1315. Dental services, as defined in the Dental Practice Act, may
be provided patients in health facilities licensed under this
chapter. Such services shall be provided by persons licensed by the
State of California pursuant to Section 1611 of the Business and
Professions Code. However, this section shall not limit or restrict
the right of a licensed physician and surgeon to perform any acts
authorized under the Medical Practice Act.
1316. (a) The rules of a health facility shall include provisions
for use of the facility by, and staff privileges for, duly licensed
podiatrists within the scope of their respective licensure, subject
to rules and regulations governing such use or privileges established
by the health facility. Such rules and regulations shall not
discriminate on the basis of whether the staff member holds a M. D.,
D.O., or D.P.M. degree, within the scope of their respective
licensure. Each health facility shall establish a staff comprised of
physicians and surgeons, podiatrists, or any combination thereof,
which shall regulate the admission, conduct suspension, or
termination of the staff appointment of the podiatrists while using
the facilities. No classification of health facilities by the state
department, nor any other classification of health facilities based
on quality of service or otherwise, by any person, body, or
governmental agency of this state or any subdivision thereof shall be
affected by a health facility's provision for use of its facilities
by duly licensed podiatrists, nor shall any such classification be
affected by the subjection of the podiatrists, to the rules and
regulations of a staff comprising podiatrists, physicians and
surgeons, or any combination thereof, which govern the podiatrists'
use of the facilities. No classification of health facilities by any
governmental agency of this state or any subdivision thereof pursuant
to present law or laws passed hereinafter for the purposes of
ascertaining eligibility for compensation, reimbursement, or other
benefit for treatment of patients shall be affected by a health
facility's provision for use of its facilities by duly licensed
podiatrists, nor shall any such classification be affected by the
subjection of the podiatrists and dentists to the rules and
regulations of a staff comprising podiatrists, physicians and
surgeons, or any combination thereof, which govern the podiatrists'
use of the facilities.
With regard to the practice of podiatry in health facilities
throughout this state, medical staff status shall include and provide
for the right to pursue and practice full clinical and surgical
privileges for holders of M.D., D.O., and D. P.M. degrees within the
scope of their respective licensure. Such rights and privileges shall
be limited or restricted only upon the basis of an individual
practitioner's demonstrated competence. Such competence shall be
determined by health facility rules, regulations, and procedures
which are necessary and are applied in good faith, equally and in a
nondiscriminatory manner, to all practitioners regardless of whether
they hold a M.D., D.O., or D.P.M. degree.
Nothing in this section shall be construed to require a health
facility to offer a specific health service or services not otherwise
offered. If a health service is offered, the facility shall not
discriminate between persons holding M.D. , D.O., or D.P.M. degrees
who are authorized by law to perform such services.
This subdivision shall not prohibit a health facility which is a
clinical teaching facility owned or operated by a university
operating a school of medicine from requiring that a podiatrist have
a faculty teaching appointment as a condition for eligibility for
staff privileges for that facility.
(b) The rules of a health facility which include provisions for
use of the facility by, and staff privileges for, medical staff shall
not discriminate on the basis of whether the staff member holds a
M.D., D.O., or D.P.M. degree, within the scope of their respective
licensure. The health facility staff processing, reviewing,
evaluating, and determining qualifications for staff privileges for
medical staff shall include, if possible, staff members that hold
M.D., D.O., and D.P.M. degrees.
(c) Any violation by a health facility of the provisions of this
section may be enjoined in an action brought in the name of the
people of the State of California by the district attorney of the
county in which the health facility is located, upon receipt of a
complaint by an aggrieved physician and surgeon or podiatrist.
1316.5. (a) (1) Each health facility owned and operated by the
state offering care or services within the scope of practice of a
psychologist shall establish rules and medical staff bylaws that
include provisions for medical staff membership and clinical
privileges for clinical psychologists within the scope of their
licensure as psychologists, subject to the rules and medical staff
bylaws governing medical staff membership or privileges as the
facility shall establish. The rules and regulations shall not
discriminate on the basis of whether the staff member holds an M.D.,
D.O., D.D.S., D.P.M., or doctoral degree in psychology within the
scope of the member's respective licensure. Each of these health
facilities owned and operated by the state shall establish a staff
comprised of physicians and surgeons, dentists, podiatrists,
psychologists, or any combination thereof, that shall regulate the
admission, conduct, suspension, or termination of the staff
appointment of psychologists employed by the health facility.
(2) With regard to the practice of psychology in health facilities
owned and operated by the state offering care or services within the
scope of practice of a psychologist, medical staff status shall
include and provide for the right to pursue and practice full
clinical privileges for holders of a doctoral degree of psychology
within the scope of their respective licensure. These rights and
privileges shall be limited or restricted only upon the basis of an
individual practitioner's demonstrated competence. Competence shall
be determined by health facility rules and medical staff bylaws that
are necessary and are applied in good faith, equally and in a
nondiscriminatory manner, to all practitioners, regardless of whether
they hold an M.D., D.O., D.D.S., D.P.M., or doctoral degree in
psychology.
(3) Nothing in this subdivision shall be construed to require a
health facility owned and operated by the state to offer a specific
health service or services not otherwise offered. If a health service
is offered in such a health facility that includes provisions for
medical staff membership and clinical privileges for clinical
psychologists, the facility shall not discriminate between persons
holding an M.D., D.O., D.D.S., D.P.M., or doctoral degree in
psychology who are authorized by law to perform the service within
the scope of the person's respective licensure.
(4) The rules and medical staff bylaws of a health facility owned
and operated by the state that include provisions for medical staff
membership and clinical privileges for medical staff and duly
licensed clinical psychologists shall not discriminate on the basis
of whether the staff member holds an M.D., D.O., D.D.S., D.P.M., or
doctoral degree in psychology within the scope of the member's
respective licensure. The health facility staff of these health
facilities who process, review, evaluate, and determine
qualifications for staff privileges for medical staff shall include,
if possible, staff members who are clinical psychologists.
(b) (1) The rules of a health facility not owned or operated by
this state may enable the appointment of clinical psychologists on
the terms and conditions that the facility shall establish. In these
health facilities, clinical psychologists may hold membership and
serve on committees of the medical staff and carry professional
responsibilities consistent with the scope of their licensure and
their competence, subject to the rules of the health facility.
(2) Nothing in this subdivision shall be construed to require a
health facility not owned or operated by this state to offer a
specific health service or services not otherwise offered. If a
health service is offered by a health facility with both licensed
physicians and surgeons and clinical psychologists on the medical
staff, which both licensed physicians and surgeons and clinical
psychologists are authorized by law to perform, the service may be
performed by either, without discrimination.
(3) This subdivision shall not prohibit a health facility that is
a clinical teaching facility owned or operated by a university
operating a school of medicine from requiring that a clinical
psychologist have a faculty teaching appointment as a condition for
eligibility for staff privileges at that facility.
(4) In any health facility that is not owned or operated by this
state that provides staff privileges to clinical psychologists, the
health facility staff who process, review, evaluate, and determine
qualifications for staff privileges for medical staff shall include,
if possible, staff members who are clinical psychologists.
(c) No classification of health facilities by the department, nor
any other classification of health facilities based on quality of
service or otherwise, by any person, body, or governmental agency of
this state or any subdivision thereof shall be affected by a health
facility's provision for use of its facilities by duly licensed
clinical psychologists, nor shall any classification of these
facilities be affected by the subjection of the psychologists to the
rules and regulations of the organized professional staff. No
classification of health facilities by any governmental agency of
this state or any subdivision thereof pursuant to any law, whether
enacted prior or subsequent to the effective date of this section,
for the purposes of ascertaining eligibility for compensation,
reimbursement, or other benefit for treatment of patients shall be
affected by a health facility's provision for use of its facilities
by duly licensed clinical psychologists, nor shall any classification
of these facilities be affected by the subjection of the
psychologists to the rules and regulations of the organized
professional staff which govern the psychologists' use of the
facilities.
(d) "Clinical psychologist," as used in this section, means a
psychologist licensed by this state who meets both of the following
requirements:
(1) Possesses an earned doctorate degree in psychology from an
educational institution meeting the criteria of subdivision (b) of
Section 2914 of the Business and Professions Code.
(2) Has not less than two years clinical experience in a
multidisciplinary facility licensed or operated by this or another
state or by the United States to provide health care, or, is listed
in the latest edition of the National Register of Health Service
Providers in Psychology, as adopted by the Council for the National
Register of Health Service Providers in Psychology.
(e) Nothing in this section is intended to expand the scope of
licensure of clinical psychologists. Notwithstanding the Ralph C.
Dills Act (Chapter 10.3 (commencing with Section 3512) of Division 4
of Title 1 of the Government Code), the Public Employment Relations
Board is precluded from creating any additional bargaining units for
the purpose of exclusive representation of state psychologist
employees that might result because of medical staff membership
and/or privilege changes for psychologists due to the enactment of
provisions by Assembly Bill No. 3141 of the 1995-96 Regular Session.
(f) The State Department of Mental Health, the State Department of
Developmental Services, and the Department of Corrections shall
report to the Legislature no later than January 1, 2006, on the
impact of medical staff membership and privileges for clinical
psychologists on quality of care, and on cost-effectiveness issues.
1316.6. Notwithstanding any other provision of this chapter, the
exercise of privileges in any health facility may be limited,
restricted, or revoked for the violation of such health facility's
rules, regulations, or procedures which are applied, in good faith,
in a nondiscriminatory manner to all practitioners in such health
facility exercising such privileges or entitled to exercise such
privileges.
1317. (a) Emergency services and care shall be provided to any
person requesting the services or care, or for whom services or care
is requested, for any condition in which the person is in danger of
loss of life, or serious injury or illness, at any health facility
licensed under this chapter that maintains and operates an emergency
department to provide emergency services to the public when the
health facility has appropriate facilities and qualified personnel
available to provide the services or care.
(b) In no event shall the provision of emergency services and care
be based upon, or affected by, the person's ethnicity, citizenship,
age, preexisting medical condition, insurance status, economic
status, ability to pay for medical services, or any other
characteristic listed or defined in subdivision (b) or (e) of Section
51 of the Civil Code, except to the extent that a circumstance such
as age, sex, preexisting medical condition, or physical or mental
disability is medically significant to the provision of appropriate
medical care to the patient.
(c) Neither the health facility, its employees, nor any physician
and surgeon, dentist, clinical psychologist, or podiatrist shall be
liable in any action arising out of a refusal to render emergency
services or care if the refusal is based on the determination,
exercising reasonable care, that the person is not suffering from an
emergency medical condition, or that the health facility does not
have the appropriate facilities or qualified personnel available to
render those services.
(d) Emergency services and care shall be rendered without first
questioning the patient or any other person as to his or her ability
to pay therefor. However, the patient or his or her legally
responsible relative or guardian shall execute an agreement to pay
therefor or otherwise supply insurance or credit information promptly
after the services are rendered.
(e) If a health facility subject to this chapter does not maintain
an emergency department, its employees shall nevertheless exercise
reasonable care to determine whether an emergency exists and shall
direct the persons seeking emergency care to a nearby facility that
can render the needed services, and shall assist the persons seeking
emergency care in obtaining the services, including transportation
services, in every way reasonable under the circumstances.
(f) No act or omission of any rescue team established by any
health facility licensed under this chapter, or operated by the
federal or state government, a county, or by the Regents of the
University of California, done or omitted while attempting to
resuscitate any person who is in immediate danger of loss of life
shall impose any liability upon the health facility, the officers,
members of the staff, nurses, or employees of the health facility,
including, but not limited to, the members of the rescue team, or
upon the federal or state government or a county, if good faith is
exercised.
(g) "Rescue team," as used in this section, means a special group
of physicians and surgeons, nurses, and employees of a health
facility who have been trained in cardiopulmonary resuscitation and
have been designated by the health facility to attempt, in cases of
emergency, to resuscitate persons who are in immediate danger of loss
of life.
(h) This section shall not relieve a health facility of any duty
otherwise imposed by law upon the health facility for the designation
and training of members of a rescue team or for the provision or
maintenance of equipment to be used by a rescue team.
1317.1. Unless the context otherwise requires, the following
definitions shall control the construction of this article:
(a) "Emergency services and care" means medical screening,
examination, and evaluation by a physician, or, to the extent
permitted by applicable law, by other appropriate personnel under the
supervision of a physician, to determine if an emergency medical
condition or active labor exists and, if it does, the care,
treatment, and surgery by a physician necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
(b) "Emergency medical condition" means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in any of the
following:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of any bodily organ or part.
(c) "Active labor" means a labor at a time at which either of the
following would occur:
(1) There is inadequate time to effect safe transfer to another
hospital prior to delivery.
(2) A transfer may pose a threat to the health and safety of the
patient or the unborn child.
(d) "Hospital" means all hospitals with an emergency department
licensed by the state department.
(e) "State department" means the State Department of Health
Services.
(f) "Medical hazard" means a material deterioration in, or
jeopardy to, a patient's medical condition or expected chances for
recovery.
(g) "Board" means the Medical Board of California.
(h) "Within the capability of the facility" means those
capabilities which the hospital is required to have as a condition of
its emergency medical services permit and services specified on
Services Inventory Form 7041 filed by the hospital with the Office of
Statewide Health Planning and Development.
(i) "Consultation" means the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and the specialty
physicians, includes review of the patient's medical record,
examination and treatment of the patient in person by a specialty
physician who is qualified to give an opinion or render the necessary
treatment in order to stabilize the patient.
1317.1. Unless the context otherwise requires, the following
definitions shall control the construction of this article and
Section 1371.4:
(a) (1) "Emergency services and care" means medical screening,
examination, and evaluation by a physician, or, to the extent
permitted by applicable law, by other appropriate personnel under the
supervision of a physician, to determine if an emergency medical
condition or active labor exists and, if it does, the care,
treatment, and surgery by a physician necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
(2) (A) "Emergency services and care" also means an additional
screening, examination, and evaluation by a physician, or other
personnel to the extent permitted by applicable law and within the
scope of their licensure and clinical privileges, to determine if a
psychiatric emergency medical condition exists, and the care and
treatment necessary to relieve or eliminate the psychiatric emergency
medical condition, within the capability of the facility.
