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| 1 | + | Amended IN Senate April 02, 2025 CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 669Introduced by Senator McGuire(Coauthors: Senators Caballero, Cervantes, Gonzalez, Hurtado, and Reyes)February 20, 2025 An act to add Article 3.5 (commencing with Section 123530) to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, relating to perinatal health care. LEGISLATIVE COUNSEL'S DIGESTSB 669, as amended, McGuire. Rural hospitals: standby perinatal medical services.Existing law finds and declares that prenatal care, delivery service, postpartum care, and neonatal and infant care are essential services necessary to assure maternal and infant health, and that these services are not currently distributed so as to meet the minimum maternal and infant health needs of many Californians. Existing law requires the State Department of Public Health to develop and maintain a statewide community-based comprehensive perinatal services program, as specified, to deliver services in medically underserved areas or areas with demonstrated need. This bill would require the department, in consultation with specified stakeholders, to establish a 5-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services, as defined. To qualify for participation in the pilot project, the bill would require a critical access or individual and small system rural hospitals to meet specified requirements, including, among others, that the hospital (1) be greater than 60 minutes from the nearest hospital providing full maternity services, (2) not have closed a full maternity or labor and delivery department within the past 3 years, on or after January 1, 2025, and (3) agree to provide routine labor and delivery services or have an agreement with a freestanding birth center, as specified. maternal and neonatal services, as specified. The bill would require a hospital selected for a pilot program to comply with certain requirements, including among others, having and maintaining specified staff, services, and equipment. The bill would require a physician, as specified, to have overall responsibility for a pilot program under these provisions.This bill would require the department, in consultation with specified stakeholders, to develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. The bill would require the department to compile the data and prepare an evaluation to be submitted to the Legislature on or before 2 years after the completion of the pilot project, and made publicly available.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. (a) The Legislature finds and declares all of the following:(1) The current minimum standards for staffing hospital maternity units in California hospitals were designed for hospitals with moderate or high volume of deliveries. (2) In the past decade, rural hospitals with low volumes of deliveries are closing their maternity units largely because of workforce and funding challenges. (3) These maternity unit closures mean that large areas of rural California have no hospitals providing maternity services, requiring long distances of travel to access an open maternity unit. (4) Studies in the United States and other developed counties show that newborn and maternal outcomes worsen when they reside more than 60 minutes from an open hospital maternity unit, and that the outcomes are progressively worse with each additional hour of travel time. (5) New models are needed to meet birthing persons needs in rural areas without hospital maternity services. (b) It is the intent of the Legislature to create a pilot project to test a new category of hospital-based maternity care, called standby perinatal medical services in hospitals that have not operated a maternity unit in the past three years. SEC. 2. Article 3.5 (commencing with Section 123530) is added to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, to read: Article 3.5. Standby Perinatal Medical Services 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Develop minimum standards Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, physicians, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other affected health care professionals, health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, licensed nurse midwives, and certified licensed midwives to meet the requirements described in subdivision (a). 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet both all of the following requirements: (a) (1)(1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department within the past three years. on or after January 1, 2025.(b)Meet either of the following conditions:(1)Have an agreement with a freestanding birth center that includes combined billing. (2)Agree to provide routine labor and delivery services.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are consistent not in conflict with the standards and recommendations of the Guidelines for Perinatal Care (8th Edition, 2017) Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists or subsequent updates. Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery. nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K)Phenylketonuria (PKU) screening.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide perinatal nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control. control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(9)(10) (A) A designated perinatal medical services space used for no other purpose. space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(10)(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee of the medical staff that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6)All physicians and certified nurse midwives providing services in the emergency room or inpatient setting are members of the organized medical staff.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services.123534. (a) (1)A physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology or Gynecology, the American Board of Pediatrics Pediatrics, or the American Board of Family Medicine shall have overall responsibility for a pilot program under this chapter.(2)If a physician that meets the requirement described in paragraph (1) is not available, a physician with training and experience in obstetrics and gynecology or pediatrics shall have overall responsibility for a pilot project pursuant to this chapter. In this circumstance, a physician that meets the requirement described in paragraph (1) shall provide consultation at a frequency that will assure high-quality service.(b) The physician described in subdivision (a) shall be responsible for all of the following:(1) Implementation of established policies and procedures.(2) Development of a system for assuring physician coverage on call 24 hours a day to the standby perinatal medical services.(3) Assurance that physician coverage is available within 30 minutes.(4) Development of a roster of specialty physicians available for consultation at all times. (5) Maintaining work relationships with intensive care newborn nursery. (6) Assurance of continuing education for the medical and nursing staff. (7) Development of order sets for pregnant patients presenting to the emergency department and for the perinatal standby unit, including all of the following:(A) Admission, including as-needed hemorrhage orders. (B) Chorioamnionitis and sepsis orders.(C) Augmentation of labor.(D) Cesarean section orders.(E) Pregnancy induced hypertension, including intrapartum and postpartum. (F) Premature rupture of membranes.(G) Preterm labor stabilization.(H) Post anesthesia recovery.(I) Postpartum care, including after vaginal delivery and after cesarean section.(J) Neonatal care.(K) Discharge for both mother and infant.123535. (a) A hospital selected for a pilot program pursuant to this chapter shall maintain equipment and supplies necessary for mothers and infants needing emergency or immediate life support, including, but not limited to, all of the following: (1) DC defibrillator, available immediately.(2) Blanket warmer. (3) Solutions and supplies for intravenous fluids, blood, and plasma and blood substitutes or fractions. (4) A fetal heart rate monitor. monitor that meets both of following requirements:(A) Ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters.(B) Maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse.(5) Adjustable examination light. (6) Sphygmomanometer. (7) Regular and fetal stethoscope. (8) Adjustable delivery table. (9) Equipment for inhalation anesthesia and regional analgesia. (10) Clock with sweep second hand. (11) Elapsed time clock. (12) Emergency supplies, including packings, syringes, needles, and drugs. (13) Emergency call button. (14) Provision for oxygen and suction for mother and infant. (15) Thermostatically controlled incubator or radiant heating device. (16)Sterile 1 percent silver nitrate and irrigating solutions for prophylactic Crede treatment of the eyes. (17)(16) Sterile clamps or ties for umbilical cord. (b) A hospital selected for a pilot project pursuant to this chapter shall maintain the following resuscitation equipment, including, but not limited to:(1) Glass trap suction device with catheter. (2) Pharyngeal airways, assorted sizes. (3) Laryngoscope, including a blade for premature infants. (4) Endotracheal catheters, assorted sizes with malleable stylets. (5) Arterial catheters, assorted sizes. (6) Ventilatory assistance bag and infant mask. (7) Bulb syringe. (8) Stethoscope.(9) Syringes, needles, and appropriate drugs. (10) Postpartum hemorrhage kit including Bakri balloon or large Foley catheter for uterine tamponade.(11) Neonatal resuscitation supplies, including supplies for umbilical access for medications.(12) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport.(13) Refrigerated medication storage unit in standby unit for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies.(c) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, to provide low-risk maternal care and readiness at all times to initiate emergency procedures to meet unexpected needs of women and newborns, including, but not limited to, all of the following:(1) Ability to begin emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits. (2) Limited obstetric ultrasonography with interpretation readily available at all times. (3) Support services readily available at all times, including laboratory testing and blood bank.(4) Capability to implement patient safety bundles for common causes of preventable maternal morbidity, including management of maternal venous thromboembolism, obstetric hemorrhage, and severe hypertension in pregnancy. (5) Ability to initiate massive transfusion protocol with processes to obtain more blood and component therapy as needed. This paragraph shall not be interpreted to require more blood to be stored than is required for rural hospitals. (6) Pharmacy capability for premixed infusions. (d) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, for stabilization and the ability to facilitate transport to a higher-level hospital when necessary, including, but not limited to, all of the following:(1) Risk identification and determination of conditions necessitating consultation, referral, and transfer.(2) A mechanism and procedure for transfer or transport to a higher-level hospital at all times. (3) A reliable, accurate, and comprehensive communication system between participating hospitals, hospital personnel and transport teams. (e) A hospital selected for a pilot project pursuant to this chapter, in collaboration with higher-level facility partners, shall maintain the ability to initiate and sustain education and quality improvement programs to maximize patient safety. | |
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| 3 | + | Amended IN Senate April 02, 2025 CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 669Introduced by Senator McGuire(Coauthors: Senators Caballero, Cervantes, Gonzalez, Hurtado, and Reyes)February 20, 2025 An act to add Article 3.5 (commencing with Section 123530) to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, relating to perinatal health care. LEGISLATIVE COUNSEL'S DIGESTSB 669, as amended, McGuire. Rural hospitals: standby perinatal medical services.Existing law finds and declares that prenatal care, delivery service, postpartum care, and neonatal and infant care are essential services necessary to assure maternal and infant health, and that these services are not currently distributed so as to meet the minimum maternal and infant health needs of many Californians. Existing law requires the State Department of Public Health to develop and maintain a statewide community-based comprehensive perinatal services program, as specified, to deliver services in medically underserved areas or areas with demonstrated need. This bill would require the department, in consultation with specified stakeholders, to establish a 5-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services, as defined. To qualify for participation in the pilot project, the bill would require a critical access or individual and small system rural hospitals to meet specified requirements, including, among others, that the hospital (1) be greater than 60 minutes from the nearest hospital providing full maternity services, (2) not have closed a full maternity or labor and delivery department within the past 3 years, on or after January 1, 2025, and (3) agree to provide routine labor and delivery services or have an agreement with a freestanding birth center, as specified. maternal and neonatal services, as specified. The bill would require a hospital selected for a pilot program to comply with certain requirements, including among others, having and maintaining specified staff, services, and equipment. The bill would require a physician, as specified, to have overall responsibility for a pilot program under these provisions.This bill would require the department, in consultation with specified stakeholders, to develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. The bill would require the department to compile the data and prepare an evaluation to be submitted to the Legislature on or before 2 years after the completion of the pilot project, and made publicly available.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO | |
