an emergency center under Section 1255 shall:, 90 days prior to reducing or eliminating the level of services provided by the emergency center, provide notice of the intended change to the State Department of Health Services, the local government entity in charge of the provision of health services, and all health care service plans or other entities under contract with the hospital to provide services to enrollees of the plan or other entity. (b) In addition to the notice required by subdivision (a) , the hospital shall, within the time limits specified in subdivision (a) , provide public notice of the intended change in a manner that is Likely to reach a significant number of residents of the community serviced by that facility. SEC. 2. Section 1255.2 is added to the Health and Safety Code, to read: 1255.2. (a) A health facility shall, prior to the date on .which it implements an emergency medical service closure or change pursuant to Section 1255.1, have an implementation plan regarding the emergency medical service or closure, and have transfer agreements with other health facilities to ensure availability of, and access to, timely and appropriate emergency care for the community served by the health facility implementing the emergency services change. (b) A health facility implementing a downgrade or change shall make reasonable efforts to ensure that the community served by its facility is informed of the downgrade or closure. Reasonable efforts may include, but not be limited to, advertising the change in terms likely to be understood by a layperson, soliciting media coverage regarding the change, informing patients of the facility of the impending change, and notifying contracting health care service plans as required in Section 1255.1. SEC. 3. Section 1255.3 is added to the health and Safety Code, to read: 1255.3. A health facility holding a special permit for a standby emergency medical service shall post signs clearly stating that the facility offers "Urgent Medical Services." The facility shall not post signs, distribute literature, or advertise that emergency services are available at the facility. Nothing in this section shall be construed to mean that a facility is no longer providing emergency services for purposes of billing or reimbursement. SEC. 4. Section 1300 of the Health and Safety Code is amended to read: 1300. (a) Any licensee or holder of a special permit may, with the approval of the state department, surrender his license or special permit for suspension or cancellation by the state department. Any license or special permit suspended or canceled pursuant to this section may be reinstated by the state department on receipt of an application showing compliance with the requirements of Section 1265. (b) Before approving a downgrade or closure of emergency or critical care services pursuant to subdivision (a) , the state department shall receive a needs assessment to determine impacts, including, but not limited to, an impact evaluation of the downgrade or closure upon the community, including community access to emergency care, and how that downgrade or closure will affect emergency services provided by other entities. Development of the impact evaluation shall incorporate at least one public hearing. The county in which the proposed downgrade or closure will occur shall ensure the completion of the impact evaluation, and shall notify the department of results of an impact evaluation within three days of the completion of that evaluation. The county may designate the local emergency medical services agency as the appropriate agency to conduct the impact evaluation. The impact evaluation and hearing shall be completed within 60 days of the county receiving notification of intent to downgrade or close emergency services: The local emergency medical services agency shall consult with all AB,2143,Assembly Bill-AMF-NE)EI) hospital and prehospital health care providers in the geographic area impacted by the service closure or change prior to completing an impact evaluation as required in this section. (c) On or before June 30, 1999, each local emergency medical services agency shall develop a policy specifying the criteria it will consider in conducting an impact evaluation pursuant to subdivision (b) . Each local emergency medical services agency shall submit its impact evaluation policy to the department and the Emergency Medical Services Authority within three days of completion of the policy. The Emergency Medical Services Authority shall provide technical assistance to a local emergency medical services agency upon request from an agency. If a local emergency medical services agency fails to submit an evaluatienpee ` en er- be ere J e 38,'-9 an impact evaluation policy, according to the requirements of this section , the Emergency Medical Services Authority may develop impact evaluation policy guidelines to be followed by the local emergency medical services agency. SEC. 5. Section 1364.1 is added to the Health and Safety Coda, to read. 1364.1. A health care service plan shall notify the planThe ne,tlee enrollees who are affected by the downgrade or closure of a hospital 's emergency services in writing no less than 30 days prior to a reduction in emergency services. The notice shall include a list of alternate hospitals that may be used by enrollees for emergency services. SEC. 7. Section 1797. 103 of the Health and Safety Code is amended to read: 1797.103. The authority shall develop planning and implementation guidelines for emergency medical services systems that address the following components: (a) Manpower, training, and prehospital care staffing levels. (b) Communications. (c) Transportation, including the extent of transfers due to nonmedical reasons and transfers occurring across county lines and between health facilities. (d) Assessment of hospitals, critical care centers, and patient census fluctuations. (e) System organization and management. (f) Data collection and evaluation. (g) Public information and education. (h) Disaster response. (i) Impact on emergency and critical care services of a region when emergency services are downgraded or closed. (j) The appropriateness of the ratio of licensed and staffed emergency services to licensed and staffed critical care beds. SEC. 8. Section 101.91 is added to the Streets and Highways Code, to read: 101.91. The department shall ensure that every sign that indicates the location of a hospital shall also indicate --3e if the hes ital dees net epeEate atn it pursuant- te this seetien, and the titke aA:gn shall alse elearly state 4c-hat there is fie hespital fer- the "Urgent Medical Services" if the hospital operates standby emergency services and does not operate at least a basic emergency department, as determined by the Stag Department of Health Services. If a hospital sign indicates "Urgent Medical .Services" pursuant to this section and the i AB 2103 Assembly Bill-AMENDED ?' nearest hospital with a basic emergency department is 30 miles or more from the location of the hospital referenced on the sign, the sign shall also clearly state "Next Emergency Care" and indicate the appropriate number of miles. SEC. 9 No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution for certain costs that may be incurred by a local agency or school district because in that regard this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. However, notwithstanding Section 17610 of the Government Code, if the Commission on State Mandates determines that this act contains other costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Hart 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code. If the statewide cost of the claim for reimbursement does not exceed one million dollars ($1,000,000) , reimbursement shall be made from the State Mandates Claims Fund. Notwithstanding Section 17580 of the Government Code, unless otherwise specified, the provisions of this act shall become operatives on the same date that the act takes effect pursuant to the California Constitution.