(B) The care and treatment necessary to relieve or eliminate a
psychiatric emergency medical condition may include admission or
transfer to a psychiatric unit within a general acute care hospital,
as defined in subdivision (a) of Section 1250, or to an acute
psychiatric hospital, as defined in subdivision (b) of Section 1250,
pursuant to subdivision (k). Nothing in this subparagraph shall be
construed to permit a transfer that is in conflict with the
Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of
Division 5 of the Welfare and Institutions Code).
(C) For the purposes of Section 1371.4, emergency services and
care as defined in subparagraph (A) shall not apply to Medi-Cal
managed care plan contracts entered into with the State Department of
Health Care Services pursuant to Chapter 7 (commencing with Section
14000), Chapter 8 (commencing with Section 14200), and Chapter 8.75
(commencing with Section 14590) of Part 3 of Division 9 of the
Welfare and Institutions Code, to the extent that those services are
excluded from coverage under those contracts.
(D) This paragraph does not expand, restrict, or otherwise affect
the scope of licensure or clinical privileges for clinical
psychologists or other medical personnel.
(b) "Emergency medical condition" means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in any of the
following:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of any bodily organ or part.
(c) "Active labor" means a labor at a time at which either of the
following would occur:
(1) There is inadequate time to effect safe transfer to another
hospital prior to delivery.
(2) A transfer may pose a threat to the health and safety of the
patient or the unborn child.
(d) "Hospital" means all hospitals with an emergency department
licensed by the state department.
(e) "State department" means the State Department of Public
Health.
(f) "Medical hazard" means a material deterioration in medical
condition in, or jeopardy to, a patient's medical condition or
expected chances for recovery.
(g) "Board" means the Medical Board of California.
(h) "Within the capability of the facility" means those
capabilities that the hospital is required to have as a condition of
its emergency medical services permit and services specified on
Services Inventory Form 7041 filed by the hospital with the Office of
Statewide Health Planning and Development.
(i) "Consultation" means the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and specialty
physicians, includes review of the patient's medical record,
examination, and treatment of the patient in person by a specialty
physician who is qualified to give an opinion or render the necessary
treatment in order to stabilize the patient.
(j) A patient is "stabilized" or "stabilization" has occurred
when, in the opinion of the treating provider, the patient's medical
condition is such that, within reasonable medical probability, no
material deterioration of the patient's condition is likely to result
from, or occur during, the release or transfer of the patient as
provided for in Section 1317.2, Section 1317.2a, or other pertinent
statute.
(k) (1) "Psychiatric emergency medical condition" means a mental
disorder that manifests itself by acute symptoms of sufficient
severity that it renders the patient as being either of the
following:
(A) An immediate danger to himself or herself or to others.
(B) Immediately unable to provide for, or utilize, food, shelter,
or clothing, due to the mental disorder.
(2) This subdivision does not expand, restrict, or otherwise
affect the scope of licensure or clinical privileges for clinical
psychologists or medical personnel.
1317.2. No person needing emergency services and care may be
transferred from a hospital to another hospital for any nonmedical
reason (such as the person's inability to pay for any emergency
service or care) unless each of the following conditions are met:
(a) The person is examined and evaluated by a physician and
surgeon, including, if necessary, consultation, prior to transfer.
(b) The person has been provided with emergency services and care
so that it can be determined, within reasonable medical probability,
that the transfer or delay caused by the transfer will not create a
medical hazard to the person.
(c) A physician and surgeon at the transferring hospital has
notified and has obtained the consent to the transfer by a physician
and surgeon at the receiving hospital and confirmation by the
receiving hospital that the person meets the hospital's admissions
criteria relating to appropriate bed, personnel, and equipment
necessary to treat the person.
(d) The transferring hospital provides for appropriate personnel
and equipment which a reasonable and prudent physician and surgeon in
the same or similar locality exercising ordinary care would use to
effect the transfer.
(e) All the person's pertinent medical records and copies of all
the appropriate diagnostic test results which are reasonably
available are transferred with the person.
(f) The records transferred with the person include a "Transfer
Summary" signed by the transferring physician and surgeon which
contains relevant transfer information. The form of the "Transfer
Summary" shall, at a minimum, contain the person's name, address,
sex, race, age, insurance status, and medical condition; the name and
address of the transferring physician and surgeon or emergency
department personnel authorizing the transfer; the time and date the
person was first presented at the transferring hospital; the name of
the physician and surgeon at the receiving hospital consenting to the
transfer and the time and date of the consent; the time and date of
the transfer; the reason for the transfer; and the declaration of the
signor that the signor is assured, within reasonable medical
probability, that the transfer creates no medical hazard to the
patient. Neither the transferring physician and surgeon nor
transferring hospital shall be required to duplicate, in the
"Transfer Summary," information contained in medical records
transferred with the person.
(g) The transfer conforms with regulations established by the
state department. These regulations may prescribe minimum protocols
for patient transfers.
(h) Nothing in this section shall apply to a transfer of a patient
for medical reasons.
(i) Nothing in this section shall prohibit the transfer or
discharge of a patient when the patient or the patient's
representative requests a transfer or discharge and gives informed
consent to the transfer or discharge against medical advice.
1317.2a. (a) A hospital which has a legal obligation, whether
imposed by statute or by contract, to the extent of that contractual
obligation, to any third-party payor, including, but not limited to,
a health maintenance organization, health care service plan,
nonprofit hospital service plan, insurer, or preferred provider
organization, a county, or an employer to provide care for a patient
under the circumstances specified in Section 1317.2 shall receive
that patient to the extent required by the applicable statute or by
the terms of the contract, or, when the hospital is unable to accept
a patient for whom it has a legal obligation to provide care whose
transfer will not create a medical hazard as specified in Section
1317.2, it shall make appropriate arrangements for the patient's
care.
(b) A county hospital shall accept a patient whose transfer will
not create a medical hazard as specified in Section 1317.2 and who is
determined by the county to be eligible to receive health care
services required under Part 5 (commencing with Section 17000) of
Division 9 of the Welfare and Institutions Code, unless the hospital
does not have appropriate bed capacity, medical personnel, or
equipment required to provide care to the patient in accordance with
accepted medical practice. When a county hospital is unable to accept
a patient whose transfer will not create a medical hazard as
specified in Section 1317.2, it shall make appropriate arrangements
for the patient's care. The obligation to make appropriate
arrangements as set forth in this subdivision does not mandate a
level of service or payment, modify the county's obligations under
Part 5 (commencing with Section 17000) of Division 9 of the Welfare
and Institutions Code, create a cause of action, or limit a county's
flexibility to manage county health systems within available
resources. However, the county's flexibility shall not diminish a
county's responsibilities under Part 5 (commencing with Section
17000) of Division 9 of the Welfare and Institutions Code or the
requirements contained in Chapter 2.5 (commencing with Section 1440).
(c) The receiving hospital shall provide personnel and equipment
reasonably required in the exercise of good medical practice for the
care of the transferred patient.
(d) Any third-party payor, including, but not limited to, a health
maintenance organization, health care service plan, nonprofit
hospital service plan, insurer, or preferred provider organization,
or employer which has a statutory or contractual obligation to
provide or indemnify emergency medical services on behalf of a
patient shall be liable, to the extent of the contractual obligation
to the patient, for the reasonable charges of the transferring
hospital and the treating physicians for the emergency services
provided pursuant to this article, except that the patient shall be
responsible for uncovered services, or any deductible or copayment
obligation. Notwithstanding this section, the liability of a
third-party payor which has contracted with health care providers for
the provision of these emergency services shall be set by the terms
of that contract. Notwithstanding this section, the liability of a
third-party payor that is licensed by the Insurance Commissioner or
the Director of the Department of Managed Health Care and has a
contractual obligation to provide or indemnify emergency medical
services under a contract which covers a subscriber or an enrollee
shall be determined in accordance with the terms of that contract and
shall remain under the sole jurisdiction of that licensing agency.
(e) A hospital which has a legal obligation to provide care for a
patient as specified by subdivision (a) of Section 1317.2a to the
extent of its legal obligation, imposed by statute or by contract to
the extent of that contractual obligation, which does not accept
transfers of, or make other appropriate arrangements for, medically
stable patients in violation of this article or regulations adopted
pursuant thereto shall be liable for the reasonable charges of the
transferring hospital and treating physicians for providing services
and care which should have been provided by the receiving hospital.
(f) Subdivisions (d) and (e) do not apply to county obligations
under Section 17000 of the Welfare and Institutions Code.
(g) Nothing in this section shall be interpreted to require a
hospital to make arrangements for the care of a patient for whom the
hospital does not have a legal obligation to provide care.
1317.3. (a) As a condition of licensure, each hospital shall adopt,
in consultation with the medical staff, policies and transfer
protocols consistent with this article and regulations adopted
hereunder.
(b) As a condition of licensure, each hospital shall adopt a
policy prohibiting discrimination in the provision of emergency
services and care based on ethnicity, citizenship, age, preexisting
medical condition, insurance status, economic status, ability to pay
for medical services, or any characteristic listed or defined in
subdivision (b) or (e) of Section 51 of the Civil Code, except to the
extent that a circumstance such as age, sex, preexisting medical
condition, or physical or mental disability is medically significant
to the provision of appropriate medical care to the patient. Transfer
by a hospital of a patient who requires evaluation for involuntary
psychiatric treatment, as determined by the receiving hospital or
other receiving health facility, based upon the decision of a
professional person duly authorized by law to make that decision,
shall not constitute discrimination for the purposes of this section,
if the transferring hospital has not been designated as an
evaluation facility by a county pursuant to Section 5150 of the
Welfare and Institutions Code, and if the transfer is in compliance
with Section 1317.2.
(c) As a condition of licensure, each hospital shall require that
physicians and surgeons who serve on an "on-call" basis to the
hospital's emergency room cannot refuse to respond to a call on the
basis of the patient's ethnicity, citizenship, age, preexisting
medical condition, insurance status, economic status, ability to pay
for medical services, or any characteristic listed or defined in
subdivision (b) or (e) of Section 51 of the Civil Code, except to the
extent that a circumstance such as age, sex, preexisting medical
condition, or physical or mental disability is medically significant
to the provision of appropriate medical care to the patient. If a
contract between a physician and surgeon and hospital for the
provision of emergency room coverage presently prevents the hospital
from imposing those conditions, the conditions shall be included in
the contract as soon as is legally permissible. Nothing in this
section shall be construed as requiring that any physician serve on
an "on-call" basis.
(d) As a condition of licensure, all hospitals shall inform all
persons presented to an emergency room or their representatives if
any are present and the person is unable to understand verbal or
written communication, both orally and in writing, of the reasons for
the transfer or refusal to provide emergency services and care and
of the person's right to emergency services and care prior to
transfer or discharge without regard to ability to pay. Nothing in
this subdivision requires notification of the reasons for the
transfer in advance of the transfer where a person is unaccompanied
and the hospital has made a reasonable effort to locate a
representative, and because of the person's physical or mental
condition, notification is not possible. All hospitals shall
prominently post a sign in their emergency rooms informing the public
of their rights. Both the posted sign and written communication
concerning the transfer or refusal to provide emergency services and
care shall give the address of the department as the government
agency to contact in the event the person wishes to complain about
the hospital's conduct.
(e) If a hospital does not timely adopt the policies and protocols
required in this article, the hospital, in addition to denial or
revocation of any of its licenses, shall be subject to a fine not to
exceed one thousand dollars ($1,000) each day after expiration of 60
days' written notice from the state department that the hospital's
policies or protocols required by this article are inadequate unless
the delay is excused by the state department upon a showing of good
and sufficient cause by the hospital. The notice shall include a
detailed statement of the state department's reasons for its
determination and suggested changes to the hospital's protocols which
would be acceptable to the state department.
(f) Each hospital's policies and protocols required in or under
this article shall be submitted for approval to the state department
by December 31, 1988.
1317.4. (a) All hospitals shall maintain records of each transfer
made or received, including the "Memorandum of Transfer" described in
subdivision (f) of Section 1317.2, for a period of three years.
(b) All hospitals making or receiving transfers shall file with
the state department annual reports on forms prescribed by the
department which shall describe the aggregate number of transfers
made and received according to the person's insurance status and
reasons for transfers.
(c) The receiving hospital, and all physicians, other licensed
emergency room health personnel, and certified prehospital emergency
personnel at the receiving hospital who know of apparent violations
of this article or the regulations adopted hereunder shall, and the
corresponding personnel at the transferring hospital and the
transferring hospital may, report the apparent violations to the
state department on a form prescribed by the state department within
one week following its occurrence. The state department shall
promptly send a copy of the form to the hospital administrator and
appropriate medical staff committee of the transferring hospital and
the local emergency medical services agency, unless the state
department concludes that the complaint does not allege facts
requiring further investigation, or is otherwise unmeritorious, or
the state department concludes, based upon the circumstances of the
case, that its investigation of the allegations would be impeded by
disclosure of the form. When two or more persons required to report
jointly have knowledge of an apparent violation, a single report may
be made by a member of the team selected by mutual agreement in
accordance with hospital protocols. Any individual, required to
report by this section, who disagrees with the proposed joint report
has a right and duty to separately report.
A failure to report under this subdivision shall not constitute a
violation within the meaning of Section 1290 or 1317.6.
(d) No hospital, government agency, or person shall retaliate
against, penalize, institute a civil action against, or recover
monetary relief from, or otherwise cause any injury to a physician or
other personnel for reporting in good faith an apparent violation of
this article or the regulations adopted hereunder to the state
department, hospital, medical staff, or any other interested party or
government agency.
(e) No hospital, government agency, or person shall retaliate
against, penalize, institute a civil action against, or recover
monetary relief from, or otherwise cause any injury to a physician
who refused to transfer a patient when the physician determines,
within reasonable medical probability, that the transfer or delay
caused by the transfer will create a medical hazard to the person.