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| 5 | - | ||
| 5 | + | Amended IN Senate April 02, 2025 | |
| 6 | 6 | ||
| 7 | - | Amended IN Senate April 10, 2025 | |
| 8 | 7 | Amended IN Senate April 02, 2025 | |
| 9 | 8 | ||
| 10 | 9 | CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION | |
| 11 | 10 | ||
| 12 | 11 | Senate Bill | |
| 13 | 12 | ||
| 14 | 13 | No. 669 | |
| 15 | 14 | ||
| 16 | - | Introduced by Senator McGuire(Coauthors: Senators Caballero, Cervantes, | |
| 15 | + | Introduced by Senator McGuire(Coauthors: Senators Caballero, Cervantes, Gonzalez, Hurtado, and Reyes)February 20, 2025 | |
| 17 | 16 | ||
| 18 | - | Introduced by Senator McGuire(Coauthors: Senators Caballero, Cervantes, | |
| 17 | + | Introduced by Senator McGuire(Coauthors: Senators Caballero, Cervantes, Gonzalez, Hurtado, and Reyes) | |
| 19 | 18 | February 20, 2025 | |
| 20 | 19 | ||
| 21 | 20 | An act to add Article 3.5 (commencing with Section 123530) to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, relating to perinatal health care. | |
| 22 | 21 | ||
| 23 | 22 | LEGISLATIVE COUNSEL'S DIGEST | |
| 24 | 23 | ||
| 25 | 24 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 26 | 25 | ||
| 27 | 26 | SB 669, as amended, McGuire. Rural hospitals: standby perinatal medical services. | |
| 28 | 27 | ||
| 29 | - | Existing law finds and declares that prenatal care, delivery service, postpartum care, and neonatal and infant care are essential services necessary to assure maternal and infant health, and that these services are not currently distributed so as to meet the minimum maternal and infant health needs of many Californians. Existing law requires the State Department of Public Health to develop and maintain a statewide community-based comprehensive perinatal services program, as specified, to deliver services in medically underserved areas or areas with demonstrated need. This bill would require the department, in consultation with specified stakeholders, to establish a 5-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services, as defined. To qualify for participation in the pilot project, the bill would require a critical access or individual and small system rural hospitals to meet specified requirements, including, among others, that the hospital (1) be greater than 60 minutes from the nearest hospital providing full maternity services, (2) not have closed a full maternity or labor and delivery department on or after January 1, 2025, and (3) agree to provide maternal and neonatal services, as specified. The bill would require a hospital selected for a pilot program to comply with certain requirements, including among others, having and maintaining specified staff, services, and equipment. The bill would require a physician, as specified, to have overall responsibility for a pilot program under these provisions.This bill would require the department, in consultation with specified stakeholders, to develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. The bill would require the department to compile the data and prepare an evaluation to be submitted to the Legislature on or before 2 years after the completion of the pilot project, and made publicly available. | |
| 28 | + | Existing law finds and declares that prenatal care, delivery service, postpartum care, and neonatal and infant care are essential services necessary to assure maternal and infant health, and that these services are not currently distributed so as to meet the minimum maternal and infant health needs of many Californians. Existing law requires the State Department of Public Health to develop and maintain a statewide community-based comprehensive perinatal services program, as specified, to deliver services in medically underserved areas or areas with demonstrated need. This bill would require the department, in consultation with specified stakeholders, to establish a 5-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services, as defined. To qualify for participation in the pilot project, the bill would require a critical access or individual and small system rural hospitals to meet specified requirements, including, among others, that the hospital (1) be greater than 60 minutes from the nearest hospital providing full maternity services, (2) not have closed a full maternity or labor and delivery department within the past 3 years, on or after January 1, 2025, and (3) agree to provide routine labor and delivery services or have an agreement with a freestanding birth center, as specified. maternal and neonatal services, as specified. The bill would require a hospital selected for a pilot program to comply with certain requirements, including among others, having and maintaining specified staff, services, and equipment. The bill would require a physician, as specified, to have overall responsibility for a pilot program under these provisions.This bill would require the department, in consultation with specified stakeholders, to develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. The bill would require the department to compile the data and prepare an evaluation to be submitted to the Legislature on or before 2 years after the completion of the pilot project, and made publicly available. | |
| 30 | 29 | ||
| 31 | 30 | Existing law finds and declares that prenatal care, delivery service, postpartum care, and neonatal and infant care are essential services necessary to assure maternal and infant health, and that these services are not currently distributed so as to meet the minimum maternal and infant health needs of many Californians. Existing law requires the State Department of Public Health to develop and maintain a statewide community-based comprehensive perinatal services program, as specified, to deliver services in medically underserved areas or areas with demonstrated need. | |
| 32 | 31 | ||
| 33 | - | This bill would require the department, in consultation with specified stakeholders, to establish a 5-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services, as defined. To qualify for participation in the pilot project, the bill would require a critical access or individual and small system rural hospitals to meet specified requirements, including, among others, that the hospital (1) be greater than 60 minutes from the nearest hospital providing full maternity services, (2) not have closed a full maternity or labor and delivery department on or after January 1, 2025, and (3) agree to provide maternal and neonatal services, as specified. The bill would require a hospital selected for a pilot program to comply with certain requirements, including among others, having and maintaining specified staff, services, and equipment. The bill would require a physician, as specified, to have overall responsibility for a pilot program under these provisions. | |
| 32 | + | This bill would require the department, in consultation with specified stakeholders, to establish a 5-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services, as defined. To qualify for participation in the pilot project, the bill would require a critical access or individual and small system rural hospitals to meet specified requirements, including, among others, that the hospital (1) be greater than 60 minutes from the nearest hospital providing full maternity services, (2) not have closed a full maternity or labor and delivery department within the past 3 years, on or after January 1, 2025, and (3) agree to provide routine labor and delivery services or have an agreement with a freestanding birth center, as specified. maternal and neonatal services, as specified. The bill would require a hospital selected for a pilot program to comply with certain requirements, including among others, having and maintaining specified staff, services, and equipment. The bill would require a physician, as specified, to have overall responsibility for a pilot program under these provisions. | |
| 34 | 33 | ||
| 35 | 34 | This bill would require the department, in consultation with specified stakeholders, to develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. The bill would require the department to compile the data and prepare an evaluation to be submitted to the Legislature on or before 2 years after the completion of the pilot project, and made publicly available. | |
| 36 | 35 | ||
| 37 | 36 | ## Digest Key | |
| 38 | 37 | ||
| 39 | 38 | ## Bill Text | |
| 40 | 39 | ||
| 41 | - | The people of the State of California do enact as follows:SECTION 1. (a) The Legislature finds and declares all of the following:(1) The current minimum standards for staffing hospital maternity units in California hospitals were designed for hospitals with moderate or high volume of deliveries. (2) In the past decade, rural hospitals with low volumes of deliveries are closing their maternity units largely because of workforce and funding challenges. (3) These maternity unit closures mean that large areas of rural California have no hospitals providing maternity services, requiring long distances of travel to access an open maternity unit. (4) Studies in the United States and other developed counties show that newborn and maternal outcomes worsen when they reside more than 60 minutes from an open hospital maternity unit, and that the outcomes are progressively worse with each additional hour of travel time. (5) New models are needed to meet birthing persons needs in rural areas without hospital maternity services. (b) It is the intent of the Legislature to create a pilot project to test a new category of hospital-based maternity care, called standby perinatal medical services in hospitals that have not operated a maternity unit in the past three years. SEC. 2. Article 3.5 (commencing with Section 123530) is added to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, to read: Article 3.5. Standby Perinatal Medical Services 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, nurse midwives, and licensed midwives to meet the requirements described in subdivision (a). 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet all of the following requirements: (1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department on or after January 1, 2025.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are not in conflict with the standards and recommendations of the Guidelines for Perinatal Care Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(10) (A) A designated perinatal medical services space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services. | |
| 40 | + | The people of the State of California do enact as follows:SECTION 1. (a) The Legislature finds and declares all of the following:(1) The current minimum standards for staffing hospital maternity units in California hospitals were designed for hospitals with moderate or high volume of deliveries. (2) In the past decade, rural hospitals with low volumes of deliveries are closing their maternity units largely because of workforce and funding challenges. (3) These maternity unit closures mean that large areas of rural California have no hospitals providing maternity services, requiring long distances of travel to access an open maternity unit. (4) Studies in the United States and other developed counties show that newborn and maternal outcomes worsen when they reside more than 60 minutes from an open hospital maternity unit, and that the outcomes are progressively worse with each additional hour of travel time. (5) New models are needed to meet birthing persons needs in rural areas without hospital maternity services. (b) It is the intent of the Legislature to create a pilot project to test a new category of hospital-based maternity care, called standby perinatal medical services in hospitals that have not operated a maternity unit in the past three years. SEC. 2. Article 3.5 (commencing with Section 123530) is added to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, to read: Article 3.5. Standby Perinatal Medical Services 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Develop minimum standards Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, physicians, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other affected health care professionals, health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, licensed nurse midwives, and certified licensed midwives to meet the requirements described in subdivision (a). 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet both all of the following requirements: (a) (1)(1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department within the past three years. on or after January 1, 2025.(b)Meet either of the following conditions:(1)Have an agreement with a freestanding birth center that includes combined billing. (2)Agree to provide routine labor and delivery services.