California Assembly Bill AB911 Amended / Bill

 BILL NUMBER: AB 911AMENDED BILL TEXT AMENDED IN SENATE JULY 2, 2009 AMENDED IN ASSEMBLY JUNE 1, 2009 INTRODUCED BY Assembly Member Lieu (Coauthors: Assembly Members Eng and Price) FEBRUARY 26, 2009 An act to  add Section 1257.10 to   add and repeal Section 1257.10 of  the Health and Safety Code, relating to health facilities. LEGISLATIVE COUNSEL'S DIGEST AB 911, as amended, Lieu. Emergency rooms: overcrowding. Existing law establishes various programs for the prevention of disease and the promotion of health to be administered by the State Department of Public Health, including, but not limited to, the licensure and regulation of health facilities. Violation of these provisions is a crime. This  bill would require every licensed general acute care hospital with an emergency department to determine the range of overcrowding scores, as defined, that constitute each category of the overcrowding scale, as determined by the bill, for its emergency department. The  bill would require every licensed general acute care hospital  with an emergency department  to calculate and record  a NEDOCS  an overcrowding  score  , as defined,  every 4 hours, except as specified, to assess the crowding condition of its emergency department. The bill would require, by January 1, 2011, every licensed general acute care hospital  with an emergency department  to develop and implement a full-capacity protocol for each of the categories of the overcrowding scale. This bill would require every licensed general acute care hospital  with an emergency department  to file its full-capacity protocol with the Office of Statewide Health Planning and Development, and to annually report revisions to its protocol.  The bill would repeal its provisions on January 1, 2014.  By changing the definition of an existing crime, this bill would impose a state-mandated local program. 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: SECTION 1. Section 1257.10 is added to the Health and Safety Code, to read: 1257.10. (a) For purposes of this section,  a "NEDOCS   an "overcrowding  score" means the score calculated using the equation  derived from the National Emergency Department Overcrowding Study and is  as follows: 85.8 (total number of patients within the emergency department/total number of  staffed  beds in the emergency department  , not to exceed the number of   licensed beds  ) + 600 (total number of admissions waiting in the emergency  department/total number of inpatient hospital beds) + 13.4 (total   department, including patients awaiting transfer/total number of acute inpatient hospital beds routinely in use by the hospital, excluding beds in the newborn nursery, neonatal intensive care unit, and obstetrics) + 13.4 (total  number of patients  on respirators  in the emergency department  admitted to the intensive care unit  ) + .93 (the longest admit time, in hours  , including transfers  ) + 5.64 (the wait time for the last patient  called from triage   waiting the longest in the waiting room  , in hours) - 20. (b) For purposes of this section the "overcrowding scale" means  the range of NEDOCS   a range of overcrowding  scores that are divided into the following categories: (1) Not busy  , which includes NEDOCS scores of 20 and below  . (2) Busy  , which includes NEDOCS scores of 21 to 60, inclusive  . (3) Extremely busy  , which includes NEDOCS scores of 61 to 100, inclusive  . (4) Overcrowded  , which includes NEDOCS scores of 101 to 140, inclusive  . (5) Severely overcrowded  , which includes NEDOCS scores of 141 to 180, inclusive  . (6) Dangerously overcrowded , which includes NEDOCS scores over 180  .  (c) Every licensed general acute care hospital with an emergency department shall determine the range of overcrowding scores that constitute each category of the overcrowding scale for its emergency department.   (c)   (d)  Every licensed general acute care hospital  with an emergency department  shall calculate, and record,  a NEDOCS   an overcrowding  score every four hours to assess the crowding condition of its emergency department.  (d)   (e)  (1) If, after calculating and recording  a NEDOCS   an overcrowding  score pursuant to subdivision  (c)   (d)  , a licensed general acute care hospital does not  record a NEDOCS   have an overcrowding  score over 60 for the previous 30 days, it may calculate and record  a NEDOCS   an overcrowding  score every eight hours rather than every four hours. (2) If a licensed general acute care hospital calculating and recording  a NEDOCS   an overcrowding score every eight hours pursuant to this subdivision scores over 60, it shall again calculate and record  a NEDOCS   an   overcrowding  score every four hours pursuant to subdivision  (c)   (d)  .  (e)   (f)  Every licensed general acute care hospital  with an emergency department  shall, by January 1, 2011, develop and implement, in consultation with its emergency department staff, a full-capacity protocol for each of the categories of the overcrowding scale that addresses all of the following  factors, except that if any of these factors do not occur at the hospital, the hospital may state in its protocol that the factor is not applicable  : (1) Notification of hospital administrators, nursing staff, medical staff, and ancillary services of category changes on the overcrowding scale. (2) Bed utilization. (3) Diversion. (4) Elective admissions. (5) Transfers. (6) Triage. (7) Responsibilities of inpatient medical staff and specialty service operations for rounds, discharges, coordination with the emergency department, and emergency consults for emergency department patients. (8) Hospital unit operations. (9) Nursing services. (10) Supplies. (11) Calling in additional medical, nursing, and ancillary staff. (12) Space utilization, including, but not limited to, alternate care sites.  (f)   (g)  Every licensed general acute care hospital shall file its full-capacity protocol with the Office of Statewide Health Planning and Development and shall annually report any revisions to its protocol.  (h) This section shall remain in effect only until January 1, 2014, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2014, deletes or extends that date.  SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because 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 XIII B of the California Constitution.