(f) Any person who violates subdivision (d) or (e) of Section
1317.4 is subject to a civil money penalty of no more than ten
thousand dollars ($10,000) per violation. The remedy specified in
this section shall be in addition to any other remedy provided by
law.
(g) The state department shall on an annual basis publish and
provide to the Legislature a statistical summary by county on the
extent of economic transfers of emergency patients, the frequency of
medically hazardous transfers, the insurance status of the patient
populations being transferred and all violations finally determined
by the state department describing the nature of the violations,
hospitals involved, and the action taken by the state department in
response. These summaries shall not reveal the identity of individual
persons transferred.
(h) Proceedings by the state department to impose a fine under
Section 1317.3 or 1317.6, and proceedings by the board to impose a
fine under Section 1317.6, shall be conducted as follows:
(1) If a hospital desires to contest a proposed fine, the hospital
shall within 15 business days after service of the notice of
proposed fine notify the director in writing of its intention to
contest the proposed fine. If requested by the hospital, the director
or the director's designee, shall hold, within 30 business days, an
informal conference, at the conclusion of which he or she may affirm,
modify, or dismiss the proposed fine. If the director or the
director's designee affirms, modifies, or dismisses the proposed
fine, he or she shall state with particularity in writing his or her
reasons for that action, and shall immediately transmit a copy
thereof to the hospital. If the hospital desires to contest a
determination made after the informal conference, the hospital shall
inform the director in writing within 15 business days after it
receives the decision by the director or director's designee. The
hospital shall not be required to request an informal conference to
contest a proposed fine, as specified in this section. If the
hospital fails to notify the director in writing that it intends to
protest the proposed fine within the times specified in this
subdivision, the proposed fine shall be deemed a final order of the
state department and shall not be subject to further administrative
review.
(2) If a hospital notifies the director that it intends to contest
a proposed fine, the director shall immediately notify the Attorney
General. Upon notification, the Attorney General shall promptly take
all appropriate action to enforce the proposed fine in a court of
competent jurisdiction for the county in which the hospital is
located.
(3) A judicial action to enforce a proposed fine shall be filed by
the Attorney General after a hospital notifies the director of its
intent to contest the proposed fine. If a judicial proceeding is
prosecuted under the provisions of this section, the state department
shall have the burden of establishing by a preponderance of the
evidence that the alleged facts supporting the proposed fine
occurred, that the alleged facts constituted a violation for which a
fine may be assessed under Section 1317.3, 1317.4, or 1317.6, and the
proposed fine is appropriate. The state department shall also have
the burden of establishing by a preponderance of the evidence that
the assessment of the proposed fine should be upheld. If a hospital
timely notifies the state department of its decision to contest a
proposed fine, the fine shall not be due and payable unless and until
the judicial proceeding is terminated in favor of the state
department.
(4) Action brought under the provisions of this section shall be
set for trial at the earliest possible date and shall take precedence
on the court calendar over all other cases except matters to which
equal or superior precedence is specifically granted by law. Times
for responsive pleading and for hearing any such proceeding shall be
set by the judge of the court with the object of securing a decision
as to subject matters at the earliest possible time.
(5) If the proposed fine is dismissed or reduced, the state
department shall take action immediately to ensure that the public
records reflect in a prominent manner that the proposed fine was
dismissed or reduced.
(6) In lieu of a judicial proceeding, the state department and the
hospital may jointly elect to submit the matter to binding
arbitration, in which case, the department shall initiate arbitration
proceedings. The parties shall agree upon an arbitrator designated
by the American Arbitration Association in accordance with the
Association's established rules and procedures. The arbitration
hearing shall be set within 45 days of the parties' joint election,
but in no event less than 28 days from the date of selection of an
arbitrator. The arbitration hearing may be continued up to 15 days if
necessary at the arbitrator's discretion. The decision of arbitrator
shall be based upon substantive law and shall be binding on all
parties, subject to judicial review. This review shall be limited to
whether there was substantial evidence to support the decision of the
arbitrator.
(7) Proceedings by the board to impose a fine under Section 1317.6
shall be conducted in accordance with Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code.
1317.4a. (a) Notwithstanding subdivision (j) of Section 1317.1, a
patient may be transferred for admission to a psychiatric unit within
a general acute care hospital, as defined in subdivision (a) of
Section 1250, or an acute psychiatric hospital, as defined in
subdivision (b) of Section 1250, for care and treatment that is
solely necessary to relieve or eliminate a psychiatric emergency
medical condition, as defined in subdivision (k) of Section 1317.1,
provided that, in the opinion of the treating provider, the patient's
psychiatric emergency medical condition is such that, within
reasonable medical probability, no material deterioration of the
patient's psychiatric emergency medical condition is likely to result
from, or occur during, a transfer of the patient. A provider shall
notify the patient's health care service plan, or the health plan's
contracting medical provider of the need for the transfer if
identification of the plan is obtained pursuant to paragraph (1) of
subdivision (b).
(b) A hospital that transfers a patient pursuant to subdivision
(a) shall do both of the following:
(1) Seek to obtain the name and contact information of the patient'
s health care service plan. The hospital shall document its attempt
to ascertain this information in the patient's medical record. The
hospital's attempt to ascertain the information shall include
requesting the patient's health care service plan member card, asking
the patient, the patient's family member, or other person
accompanying the patient if he or she can identify the patient's
health care service plan, or using other means known to the hospital
to accurately identify the patient's health care service plan.
(2) Notify the patient's health care service plan or the health
plan's contracting medical provider of the transfer, provided that
the identification of the plan was obtained pursuant to paragraph
(1). The hospital shall provide the plan or its contracting medical
provider with the name of the patient, the patient's member
identification number, if known, the location and contact
information, including a telephone number, for the location where the
patient will be admitted, and the preliminary diagnosis.
(c) (1) A hospital shall make the notification described in
paragraph (2) of subdivision (b) by either following the instructions
on the patient's health care service plan member card or by using
the contact information provided by the patient's health care service
plan. A health care service plan shall provide all noncontracting
hospitals in the state to which one of its members would be
transferred pursuant to paragraph (1) of subdivision (b) with
specific contact information needed to make the contact required by
this section. The contact information provided to hospitals shall be
updated as necessary, but no less than once a year.
(2) A hospital making the transfer pursuant to subdivision (a)
shall not be required to make more than one telephone call to the
health care service plan, or its contracting medical provider,
provided that in all cases the health care service plan, or its
contracting medical provider, shall be able to reach a representative
of the provider upon returning the call, should the plan, or its
contracting medical provider, need to call back. The representative
of the hospital who makes the telephone call may be, but is not
required to be, a physician and surgeon.
(d) If a transfer made pursuant to subdivision (a) is made to a
facility that does not have a contract with the patient's health care
service plan, the plan may subsequently require and make provision
for the transfer of the patient receiving services pursuant to this
section and subdivision (a) of Section 1317.1 from the noncontracting
facility to a general acute care hospital, as defined in subdivision
(a) of Section 1250, or an acute psychiatric hospital, as defined in
subdivision (b) of Section 1250, that has a contract with the plan
or its delegated payer, provided that in the opinion of the treating
provider the patient's psychiatric emergency medical condition is
such that, within reasonable medical probability, no material
deterioration of the patient's psychiatric emergency medical
condition is likely to result from, or occur during, the transfer of
the patient.
(e) Upon admission, the hospital to which the patient was
transferred shall notify the health care service plan of the
transfer, provided that the facility has the name and contact
information of the patient's health care service plan. The facility
shall not be required to make more than one telephone call to the
health care service plan, or its contracting medical provider,
provided that in all cases the health care service plan, or its
contracting medical provider, shall be able to reach a representative
of the facility upon returning the call, should the plan, or its
contracting medical provider, need to call back. The representative
of the facility who makes the telephone call may be, but is not
required to be, a physician and surgeon.
(f) Nothing in this subdivision shall be construed to require
providers to seek authorization to provide emergency services and
care, as defined in paragraph (2) of subdivision (a) of Section
1317.1, to a patient who has a psychiatric emergency medical
condition, as defined in subdivision (k) of Section 1317.1, that is
not otherwise required by law.
1317.5. (a) All alleged violations of this article and the
regulations adopted hereunder shall be investigated by the state
department. The state department, with the agreement of the local EMS
agency, may refer violations of this article to the local EMS agency
for investigation. The investigation shall be conducted pursuant to
procedures established by the state department and shall be completed
no later than 60 days after the report of apparent violation is
received by the state department.
(b) At the conclusion of its investigation, the state department
or the local EMS agency shall refer any alleged violation by a
physician to the Medical Board of California unless it is determined
that the complaint is without a reasonable basis.
1317.5. (a) All alleged violations of this article and the
regulations adopted hereunder shall be investigated by the state
department. The state department, with the agreement of the local EMS
agency, may refer violations of this article to the local EMS agency
for investigation. The investigation shall be conducted pursuant to
procedures established by the state department and shall be completed
no later than 60 days after the report of apparent violation is
received by the state department.
(b) At the conclusion of its investigation, the state department
or the local EMS agency shall refer any alleged violation by a
physician to the Medical Board of California unless it is determined
that the complaint is without a reasonable basis.
1317.6. (a) Hospitals found by the state department to have
committed or to be responsible for a violation of this article or the
regulations adopted pursuant thereto shall be subject to a civil
penalty by the state department in an amount not to exceed
twenty-five thousand dollars ($25,000) for each hospital violation.
In determining the amount of the fine for a hospital violation, the
state department shall take into account all of the following:
(1) Whether the violation was knowing or unintentional.
(2) Whether the violation resulted or was reasonably likely to
result in a medical hazard to the patient.
(3) The frequency or gravity of the violation.
(4) Other civil fines which have been imposed as a result of the
violation under Section 1395 of Title 42 of the United States Code.
(b) Notwithstanding this section, the director shall refer any
alleged violation by a hospital owned and operated by a health care
service plan involving a plan member or enrollee to the Department of
Managed Health Care unless the director determines the complaint is
without reasonable basis. The Department of Managed Health Care shall
have sole authority and responsibility to enforce this article with
respect to violations involving hospitals owned and operated by
health care service plans in their treatment of plan members or
enrollees.
(c) Physicians and surgeons found by the board to have committed,
or to be responsible for, a violation of this article or the
regulations adopted pursuant thereto shall be subject to any and all
penalties which the board may lawfully impose and may be subject to a
civil penalty by the board in an amount not to exceed five thousand
dollars ($5,000) for each violation. A civil penalty imposed under
this subdivision shall not duplicate federal fines, and the board
shall credit any federal fine against a civil penalty imposed under
this subdivision.
(d) The board may impose fines when it finds any of the following:
(1) The violation was knowing or willful.
(2) The violation was reasonably likely to result in a medical
hazard.
(3) There are repeated violations.
(e) It is the intent of the Legislature that the state department
has primary responsibility for regulating the conduct of hospital
emergency departments and that fines imposed under this section
should not be duplicated by additional fines imposed by the federal
government as a result of the conduct which constituted a violation
of this section. To effectuate the Legislature's intent, the Governor
shall inform the Secretary of the federal Department of Health and
Human Services of the enactment of this section and request the
federal department to credit any penalty assessed under this section
against any subsequent civil monetary penalty assessed pursuant to
Section 1395dd of Title 42 of the United States Code for the same
violation.
(f) There shall be a cumulative maximum limit of thirty thousand
dollars ($30,000) in fines assessed against hospitals under this
article and under Section 1395dd of Title 42 of the United States
Code for the same circumstances. To effectuate this cumulative
maximum limit, the state department shall do both of the following:
(1) As to state fines assessed prior to the final conclusion,
including judicial review, if available, of an action against a
hospital by the federal Department of Health and Human Services under
Section 1395dd of Title 42 of the United States Code (for the same
circumstances finally deemed to have been a violation of this article
or the regulations adopted hereunder, because of the state
department action authorized by this article), remit and return to
the hospital within 30 days after conclusion of the federal action,
that portion of the state fine necessary to assure that the
cumulative maximum limit is not exceeded.
(2) Immediately credit against state fines assessed after the
final conclusion, including judicial review, if available, of an
action against a hospital by the federal Department of Health and
Human Services under Section 1395dd of Title 42 of the United States
Code, which results in a fine against a hospital (for the same
circumstances finally deemed to have been a violation of this article
or the regulations adopted hereunder, because of the state
department action authorized by this article), the amount of the
federal fine, necessary to assure the cumulative maximum limit is not
exceeded.
(g) Any hospital found by the state department pursuant to
procedures established by the state department to have committed a
violation of this article or the regulations adopted hereunder may
have its emergency medical service permit revoked or suspended by the
state department.
(h) Any administrative or medical personnel who knowingly and
intentionally violates any provision of this article, may be charged
by the local district attorney with a misdemeanor.
(i) Notification of each violation found by the state department
of the provisions of this article or the regulations adopted
hereunder shall be sent by the state department to the Joint
Commission for the Accreditation of Hospitals, the state emergency
medical services authority, and local emergency medical services
agencies.
(j) Any person who suffers personal harm and any medical facility
which suffers a financial loss as a result of a violation of this
article or the regulations adopted hereunder may recover, in a civil
action against the transferring or receiving hospital, damages,
reasonable attorney's fees, and other appropriate relief.
Transferring and receiving hospitals from which inappropriate
transfers of persons are made or refused in violation of this article
and the regulations adopted hereunder shall be liable for the
reasonable charges of the receiving or transferring hospital for
providing the services and care which should have been provided. Any
person potentially harmed by a violation of this article or the
regulations adopted hereunder, or the local district attorney or the
Attorney General, may bring a civil action against the responsible
hospital or administrative or medical personnel, to enjoin the
violation, and if the injunction issues, the court shall award
reasonable attorney's fees. The provisions of this subdivision are in
addition to other civil remedies and do not limit the availability
of the other remedies.
(k) The civil remedies established by this section do not apply to
violations of any requirements established by any county or county
agency.