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are consistent not in conflict with the standards and recommendations of the Guidelines for Perinatal Care (8th Edition, 2017) Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists or subsequent updates. Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery. nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K)Phenylketonuria (PKU) screening.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide perinatal nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control. control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(9)(10) (A) A designated perinatal medical services space used for no other purpose. space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(10)(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee of the medical staff that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6)All physicians and certified nurse midwives providing services in the emergency room or inpatient setting are members of the organized medical staff.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services.123534. (a) (1)A physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology or Gynecology, the American Board of Pediatrics Pediatrics, or the American Board of Family Medicine shall have overall responsibility for a pilot program under this chapter.(2)If a physician that meets the requirement described in paragraph (1) is not available, a physician with training and experience in obstetrics and gynecology or pediatrics shall have overall responsibility for a pilot project pursuant to this chapter. In this circumstance, a physician that meets the requirement described in paragraph (1) shall provide consultation at a frequency that will assure high-quality service.(b) The physician described in subdivision (a) shall be responsible for all of the following:(1) Implementation of established policies and procedures.(2) Development of a system for assuring physician coverage on call 24 hours a day to the standby perinatal medical services.(3) Assurance that physician coverage is available within 30 minutes.(4) Development of a roster of specialty physicians available for consultation at all times. (5) Maintaining work relationships with intensive care newborn nursery. (6) Assurance of continuing education for the medical and nursing staff. (7) Development of order sets for pregnant patients presenting to the emergency department and for the perinatal standby unit, including all of the following:(A) Admission, including as-needed hemorrhage orders. (B) Chorioamnionitis and sepsis orders.(C) Augmentation of labor.(D) Cesarean section orders.(E) Pregnancy induced hypertension, including intrapartum and postpartum. (F) Premature rupture of membranes.(G) Preterm labor stabilization.(H) Post anesthesia recovery.(I) Postpartum care, including after vaginal delivery and after cesarean section.(J) Neonatal care.(K) Discharge for both mother and infant.123535. (a) A hospital selected for a pilot program pursuant to this chapter shall maintain equipment and supplies necessary for mothers and infants needing emergency or immediate life support, including, but not limited to, all of the following: (1) DC defibrillator, available immediately.(2) Blanket warmer. (3) Solutions and supplies for intravenous fluids, blood, and plasma and blood substitutes or fractions. (4) A fetal heart rate monitor. monitor that meets both of following requirements:(A) Ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters.(B) Maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse.(5) Adjustable examination light. (6) Sphygmomanometer. (7) Regular and fetal stethoscope. (8) Adjustable delivery table. (9) Equipment for inhalation anesthesia and regional analgesia. (10) Clock with sweep second hand. (11) Elapsed time clock. (12) Emergency supplies, including packings, syringes, needles, and drugs. (13) Emergency call button. (14) Provision for oxygen and suction for mother and infant. (15) Thermostatically controlled incubator or radiant heating device. (16)Sterile 1 percent silver nitrate and irrigating solutions for prophylactic Crede treatment of the eyes. (17)(16) Sterile clamps or ties for umbilical cord. (b) A hospital selected for a pilot project pursuant to this chapter shall maintain the following resuscitation equipment, including, but not limited to:(1) Glass trap suction device with catheter. (2) Pharyngeal airways, assorted sizes. (3) Laryngoscope, including a blade for premature infants. (4) Endotracheal catheters, assorted sizes with malleable stylets. (5) Arterial catheters, assorted sizes. (6) Ventilatory assistance bag and infant mask. (7) Bulb syringe. (8) Stethoscope.(9) Syringes, needles, and appropriate drugs. (10) Postpartum hemorrhage kit including Bakri balloon or large Foley catheter for uterine tamponade.(11) Neonatal resuscitation supplies, including supplies for umbilical access for medications.(12) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport.(13) Refrigerated medication storage unit in standby unit for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies.(c) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, to provide low-risk maternal care and readiness at all times to initiate emergency procedures to meet unexpected needs of women and newborns, including, but not limited to, all of the following:(1) Ability to begin emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits. (2) Limited obstetric ultrasonography with interpretation readily available at all times. (3) Support services readily available at all times, including laboratory testing and blood bank.(4) Capability to implement patient safety bundles for common causes of preventable maternal morbidity, including management of maternal venous thromboembolism, obstetric hemorrhage, and severe hypertension in pregnancy. (5) Ability to initiate massive transfusion protocol with processes to obtain more blood and component therapy as needed. This paragraph shall not be interpreted to require more blood to be stored than is required for rural hospitals. (6) Pharmacy capability for premixed infusions. (d) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, for stabilization and the ability to facilitate transport to a higher-level hospital when necessary, including, but not limited to, all of the following:(1) Risk identification and determination of conditions necessitating consultation, referral, and transfer.(2) A mechanism and procedure for transfer or transport to a higher-level hospital at all times. (3) A reliable, accurate, and comprehensive communication system between participating hospitals, hospital personnel and transport teams. (e) A hospital selected for a pilot project pursuant to this chapter, in collaboration with higher-level facility partners, shall maintain the ability to initiate and sustain education and quality improvement programs to maximize patient safety. | |
| 42 | 41 | ||
| 43 | 42 | The people of the State of California do enact as follows: | |
| 44 | 43 | ||
| 45 | 44 | ## The people of the State of California do enact as follows: | |
| 46 | 45 | ||
| 47 | 46 | SECTION 1. (a) The Legislature finds and declares all of the following:(1) The current minimum standards for staffing hospital maternity units in California hospitals were designed for hospitals with moderate or high volume of deliveries. (2) In the past decade, rural hospitals with low volumes of deliveries are closing their maternity units largely because of workforce and funding challenges. (3) These maternity unit closures mean that large areas of rural California have no hospitals providing maternity services, requiring long distances of travel to access an open maternity unit. (4) Studies in the United States and other developed counties show that newborn and maternal outcomes worsen when they reside more than 60 minutes from an open hospital maternity unit, and that the outcomes are progressively worse with each additional hour of travel time. (5) New models are needed to meet birthing persons needs in rural areas without hospital maternity services. (b) It is the intent of the Legislature to create a pilot project to test a new category of hospital-based maternity care, called standby perinatal medical services in hospitals that have not operated a maternity unit in the past three years. | |
| 48 | 47 | ||
| 49 | 48 | SECTION 1. (a) The Legislature finds and declares all of the following:(1) The current minimum standards for staffing hospital maternity units in California hospitals were designed for hospitals with moderate or high volume of deliveries. (2) In the past decade, rural hospitals with low volumes of deliveries are closing their maternity units largely because of workforce and funding challenges. (3) These maternity unit closures mean that large areas of rural California have no hospitals providing maternity services, requiring long distances of travel to access an open maternity unit. (4) Studies in the United States and other developed counties show that newborn and maternal outcomes worsen when they reside more than 60 minutes from an open hospital maternity unit, and that the outcomes are progressively worse with each additional hour of travel time. (5) New models are needed to meet birthing persons needs in rural areas without hospital maternity services. (b) It is the intent of the Legislature to create a pilot project to test a new category of hospital-based maternity care, called standby perinatal medical services in hospitals that have not operated a maternity unit in the past three years. | |
| 50 | 49 | ||
| 51 | 50 | SECTION 1. (a) The Legislature finds and declares all of the following: | |
| 52 | 51 | ||
| 53 | 52 | ### SECTION 1. | |
| 54 | 53 | ||
| 55 | 54 | (1) The current minimum standards for staffing hospital maternity units in California hospitals were designed for hospitals with moderate or high volume of deliveries. | |
| 56 | 55 | ||
| 57 | 56 | (2) In the past decade, rural hospitals with low volumes of deliveries are closing their maternity units largely because of workforce and funding challenges. | |
| 58 | 57 | ||
| 59 | 58 | (3) These maternity unit closures mean that large areas of rural California have no hospitals providing maternity services, requiring long distances of travel to access an open maternity unit. | |
| 60 | 59 | ||
| 61 | 60 | (4) Studies in the United States and other developed counties show that newborn and maternal outcomes worsen when they reside more than 60 minutes from an open hospital maternity unit, and that the outcomes are progressively worse with each additional hour of travel time. | |
| 62 | 61 | ||
| 63 | 62 | (5) New models are needed to meet birthing persons needs in rural areas without hospital maternity services. | |
| 64 | 63 | ||
| 65 | 64 | (b) It is the intent of the Legislature to create a pilot project to test a new category of hospital-based maternity care, called standby perinatal medical services in hospitals that have not operated a maternity unit in the past three years. | |
| 66 | 65 | ||
| 67 | - | SEC. 2. Article 3.5 (commencing with Section 123530) is added to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, to read: Article 3.5. Standby Perinatal Medical Services 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, nurse midwives, and licensed midwives to meet the requirements described in subdivision (a). 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet all of the following requirements: (1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department on or after January 1, 2025.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are not in conflict with the standards and recommendations of the Guidelines for Perinatal Care Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(10) (A) A designated perinatal medical services space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services. | |
