California Assembly Bill AB1177 Amended / Bill

 BILL NUMBER: AB 1177AMENDED BILL TEXT AMENDED IN SENATE AUGUST 24, 2015 AMENDED IN SENATE JULY 16, 2015 AMENDED IN SENATE JULY 8, 2015 INTRODUCED BY Assembly Members Gomez, Burke, and Low FEBRUARY 27, 2015 An act to add and repeal Section 1204.2 of the Health and Safety Code, relating to primary care clinics. LEGISLATIVE COUNSEL'S DIGEST AB 1177, as amended, Gomez. Primary care clinics: written transfer agreements. Existing regulations require primary care clinics to maintain a written transfer agreement with one or more nearby hospitals and other facilities as appropriate to meet medical emergencies. Existing law authorizes certain clinics to request that the State Department of Public Health waive this requirement. This bill would provide that a licensed primary care clinic is not required to enter into a written transfer agreement pursuant to those provisions as a condition of licensure, except as provided for  a primary care clinic where anesthesia is used in compliance with the community standard of practice, in doses that, when administered, have the probability of placing a patient at risk for loss of the patient's life-preserving protective reflexes. The bill would exempt a primary care clinic from the above-referenced hospital transfer agreement requirement if the clinic submits to the State Department of Public Health competent evidence, as defined, that documents its attempt to obtain a written transfer agreement from at least 2 local hospitals, except as provided. The bill would impose similar requirements upon  an alternative birth center licensed as a primary care clinic, as specified.  The bill would require a primary care clinic, except as specified, to send with each patient at the time of transfer, or in the case of an emergency, as promptly as p   ossible, copies of all medical records related to the patient's transfer, and would require the medical records to inclu   de, among other things, current medical findings and a brief summary of the course of treatment provided prior to the patient's transfer.  The bill would require the department to  amend   repeal  its regulations to conform to these changes. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1204.2 is added to the Health and Safety Code, to read: 1204.2. (a)  (1)    Notwithstanding any other law, including, but not limited to, Section 75047 of Title 22 of the California Code of Regulations, and except as provided in  paragraph (2),   subdivision (c),  a primary care clinic described in subdivision (a) of Section 1204 that is licensed pursuant to this chapter shall not be required to enter into a written transfer agreement with a nearby hospital as a condition of licensure.  (2) (A) A primary care clinic where anesthesia is used in compliance with the community standard of practice, in doses that, when administered, have the probability of placing a patient at risk for loss of the patient's life-preserving protective reflexes, shall have a written transfer agreement with a local accredited or licensed general acute care hospital.   (B) A primary care clinic described in subparagraph (A) is exempt from the requirements of subparagraph (A) if that clinic submits to the department any competent evidence that documents its attempt to obtain a written transfer agreement from at least two local hospitals that have elected not to enter into a transfer agreement with that primary care clinic. If the primary care clinic determines that there are not two hospitals that are reasonably accessible by road travel for purposes of providing patients with emergency medical care, the primary care clinic shall only be required to submit competent evidence to the department that documents its attempt to obtain a written transfer agreement from one local hospital.   (C) For the purposes of this section, "competent evidence" means evidence that is relevant and of such a nature that it can be received by a court of law, and includes, but is not limited to, an affidavit of someone with the legal authority to bind the clinic operation.   (b) (1) A primary care clinic shall send with each patient at the time of transfer, or in the case of an emergency, as promptly as possible, copies of all medical records related to the patient's transfer. To the extent practicable and applicable to the patient's transfer, the medical records shall include current medical findings, diagnoses, laboratory results, medications provided prior to transfer, a brief summary of the course of treatment provided prior to transfer, ambulation status, nursing and dietary information, name and contact information for the treating physician at the clinic, and as appropriate, pertinent administrative and demographic information related to the patient, including name and date of birth.   (2) The requirements in paragraph (1) shall not apply if the primary care clinic has entered into a written transfer agreement with a local hospital that provides for the transfer of medical records.   (D)   (c)  An alternative birth center that is licensed under this chapter as a primary care clinic, as a condition of licensure, shall be required to maintain a written transfer agreement with a local hospital. The transfer agreement shall include provisions for communication and transportation to meet medical emergencies. Essential personal, health, and medical information shall either accompany the patient upon transfer or be transmitted immediately by telephone to the receiving facility. This section does not modify or supersede the requirements imposed on alternative birth centers described in Section 1204.3.  (b) This section does not require a primary care clinic to have a hospital transfer agreement with a local hospital, if that clinic provides only the following types of analgesia and sedation services:   (1) Local anesthesia.   (2) Peripheral nerve blocks.   (3) A combination of both local anesthesia and peripheral nerve blocks.   (4) Conscious sedation, as defined in Section 1647.1 of the Business and Professions Code.   (c)   (d)  The State Department of Public Health, no later than July 1, 2016, shall  amend   repeal  Section 75047 of Chapter 7 of Division 5 of Title 22 of the California Code of  Regulations to be consistent with this section.   Regulations.   (d)   (e)  This section shall remain in effect only until January 1, 2018, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2018, deletes or extends that date. SEC. 2. Section 1204.2 is added to the Health and Safety Code, to read: 1204.2. (a)  (1)    Notwithstanding any other law, and except as provided in  paragraph (2),   subdivision (c),  a primary care clinic described in subdivision (a) of Section 1204 that is licensed pursuant to this chapter shall not be required to enter into a written transfer agreement with a nearby hospital as a condition of licensure.  (2) (A) A primary care clinic where anesthesia is used in compliance with the community standard of practice, in doses that, when administered, have the probability of placing a patient at risk for loss of the patient's life-preserving protective reflexes, shall have a written transfer agreement with a local accredited or licensed acute general care hospital.   (B) A primary care clinic described in subparagraph (A) is exempt from the requirements of subparagraph (A) if it submits to the department any competent evidence that documents its attempts to obtain a written transfer agreement from at least two local hospitals that have elected to not enter into a transfer agreement with that primary care clinic. If the primary care clinic determines that there are not two hospitals that are reasonably accessible by road travel for purposes of providing patients with emergency medical care, the primary care clinic shall only be required to submit competent evidence to the department that documents its attempt to obtain a written transfer agreement from one local hospital.   (C) For the purposes of this section, "competent evidence" means evidence that is relevant and of such a nature that it can be received by a court of law, and includes, but is not limited to, an affidavit of someone with the legal authority to bind the clinic operation.   (b) (1) A primary care clinic shall send with each patient at the time of transfer, or in the case of an emergency, as promptly as possible, copies of all medical records related to the patient's transfer. To the extent practicable and applicable to the patient's transfer, the medical records shall include current medical findings, diagnoses, laboratory results, medications provided prior to transfer, a brief summary of the course of treatment provided prior to transfer, ambulation status, nursing and dietary information, name and contact information for the treating physician at the clinic, and as appropriate, pertinent administrative and demographic information related to the patient, including name and date of birth.   (2) The requirements in paragraph (1) shall not apply if the primary care clinic has entered into a written transfer agreement with a local hospital that provides for the transfer of medical records.   (D)   (c)  An alternative birth center that is licensed under this chapter as a primary care clinic, as a condition of licensure, shall be required to maintain a written transfer agreement with a local hospital. The transfer agreement shall include provisions for communication and transportation to meet medical emergencies. Essential personal, health, and medical information shall either accompany the patient upon transfer or be transmitted immediately by telephone to the receiving facility. This section does not modify or supersede the requirements imposed on alternative birth centers described in Section 1204.3.  (b) This section does not require a primary care clinic to have a hospital transfer agreement with a nearby hospital, if that clinic provides only the following types of analgesia and sedation services:   (1) Local anesthesia.   (2) Peripheral nerve blocks.   (3) A combination of both local anesthesia and peripheral nerve blocks.   (4) Conscious sedation, as defined in Section 1647.1 of the Business and Professions Code.   (c) This section shall become operative on January 1, 2018.  ____ CORRECTIONS Text--Page 6. ____