1317.7. This article does not preempt any county or any other
governmental agency acting within its authority from regulating
emergency care or patient transfers, including the imposition of more
specific duties, consistent with the requirements of this article
and its implementing regulations. Any inconsistent requirements
imposed by the Medi-Cal program shall preempt this article with
respect to Medi-Cal beneficiaries. To the extent hospitals and
physicians enter into contractual relationships with county or other
governmental agencies which impose more stringent transfer
requirements, those contractual agreements shall control.
1317.8. If any provision of this article is declared unlawful or
unconstitutional in any judicial action, the remaining provisions of
this chapter shall remain in effect.
1317.9a. (a) This article shall not be construed as altering or
repealing Section 2400 of the Business and Professions Code.
(b) Nothing in Sections 1317 et seq. and 1798.170 et seq. shall
prevent a physician from exercising his or her professional judgment
in conflict with any state or local regulation adopted pursuant to
Section 1317 et seq. or 1798.170 et seq., so long as the judgment
conforms with Sections 1317, 1317.1, and, except for subdivision (g),
Section 1317.2, and acting in compliance with the state or local
regulation would be contrary to the best interests of the patient.
1318. (a) The director shall require as a condition precedent to
the issuance, or renewal, of any license for a health facility, if
the licensee handles or will handle any money of patients within the
health facility, that the applicant for the license or the renewal of
the license file or have on file with the state department a bond
executed by an admitted surety insurer in a sum to be fixed by the
state department based upon the magnitude of the operations of the
applicant, but which sum shall not be less than one thousand dollars
($1,000), running to the State of California and conditioned upon the
licensee's faithful and honest handling of the money of patients
within the health facility.
(b) Every person injured as a result of any improper or unlawful
handling of the money of a patient of a health facility may bring an
action in a proper court on the bond required to be posted by the
licensee pursuant to this section for the amount of damage the person
suffered as a result thereof to the extent covered by the bond.
(c) The failure of any licensee under this section to maintain on
file with the state department a bond in the amount prescribed by the
director or who embezzles any patient's trust funds shall constitute
cause for the revocation of the license.
(d) The provisions of this section shall not apply if the licensee
handles less than twenty-five dollars ($25) per patient and less
than five hundred dollars ($500) for all patients in any month.
(e) The director may exempt licensed health facilities of the
types specified in subdivisions (a), (b), (c), and (f) of Section
1250 from the requirements of this section. However, the exemption
from the bond purchase requirements of this section shall not affect
the financial liability of such health facilities.
1319. The rules of a health facility may include provisions that
require every member of the medical staff to have professional
liability insurance as a condition to being on the medical staff of
the health facility.
1320. A skilled nursing facility or intermediate care facility
shall not require patients to purchase drugs, or rent or purchase
medical supplies or equipment, from any particular pharmacy or other
source.
This section shall not preclude a skilled nursing facility or
intermediate care facility from requiring that the patient's pharmacy
or other source comply with the facility's policies and procedures
reasonably necessary for the care of the patient or policies and
procedures required to meet the intent of state or federal
regulations. Nothing in this section shall preclude a skilled nursing
facility or intermediate care facility from requiring that
controlled substances which are periodically counted by the facility
on at least a daily basis be dispensed by the patient's pharmacy in
containers suitable for that purpose.
1321. No health facility shall advertise or represent in any way
that it provides occupational therapy services unless such services
are provided under the administrative control of the health facility
by an occupational therapist or occupational therapy assistant within
the meaning of Section 2570 of the Business and Professions Code.
1322. A hospital which contracts with an insurer, nonprofit
hospital service plan, or health care service plan shall not
determine or condition medical staff membership or clinical
privileges upon the basis of a physician and surgeon's or podiatrist'
s participation or nonparticipation in a contract with that insurer,
hospital service plan, or health care service plan.
1323. (a) A health facility, as defined by subdivisions (c) to (g),
inclusive, of Section 1250, which has a significant beneficial
interest in an ancillary health service provider or which knows that
an ancillary health service provider has a significant beneficial
interest in the health facility shall disclose that interest in
writing to the patients of the health facility, or their
representatives, and advise the patients, or their representatives,
that they may choose to have another ancillary health service
provider provide any supplies or services ordered by a member of the
medical staff of the health facility.
(b) If supplies or services are provided on an outpatient basis by
an ancillary health service provider which is not on the same site
as, or which is not on a site which is adjacent to, a health
facility, as defined by subdivision (a) or (b) of Section 1250, which
has a significant beneficial interest in the ancillary health
service provider, or if the ancillary health service provider has a
significant beneficial interest in the health facility, the ancillary
health service provider shall disclose that interest in writing to
the customers of the ancillary health service provider, or their
representatives, and advise the customers, or their representatives,
that they may choose to have another ancillary health service
provider provide any supplies or services ordered by a member of the
medical staff of the health facility.
(c) A health facility, as defined by Section 1250, shall not
charge, bill, or otherwise solicit payment from a patient on behalf
of, or refer a patient to, another health facility in which the
health facility has a significant beneficial interest unless the
health facility first discloses in writing to the patient, or his or
her representative, that the patient may choose to have another
health facility provide any supplies or services ordered by a member
of the medical staff of the health facility.
(d) (1) Except as provided in paragraph (2), "significant
beneficial interest" means any financial interest that is equal to or
greater than the lesser of the following:
(A) Five percent of the whole.
(B) Five thousand dollars ($5,000).
(2) "Significant beneficial interest" does not include any of the
following interests:
(A) A lease agreement between a health facility, ancillary health
service provider, another health facility, or a parent corporation of
the health facility, or any combination thereof.
(B) Any financial interest held by a health facility or ancillary
health service provider in the stock of a publicly held health
facility or ancillary health service provider, or any parent
corporation of a health facility or ancillary health service
provider, if that financial interest does not exceed 5 percent of any
class of equity securities of the health facility, ancillary health
service provid
1315. Dental services, as defined in the Dental Practice Act, may
be provided patients in health facilities licensed under this
chapter. Such services shall be provided by persons licensed by the
State of California pursuant to Section 1611 of the Business and
Professions Code. However, this section shall not limit or restrict
the right of a licensed physician and surgeon to perform any acts
authorized under the Medical Practice Act.
1316. (a) The rules of a health facility shall include provisions
for use of the facility by, and staff privileges for, duly licensed
podiatrists within the scope of their respective licensure, subject
to rules and regulations governing such use or privileges established
by the health facility. Such rules and regulations shall not
discriminate on the basis of whether the staff member holds a M. D.,
D.O., or D.P.M. degree, within the scope of their respective
licensure. Each health facility shall establish a staff comprised of
physicians and surgeons, podiatrists, or any combination thereof,
which shall regulate the admission, conduct suspension, or
termination of the staff appointment of the podiatrists while using
the facilities. No classification of health facilities by the state
department, nor any other classification of health facilities based
on quality of service or otherwise, by any person, body, or
governmental agency of this state or any subdivision thereof shall be
affected by a health facility's provision for use of its facilities
by duly licensed podiatrists, nor shall any such classification be
affected by the subjection of the podiatrists, to the rules and
regulations of a staff comprising podiatrists, physicians and
surgeons, or any combination thereof, which govern the podiatrists'
use of the facilities. No classification of health facilities by any
governmental agency of this state or any subdivision thereof pursuant
to present law or laws passed hereinafter for the purposes of
ascertaining eligibility for compensation, reimbursement, or other
benefit for treatment of patients shall be affected by a health
facility's provision for use of its facilities by duly licensed
podiatrists, nor shall any such classification be affected by the
subjection of the podiatrists and dentists to the rules and
regulations of a staff comprising podiatrists, physicians and
surgeons, or any combination thereof, which govern the podiatrists'
use of the facilities.
With regard to the practice of podiatry in health facilities
throughout this state, medical staff status shall include and provide
for the right to pursue and practice full clinical and surgical
privileges for holders of M.D., D.O., and D. P.M. degrees within the
scope of their respective licensure. Such rights and privileges shall
be limited or restricted only upon the basis of an individual
practitioner's demonstrated competence. Such competence shall be
determined by health facility rules, regulations, and procedures
which are necessary and are applied in good faith, equally and in a
nondiscriminatory manner, to all practitioners regardless of whether
they hold a M.D., D.O., or D.P.M. degree.
Nothing in this section shall be construed to require a health
facility to offer a specific health service or services not otherwise
offered. If a health service is offered, the facility shall not
discriminate between persons holding M.D. , D.O., or D.P.M. degrees
who are authorized by law to perform such services.
This subdivision shall not prohibit a health facility which is a
clinical teaching facility owned or operated by a university
operating a school of medicine from requiring that a podiatrist have
a faculty teaching appointment as a condition for eligibility for
staff privileges for that facility.
(b) The rules of a health facility which include provisions for
use of the facility by, and staff privileges for, medical staff shall
not discriminate on the basis of whether the staff member holds a
M.D., D.O., or D.P.M. degree, within the scope of their respective
licensure. The health facility staff processing, reviewing,
evaluating, and determining qualifications for staff privileges for
medical staff shall include, if possible, staff members that hold
M.D., D.O., and D.P.M. degrees.
(c) Any violation by a health facility of the provisions of this
section may be enjoined in an action brought in the name of the
people of the State of California by the district attorney of the
county in which the health facility is located, upon receipt of a
complaint by an aggrieved physician and surgeon or podiatrist.
1316.5. (a) (1) Each health facility owned and operated by the
state offering care or services within the scope of practice of a
psychologist shall establish rules and medical staff bylaws that
include provisions for medical staff membership and clinical
privileges for clinical psychologists within the scope of their
licensure as psychologists, subject to the rules and medical staff
bylaws governing medical staff membership or privileges as the
facility shall establish. The rules and regulations shall not
discriminate on the basis of whether the staff member holds an M.D.,
D.O., D.D.S., D.P.M., or doctoral degree in psychology within the
scope of the member's respective licensure. Each of these health
facilities owned and operated by the state shall establish a staff
comprised of physicians and surgeons, dentists, podiatrists,
psychologists, or any combination thereof, that shall regulate the
admission, conduct, suspension, or termination of the staff
appointment of psychologists employed by the health facility.
(2) With regard to the practice of psychology in health facilities
owned and operated by the state offering care or services within the
scope of practice of a psychologist, medical staff status shall
include and provide for the right to pursue and practice full
clinical privileges for holders of a doctoral degree of psychology
within the scope of their respective licensure. These rights and
privileges shall be limited or restricted only upon the basis of an
individual practitioner's demonstrated competence. Competence shall
be determined by health facility rules and medical staff bylaws that
are necessary and are applied in good faith, equally and in a
nondiscriminatory manner, to all practitioners, regardless of whether
they hold an M.D., D.O., D.D.S., D.P.M., or doctoral degree in
psychology.
(3) Nothing in this subdivision shall be construed to require a
health facility owned and operated by the state to offer a specific
health service or services not otherwise offered. If a health service
is offered in such a health facility that includes provisions for
medical staff membership and clinical privileges for clinical
psychologists, the facility shall not discriminate between persons
holding an M.D., D.O., D.D.S., D.P.M., or doctoral degree in
psychology who are authorized by law to perform the service within
the scope of the person's respective licensure.
(4) The rules and medical staff bylaws of a health facility owned
and operated by the state that include provisions for medical staff
membership and clinical privileges for medical staff and duly
licensed clinical psychologists shall not discriminate on the basis
of whether the staff member holds an M.D., D.O., D.D.S., D.P.M., or
doctoral degree in psychology within the scope of the member's
respective licensure. The health facility staff of these health
facilities who process, review, evaluate, and determine
qualifications for staff privileges for medical staff shall include,
if possible, staff members who are clinical psychologists.
(b) (1) The rules of a health facility not owned or operated by
this state may enable the appointment of clinical psychologists on
the terms and conditions that the facility shall establish. In these
health facilities, clinical psychologists may hold membership and
serve on committees of the medical staff and carry professional
responsibilities consistent with the scope of their licensure and
their competence, subject to the rules of the health facility.
(2) Nothing in this subdivision shall be construed to require a
health facility not owned or operated by this state to offer a
specific health service or services not otherwise offered. If a
health service is offered by a health facility with both licensed
physicians and surgeons and clinical psychologists on the medical
staff, which both licensed physicians and surgeons and clinical
psychologists are authorized by law to perform, the service may be
performed by either, without discrimination.
(3) This subdivision shall not prohibit a health facility that is
a clinical teaching facility owned or operated by a university
operating a school of medicine from requiring that a clinical
psychologist have a faculty teaching appointment as a condition for
eligibility for staff privileges at that facility.
(4) In any health facility that is not owned or operated by this
state that provides staff privileges to clinical psychologists, the
health facility staff who process, review, evaluate, and determine
qualifications for staff privileges for medical staff shall include,
if possible, staff members who are clinical psychologists.
(c) No classification of health facilities by the department, nor
any other classification of health facilities based on quality of
service or otherwise, by any person, body, or governmental agency of
this state or any subdivision thereof shall be affected by a health
facility's provision for use of its facilities by duly licensed
clinical psychologists, nor shall any classification of these
facilities be affected by the subjection of the psychologists to the
rules and regulations of the organized professional staff. No
classification of health facilities by any governmental agency of
this state or any subdivision thereof pursuant to any law, whether
enacted prior or subsequent to the effective date of this section,
for the purposes of ascertaining eligibility for compensation,
reimbursement, or other benefit for treatment of patients shall be
affected by a health facility's provision for use of its facilities
by duly licensed clinical psychologists, nor shall any classification
of these facilities be affected by the subjection of the
psychologists to the rules and regulations of the organized
professional staff which govern the psychologists' use of the
facilities.
(d) "Clinical psychologist," as used in this section, means a
psychologist licensed by this state who meets both of the following
requirements:
(1) Possesses an earned doctorate degree in psychology from an
educational institution meeting the criteria of subdivision (b) of
Section 2914 of the Business and Professions Code.
(2) Has not less than two years clinical experience in a
multidisciplinary facility licensed or operated by this or another
state or by the United States to provide health care, or, is listed
in the latest edition of the National Register of Health Service
Providers in Psychology, as adopted by the Council for the National
Register of Health Service Providers in Psychology.