| 66 | + | SEC. 2. Article 3.5 (commencing with Section 123530) is added to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, to read: Article 3.5. Standby Perinatal Medical Services 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Develop minimum standards Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, physicians, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other affected health care professionals, health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, licensed nurse midwives, and certified licensed midwives to meet the requirements described in subdivision (a). 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet both all of the following requirements: (a) (1)(1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department within the past three years. on or after January 1, 2025.(b)Meet either of the following conditions:(1)Have an agreement with a freestanding birth center that includes combined billing. (2)Agree to provide routine labor and delivery services.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are consistent not in conflict with the standards and recommendations of the Guidelines for Perinatal Care (8th Edition, 2017) Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists or subsequent updates. Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery. nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K)Phenylketonuria (PKU) screening.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide perinatal nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control. control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(9)(10) (A) A designated perinatal medical services space used for no other purpose. space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(10)(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee of the medical staff that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6)All physicians and certified nurse midwives providing services in the emergency room or inpatient setting are members of the organized medical staff.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services.123534. (a) (1)A physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology or Gynecology, the American Board of Pediatrics Pediatrics, or the American Board of Family Medicine shall have overall responsibility for a pilot program under this chapter.(2)If a physician that meets the requirement described in paragraph (1) is not available, a physician with training and experience in obstetrics and gynecology or pediatrics shall have overall responsibility for a pilot project pursuant to this chapter. In this circumstance, a physician that meets the requirement described in paragraph (1) shall provide consultation at a frequency that will assure high-quality service.(b) The physician described in subdivision (a) shall be responsible for all of the following:(1) Implementation of established policies and procedures.(2) Development of a system for assuring physician coverage on call 24 hours a day to the standby perinatal medical services.(3) Assurance that physician coverage is available within 30 minutes.(4) Development of a roster of specialty physicians available for consultation at all times. (5) Maintaining work relationships with intensive care newborn nursery. (6) Assurance of continuing education for the medical and nursing staff. (7) Development of order sets for pregnant patients presenting to the emergency department and for the perinatal standby unit, including all of the following:(A) Admission, including as-needed hemorrhage orders. (B) Chorioamnionitis and sepsis orders.(C) Augmentation of labor.(D) Cesarean section orders.(E) Pregnancy induced hypertension, including intrapartum and postpartum. (F) Premature rupture of membranes.(G) Preterm labor stabilization.(H) Post anesthesia recovery.(I) Postpartum care, including after vaginal delivery and after cesarean section.(J) Neonatal care.(K) Discharge for both mother and infant.123535. (a) A hospital selected for a pilot program pursuant to this chapter shall maintain equipment and supplies necessary for mothers and infants needing emergency or immediate life support, including, but not limited to, all of the following: (1) DC defibrillator, available immediately.(2) Blanket warmer. (3) Solutions and supplies for intravenous fluids, blood, and plasma and blood substitutes or fractions. (4) A fetal heart rate monitor. monitor that meets both of following requirements:(A) Ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters.(B) Maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse.(5) Adjustable examination light. (6) Sphygmomanometer. (7) Regular and fetal stethoscope. (8) Adjustable delivery table. (9) Equipment for inhalation anesthesia and regional analgesia. (10) Clock with sweep second hand. (11) Elapsed time clock. (12) Emergency supplies, including packings, syringes, needles, and drugs. (13) Emergency call button. (14) Provision for oxygen and suction for mother and infant. (15) Thermostatically controlled incubator or radiant heating device. (16)Sterile 1 percent silver nitrate and irrigating solutions for prophylactic Crede treatment of the eyes. (17)(16) Sterile clamps or ties for umbilical cord. (b) A hospital selected for a pilot project pursuant to this chapter shall maintain the following resuscitation equipment, including, but not limited to:(1) Glass trap suction device with catheter. (2) Pharyngeal airways, assorted sizes. (3) Laryngoscope, including a blade for premature infants. (4) Endotracheal catheters, assorted sizes with malleable stylets. (5) Arterial catheters, assorted sizes. (6) Ventilatory assistance bag and infant mask. (7) Bulb syringe. (8) Stethoscope.(9) Syringes, needles, and appropriate drugs. (10) Postpartum hemorrhage kit including Bakri balloon or large Foley catheter for uterine tamponade.(11) Neonatal resuscitation supplies, including supplies for umbilical access for medications.(12) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport.(13) Refrigerated medication storage unit in standby unit for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies.(c) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, to provide low-risk maternal care and readiness at all times to initiate emergency procedures to meet unexpected needs of women and newborns, including, but not limited to, all of the following:(1) Ability to begin emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits. (2) Limited obstetric ultrasonography with interpretation readily available at all times. (3) Support services readily available at all times, including laboratory testing and blood bank.(4) Capability to implement patient safety bundles for common causes of preventable maternal morbidity, including management of maternal venous thromboembolism, obstetric hemorrhage, and severe hypertension in pregnancy. (5) Ability to initiate massive transfusion protocol with processes to obtain more blood and component therapy as needed. This paragraph shall not be interpreted to require more blood to be stored than is required for rural hospitals. (6) Pharmacy capability for premixed infusions. (d) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, for stabilization and the ability to facilitate transport to a higher-level hospital when necessary, including, but not limited to, all of the following:(1) Risk identification and determination of conditions necessitating consultation, referral, and transfer.(2) A mechanism and procedure for transfer or transport to a higher-level hospital at all times. (3) A reliable, accurate, and comprehensive communication system between participating hospitals, hospital personnel and transport teams. (e) A hospital selected for a pilot project pursuant to this chapter, in collaboration with higher-level facility partners, shall maintain the ability to initiate and sustain education and quality improvement programs to maximize patient safety. | |
| 68 | 67 | ||
| 69 | 68 | SEC. 2. Article 3.5 (commencing with Section 123530) is added to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, to read: | |
| 70 | 69 | ||
| 71 | 70 | ### SEC. 2. | |
| 72 | 71 | ||
| 73 | - | Article 3.5. Standby Perinatal Medical Services 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, nurse midwives, and licensed midwives to meet the requirements described in subdivision (a). 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet all of the following requirements: (1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department on or after January 1, 2025.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are not in conflict with the standards and recommendations of the Guidelines for Perinatal Care Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(10) (A) A designated perinatal medical services space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services. | |
| 72 | + | Article 3.5. Standby Perinatal Medical Services 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Develop minimum standards Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, physicians, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other affected health care professionals, health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, licensed nurse midwives, and certified licensed midwives to meet the requirements described in subdivision (a). 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet both all of the following requirements: (a) (1)(1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department within the past three years. on or after January 1, 2025.(b)Meet either of the following conditions:(1)Have an agreement with a freestanding birth center that includes combined billing. (2)Agree to provide routine labor and delivery services.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are consistent not in conflict with the standards and recommendations of the Guidelines for Perinatal Care (8th Edition, 2017) Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists or subsequent updates. Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery. nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K)Phenylketonuria (PKU) screening.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide perinatal nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control. control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(9)(10) (A) A designated perinatal medical services space used for no other purpose. space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(10)(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee of the medical staff that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6)All physicians and certified nurse midwives providing services in the emergency room or inpatient setting are members of the organized medical staff.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services.123534. (a) (1)A physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology or Gynecology, the American Board of Pediatrics Pediatrics, or the American Board of Family Medicine shall have overall responsibility for a pilot program under this chapter.(2)If a physician that meets the requirement described in paragraph (1) is not available, a physician with training and experience in obstetrics and gynecology or pediatrics shall have overall responsibility for a pilot project pursuant to this chapter. In this circumstance, a physician that meets the requirement described in paragraph (1) shall provide consultation at a frequency that will assure high-quality service.(b) The physician described in subdivision (a) shall be responsible for all of the following:(1) Implementation of established policies and procedures.(2) Development of a system for assuring physician coverage on call 24 hours a day to the standby perinatal medical services.(3) Assurance that physician coverage is available within 30 minutes.(4) Development of a roster of specialty physicians available for consultation at all times. (5) Maintaining work relationships with intensive care newborn nursery. (6) Assurance of continuing education for the medical and nursing staff. (7) Development of order sets for pregnant patients presenting to the emergency department and for the perinatal standby unit, including all of the following:(A) Admission, including as-needed hemorrhage orders. (B) Chorioamnionitis and sepsis orders.(C) Augmentation of labor.(D) Cesarean section orders.(E) Pregnancy induced hypertension, including intrapartum and postpartum. (F) Premature rupture of membranes.(G) Preterm labor stabilization.(H) Post anesthesia recovery.(I) Postpartum care, including after vaginal delivery and after cesarean section.(J) Neonatal care.(K) Discharge for both mother and infant.123535. (a) A hospital selected for a pilot program pursuant to this chapter shall maintain equipment and supplies necessary for mothers and infants needing emergency or immediate life support, including, but not limited to, all of the following: (1) DC defibrillator, available immediately.(2) Blanket warmer. (3) Solutions and supplies for intravenous fluids, blood, and plasma and blood substitutes or fractions. (4) A fetal heart rate monitor. monitor that meets both of following requirements:(A) Ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters.(B) Maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse.(5) Adjustable examination light. (6) Sphygmomanometer. (7) Regular and fetal stethoscope. (8) Adjustable delivery table. (9) Equipment for inhalation anesthesia and regional analgesia. (10) Clock with sweep second hand. (11) Elapsed time clock. (12) Emergency supplies, including packings, syringes, needles, and drugs. (13) Emergency call button. (14) Provision for oxygen and suction for mother and infant. (15) Thermostatically controlled incubator or radiant heating device. (16)Sterile 1 percent silver nitrate and irrigating solutions for prophylactic Crede treatment of the eyes. (17)(16) Sterile clamps or ties for umbilical cord. (b) A hospital selected for a pilot project pursuant to this chapter shall maintain the following resuscitation equipment, including, but not limited to:(1) Glass trap suction device with catheter. (2) Pharyngeal airways, assorted sizes. (3) Laryngoscope, including a blade for premature infants. (4) Endotracheal catheters, assorted sizes with malleable stylets. (5) Arterial catheters, assorted sizes. (6) Ventilatory assistance bag and infant mask. (7) Bulb syringe. (8) Stethoscope.(9) Syringes, needles, and appropriate drugs. (10) Postpartum hemorrhage kit including Bakri balloon or large Foley catheter for uterine tamponade.(11) Neonatal resuscitation supplies, including supplies for umbilical access for medications.(12) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport.(13) Refrigerated medication storage unit in standby unit for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies.(c) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, to provide low-risk maternal care and readiness at all times to initiate emergency procedures to meet unexpected needs of women and newborns, including, but not limited to, all of the following:(1) Ability to begin emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits. (2) Limited obstetric ultrasonography with interpretation readily available at all times. (3) Support services readily available at all times, including laboratory testing and blood bank.(4) Capability to implement patient safety bundles for common causes of preventable maternal morbidity, including management of maternal venous thromboembolism, obstetric hemorrhage, and severe hypertension in pregnancy. (5) Ability to initiate massive transfusion protocol with processes to obtain more blood and component therapy as needed. This paragraph shall not be interpreted to require more blood to be stored than is required for rural hospitals. (6) Pharmacy capability for premixed infusions. (d) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, for stabilization and the ability to facilitate transport to a higher-level hospital when necessary, including, but not limited to, all of the following:(1) Risk identification and determination of conditions necessitating consultation, referral, and transfer.(2) A mechanism and procedure for transfer or transport to a higher-level hospital at all times. (3) A reliable, accurate, and comprehensive communication system between participating hospitals, hospital personnel and transport teams. (e) A hospital selected for a pilot project pursuant to this chapter, in collaboration with higher-level facility partners, shall maintain the ability to initiate and sustain education and quality improvement programs to maximize patient safety. | |