(e) Nothing in this section is intended to expand the scope of
licensure of clinical psychologists. Notwithstanding the Ralph C.
Dills Act (Chapter 10.3 (commencing with Section 3512) of Division 4
of Title 1 of the Government Code), the Public Employment Relations
Board is precluded from creating any additional bargaining units for
the purpose of exclusive representation of state psychologist
employees that might result because of medical staff membership
and/or privilege changes for psychologists due to the enactment of
provisions by Assembly Bill No. 3141 of the 1995-96 Regular Session.
(f) The State Department of Mental Health, the State Department of
Developmental Services, and the Department of Corrections shall
report to the Legislature no later than January 1, 2006, on the
impact of medical staff membership and privileges for clinical
psychologists on quality of care, and on cost-effectiveness issues.
1316.6. Notwithstanding any other provision of this chapter, the
exercise of privileges in any health facility may be limited,
restricted, or revoked for the violation of such health facility's
rules, regulations, or procedures which are applied, in good faith,
in a nondiscriminatory manner to all practitioners in such health
facility exercising such privileges or entitled to exercise such
privileges.
1317. (a) Emergency services and care shall be provided to any
person requesting the services or care, or for whom services or care
is requested, for any condition in which the person is in danger of
loss of life, or serious injury or illness, at any health facility
licensed under this chapter that maintains and operates an emergency
department to provide emergency services to the public when the
health facility has appropriate facilities and qualified personnel
available to provide the services or care.
(b) In no event shall the provision of emergency services and care
be based upon, or affected by, the person's ethnicity, citizenship,
age, preexisting medical condition, insurance status, economic
status, ability to pay for medical services, or any other
characteristic listed or defined in subdivision (b) or (e) of Section
51 of the Civil Code, except to the extent that a circumstance such
as age, sex, preexisting medical condition, or physical or mental
disability is medically significant to the provision of appropriate
medical care to the patient.
(c) Neither the health facility, its employees, nor any physician
and surgeon, dentist, clinical psychologist, or podiatrist shall be
liable in any action arising out of a refusal to render emergency
services or care if the refusal is based on the determination,
exercising reasonable care, that the person is not suffering from an
emergency medical condition, or that the health facility does not
have the appropriate facilities or qualified personnel available to
render those services.
(d) Emergency services and care shall be rendered without first
questioning the patient or any other person as to his or her ability
to pay therefor. However, the patient or his or her legally
responsible relative or guardian shall execute an agreement to pay
therefor or otherwise supply insurance or credit information promptly
after the services are rendered.
(e) If a health facility subject to this chapter does not maintain
an emergency department, its employees shall nevertheless exercise
reasonable care to determine whether an emergency exists and shall
direct the persons seeking emergency care to a nearby facility that
can render the needed services, and shall assist the persons seeking
emergency care in obtaining the services, including transportation
services, in every way reasonable under the circumstances.
(f) No act or omission of any rescue team established by any
health facility licensed under this chapter, or operated by the
federal or state government, a county, or by the Regents of the
University of California, done or omitted while attempting to
resuscitate any person who is in immediate danger of loss of life
shall impose any liability upon the health facility, the officers,
members of the staff, nurses, or employees of the health facility,
including, but not limited to, the members of the rescue team, or
upon the federal or state government or a county, if good faith is
exercised.
(g) "Rescue team," as used in this section, means a special group
of physicians and surgeons, nurses, and employees of a health
facility who have been trained in cardiopulmonary resuscitation and
have been designated by the health facility to attempt, in cases of
emergency, to resuscitate persons who are in immediate danger of loss
of life.
(h) This section shall not relieve a health facility of any duty
otherwise imposed by law upon the health facility for the designation
and training of members of a rescue team or for the provision or
maintenance of equipment to be used by a rescue team.
1317.1. Unless the context otherwise requires, the following
definitions shall control the construction of this article:
(a) "Emergency services and care" means medical screening,
examination, and evaluation by a physician, or, to the extent
permitted by applicable law, by other appropriate personnel under the
supervision of a physician, to determine if an emergency medical
condition or active labor exists and, if it does, the care,
treatment, and surgery by a physician necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
(b) "Emergency medical condition" means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in any of the
following:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of any bodily organ or part.
(c) "Active labor" means a labor at a time at which either of the
following would occur:
(1) There is inadequate time to effect safe transfer to another
hospital prior to delivery.
(2) A transfer may pose a threat to the health and safety of the
patient or the unborn child.
(d) "Hospital" means all hospitals with an emergency department
licensed by the state department.
(e) "State department" means the State Department of Health
Services.
(f) "Medical hazard" means a material deterioration in, or
jeopardy to, a patient's medical condition or expected chances for
recovery.
(g) "Board" means the Medical Board of California.
(h) "Within the capability of the facility" means those
capabilities which the hospital is required to have as a condition of
its emergency medical services permit and services specified on
Services Inventory Form 7041 filed by the hospital with the Office of
Statewide Health Planning and Development.
(i) "Consultation" means the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and the specialty
physicians, includes review of the patient's medical record,
examination and treatment of the patient in person by a specialty
physician who is qualified to give an opinion or render the necessary
treatment in order to stabilize the patient.
1317.1. Unless the context otherwise requires, the following
definitions shall control the construction of this article and
Section 1371.4:
(a) (1) "Emergency services and care" means medical screening,
examination, and evaluation by a physician, or, to the extent
permitted by applicable law, by other appropriate personnel under the
supervision of a physician, to determine if an emergency medical
condition or active labor exists and, if it does, the care,
treatment, and surgery by a physician necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
(2) (A) "Emergency services and care" also means an additional
screening, examination, and evaluation by a physician, or other
personnel to the extent permitted by applicable law and within the
scope of their licensure and clinical privileges, to determine if a
psychiatric emergency medical condition exists, and the care and
treatment necessary to relieve or eliminate the psychiatric emergency
medical condition, within the capability of the facility.
(B) The care and treatment necessary to relieve or eliminate a
psychiatric emergency medical condition may include admission or
transfer to a psychiatric unit within a general acute care hospital,
as defined in subdivision (a) of Section 1250, or to an acute
psychiatric hospital, as defined in subdivision (b) of Section 1250,
pursuant to subdivision (k). Nothing in this subparagraph shall be
construed to permit a transfer that is in conflict with the
Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of
Division 5 of the Welfare and Institutions Code).
(C) For the purposes of Section 1371.4, emergency services and
care as defined in subparagraph (A) shall not apply to Medi-Cal
managed care plan contracts entered into with the State Department of
Health Care Services pursuant to Chapter 7 (commencing with Section
14000), Chapter 8 (commencing with Section 14200), and Chapter 8.75
(commencing with Section 14590) of Part 3 of Division 9 of the
Welfare and Institutions Code, to the extent that those services are
excluded from coverage under those contracts.
(D) This paragraph does not expand, restrict, or otherwise affect
the scope of licensure or clinical privileges for clinical
psychologists or other medical personnel.
(b) "Emergency medical condition" means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in any of the
following:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of any bodily organ or part.
(c) "Active labor" means a labor at a time at which either of the
following would occur:
(1) There is inadequate time to effect safe transfer to another
hospital prior to delivery.
(2) A transfer may pose a threat to the health and safety of the
patient or the unborn child.
(d) "Hospital" means all hospitals with an emergency department
licensed by the state department.
(e) "State department" means the State Department of Public
Health.
(f) "Medical hazard" means a material deterioration in medical
condition in, or jeopardy to, a patient's medical condition or
expected chances for recovery.
(g) "Board" means the Medical Board of California.
(h) "Within the capability of the facility" means those
capabilities that the hospital is required to have as a condition of
its emergency medical services permit and services specified on
Services Inventory Form 7041 filed by the hospital with the Office of
Statewide Health Planning and Development.
(i) "Consultation" means the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and specialty
physicians, includes review of the patient's medical record,
examination, and treatment of the patient in person by a specialty
physician who is qualified to give an opinion or render the necessary
treatment in order to stabilize the patient.
(j) A patient is "stabilized" or "stabilization" has occurred
when, in the opinion of the treating provider, the patient's medical
condition is such that, within reasonable medical probability, no
material deterioration of the patient's condition is likely to result
from, or occur during, the release or transfer of the patient as
provided for in Section 1317.2, Section 1317.2a, or other pertinent
statute.
(k) (1) "Psychiatric emergency medical condition" means a mental
disorder that manifests itself by acute symptoms of sufficient
severity that it renders the patient as being either of the
following:
(A) An immediate danger to himself or herself or to others.
(B) Immediately unable to provide for, or utilize, food, shelter,
or clothing, due to the mental disorder.
(2) This subdivision does not expand, restrict, or otherwise
affect the scope of licensure or clinical privileges for clinical
psychologists or medical personnel.
1317.2. No person needing emergency services and care may be
transferred from a hospital to another hospital for any nonmedical
reason (such as the person's inability to pay for any emergency
service or care) unless each of the following conditions are met:
(a) The person is examined and evaluated by a physician and
surgeon, including, if necessary, consultation, prior to transfer.
(b) The person has been provided with emergency services and care
so that it can be determined, within reasonable medical probability,
that the transfer or delay caused by the transfer will not create a
medical hazard to the person.
(c) A physician and surgeon at the transferring hospital has
notified and has obtained the consent to the transfer by a physician
and surgeon at the receiving hospital and confirmation by the
receiving hospital that the person meets the hospital's admissions
criteria relating to appropriate bed, personnel, and equipment
necessary to treat the person.
(d) The transferring hospital provides for appropriate personnel
and equipment which a reasonable and prudent physician and surgeon in
the same or similar locality exercising ordinary care would use to
effect the transfer.
(e) All the person's pertinent medical records and copies of all
the appropriate diagnostic test results which are reasonably
available are transferred with the person.
(f) The records transferred with the person include a "Transfer
Summary" signed by the transferring physician and surgeon which
contains relevant transfer information. The form of the "Transfer
Summary" shall, at a minimum, contain the person's name, address,
sex, race, age, insurance status, and medical condition; the name and
address of the transferring physician and surgeon or emergency
department personnel authorizing the transfer; the time and date the
person was first presented at the transferring hospital; the name of
the physician and surgeon at the receiving hospital consenting to the
transfer and the time and date of the consent; the time and date of
the transfer; the reason for the transfer; and the declaration of the
signor that the signor is assured, within reasonable medical
probability, that the transfer creates no medical hazard to the
patient. Neither the transferring physician and surgeon nor
transferring hospital shall be required to duplicate, in the
"Transfer Summary," information contained in medical records
transferred with the person.
(g) The transfer conforms with regulations established by the
state department. These regulations may prescribe minimum protocols
for patient transfers.
(h) Nothing in this section shall apply to a transfer of a patient
for medical reasons.
(i) Nothing in this section shall prohibit the transfer or
discharge of a patient when the patient or the patient's
representative requests a transfer or discharge and gives informed
consent to the transfer or discharge against medical advice.
1317.2a. (a) A hospital which has a legal obligation, whether
imposed by statute or by contract, to the extent of that contractual
obligation, to any third-party payor, including, but not limited to,
a health maintenance organization, health care service plan,
nonprofit hospital service plan, insurer, or preferred provider
organization, a county, or an employer to provide care for a patient
under the circumstances specified in Section 1317.2 shall receive
that patient to the extent required by the applicable statute or by
the terms of the contract, or, when the hospital is unable to accept
a patient for whom it has a legal obligation to provide care whose
transfer will not create a medical hazard as specified in Section
1317.2, it shall make appropriate arrangements for the patient's
care.
(b) A county hospital shall accept a patient whose transfer will
not create a medical hazard as specified in Section 1317.2 and who is
determined by the county to be eligible to receive health care
services required under Part 5 (commencing with Section 17000) of
Division 9 of the Welfare and Institutions Code, unless the hospital
does not have appropriate bed capacity, medical personnel, or
equipment required to provide care to the patient in accordance with
accepted medical practice. When a county hospital is unable to accept
a patient whose transfer will not create a medical hazard as
specified in Section 1317.2, it shall make appropriate arrangements
for the patient's care. The obligation to make appropriate
arrangements as set forth in this subdivision does not mandate a
level of service or payment, modify the county's obligations under
Part 5 (commencing with Section 17000) of Division 9 of the Welfare
and Institutions Code, create a cause of action, or limit a county's
flexibility to manage county health systems within available
resources. However, the county's flexibility shall not diminish a
county's responsibilities under Part 5 (commencing with Section
17000) of Division 9 of the Welfare and Institutions Code or the
requirements contained in Chapter 2.5 (commencing with Section 1440).
(c) The receiving hospital shall provide personnel and equipment
reasonably required in the exercise of good medical practice for the
care of the transferred patient.
(d) Any third-party payor, including, but not limited to, a health
maintenance organization, health care service plan, nonprofit
hospital service plan, insurer, or preferred provider organization,
or employer which has a statutory or contractual obligation to
provide or indemnify emergency medical services on behalf of a
patient shall be liable, to the extent of the contractual obligation
to the patient, for the reasonable charges of the transferring
hospital and the treating physicians for the emergency services
provided pursuant to this article, except that the patient shall be
responsible for uncovered services, or any deductible or copayment
obligation. Notwithstanding this section, the liability of a
third-party payor which has contracted with health care providers for
the provision of these emergency services shall be set by the terms
of that contract. Notwithstanding this section, the liability of a
third-party payor that is licensed by the Insurance Commissioner or
the Director of the Department of Managed Health Care and has a
contractual obligation to provide or indemnify emergency medical
services under a contract which covers a subscriber or an enrollee
shall be determined in accordance with the terms of that contract and
shall remain under the sole jurisdiction of that licensing agency.
(e) A hospital which has a legal obligation to provide care for a
patient as specified by subdivision (a) of Section 1317.2a to the
extent of its legal obligation, imposed by statute or by contract to
the extent of that contractual obligation, which does not accept
transfers of, or make other appropriate arrangements for, medically
stable patients in violation of this article or regulations adopted
pursuant thereto shall be liable for the reasonable charges of the
transferring hospital and treating physicians for providing services
and care which should have been provided by the receiving hospital.
(f) Subdivisions (d) and (e) do not apply to county obligations
under Section 17000 of the Welfare and Institutions Code.
(g) Nothing in this section shall be interpreted to require a
hospital to make arrangements for the care of a patient for whom the
hospital does not have a legal obligation to provide care.
1317.3. (a) As a condition of licensure, each hospital shall adopt,
in consultation with the medical staff, policies and transfer
protocols consistent with this article and regulations adopted
hereunder.
(b) As a condition of licensure, each hospital shall adopt a
policy prohibiting discrimination in the provision of emergency
services and care based on ethnicity, citizenship, age, preexisting
medical condition, insurance status, economic status, ability to pay
for medical services, or any characteristic listed or defined in
subdivision (b) or (e) of Section 51 of the Civil Code, except to the
extent that a circumstance such as age, sex, preexisting medical
condition, or physical or mental disability is medically significant
to the provision of appropriate medical care to the patient. Transfer
by a hospital of a patient who requires evaluation for involuntary
psychiatric treatment, as determined by the receiving hospital or
other receiving health facility, based upon the decision of a
professional person duly authorized by law to make that decision,
shall not constitute discrimination for the purposes of this section,
if the transferring hospital has not been designated as an
evaluation facility by a county pursuant to Section 5150 of the
Welfare and Institutions Code, and if the transfer is in compliance
with Section 1317.2.
(c) As a condition of licensure, each hospital shall require that
physicians and surgeons who serve on an "on-call" basis to the
hospital's emergency room cannot refuse to respond to a call on the
basis of the patient's ethnicity, citizenship, age, preexisting
medical condition, insurance status, economic status, ability to pay
for medical services, or any characteristic listed or defined in
subdivision (b) or (e) of Section 51 of the Civil Code, except to the
extent that a circumstance such as age, sex, preexisting medical
condition, or physical or mental disability is medically significant
to the provision of appropriate medical care to the patient. If a
contract between a physician and surgeon and hospital for the
provision of emergency room coverage presently prevents the hospital
from imposing those conditions, the conditions shall be included in
the contract as soon as is legally permissible. Nothing in this
section shall be construed as requiring that any physician serve on
an "on-call" basis.
(d) As a condition of licensure, all hospitals shall inform all
persons presented to an emergency room or their representatives if
any are present and the person is unable to understand verbal or
written communication, both orally and in writing, of the reasons for
the transfer or refusal to provide emergency services and care and
of the person's right to emergency services and care prior to
transfer or discharge without regard to ability to pay. Nothing in
this subdivision requires notification of the reasons for the
transfer in advance of the transfer where a person is unaccompanied
and the hospital has made a reasonable effort to locate a
representative, and because of the person's physical or mental
condition, notification is not possible. All hospitals shall
prominently post a sign in their emergency rooms informing the public
of their rights. Both the posted sign and written communication
concerning the transfer or refusal to provide emergency services and
care shall give the address of the department as the government
agency to contact in the event the person wishes to complain about
the hospital's conduct.
(e) If a hospital does not timely adopt the policies and protocols
required in this article, the hospital, in addition to denial or
revocation of any of its licenses, shall be subject to a fine not to
exceed one thousand dollars ($1,000) each day after expiration of 60
days' written notice from the state department that the hospital's
policies or protocols required by this article are inadequate unless
the delay is excused by the state department upon a showing of good
and sufficient cause by the hospital. The notice shall include a
detailed statement of the state department's reasons for its
determination and suggested changes to the hospital's protocols which
would be acceptable to the state department.
(f) Each hospital's policies and protocols required in or under
this article shall be submitted for approval to the state department
by December 31, 1988.
1317.4. (a) All hospitals shall maintain records of each transfer
made or received, including the "Memorandum of Transfer" described in
subdivision (f) of Section 1317.2, for a period of three years.
(b) All hospitals making or receiving transfers shall file with
the state department annual reports on forms prescribed by the
department which shall describe the aggregate number of transfers
made and received according to the person's insurance status and
reasons for transfers.
(c) The receiving hospital, and all physicians, other licensed
emergency room health personnel, and certified prehospital emergency
personnel at the receiving hospital who know of apparent violations
of this article or the regulations adopted hereunder shall, and the
corresponding personnel at the transferring hospital and the
transferring hospital may, report the apparent violations to the
state department on a form prescribed by the state department within
one week following its occurrence. The state department shall
promptly send a copy of the form to the hospital administrator and
appropriate medical staff committee of the transferring hospital and
the local emergency medical services agency, unless the state
department concludes that the complaint does not allege facts
requiring further investigation, or is otherwise unmeritorious, or
the state department concludes, based upon the circumstances of the
case, that its investigation of the allegations would be impeded by
disclosure of the form. When two or more persons required to report
jointly have knowledge of an apparent violation, a single report may
be made by a member of the team selected by mutual agreement in
accordance with hospital protocols. Any individual, required to
report by this section, who disagrees with the proposed joint report
has a right and duty to separately report.
A failure to report under this subdivision shall not constitute a
violation within the meaning of Section 1290 or 1317.6.
(d) No hospital, government agency, or person shall retaliate
against, penalize, institute a civil action against, or recover
monetary relief from, or otherwise cause any injury to a physician or
other personnel for reporting in good faith an apparent violation of
this article or the regulations adopted hereunder to the state
department, hospital, medical staff, or any other interested party or
government agency.
(e) No hospital, government agency, or person shall retaliate
against, penalize, institute a civil action against, or recover
monetary relief from, or otherwise cause any injury to a physician
who refused to transfer a patient when the physician determines,
within reasonable medical probability, that the transfer or delay
caused by the transfer will create a medical hazard to the person.
(f) Any person who violates subdivision (d) or (e) of Section
1317.4 is subject to a civil money penalty of no more than ten
thousand dollars ($10,000) per violation. The remedy specified in
this section shall be in addition to any other remedy provided by
law.
(g) The state department shall on an annual basis publish and
provide to the Legislature a statistical summary by county on the
extent of economic transfers of emergency patients, the frequency of
medically hazardous transfers, the insurance status of the patient
populations being transferred and all violations finally determined
by the state department describing the nature of the violations,
hospitals involved, and the action taken by the state department in
response. These summaries shall not reveal the identity of individual
persons transferred.
(h) Proceedings by the state department to impose a fine under
Section 1317.3 or 1317.6, and proceedings by the board to impose a
fine under Section 1317.6, shall be conducted as follows:
(1) If a hospital desires to contest a proposed fine, the hospital
shall within 15 business days after service of the notice of
proposed fine notify the director in writing of its intention to
contest the proposed fine. If requested by the hospital, the director
or the director's designee, shall hold, within 30 business days, an
informal conference, at the conclusion of which he or she may affirm,
modify, or dismiss the proposed fine. If the director or the
director's designee affirms, modifies, or dismisses the proposed
fine, he or she shall state with particularity in writing his or her
reasons for that action, and shall immediately transmit a copy
thereof to the hospital. If the hospital desires to contest a
determination made after the informal conference, the hospital shall
inform the director in writing within 15 business days after it
receives the decision by the director or director's designee. The
hospital shall not be required to request an informal conference to
contest a proposed fine, as specified in this section. If the
hospital fails to notify the director in writing that it intends to
protest the proposed fine within the times specified in this
subdivision, the proposed fine shall be deemed a final order of the
state department and shall not be subject to further administrative
review.
(2) If a hospital notifies the director that it intends to contest
a proposed fine, the director shall immediately notify the Attorney
General. Upon notification, the Attorney General shall promptly take
all appropriate action to enforce the proposed fine in a court of
competent jurisdiction for the county in which the hospital is
located.
(3) A judicial action to enforce a proposed fine shall be filed by
the Attorney General after a hospital notifies the director of its
intent to contest the proposed fine. If a judicial proceeding is
prosecuted under the provisions of this section, the state department
shall have the burden of establishing by a preponderance of the
evidence that the alleged facts supporting the proposed fine
occurred, that the alleged facts constituted a violation for which a
fine may be assessed under Section 1317.3, 1317.4, or 1317.6, and the
proposed fine is appropriate. The state department shall also have
the burden of establishing by a preponderance of the evidence that
the assessment of the proposed fine should be upheld. If a hospital
timely notifies the state department of its decision to contest a
proposed fine, the fine shall not be due and payable unless and until
the judicial proceeding is terminated in favor of the state
department.
(4) Action brought under the provisions of this section shall be
set for trial at the earliest possible date and shall take precedence
on the court calendar over all other cases except matters to which
equal or superior precedence is specifically granted by law. Times
for responsive pleading and for hearing any such proceeding shall be
set by the judge of the court with the object of securing a decision
as to subject matters at the earliest possible time.
(5) If the proposed fine is dismissed or reduced, the state
department shall take action immediately to ensure that the public
records reflect in a prominent manner that the proposed fine was
dismissed or reduced.
(6) In lieu of a judicial proceeding, the state department and the
hospital may jointly elect to submit the matter to binding
arbitration, in which case, the department shall initiate arbitration
proceedings. The parties shall agree upon an arbitrator designated
by the American Arbitration Association in accordance with the
Association's established rules and procedures. The arbitration
hearing shall be set within 45 days of the parties' joint election,
but in no event less than 28 days from the date of selection of an
arbitrator. The arbitration hearing may be continued up to 15 days if
necessary at the arbitrator's discretion. The decision of arbitrator
shall be based upon substantive law and shall be binding on all
parties, subject to judicial review. This review shall be limited to
whether there was substantial evidence to support the decision of the
arbitrator.
(7) Proceedings by the board to impose a fine under Section 1317.6
shall be conducted in accordance with Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code.
1317.4a. (a) Notwithstanding subdivision (j) of Section 1317.1, a
patient may be transferred for admission to a psychiatric unit within
a general acute care hospital, as defined in subdivision (a) of
Section 1250, or an acute psychiatric hospital, as defined in
subdivision (b) of Section 1250, for care and treatment that is
solely necessary to relieve or eliminate a psychiatric emergency
medical condition, as defined in subdivision (k) of Section 1317.1,
provided that, in the opinion of the treating provider, the patient's
psychiatric emergency medical condition is such that, within
reasonable medical probability, no material deterioration of the
patient's psychiatric emergency medical condition is likely to result
from, or occur during, a transfer of the patient. A provider shall
notify the patient's health care service plan, or the health plan's
contracting medical provider of the need for the transfer if
identification of the plan is obtained pursuant to paragraph (1) of
subdivision (b).
(b) A hospital that transfers a patient pursuant to subdivision
(a) shall do both of the following:
(1) Seek to obtain the name and contact information of the patient'
s health care service plan. The hospital shall document its attempt
to ascertain this information in the patient's medical record. The
hospital's attempt to ascertain the information shall include
requesting the patient's health care service plan member card, asking
the patient, the patient's family member, or other person
accompanying the patient if he or she can identify the patient's
health care service plan, or using other means known to the hospital
to accurately identify the patient's health care service plan.
(2) Notify the patient's health care service plan or the health
plan's contracting medical provider of the transfer, provided that
the identification of the plan was obtained pursuant to paragraph
(1). The hospital shall provide the plan or its contracting medical
provider with the name of the patient, the patient's member
identification number, if known, the location and contact
information, including a telephone number, for the location where the
patient will be admitted, and the preliminary diagnosis.
(c) (1) A hospital shall make the notification described in
paragraph (2) of subdivision (b) by either following the instructions
on the patient's health care service plan member card or by using
the contact information provided by the patient's health care service
plan. A health care service plan shall provide all noncontracting
hospitals in the state to which one of its members would be
transferred pursuant to paragraph (1) of subdivision (b) with
specific contact information needed to make the contact required by
this section. The contact information provided to hospitals shall be
updated as necessary, but no less than once a year.
(2) A hospital making the transfer pursuant to subdivision (a)
shall not be required to make more than one telephone call to the
health care service plan, or its contracting medical provider,
provided that in all cases the health care service plan, or its
contracting medical provider, shall be able to reach a representative
of the provider upon returning the call, should the plan, or its
contracting medical provider, need to call back. The representative
of the hospital who makes the telephone call may be, but is not
required to be, a physician and surgeon.
(d) If a transfer made pursuant to subdivision (a) is made to a
facility that does not have a contract with the patient's health care
service plan, the plan may subsequently require and make provision
for the transfer of the patient receiving services pursuant to this
section and subdivision (a) of Section 1317.1 from the noncontracting
facility to a general acute care hospital, as defined in subdivision
(a) of Section 1250, or an acute psychiatric hospital, as defined in
subdivision (b) of Section 1250, that has a contract with the plan
or its delegated payer, provided that in the opinion of the treating
provider the patient's psychiatric emergency medical condition is
such that, within reasonable medical probability, no material
deterioration of the patient's psychiatric emergency medical
condition is likely to result from, or occur during, the transfer of
the patient.
(e) Upon admission, the hospital to which the patient was
transferred shall notify the health care service plan of the
transfer, provided that the facility has the name and contact
information of the patient's health care service plan. The facility
shall not be required to make more than one telephone call to the
health care service plan, or its contracting medical provider,
provided that in all cases the health care service plan, or its
contracting medical provider, shall be able to reach a representative
of the facility upon returning the call, should the plan, or its
contracting medical provider, need to call back. The representative
of the facility who makes the telephone call may be, but is not
required to be, a physician and surgeon.
(f) Nothing in this subdivision shall be construed to require
providers to seek authorization to provide emergency services and
care, as defined in paragraph (2) of subdivision (a) of Section
1317.1, to a patient who has a psychiatric emergency medical
condition, as defined in subdivision (k) of Section 1317.1, that is
not otherwise required by law.
1317.5. (a) All alleged violations of this article and the
regulations adopted hereunder shall be investigated by the state
department. The state department, with the agreement of the local EMS
agency, may refer violations of this article to the local EMS agency
for investigation. The investigation shall be conducted pursuant to
procedures established by the state department and shall be completed
no later than 60 days after the report of apparent violation is
received by the state department.