| 74 | 73 | ||
| 75 | - | Article 3.5. Standby Perinatal Medical Services 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, nurse midwives, and licensed midwives to meet the requirements described in subdivision (a). 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet all of the following requirements: (1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department on or after January 1, 2025.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are not in conflict with the standards and recommendations of the Guidelines for Perinatal Care Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(10) (A) A designated perinatal medical services space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services. | |
| 74 | + | Article 3.5. Standby Perinatal Medical Services 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Develop minimum standards Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, physicians, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other affected health care professionals, health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, licensed nurse midwives, and certified licensed midwives to meet the requirements described in subdivision (a). 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet both all of the following requirements: (a) (1)(1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department within the past three years. on or after January 1, 2025.(b)Meet either of the following conditions:(1)Have an agreement with a freestanding birth center that includes combined billing. (2)Agree to provide routine labor and delivery services.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are consistent not in conflict with the standards and recommendations of the Guidelines for Perinatal Care (8th Edition, 2017) Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists or subsequent updates. Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery. nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K)Phenylketonuria (PKU) screening.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide perinatal nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control. control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(9)(10) (A) A designated perinatal medical services space used for no other purpose. space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(10)(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee of the medical staff that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6)All physicians and certified nurse midwives providing services in the emergency room or inpatient setting are members of the organized medical staff.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services.123534. (a) (1)A physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology or Gynecology, the American Board of Pediatrics Pediatrics, or the American Board of Family Medicine shall have overall responsibility for a pilot program under this chapter.(2)If a physician that meets the requirement described in paragraph (1) is not available, a physician with training and experience in obstetrics and gynecology or pediatrics shall have overall responsibility for a pilot project pursuant to this chapter. In this circumstance, a physician that meets the requirement described in paragraph (1) shall provide consultation at a frequency that will assure high-quality service.(b) The physician described in subdivision (a) shall be responsible for all of the following:(1) Implementation of established policies and procedures.(2) Development of a system for assuring physician coverage on call 24 hours a day to the standby perinatal medical services.(3) Assurance that physician coverage is available within 30 minutes.(4) Development of a roster of specialty physicians available for consultation at all times. (5) Maintaining work relationships with intensive care newborn nursery. (6) Assurance of continuing education for the medical and nursing staff. (7) Development of order sets for pregnant patients presenting to the emergency department and for the perinatal standby unit, including all of the following:(A) Admission, including as-needed hemorrhage orders. (B) Chorioamnionitis and sepsis orders.(C) Augmentation of labor.(D) Cesarean section orders.(E) Pregnancy induced hypertension, including intrapartum and postpartum. (F) Premature rupture of membranes.(G) Preterm labor stabilization.(H) Post anesthesia recovery.(I) Postpartum care, including after vaginal delivery and after cesarean section.(J) Neonatal care.(K) Discharge for both mother and infant.123535. (a) A hospital selected for a pilot program pursuant to this chapter shall maintain equipment and supplies necessary for mothers and infants needing emergency or immediate life support, including, but not limited to, all of the following: (1) DC defibrillator, available immediately.(2) Blanket warmer. (3) Solutions and supplies for intravenous fluids, blood, and plasma and blood substitutes or fractions. (4) A fetal heart rate monitor. monitor that meets both of following requirements:(A) Ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters.(B) Maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse.(5) Adjustable examination light. (6) Sphygmomanometer. (7) Regular and fetal stethoscope. (8) Adjustable delivery table. (9) Equipment for inhalation anesthesia and regional analgesia. (10) Clock with sweep second hand. (11) Elapsed time clock. (12) Emergency supplies, including packings, syringes, needles, and drugs. (13) Emergency call button. (14) Provision for oxygen and suction for mother and infant. (15) Thermostatically controlled incubator or radiant heating device. (16)Sterile 1 percent silver nitrate and irrigating solutions for prophylactic Crede treatment of the eyes. (17)(16) Sterile clamps or ties for umbilical cord. (b) A hospital selected for a pilot project pursuant to this chapter shall maintain the following resuscitation equipment, including, but not limited to:(1) Glass trap suction device with catheter. (2) Pharyngeal airways, assorted sizes. (3) Laryngoscope, including a blade for premature infants. (4) Endotracheal catheters, assorted sizes with malleable stylets. (5) Arterial catheters, assorted sizes. (6) Ventilatory assistance bag and infant mask. (7) Bulb syringe. (8) Stethoscope.(9) Syringes, needles, and appropriate drugs. (10) Postpartum hemorrhage kit including Bakri balloon or large Foley catheter for uterine tamponade.(11) Neonatal resuscitation supplies, including supplies for umbilical access for medications.(12) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport.(13) Refrigerated medication storage unit in standby unit for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies.(c) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, to provide low-risk maternal care and readiness at all times to initiate emergency procedures to meet unexpected needs of women and newborns, including, but not limited to, all of the following:(1) Ability to begin emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits. (2) Limited obstetric ultrasonography with interpretation readily available at all times. (3) Support services readily available at all times, including laboratory testing and blood bank.(4) Capability to implement patient safety bundles for common causes of preventable maternal morbidity, including management of maternal venous thromboembolism, obstetric hemorrhage, and severe hypertension in pregnancy. (5) Ability to initiate massive transfusion protocol with processes to obtain more blood and component therapy as needed. This paragraph shall not be interpreted to require more blood to be stored than is required for rural hospitals. (6) Pharmacy capability for premixed infusions. (d) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, for stabilization and the ability to facilitate transport to a higher-level hospital when necessary, including, but not limited to, all of the following:(1) Risk identification and determination of conditions necessitating consultation, referral, and transfer.(2) A mechanism and procedure for transfer or transport to a higher-level hospital at all times. (3) A reliable, accurate, and comprehensive communication system between participating hospitals, hospital personnel and transport teams. (e) A hospital selected for a pilot project pursuant to this chapter, in collaboration with higher-level facility partners, shall maintain the ability to initiate and sustain education and quality improvement programs to maximize patient safety. | |
| 76 | 75 | ||
| 77 | 76 | Article 3.5. Standby Perinatal Medical Services | |
| 78 | 77 | ||
| 79 | 78 | Article 3.5. Standby Perinatal Medical Services | |
| 80 | 79 | ||
| 81 | 80 | 123530. For purposes of this article, the following definitions apply:(a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (b) Department means the State Department of Public Health. (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes. | |
| 82 | 81 | ||
| 83 | 82 | ||
| 84 | 83 | ||
| 85 | 84 | 123530. For purposes of this article, the following definitions apply: | |
| 86 | 85 | ||
| 87 | 86 | (a) Critical access hospital means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. | |
| 88 | 87 | ||
| 89 | 88 | (b) Department means the State Department of Public Health. | |
| 90 | 89 | ||
| 91 | 90 | (c) Rural hospital means a rural general acute care hospital as set forth in subdivision (a) of Section 1250 or a hospital located in a rural or frontier medical study service area, as defined by the California Healthcare Workforce Policy Commission. | |
| 92 | 91 | ||
| 93 | 92 | (d) Standby perinatal medical services means the provision of emergency obstetric medical care in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients with urgent obstetric problems and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes. | |
| 94 | 93 | ||
| 95 | - | 123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, nurse midwives, and licensed midwives to meet the requirements described in subdivision (a). | |
| 94 | + | 123531. (a) The department shall do all of the following:(1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. (2) Develop minimum standards Determine eligibility for hospitals selected to participate in the pilot project. (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.(b) The department shall consult with stakeholders representing hospitals, consumers, physicians, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other affected health care professionals, health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, licensed nurse midwives, and certified licensed midwives to meet the requirements described in subdivision (a). | |
| 96 | 95 | ||
| 97 | 96 | ||
| 98 | 97 | ||
| 99 | 98 | 123531. (a) The department shall do all of the following: | |
| 100 | 99 | ||
| 101 | 100 | (1) Establish a five-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services. | |
| 102 | 101 | ||
| 103 | - | (2) Determine eligibility for hospitals selected to participate in the pilot project. | |
| 102 | + | (2) Develop minimum standards Determine eligibility for hospitals selected to participate in the pilot project. | |
| 104 | 103 | ||
| 105 | 104 | (3) (A) Develop a monitoring plan and reporting template to collect and evaluate data on safety, outcomes, utilization, and populations served using stratified demographic data to the extent statistically reliable data is available and complies with medical privacy laws and practices. | |
| 106 | 105 | ||
| 107 | 106 | (B) Compile the data collected pursuant to subparagraph (A) and prepare an evaluation to be submitted to the Legislature and made publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. | |
| 108 | 107 | ||
| 109 | 108 | (C) The evaluation to be submitted to the Legislature pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code. | |
| 110 | 109 | ||
| 111 | - | (b) The department shall consult with stakeholders representing hospitals, consumers, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, nurse midwives, and licensed midwives to meet the requirements described in subdivision (a). | |