(b) At the conclusion of its investigation, the state department
or the local EMS agency shall refer any alleged violation by a
physician to the Medical Board of California unless it is determined
that the complaint is without a reasonable basis.
1317.5. (a) All alleged violations of this article and the
regulations adopted hereunder shall be investigated by the state
department. The state department, with the agreement of the local EMS
agency, may refer violations of this article to the local EMS agency
for investigation. The investigation shall be conducted pursuant to
procedures established by the state department and shall be completed
no later than 60 days after the report of apparent violation is
received by the state department.
(b) At the conclusion of its investigation, the state department
or the local EMS agency shall refer any alleged violation by a
physician to the Medical Board of California unless it is determined
that the complaint is without a reasonable basis.
1317.6. (a) Hospitals found by the state department to have
committed or to be responsible for a violation of this article or the
regulations adopted pursuant thereto shall be subject to a civil
penalty by the state department in an amount not to exceed
twenty-five thousand dollars ($25,000) for each hospital violation.
In determining the amount of the fine for a hospital violation, the
state department shall take into account all of the following:
(1) Whether the violation was knowing or unintentional.
(2) Whether the violation resulted or was reasonably likely to
result in a medical hazard to the patient.
(3) The frequency or gravity of the violation.
(4) Other civil fines which have been imposed as a result of the
violation under Section 1395 of Title 42 of the United States Code.
(b) Notwithstanding this section, the director shall refer any
alleged violation by a hospital owned and operated by a health care
service plan involving a plan member or enrollee to the Department of
Managed Health Care unless the director determines the complaint is
without reasonable basis. The Department of Managed Health Care shall
have sole authority and responsibility to enforce this article with
respect to violations involving hospitals owned and operated by
health care service plans in their treatment of plan members or
enrollees.
(c) Physicians and surgeons found by the board to have committed,
or to be responsible for, a violation of this article or the
regulations adopted pursuant thereto shall be subject to any and all
penalties which the board may lawfully impose and may be subject to a
civil penalty by the board in an amount not to exceed five thousand
dollars ($5,000) for each violation. A civil penalty imposed under
this subdivision shall not duplicate federal fines, and the board
shall credit any federal fine against a civil penalty imposed under
this subdivision.
(d) The board may impose fines when it finds any of the following:
(1) The violation was knowing or willful.
(2) The violation was reasonably likely to result in a medical
hazard.
(3) There are repeated violations.
(e) It is the intent of the Legislature that the state department
has primary responsibility for regulating the conduct of hospital
emergency departments and that fines imposed under this section
should not be duplicated by additional fines imposed by the federal
government as a result of the conduct which constituted a violation
of this section. To effectuate the Legislature's intent, the Governor
shall inform the Secretary of the federal Department of Health and
Human Services of the enactment of this section and request the
federal department to credit any penalty assessed under this section
against any subsequent civil monetary penalty assessed pursuant to
Section 1395dd of Title 42 of the United States Code for the same
violation.
(f) There shall be a cumulative maximum limit of thirty thousand
dollars ($30,000) in fines assessed against hospitals under this
article and under Section 1395dd of Title 42 of the United States
Code for the same circumstances. To effectuate this cumulative
maximum limit, the state department shall do both of the following:
(1) As to state fines assessed prior to the final conclusion,
including judicial review, if available, of an action against a
hospital by the federal Department of Health and Human Services under
Section 1395dd of Title 42 of the United States Code (for the same
circumstances finally deemed to have been a violation of this article
or the regulations adopted hereunder, because of the state
department action authorized by this article), remit and return to
the hospital within 30 days after conclusion of the federal action,
that portion of the state fine necessary to assure that the
cumulative maximum limit is not exceeded.
(2) Immediately credit against state fines assessed after the
final conclusion, including judicial review, if available, of an
action against a hospital by the federal Department of Health and
Human Services under Section 1395dd of Title 42 of the United States
Code, which results in a fine against a hospital (for the same
circumstances finally deemed to have been a violation of this article
or the regulations adopted hereunder, because of the state
department action authorized by this article), the amount of the
federal fine, necessary to assure the cumulative maximum limit is not
exceeded.
(g) Any hospital found by the state department pursuant to
procedures established by the state department to have committed a
violation of this article or the regulations adopted hereunder may
have its emergency medical service permit revoked or suspended by the
state department.
(h) Any administrative or medical personnel who knowingly and
intentionally violates any provision of this article, may be charged
by the local district attorney with a misdemeanor.
(i) Notification of each violation found by the state department
of the provisions of this article or the regulations adopted
hereunder shall be sent by the state department to the Joint
Commission for the Accreditation of Hospitals, the state emergency
medical services authority, and local emergency medical services
agencies.
(j) Any person who suffers personal harm and any medical facility
which suffers a financial loss as a result of a violation of this
article or the regulations adopted hereunder may recover, in a civil
action against the transferring or receiving hospital, damages,
reasonable attorney's fees, and other appropriate relief.
Transferring and receiving hospitals from which inappropriate
transfers of persons are made or refused in violation of this article
and the regulations adopted hereunder shall be liable for the
reasonable charges of the receiving or transferring hospital for
providing the services and care which should have been provided. Any
person potentially harmed by a violation of this article or the
regulations adopted hereunder, or the local district attorney or the
Attorney General, may bring a civil action against the responsible
hospital or administrative or medical personnel, to enjoin the
violation, and if the injunction issues, the court shall award
reasonable attorney's fees. The provisions of this subdivision are in
addition to other civil remedies and do not limit the availability
of the other remedies.
(k) The civil remedies established by this section do not apply to
violations of any requirements established by any county or county
agency.
1317.7. This article does not preempt any county or any other
governmental agency acting within its authority from regulating
emergency care or patient transfers, including the imposition of more
specific duties, consistent with the requirements of this article
and its implementing regulations. Any inconsistent requirements
imposed by the Medi-Cal program shall preempt this article with
respect to Medi-Cal beneficiaries. To the extent hospitals and
physicians enter into contractual relationships with county or other
governmental agencies which impose more stringent transfer
requirements, those contractual agreements shall control.
1317.8. If any provision of this article is declared unlawful or
unconstitutional in any judicial action, the remaining provisions of
this chapter shall remain in effect.
1317.9a. (a) This article shall not be construed as altering or
repealing Section 2400 of the Business and Professions Code.
(b) Nothing in Sections 1317 et seq. and 1798.170 et seq. shall
prevent a physician from exercising his or her professional judgment
in conflict with any state or local regulation adopted pursuant to
Section 1317 et seq. or 1798.170 et seq., so long as the judgment
conforms with Sections 1317, 1317.1, and, except for subdivision (g),
Section 1317.2, and acting in compliance with the state or local
regulation would be contrary to the best interests of the patient.
1318. (a) The director shall require as a condition precedent to
the issuance, or renewal, of any license for a health facility, if
the licensee handles or will handle any money of patients within the
health facility, that the applicant for the license or the renewal of
the license file or have on file with the state department a bond
executed by an admitted surety insurer in a sum to be fixed by the
state department based upon the magnitude of the operations of the
applicant, but which sum shall not be less than one thousand dollars
($1,000), running to the State of California and conditioned upon the
licensee's faithful and honest handling of the money of patients
within the health facility.
(b) Every person injured as a result of any improper or unlawful
handling of the money of a patient of a health facility may bring an
action in a proper court on the bond required to be posted by the
licensee pursuant to this section for the amount of damage the person
suffered as a result thereof to the extent covered by the bond.
(c) The failure of any licensee under this section to maintain on
file with the state department a bond in the amount prescribed by the
director or who embezzles any patient's trust funds shall constitute
cause for the revocation of the license.
(d) The provisions of this section shall not apply if the licensee
handles less than twenty-five dollars ($25) per patient and less
than five hundred dollars ($500) for all patients in any month.
(e) The director may exempt licensed health facilities of the
types specified in subdivisions (a), (b), (c), and (f) of Section
1250 from the requirements of this section. However, the exemption
from the bond purchase requirements of this section shall not affect
the financial liability of such health facilities.
1319. The rules of a health facility may include provisions that
require every member of the medical staff to have professional
liability insurance as a condition to being on the medical staff of
the health facility.
1320. A skilled nursing facility or intermediate care facility
shall not require patients to purchase drugs, or rent or purchase
medical supplies or equipment, from any particular pharmacy or other
source.
This section shall not preclude a skilled nursing facility or
intermediate care facility from requiring that the patient's pharmacy
or other source comply with the facility's policies and procedures
reasonably necessary for the care of the patient or policies and
procedures required to meet the intent of state or federal
regulations. Nothing in this section shall preclude a skilled nursing
facility or intermediate care facility from requiring that
controlled substances which are periodically counted by the facility
on at least a daily basis be dispensed by the patient's pharmacy in
containers suitable for that purpose.
1321. No health facility shall advertise or represent in any way
that it provides occupational therapy services unless such services
are provided under the administrative control of the health facility
by an occupational therapist or occupational therapy assistant within
the meaning of Section 2570 of the Business and Professions Code.
1322. A hospital which contracts with an insurer, nonprofit
hospital service plan, or health care service plan shall not
determine or condition medical staff membership or clinical
privileges upon the basis of a physician and surgeon's or podiatrist'
s participation or nonparticipation in a contract with that insurer,
hospital service plan, or health care service plan.
1323. (a) A health facility, as defined by subdivisions (c) to (g),
inclusive, of Section 1250, which has a significant beneficial
interest in an ancillary health service provider or which knows that
an ancillary health service provider has a significant beneficial
interest in the health facility shall disclose that interest in
writing to the patients of the health facility, or their
representatives, and advise the patients, or their representatives,
that they may choose to have another ancillary health service
provider provide any supplies or services ordered by a member of the
medical staff of the health facility.
(b) If supplies or services are provided on an outpatient basis by
an ancillary health service provider which is not on the same site
as, or which is not on a site which is adjacent to, a health
facility, as defined by subdivision (a) or (b) of Section 1250, which
has a significant beneficial interest in the ancillary health
service provider, or if the ancillary health service provider has a
significant beneficial interest in the health facility, the ancillary
health service provider shall disclose that interest in writing to
the customers of the ancillary health service provider, or their
representatives, and advise the customers, or their representatives,
that they may choose to have another ancillary health service
provider provide any supplies or services ordered by a member of the
medical staff of the health facility.
(c) A health facility, as defined by Section 1250, shall not
charge, bill, or otherwise solicit payment from a patient on behalf
of, or refer a patient to, another health facility in which the
health facility has a significant beneficial interest unless the
health facility first discloses in writing to the patient, or his or
her representative, that the patient may choose to have another
health facility provide any supplies or services ordered by a member
of the medical staff of the health facility.
(d) (1) Except as provided in paragraph (2), "significant
beneficial interest" means any financial interest that is equal to or
greater than the lesser of the following:
(A) Five percent of the whole.
(B) Five thousand dollars ($5,000).
(2) "Significant beneficial interest" does not include any of the
following interests:
(A) A lease agreement between a health facility, ancillary health
service provider, another health facility, or a parent corporation of
the health facility, or any combination thereof.
(B) Any financial interest held by a health facility or ancillary
health service provider in the stock of a publicly held health
facility or ancillary health service provider, or any parent
corporation of a health facility or ancillary health service
provider, if that financial interest does not exceed 5 percent of any
class of equity securities of the health facility, ancillary health
service provid
1315. Dental services, as defined in the Dental Practice Act, may
be provided patients in health facilities licensed under this
chapter. Such services shall be provided by persons licensed by the
State of California pursuant to Section 1611 of the Business and
Professions Code. However, this section shall not limit or restrict
the right of a licensed physician and surgeon to perform any acts
authorized under the Medical Practice Act.
1316. (a) The rules of a health facility shall include provisions
for use of the facility by, and staff privileges for, duly licensed
podiatrists within the scope of their respective licensure, subject
to rules and regulations governing such use or privileges established
by the health facility. Such rules and regulations shall not
discriminate on the basis of whether the staff member holds a M. D.,
D.O., or D.P.M. degree, within the scope of their respective
licensure. Each health facility shall establish a staff comprised of
physicians and surgeons, podiatrists, or any combination thereof,
which shall regulate the admission, conduct suspension, or
termination of the staff appointment of the podiatrists while using
the facilities. No classification of health facilities by the state
department, nor any other classification of health facilities based
on quality of service or otherwise, by any person, body, or
governmental agency of this state or any subdivision thereof shall be
affected by a health facility's provision for use of its facilities
by duly licensed podiatrists, nor shall any such classification be
affected by the subjection of the podiatrists, to the rules and
regulations of a staff comprising podiatrists, physicians and
surgeons, or any combination thereof, which govern the podiatrists'
use of the facilities. No classification of health facilities by any
governmental agency of this state or any subdivision thereof pursuant
to present law or laws passed hereinafter for the purposes of
ascertaining eligibility for compensation, reimbursement, or other
benefit for treatment of patients shall be affected by a health
facility's provision for use of its facilities by duly licensed
podiatrists, nor shall any such classification be affected by the
subjection of the podiatrists and dentists to the rules and
regulations of a staff comprising podiatrists, physicians and
surgeons, or any combination thereof, which govern the podiatrists'
use of the facilities.
With regard to the practice of podiatry in health facilities
throughout this state, medical staff status shall include and provide
for the right to pursue and practice full clinical and surgical
privileges for holders of M.D., D.O., and D. P.M. degrees within the
scope of their respective licensure. Such rights and privileges shall
be limited or restricted only upon the basis of an individual
practitioner's demonstrated competence. Such competence shall be
determined by health facility rules, regulations, and procedures
which are necessary and are applied in good faith, equally and in a
nondiscriminatory manner, to all practitioners regardless of whether
they hold a M.D., D.O., or D.P.M. degree.
Nothing in this section shall be construed to require a health
facility to offer a specific health service or services not otherwise
offered. If a health service is offered, the facility shall not
discriminate between persons holding M.D. , D.O., or D.P.M. degrees
who are authorized by law to perform such services.
This subdivision shall not prohibit a health facility which is a
clinical teaching facility owned or operated by a university
operating a school of medicine from requiring that a podiatrist have
a faculty teaching appointment as a condition for eligibility for
staff privileges for that facility.