| 110 | + | (b) The department shall consult with stakeholders representing hospitals, consumers, physicians, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, health plans, labor and other affected health care professionals, health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, licensed nurse midwives, and certified licensed midwives to meet the requirements described in subdivision (a). | |
| 112 | 111 | ||
| 113 | - | 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet all of the following requirements: (1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department on or after January 1, 2025.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. | |
| 112 | + | 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet both all of the following requirements: (a) (1)(1) Be greater than 60 minutes from the nearest hospital providing full maternity services.(2) Not have closed a full maternity or labor and delivery department within the past three years. on or after January 1, 2025.(b)Meet either of the following conditions:(1)Have an agreement with a freestanding birth center that includes combined billing. (2)Agree to provide routine labor and delivery services.(3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care.(b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. | |
| 114 | 113 | ||
| 115 | 114 | ||
| 116 | 115 | ||
| 117 | - | 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet all of the following requirements: | |
| 116 | + | 123532. (a) To qualify for participation in a pilot program under this chapter, a critical access or individual and small system rural hospital shall meet both all of the following requirements: | |
| 117 | + | ||
| 118 | + | (a) (1) | |
| 119 | + | ||
| 120 | + | ||
| 118 | 121 | ||
| 119 | 122 | (1) Be greater than 60 minutes from the nearest hospital providing full maternity services. | |
| 120 | 123 | ||
| 121 | - | (2) Not have closed a full maternity or labor and delivery department on or after January 1, 2025. | |
| 124 | + | (2) Not have closed a full maternity or labor and delivery department within the past three years. on or after January 1, 2025. | |
| 125 | + | ||
| 126 | + | (b)Meet either of the following conditions: | |
| 127 | + | ||
| 128 | + | ||
| 129 | + | ||
| 130 | + | (1)Have an agreement with a freestanding birth center that includes combined billing. | |
| 131 | + | ||
| 132 | + | ||
| 133 | + | ||
| 134 | + | (2)Agree to provide routine labor and delivery services. | |
| 135 | + | ||
| 136 | + | ||
| 122 | 137 | ||
| 123 | 138 | (3) Agree to provide basic level I maternal and neonatal services pursuant to the American College of Obstetricians and Gynecologists Levels of Maternal Care. | |
| 124 | 139 | ||
| 125 | 140 | (b) A hospital participating in the pilot program and meeting the requirements in this chapter may serve as the hospital with the capacity for the management of obstetrical and neonatal emergencies for an alternative birth center, as described in subparagraph (A) of paragraph (4) of subdivision (a) of Section 1204.3. | |
| 126 | 141 | ||
| 127 | - | 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are not in conflict with the standards and recommendations of the Guidelines for Perinatal Care Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(10) (A) A designated perinatal medical services space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services. | |
| 142 | + | 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: (a) (1) Have written policies and procedures that are consistent not in conflict with the standards and recommendations of the Guidelines for Perinatal Care (8th Edition, 2017) Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists or subsequent updates. Gynecologists.(2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following:(A) Relationships to other services in the hospital.(B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center.(C) Consultations from an intensive care newborn nursery. nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times.(D) Telemedicine services for real-time perinatal and neonatal consultation.(E) Infection control and relationship to the hospital infection committee.(F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery.(G) Prevention and treatment of neonatal hemorrhagic disease.(H) Resuscitation of newborn.(I) Administering and monitoring of oxygen and respiratory therapy.(J) Transfusions.(K)Phenylketonuria (PKU) screening.(K) Current state newborn screening requirements.(L) Rhesus (Rh) hemolytic disease identification, reporting and prevention.(M) Management of hyperbilirubinemia.(N) Discharge and continuity of care with referral to community support services.(O) Patient identification system.(P) Perinatal unit activation protocols.(Q) Condition specific management protocols outlining best practices.(R) Emergency codes, including, but not limited to, code pink, code blue, and code c.(S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate.(T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.(U) Anesthesia services readily available at all times. (3) The policies required by this subdivision shall be approved by the governing body.(b) Have and maintain all of the following:(1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services.(2) The capacity for operative delivery, including caesarean section at all times.(3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes.(4) A registered nurse immediately available within the hospital to provide perinatal nursing care, including emergency maternal fetal triage and infant resuscitation.(5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: (A) A blood bank.(B) An intensive care newborn nursery.(C) Ambulance transport and rescue services.(6) (A) Training and continuing education standards.(B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control. control, including all of the following:(i) Documented current registered nurse license.(ii) Current Basic Life Support (BLS) certification.(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.(iv) Electronic fetal monitoring certification.(v) S.T.A.B.L.E neonatal education program certification.(vi) Neonatal resuscitation program certification.(vii) Neonatal airway management program certification.(7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services.(8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services:(A) Administration of intravenous or intramuscular antibiotics.(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.(C) Administration of intravenous or intramuscular anticonvulsants.(D) Manual removal of the placenta.(E) Removal of retained products of conception.(F) Basic neonatal resuscitation.(G) Surgery, including caesarean sections.(H) Blood transfusions.(I) Additional services specified by the department.(9) Nursing competencies documented as follows:(A) Maternal care competencies documented annually, including all of the following:(i) Maternal assessment including vital signs, fetal monitoring, and pain assessment.(ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies.(iii) Recognition, response, and intervention to abnormal fetal heart rate patterns.(iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications.(v) Assist with emergency delivery.(B) Fetal and newborn care competencies documented annually, including all of the following:(i) Operates and interprets electronic fetal monitoring.(ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions.(iii) Prepares for and assists in neonatal resuscitation.(C) Post-delivery care, including all of the following:(i) Apgar score assignment.(ii) Thermoregulation or stabilization of newborn.(iii) Skin-to-skin breastfeeding support.(iv) Monitoring for postpartum hemorrhage and maternal complications.(D) Emergency situations competency validation, including all of the following:(i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage.(ii) Assistance with emergency cesarean section prep and neonatal transfer.(iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation.(9)(10) (A) A designated perinatal medical services space used for no other purpose. space.(B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit.(10)(11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses.(c) Ensure all of the following:(1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. (2) All infections are reported to the hospital infection control committee promptly.(3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours.(4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period.(5) An appropriate obstetric committee of the medical staff that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.(6)All physicians and certified nurse midwives providing services in the emergency room or inpatient setting are members of the organized medical staff.(6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services. | |
| 128 | 143 | ||
| 129 | 144 | ||
| 130 | 145 | ||
| 131 | 146 | 123533. A hospital selected for a pilot program pursuant to this chapter shall comply with all of the following requirements: | |
| 132 | 147 | ||
| 133 | - | (a) (1) Have written policies and procedures that are not in conflict with the standards and recommendations of the Guidelines for Perinatal Care Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. | |
| 148 | + | (a) (1) Have written policies and procedures that are consistent not in conflict with the standards and recommendations of the Guidelines for Perinatal Care (8th Edition, 2017) Level I developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists or subsequent updates. Gynecologists. | |
| 134 | 149 | ||
| 135 | 150 | (2) The person responsible for the standby perinatal medical services, in consultation with other appropriate health professionals and administration, shall develop and maintain the written policies and procedures required by paragraph (1). The policies and procedures shall include, but not be limited to, policies and procedures regarding all of the following: | |
| 136 | 151 | ||
| 137 | 152 | (A) Relationships to other services in the hospital. | |
| 138 | 153 | ||
| 139 | 154 | (B) Admission policies, including infants delivered prior to admission and infants transferred from a freestanding birth center. | |
| 140 | 155 | ||
| 141 | - | (C) Consultations from an intensive care newborn nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times. | |
| 156 | + | (C) Consultations from an intensive care newborn nursery. nursery and from an obstetric unit that includes maternal fetal medicine consultation available at all times. | |
| 142 | 157 | ||
| 143 | 158 | (D) Telemedicine services for real-time perinatal and neonatal consultation. | |
| 144 | 159 | ||
| 145 | 160 | (E) Infection control and relationship to the hospital infection committee. | |
| 146 | 161 | ||
| 147 | 162 | (F) Transfer of mothers to appropriate higher level of care services or infants to an intensive care newborn nursery. | |
| 148 | 163 | ||
| 149 | 164 | (G) Prevention and treatment of neonatal hemorrhagic disease. | |
| 150 | 165 | ||
| 151 | 166 | (H) Resuscitation of newborn. | |
| 152 | 167 | ||
| 153 | 168 | (I) Administering and monitoring of oxygen and respiratory therapy. | |
| 154 | 169 | ||
| 155 | 170 | (J) Transfusions. | |
| 171 | + | ||
| 172 | + | (K)Phenylketonuria (PKU) screening. | |
| 173 | + | ||
| 174 | + | ||
| 156 | 175 | ||
| 157 | 176 | (K) Current state newborn screening requirements. | |
| 158 | 177 | ||
| 159 | 178 | (L) Rhesus (Rh) hemolytic disease identification, reporting and prevention. | |
| 160 | 179 | ||
| 161 | 180 | (M) Management of hyperbilirubinemia. | |
| 162 | 181 | ||
| 163 | 182 | (N) Discharge and continuity of care with referral to community support services. | |
| 164 | 183 | ||
| 165 | 184 | (O) Patient identification system. | |
| 166 | 185 | ||
| 167 | 186 | (P) Perinatal unit activation protocols. | |
| 168 | 187 | ||
| 169 | 188 | (Q) Condition specific management protocols outlining best practices. | |
| 170 | 189 | ||
| 171 | 190 | (R) Emergency codes, including, but not limited to, code pink, code blue, and code c. | |
| 172 | 191 | ||
| 173 | 192 | (S) Monitoring and check off to ensure equipment stays in the standby unit and does not outdate. | |
| 174 | 193 | ||
| 175 | 194 | (T) Documentation standards for antepartum, intrapartum, postpartum, and newborn care. | |
| 176 | 195 | ||
| 177 | 196 | (U) Anesthesia services readily available at all times. | |
| 178 | 197 | ||
| 179 | 198 | (3) The policies required by this subdivision shall be approved by the governing body. | |
| 180 | 199 | ||
| 181 | 200 | (b) Have and maintain all of the following: | |
| 182 | 201 | ||
| 183 | 202 | (1) A roster of physicians and certified nurse midwives, and their immediate contact information, who are available to provide emergency perinatal services. | |
| 184 | 203 | ||
| 185 | 204 | (2) The capacity for operative delivery, including caesarean section at all times. | |
| 186 | 205 | ||
| 187 | 206 | (3) Physician and nursing staff coverage on call 24 hours a day for the standby perinatal medical service within 30 minutes. | |
| 188 | 207 | ||
| 189 | - | (4) A registered nurse immediately available within the hospital to provide nursing care, including emergency maternal fetal triage and infant resuscitation. | |
| 208 | + | (4) A registered nurse immediately available within the hospital to provide perinatal nursing care, including emergency maternal fetal triage and infant resuscitation. | |
| 190 | 209 | ||
| 191 | 210 | (5) A list of referral services available in the standby perinatal medical service that shall include the name, address, and telephone number of all of the following: | |
| 192 | 211 | ||
| 193 | 212 | (A) A blood bank. | |
| 194 | 213 | ||
| 195 | 214 | (B) An intensive care newborn nursery. | |
| 196 | 215 | ||
| 197 | 216 | (C) Ambulance transport and rescue services. | |
| 198 | 217 | ||
| 199 | 218 | (6) (A) Training and continuing education standards. | |
| 200 | 219 | ||
| 201 | - | (B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control, including all of the following: | |
| 220 | + | (B) Evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control. control, including all of the following: | |
| 202 | 221 | ||
| 203 | 222 | (i) Documented current registered nurse license. | |
| 204 | 223 | ||
| 205 | 224 | (ii) Current Basic Life Support (BLS) certification. | |
| 206 | 225 | ||
| 207 | 226 | (iii) Current Advanced Cardiovascular Life Support (ACLS) certification. | |
| 208 | 227 | ||
| 209 | 228 | (iv) Electronic fetal monitoring certification. | |
| 210 | 229 | ||
| 211 | 230 | (v) S.T.A.B.L.E neonatal education program certification. | |
| 212 | 231 | ||
| 213 | 232 | (vi) Neonatal resuscitation program certification. | |
| 214 | 233 | ||
| 215 | 234 | (vii) Neonatal airway management program certification. | |
| 216 | 235 | ||
| 217 | 236 | (7) Formal arrangements for consultation or transfer of an infant to an intensive care newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal medical services. | |
| 218 | 237 | ||
| 219 | 238 | (8) The ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability by including all of the following services: | |
| 220 | 239 | ||
| 221 | 240 | (A) Administration of intravenous or intramuscular antibiotics. | |
| 222 | 241 | ||
| 223 | 242 | (B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin. | |
| 224 | 243 | ||
| 225 | 244 | (C) Administration of intravenous or intramuscular anticonvulsants. | |
| 226 | 245 | ||
| 227 | 246 | (D) Manual removal of the placenta. | |
| 228 | 247 | ||
| 229 | 248 | (E) Removal of retained products of conception. | |
| 230 | 249 | ||
| 231 | 250 | (F) Basic neonatal resuscitation. | |
| 232 | 251 | ||
| 233 | 252 | (G) Surgery, including caesarean sections. | |
| 234 | 253 | ||
| 235 | 254 | (H) Blood transfusions. | |
| 236 | 255 | ||
| 237 | 256 | (I) Additional services specified by the department. | |
| 238 | 257 | ||
| 239 | 258 | (9) Nursing competencies documented as follows: | |
| 240 | 259 | ||
| 241 | 260 | (A) Maternal care competencies documented annually, including all of the following: | |
| 242 | 261 | ||
| 243 | 262 | (i) Maternal assessment including vital signs, fetal monitoring, and pain assessment. | |
| 244 | 263 | ||
| 245 | 264 | (ii) Identification of signs of preeclampsia, placental abruption, preterm labor, hemorrhage, and other obstetric emergencies. | |
| 246 | 265 | ||
| 247 | 266 | (iii) Recognition, response, and intervention to abnormal fetal heart rate patterns. | |
| 248 | 267 | ||
| 249 | 268 | (iv) Administration of oxytocin, magnesium sulfate, and other perinatal specific medications. | |
| 250 | 269 | ||
| 251 | 270 | (v) Assist with emergency delivery. | |
| 252 | 271 | ||
| 253 | 272 | (B) Fetal and newborn care competencies documented annually, including all of the following: | |
| 254 | 273 | ||
| 255 | 274 | (i) Operates and interprets electronic fetal monitoring. | |
| 256 | 275 | ||
| 257 | 276 | (ii) Identifies non-reassuring fetal heart rate tracings and initiates interventions. | |
| 258 | 277 | ||
| 259 | 278 | (iii) Prepares for and assists in neonatal resuscitation. | |
| 260 | 279 | ||
| 261 | 280 | (C) Post-delivery care, including all of the following: | |
| 262 | 281 | ||
| 263 | 282 | (i) Apgar score assignment. | |
| 264 | 283 | ||
| 265 | 284 | (ii) Thermoregulation or stabilization of newborn. | |
| 266 | 285 | ||
| 267 | 286 | (iii) Skin-to-skin breastfeeding support. | |
| 268 | 287 | ||
| 269 | 288 | (iv) Monitoring for postpartum hemorrhage and maternal complications. | |
| 270 | 289 | ||
| 271 | 290 | (D) Emergency situations competency validation, including all of the following: | |
| 272 | 291 | ||
| 273 | 292 | (i) Recognition and response to hypertensive crisis, shoulder dystocia, cord prolapse, uterine rupture, and postpartum hemorrhage. | |
| 274 | 293 | ||
| 275 | 294 | (ii) Assistance with emergency cesarean section prep and neonatal transfer. | |
| 276 | 295 | ||
| 277 | 296 | (iii) Participation in simulation-based training to reinforce response to obstetric emergencies, including postpartum hemorrhage, eclampsia, shoulder dystocia, nurse delivery, and neonatal resuscitation. | |
| 278 | 297 | ||
| 279 | - | (10) (A) A designated perinatal medical services space. | |
| 298 | + | (9) | |
| 299 | + | ||
| 300 | + | ||
| 301 | + | ||
| 302 | + | (10) (A) A designated perinatal medical services space used for no other purpose. space. | |
| 280 | 303 | ||
| 281 | 304 | (B) Notwithstanding subparagraph (A), in a rural hospital with a licensed bed capacity of 25 or less, the operating room may serve as the emergency perinatal unit. | |
| 305 | + | ||
| 306 | + | (10) | |
| 307 | + | ||
| 308 | + | ||
| 282 | 309 | ||
| 283 | 310 | (11) A laboratory with the capability of performing blood gas analyses, pH and microbiologic analyses. | |
| 284 | 311 | ||
| 285 | 312 | (c) Ensure all of the following: | |
| 286 | 313 | ||
| 287 | 314 | (1) Standardized obstetric and newborn emergency nursing procedures are developed by an appropriate committee of the medical staff. | |
| 288 | 315 | ||
| 289 | 316 | (2) All infections are reported to the hospital infection control committee promptly. | |
| 290 | 317 | ||
| 291 | 318 | (3) Oxygen is administered to newborn infants only on the written order of a physician or certified nurse midwife. The order shall include the concentration by volume percent, or desired arterial partial pressure of oxygen and be reviewed, modified, or discontinued after 24 hours. | |
| 292 | 319 | ||
| 293 | 320 | (4) Patients are attended by a physician, certified nurse midwife, or licensed nurse when under the effect of anesthesia or regional analgesia, when in active labor, during delivery, or in the immediate postpartum period. | |
| 294 | 321 | ||
| 295 | - | (5) An appropriate obstetric committee that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration. | |
| 322 | + | (5) An appropriate obstetric committee of the medical staff that periodically evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration. | |
| 323 | + | ||
| 324 | + | (6)All physicians and certified nurse midwives providing services in the emergency room or inpatient setting are members of the organized medical staff. | |
| 325 | + | ||
| 326 | + | ||
| 296 | 327 | ||
| 297 | 328 | (6) A provider that provides services in the emergency room, standby perinatal unit, or inpatient setting has privileges and is credentialed by the medical staff. | |
| 298 | 329 | ||
| 299 | 330 | (d) Define the responsibilities of the medical staff and administration associated with the standby perinatal medical services. | |
| 300 | 331 | ||
| 301 | - | (e) Ensure that standby perinatal medical services comply with the same licensed nurse-to-patient ratios as a combined labor, delivery, and postpartum area of perinatal services. This subdivision does not alter or amend the effect of any regulation adopted pursuant to Section 1276.4. | |
| 302 | - | ||
| 303 | - | 123534. (a) A physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology, the American Board of Pediatrics, or the American Board of Family Medicine shall have overall responsibility for a pilot program under this chapter.(b) The physician described in subdivision (a) shall be responsible for all of the following:(1) Implementation of established policies and procedures.(2) Development of a system for assuring physician coverage on call 24 hours a day to the standby perinatal medical services.(3) Assurance that physician coverage is available within 30 minutes.(4) Development of a roster of specialty physicians available for consultation at all times. (5) Maintaining work relationships with intensive care newborn nursery. (6) Assurance of continuing education for the medical and nursing staff. (7) Development of order sets for pregnant patients presenting to the emergency department and for the perinatal standby unit, including all of the following:(A) Admission, including as-needed hemorrhage orders. (B) Chorioamnionitis and sepsis orders.(C) Augmentation of labor.(D) Cesarean section orders.(E) Pregnancy induced hypertension, including intrapartum and postpartum. (F) Premature rupture of membranes.(G) Preterm labor stabilization.(H) Post anesthesia recovery.(I) Postpartum care, including after vaginal delivery and after cesarean section.(J) Neonatal care.(K) Discharge for both mother and infant. | |
| 332 | + | 123534. (a) (1)A physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology or Gynecology, the American Board of Pediatrics Pediatrics, or the American Board of Family Medicine shall have overall responsibility for a pilot program under this chapter.(2)If a physician that meets the requirement described in paragraph (1) is not available, a physician with training and experience in obstetrics and gynecology or pediatrics shall have overall responsibility for a pilot project pursuant to this chapter. In this circumstance, a physician that meets the requirement described in paragraph (1) shall provide consultation at a frequency that will assure high-quality service.(b) The physician described in subdivision (a) shall be responsible for all of the following:(1) Implementation of established policies and procedures.(2) Development of a system for assuring physician coverage on call 24 hours a day to the standby perinatal medical services.(3) Assurance that physician coverage is available within 30 minutes.(4) Development of a roster of specialty physicians available for consultation at all times. (5) Maintaining work relationships with intensive care newborn nursery. (6) Assurance of continuing education for the medical and nursing staff. (7) Development of order sets for pregnant patients presenting to the emergency department and for the perinatal standby unit, including all of the following:(A) Admission, including as-needed hemorrhage orders. (B) Chorioamnionitis and sepsis orders.(C) Augmentation of labor.(D) Cesarean section orders.(E) Pregnancy induced hypertension, including intrapartum and postpartum. (F) Premature rupture of membranes.(G) Preterm labor stabilization.(H) Post anesthesia recovery.(I) Postpartum care, including after vaginal delivery and after cesarean section.(J) Neonatal care.(K) Discharge for both mother and infant. | |
| 304 | 333 | ||
| 305 | 334 | ||
| 306 | 335 | ||
| 307 | - | 123534. (a) A physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology, the American Board of Pediatrics, or the American Board of Family Medicine shall have overall responsibility for a pilot program under this chapter. | |
| 336 | + | 123534. (a) (1)A physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology or Gynecology, the American Board of Pediatrics Pediatrics, or the American Board of Family Medicine shall have overall responsibility for a pilot program under this chapter. | |
| 337 | + | ||
| 338 | + | (2)If a physician that meets the requirement described in paragraph (1) is not available, a physician with training and experience in obstetrics and gynecology or pediatrics shall have overall responsibility for a pilot project pursuant to this chapter. In this circumstance, a physician that meets the requirement described in paragraph (1) shall provide consultation at a frequency that will assure high-quality service. | |
| 339 | + | ||
| 340 | + | ||
| 308 | 341 | ||
| 309 | 342 | (b) The physician described in subdivision (a) shall be responsible for all of the following: | |
| 310 | 343 | ||
| 311 | 344 | (1) Implementation of established policies and procedures. | |
| 312 | 345 | ||
| 313 | 346 | (2) Development of a system for assuring physician coverage on call 24 hours a day to the standby perinatal medical services. | |
| 314 | 347 | ||
| 315 | 348 | (3) Assurance that physician coverage is available within 30 minutes. | |
| 316 | 349 | ||
| 317 | 350 | (4) Development of a roster of specialty physicians available for consultation at all times. | |
| 318 | 351 | ||
| 319 | 352 | (5) Maintaining work relationships with intensive care newborn nursery. | |
| 320 | 353 | ||
| 321 | 354 | (6) Assurance of continuing education for the medical and nursing staff. | |
| 322 | 355 | ||
| 323 | 356 | (7) Development of order sets for pregnant patients presenting to the emergency department and for the perinatal standby unit, including all of the following: | |
| 324 | 357 | ||
| 325 | 358 | (A) Admission, including as-needed hemorrhage orders. | |
| 326 | 359 | ||
| 327 | 360 | (B) Chorioamnionitis and sepsis orders. | |
| 328 | 361 | ||
| 329 | 362 | (C) Augmentation of labor. | |
| 330 | 363 | ||
| 331 | 364 | (D) Cesarean section orders. | |
| 332 | 365 | ||
| 333 | 366 | (E) Pregnancy induced hypertension, including intrapartum and postpartum. | |
| 334 | 367 | ||
| 335 | 368 | (F) Premature rupture of membranes. | |
| 336 | 369 | ||
| 337 | 370 | (G) Preterm labor stabilization. | |
| 338 | 371 | ||
| 339 | 372 | (H) Post anesthesia recovery. | |
| 340 | 373 | ||
| 341 | 374 | (I) Postpartum care, including after vaginal delivery and after cesarean section. | |
| 342 | 375 | ||
| 343 | 376 | (J) Neonatal care. | |
| 344 | 377 | ||
| 345 | 378 | (K) Discharge for both mother and infant. | |
| 346 | 379 | ||
| 347 | - | 123535. (a) A hospital selected for a pilot program pursuant to this chapter shall maintain equipment and supplies necessary for mothers and infants needing emergency or immediate life support, including, but not limited to, all of the following: (1) DC defibrillator, available immediately.(2) Blanket warmer. (3) Solutions and supplies for intravenous fluids, blood, and plasma and blood substitutes or fractions. (4) A fetal heart rate monitor that meets both of following requirements:(A) Ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters.(B) Maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse.(5) Adjustable examination light. (6) Sphygmomanometer. (7) Regular and fetal stethoscope. (8) Adjustable delivery table. (9) Equipment for inhalation anesthesia and regional analgesia. (10) Clock with sweep second hand. (11) Elapsed time clock. (12) Emergency supplies, including packings, syringes, needles, and drugs. (13) Emergency call button. (14) Provision for oxygen and suction for mother and infant. (15) Thermostatically controlled incubator or radiant heating device. (16) Sterile clamps or ties for umbilical cord. (b) A hospital selected for a pilot project pursuant to this chapter shall maintain the following resuscitation equipment, including, but not limited to:(1) Glass trap suction device with catheter. (2) Pharyngeal airways, assorted sizes. (3) Laryngoscope, including a blade for premature infants. (4) Endotracheal catheters, assorted sizes with malleable stylets. (5) Arterial catheters, assorted sizes. (6) Ventilatory assistance bag and infant mask. (7) Bulb syringe. (8) Stethoscope.(9) Syringes, needles, and appropriate drugs. (10) Postpartum hemorrhage kit including Bakri balloon or large Foley catheter for uterine tamponade.(11) Neonatal resuscitation supplies, including supplies for umbilical access for medications.(12) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport.(13) Refrigerated medication storage unit in standby unit for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies.(c) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, to provide low-risk maternal care and readiness at all times to initiate emergency procedures to meet unexpected needs of women and newborns, including, but not limited to, all of the following:(1) Ability to begin emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits. (2) Limited obstetric ultrasonography with interpretation readily available at all times. (3) Support services readily available at all times, including laboratory testing and blood bank.(4) Capability to implement patient safety bundles for common causes of preventable maternal morbidity, including management of maternal venous thromboembolism, obstetric hemorrhage, and severe hypertension in pregnancy. (5) Ability to initiate massive transfusion protocol with processes to obtain more blood and component therapy as needed. This paragraph shall not be interpreted to require more blood to be stored than is required for rural hospitals. (6) Pharmacy capability for premixed infusions. (d) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, for stabilization and the ability to facilitate transport to a higher-level hospital when necessary, including, but not limited to, all of the following:(1) Risk identification and determination of conditions necessitating consultation, referral, and transfer.(2) A mechanism and procedure for transfer or transport to a higher-level hospital at all times. (3) A reliable, accurate, and comprehensive communication system between participating hospitals, hospital personnel and transport teams. (e) A hospital selected for a pilot project pursuant to this chapter, in collaboration with higher-level facility partners, shall maintain the ability to initiate and sustain education and quality improvement programs to maximize patient safety. | |
| 380 | + | 123535. (a) A hospital selected for a pilot program pursuant to this chapter shall maintain equipment and supplies necessary for mothers and infants needing emergency or immediate life support, including, but not limited to, all of the following: (1) DC defibrillator, available immediately.(2) Blanket warmer. (3) Solutions and supplies for intravenous fluids, blood, and plasma and blood substitutes or fractions. (4) A fetal heart rate monitor. monitor that meets both of following requirements:(A) Ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters.(B) Maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse.(5) Adjustable examination light. (6) Sphygmomanometer. (7) Regular and fetal stethoscope. (8) Adjustable delivery table. (9) Equipment for inhalation anesthesia and regional analgesia. (10) Clock with sweep second hand. (11) Elapsed time clock. (12) Emergency supplies, including packings, syringes, needles, and drugs. (13) Emergency call button. (14) Provision for oxygen and suction for mother and infant. (15) Thermostatically controlled incubator or radiant heating device. (16)Sterile 1 percent silver nitrate and irrigating solutions for prophylactic Crede treatment of the eyes. (17)(16) Sterile clamps or ties for umbilical cord. (b) A hospital selected for a pilot project pursuant to this chapter shall maintain the following resuscitation equipment, including, but not limited to:(1) Glass trap suction device with catheter. (2) Pharyngeal airways, assorted sizes. (3) Laryngoscope, including a blade for premature infants. (4) Endotracheal catheters, assorted sizes with malleable stylets. (5) Arterial catheters, assorted sizes. (6) Ventilatory assistance bag and infant mask. (7) Bulb syringe. (8) Stethoscope.(9) Syringes, needles, and appropriate drugs. (10) Postpartum hemorrhage kit including Bakri balloon or large Foley catheter for uterine tamponade.(11) Neonatal resuscitation supplies, including supplies for umbilical access for medications.(12) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport.(13) Refrigerated medication storage unit in standby unit for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies.(c) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, to provide low-risk maternal care and readiness at all times to initiate emergency procedures to meet unexpected needs of women and newborns, including, but not limited to, all of the following:(1) Ability to begin emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits. (2) Limited obstetric ultrasonography with interpretation readily available at all times. (3) Support services readily available at all times, including laboratory testing and blood bank.(4) Capability to implement patient safety bundles for common causes of preventable maternal morbidity, including management of maternal venous thromboembolism, obstetric hemorrhage, and severe hypertension in pregnancy. (5) Ability to initiate massive transfusion protocol with processes to obtain more blood and component therapy as needed. This paragraph shall not be interpreted to require more blood to be stored than is required for rural hospitals. (6) Pharmacy capability for premixed infusions. (d) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, for stabilization and the ability to facilitate transport to a higher-level hospital when necessary, including, but not limited to, all of the following:(1) Risk identification and determination of conditions necessitating consultation, referral, and transfer.(2) A mechanism and procedure for transfer or transport to a higher-level hospital at all times. (3) A reliable, accurate, and comprehensive communication system between participating hospitals, hospital personnel and transport teams. (e) A hospital selected for a pilot project pursuant to this chapter, in collaboration with higher-level facility partners, shall maintain the ability to initiate and sustain education and quality improvement programs to maximize patient safety. | |
| 348 | 381 | ||
| 349 | 382 | ||
| 350 | 383 | ||
| 351 | 384 | 123535. (a) A hospital selected for a pilot program pursuant to this chapter shall maintain equipment and supplies necessary for mothers and infants needing emergency or immediate life support, including, but not limited to, all of the following: | |
| 352 | 385 | ||
| 353 | 386 | (1) DC defibrillator, available immediately. | |
| 354 | 387 | ||
| 355 | 388 | (2) Blanket warmer. | |
| 356 | 389 | ||
| 357 | 390 | (3) Solutions and supplies for intravenous fluids, blood, and plasma and blood substitutes or fractions. | |
| 358 | 391 | ||
| 359 | - | (4) A fetal heart rate monitor that meets both of following requirements: | |
| 392 | + | (4) A fetal heart rate monitor. monitor that meets both of following requirements: | |
| 360 | 393 | ||
| 361 | 394 | (A) Ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters. | |
| 362 | 395 | ||
| 363 | 396 | (B) Maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse. | |
| 364 | 397 | ||
| 365 | 398 | (5) Adjustable examination light. | |
| 366 | 399 | ||
| 367 | 400 | (6) Sphygmomanometer. | |
| 368 | 401 | ||
| 369 | 402 | (7) Regular and fetal stethoscope. | |
| 370 | 403 | ||
| 371 | 404 | (8) Adjustable delivery table. | |
| 372 | 405 | ||
| 373 | 406 | (9) Equipment for inhalation anesthesia and regional analgesia. | |
| 374 | 407 | ||
| 375 | 408 | (10) Clock with sweep second hand. | |
| 376 | 409 | ||
| 377 | 410 | (11) Elapsed time clock. | |
| 378 | 411 | ||
| 379 | 412 | (12) Emergency supplies, including packings, syringes, needles, and drugs. | |
| 380 | 413 | ||
| 381 | 414 | (13) Emergency call button. | |
| 382 | 415 | ||
| 383 | 416 | (14) Provision for oxygen and suction for mother and infant. | |
| 384 | 417 | ||
| 385 | 418 | (15) Thermostatically controlled incubator or radiant heating device. | |
| 419 | + | ||
| 420 | + | (16)Sterile 1 percent silver nitrate and irrigating solutions for prophylactic Crede treatment of the eyes. | |
| 421 | + | ||
| 422 | + | ||
| 423 | + | ||
| 424 | + | (17) | |
| 425 | + | ||
| 426 | + | ||
| 386 | 427 | ||
| 387 | 428 | (16) Sterile clamps or ties for umbilical cord. | |
| 388 | 429 | ||
| 389 | 430 | (b) A hospital selected for a pilot project pursuant to this chapter shall maintain the following resuscitation equipment, including, but not limited to: | |
| 390 | 431 | ||
| 391 | 432 | (1) Glass trap suction device with catheter. | |
| 392 | 433 | ||
| 393 | 434 | (2) Pharyngeal airways, assorted sizes. | |
| 394 | 435 | ||
| 395 | 436 | (3) Laryngoscope, including a blade for premature infants. | |
| 396 | 437 | ||
| 397 | 438 | (4) Endotracheal catheters, assorted sizes with malleable stylets. | |
| 398 | 439 | ||
| 399 | 440 | (5) Arterial catheters, assorted sizes. | |
| 400 | 441 | ||
| 401 | 442 | (6) Ventilatory assistance bag and infant mask. | |
| 402 | 443 | ||
| 403 | 444 | (7) Bulb syringe. | |
| 404 | 445 | ||
| 405 | 446 | (8) Stethoscope. | |
| 406 | 447 | ||
| 407 | 448 | (9) Syringes, needles, and appropriate drugs. | |
| 408 | 449 | ||
| 409 | 450 | (10) Postpartum hemorrhage kit including Bakri balloon or large Foley catheter for uterine tamponade. | |
| 410 | 451 | ||
| 411 | 452 | (11) Neonatal resuscitation supplies, including supplies for umbilical access for medications. | |
| 412 | 453 | ||
| 413 | 454 | (12) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport. | |
| 414 | 455 | ||
| 415 | 456 | (13) Refrigerated medication storage unit in standby unit for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies. | |
| 416 | 457 | ||
| 417 | 458 | (c) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, to provide low-risk maternal care and readiness at all times to initiate emergency procedures to meet unexpected needs of women and newborns, including, but not limited to, all of the following: | |
| 418 | 459 | ||
| 419 | 460 | (1) Ability to begin emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits. | |
| 420 | 461 | ||
| 421 | 462 | (2) Limited obstetric ultrasonography with interpretation readily available at all times. | |
| 422 | 463 | ||
| 423 | 464 | (3) Support services readily available at all times, including laboratory testing and blood bank. | |
| 424 | 465 | ||
| 425 | 466 | (4) Capability to implement patient safety bundles for common causes of preventable maternal morbidity, including management of maternal venous thromboembolism, obstetric hemorrhage, and severe hypertension in pregnancy. | |
| 426 | 467 | ||
| 427 | 468 | (5) Ability to initiate massive transfusion protocol with processes to obtain more blood and component therapy as needed. This paragraph shall not be interpreted to require more blood to be stored than is required for rural hospitals. | |
| 428 | 469 | ||
| 429 | 470 | (6) Pharmacy capability for premixed infusions. | |
| 430 | 471 | ||
| 431 | 472 | (d) A hospital selected for a pilot project pursuant to this chapter shall maintain the following capabilities, including necessary equipment, for stabilization and the ability to facilitate transport to a higher-level hospital when necessary, including, but not limited to, all of the following: | |
| 432 | 473 | ||
| 433 | 474 | (1) Risk identification and determination of conditions necessitating consultation, referral, and transfer. | |
| 434 | 475 | ||
| 435 | 476 | (2) A mechanism and procedure for transfer or transport to a higher-level hospital at all times. | |
| 436 | 477 | ||
| 437 | 478 | (3) A reliable, accurate, and comprehensive communication system between participating hospitals, hospital personnel and transport teams. | |
| 438 | 479 | ||
| 439 | 480 | (e) A hospital selected for a pilot project pursuant to this chapter, in collaboration with higher-level facility partners, shall maintain the ability to initiate and sustain education and quality improvement programs to maximize patient safety. |