(b) The rules of a health facility which include provisions for
use of the facility by, and staff privileges for, medical staff shall
not discriminate on the basis of whether the staff member holds a
M.D., D.O., or D.P.M. degree, within the scope of their respective
licensure. The health facility staff processing, reviewing,
evaluating, and determining qualifications for staff privileges for
medical staff shall include, if possible, staff members that hold
M.D., D.O., and D.P.M. degrees.
(c) Any violation by a health facility of the provisions of this
section may be enjoined in an action brought in the name of the
people of the State of California by the district attorney of the
county in which the health facility is located, upon receipt of a
complaint by an aggrieved physician and surgeon or podiatrist.
1316.5. (a) (1) Each health facility owned and operated by the
state offering care or services within the scope of practice of a
psychologist shall establish rules and medical staff bylaws that
include provisions for medical staff membership and clinical
privileges for clinical psychologists within the scope of their
licensure as psychologists, subject to the rules and medical staff
bylaws governing medical staff membership or privileges as the
facility shall establish. The rules and regulations shall not
discriminate on the basis of whether the staff member holds an M.D.,
D.O., D.D.S., D.P.M., or doctoral degree in psychology within the
scope of the member's respective licensure. Each of these health
facilities owned and operated by the state shall establish a staff
comprised of physicians and surgeons, dentists, podiatrists,
psychologists, or any combination thereof, that shall regulate the
admission, conduct, suspension, or termination of the staff
appointment of psychologists employed by the health facility.
(2) With regard to the practice of psychology in health facilities
owned and operated by the state offering care or services within the
scope of practice of a psychologist, medical staff status shall
include and provide for the right to pursue and practice full
clinical privileges for holders of a doctoral degree of psychology
within the scope of their respective licensure. These rights and
privileges shall be limited or restricted only upon the basis of an
individual practitioner's demonstrated competence. Competence shall
be determined by health facility rules and medical staff bylaws that
are necessary and are applied in good faith, equally and in a
nondiscriminatory manner, to all practitioners, regardless of whether
they hold an M.D., D.O., D.D.S., D.P.M., or doctoral degree in
psychology.
(3) Nothing in this subdivision shall be construed to require a
health facility owned and operated by the state to offer a specific
health service or services not otherwise offered. If a health service
is offered in such a health facility that includes provisions for
medical staff membership and clinical privileges for clinical
psychologists, the facility shall not discriminate between persons
holding an M.D., D.O., D.D.S., D.P.M., or doctoral degree in
psychology who are authorized by law to perform the service within
the scope of the person's respective licensure.
(4) The rules and medical staff bylaws of a health facility owned
and operated by the state that include provisions for medical staff
membership and clinical privileges for medical staff and duly
licensed clinical psychologists shall not discriminate on the basis
of whether the staff member holds an M.D., D.O., D.D.S., D.P.M., or
doctoral degree in psychology within the scope of the member's
respective licensure. The health facility staff of these health
facilities who process, review, evaluate, and determine
qualifications for staff privileges for medical staff shall include,
if possible, staff members who are clinical psychologists.
(b) (1) The rules of a health facility not owned or operated by
this state may enable the appointment of clinical psychologists on
the terms and conditions that the facility shall establish. In these
health facilities, clinical psychologists may hold membership and
serve on committees of the medical staff and carry professional
responsibilities consistent with the scope of their licensure and
their competence, subject to the rules of the health facility.
(2) Nothing in this subdivision shall be construed to require a
health facility not owned or operated by this state to offer a
specific health service or services not otherwise offered. If a
health service is offered by a health facility with both licensed
physicians and surgeons and clinical psychologists on the medical
staff, which both licensed physicians and surgeons and clinical
psychologists are authorized by law to perform, the service may be
performed by either, without discrimination.
(3) This subdivision shall not prohibit a health facility that is
a clinical teaching facility owned or operated by a university
operating a school of medicine from requiring that a clinical
psychologist have a faculty teaching appointment as a condition for
eligibility for staff privileges at that facility.
(4) In any health facility that is not owned or operated by this
state that provides staff privileges to clinical psychologists, the
health facility staff who process, review, evaluate, and determine
qualifications for staff privileges for medical staff shall include,
if possible, staff members who are clinical psychologists.
(c) No classification of health facilities by the department, nor
any other classification of health facilities based on quality of
service or otherwise, by any person, body, or governmental agency of
this state or any subdivision thereof shall be affected by a health
facility's provision for use of its facilities by duly licensed
clinical psychologists, nor shall any classification of these
facilities be affected by the subjection of the psychologists to the
rules and regulations of the organized professional staff. No
classification of health facilities by any governmental agency of
this state or any subdivision thereof pursuant to any law, whether
enacted prior or subsequent to the effective date of this section,
for the purposes of ascertaining eligibility for compensation,
reimbursement, or other benefit for treatment of patients shall be
affected by a health facility's provision for use of its facilities
by duly licensed clinical psychologists, nor shall any classification
of these facilities be affected by the subjection of the
psychologists to the rules and regulations of the organized
professional staff which govern the psychologists' use of the
facilities.
(d) "Clinical psychologist," as used in this section, means a
psychologist licensed by this state who meets both of the following
requirements:
(1) Possesses an earned doctorate degree in psychology from an
educational institution meeting the criteria of subdivision (b) of
Section 2914 of the Business and Professions Code.
(2) Has not less than two years clinical experience in a
multidisciplinary facility licensed or operated by this or another
state or by the United States to provide health care, or, is listed
in the latest edition of the National Register of Health Service
Providers in Psychology, as adopted by the Council for the National
Register of Health Service Providers in Psychology.
(e) Nothing in this section is intended to expand the scope of
licensure of clinical psychologists. Notwithstanding the Ralph C.
Dills Act (Chapter 10.3 (commencing with Section 3512) of Division 4
of Title 1 of the Government Code), the Public Employment Relations
Board is precluded from creating any additional bargaining units for
the purpose of exclusive representation of state psychologist
employees that might result because of medical staff membership
and/or privilege changes for psychologists due to the enactment of
provisions by Assembly Bill No. 3141 of the 1995-96 Regular Session.
(f) The State Department of Mental Health, the State Department of
Developmental Services, and the Department of Corrections shall
report to the Legislature no later than January 1, 2006, on the
impact of medical staff membership and privileges for clinical
psychologists on quality of care, and on cost-effectiveness issues.
1316.6. Notwithstanding any other provision of this chapter, the
exercise of privileges in any health facility may be limited,
restricted, or revoked for the violation of such health facility's
rules, regulations, or procedures which are applied, in good faith,
in a nondiscriminatory manner to all practitioners in such health
facility exercising such privileges or entitled to exercise such
privileges.
1317. (a) Emergency services and care shall be provided to any
person requesting the services or care, or for whom services or care
is requested, for any condition in which the person is in danger of
loss of life, or serious injury or illness, at any health facility
licensed under this chapter that maintains and operates an emergency
department to provide emergency services to the public when the
health facility has appropriate facilities and qualified personnel
available to provide the services or care.
(b) In no event shall the provision of emergency services and care
be based upon, or affected by, the person's ethnicity, citizenship,
age, preexisting medical condition, insurance status, economic
status, ability to pay for medical services, or any other
characteristic listed or defined in subdivision (b) or (e) of Section
51 of the Civil Code, except to the extent that a circumstance such
as age, sex, preexisting medical condition, or physical or mental
disability is medically significant to the provision of appropriate
medical care to the patient.
(c) Neither the health facility, its employees, nor any physician
and surgeon, dentist, clinical psychologist, or podiatrist shall be
liable in any action arising out of a refusal to render emergency
services or care if the refusal is based on the determination,
exercising reasonable care, that the person is not suffering from an
emergency medical condition, or that the health facility does not
have the appropriate facilities or qualified personnel available to
render those services.
(d) Emergency services and care shall be rendered without first
questioning the patient or any other person as to his or her ability
to pay therefor. However, the patient or his or her legally
responsible relative or guardian shall execute an agreement to pay
therefor or otherwise supply insurance or credit information promptly
after the services are rendered.
(e) If a health facility subject to this chapter does not maintain
an emergency department, its employees shall nevertheless exercise
reasonable care to determine whether an emergency exists and shall
direct the persons seeking emergency care to a nearby facility that
can render the needed services, and shall assist the persons seeking
emergency care in obtaining the services, including transportation
services, in every way reasonable under the circumstances.
(f) No act or omission of any rescue team established by any
health facility licensed under this chapter, or operated by the
federal or state government, a county, or by the Regents of the
University of California, done or omitted while attempting to
resuscitate any person who is in immediate danger of loss of life
shall impose any liability upon the health facility, the officers,
members of the staff, nurses, or employees of the health facility,
including, but not limited to, the members of the rescue team, or
upon the federal or state government or a county, if good faith is
exercised.
(g) "Rescue team," as used in this section, means a special group
of physicians and surgeons, nurses, and employees of a health
facility who have been trained in cardiopulmonary resuscitation and
have been designated by the health facility to attempt, in cases of
emergency, to resuscitate persons who are in immediate danger of loss
of life.
(h) This section shall not relieve a health facility of any duty
otherwise imposed by law upon the health facility for the designation
and training of members of a rescue team or for the provision or
maintenance of equipment to be used by a rescue team.
1317.1. Unless the context otherwise requires, the following
definitions shall control the construction of this article:
(a) "Emergency services and care" means medical screening,
examination, and evaluation by a physician, or, to the extent
permitted by applicable law, by other appropriate personnel under the
supervision of a physician, to determine if an emergency medical
condition or active labor exists and, if it does, the care,
treatment, and surgery by a physician necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
(b) "Emergency medical condition" means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in any of the
following:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of any bodily organ or part.
(c) "Active labor" means a labor at a time at which either of the
following would occur:
(1) There is inadequate time to effect safe transfer to another
hospital prior to delivery.
(2) A transfer may pose a threat to the health and safety of the
patient or the unborn child.
(d) "Hospital" means all hospitals with an emergency department
licensed by the state department.
(e) "State department" means the State Department of Health
Services.
(f) "Medical hazard" means a material deterioration in, or
jeopardy to, a patient's medical condition or expected chances for
recovery.
(g) "Board" means the Medical Board of California.
(h) "Within the capability of the facility" means those
capabilities which the hospital is required to have as a condition of
its emergency medical services permit and services specified on
Services Inventory Form 7041 filed by the hospital with the Office of
Statewide Health Planning and Development.
(i) "Consultation" means the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and the specialty
physicians, includes review of the patient's medical record,
examination and treatment of the patient in person by a specialty
physician who is qualified to give an opinion or render the necessary
treatment in order to stabilize the patient.
1317.1. Unless the context otherwise requires, the following
definitions shall control the construction of this article and
Section 1371.4:
(a) (1) "Emergency services and care" means medical screening,
examination, and evaluation by a physician, or, to the extent
permitted by applicable law, by other appropriate personnel under the
supervision of a physician, to determine if an emergency medical
condition or active labor exists and, if it does, the care,
treatment, and surgery by a physician necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
(2) (A) "Emergency services and care" also means an additional
screening, examination, and evaluation by a physician, or other
personnel to the extent permitted by applicable law and within the
scope of their licensure and clinical privileges, to determine if a
psychiatric emergency medical condition exists, and the care and
treatment necessary to relieve or eliminate the psychiatric emergency
medical condition, within the capability of the facility.
(B) The care and treatment necessary to relieve or eliminate a
psychiatric emergency medical condition may include admission or
transfer to a psychiatric unit within a general acute care hospital,
as defined in subdivision (a) of Section 1250, or to an acute
psychiatric hospital, as defined in subdivision (b) of Section 1250,
pursuant to subdivision (k). Nothing in this subparagraph shall be
construed to permit a transfer that is in conflict with the
Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of
Division 5 of the Welfare and Institutions Code).
(C) For the purposes of Section 1371.4, emergency services and
care as defined in subparagraph (A) shall not apply to Medi-Cal
managed care plan contracts entered into with the State Department of
Health Care Services pursuant to Chapter 7 (commencing with Section
14000), Chapter 8 (commencing with Section 14200), and Chapter 8.75
(commencing with Section 14590) of Part 3 of Division 9 of the
Welfare and Institutions Code, to the extent that those services are
excluded from coverage under those contracts.
(D) This paragraph does not expand, restrict, or otherwise affect
the scope of licensure or clinical privileges for clinical
psychologists or other medical personnel.
(b) "Emergency medical condition" means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in any of the
following:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of any bodily organ or part.
(c) "Active labor" means a labor at a time at which either of the
following would occur:
(1) There is inadequate time to effect safe transfer to another
hospital prior to delivery.
(2) A transfer may pose a threat to the health and safety of the
patient or the unborn child.
(d) "Hospital" means all hospitals with an emergency department
licensed by the state department.
(e) "State department" means the State Department of Public
Health.
(f) "Medical hazard" means a material deterioration in medical
condition in, or jeopardy to, a patient's medical condition or
expected chances for recovery.
(g) "Board" means the Medical Board of California.
(h) "Within the capability of the facility" means those
capabilities that the hospital is required to have as a condition of
its emergency medical services permit and services specified on
Services Inventory Form 7041 filed by the hospital with the Office of
Statewide Health Planning and Development.
(i) "Consultation" means the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and specialty
physicians, includes review of the patient's medical record,
examination, and treatment of the patient in person by a specialty
physician who is qualified to give an opinion or render the necessary
treatment in order to stabilize the patient.
(j) A patient is "stabilized" or "stabilization" has occurred
when, in the opinion of the treating provider, the patient's medical
condition is such that, within reasonable medical probability, no
material deterioration of the patient's condition is likely to result
from, or occur during, the release or transfer of the patient as
provided for in Section 1317.2, Section 1317.2a, or other pertinent
statute.
(k) (1) "Psychiatric emergency medical condition" means a mental
disorder that manifests itself by acute symptoms of sufficient
severity that it renders the patient as being either of the
following:
(A) An immediate danger to himself or herself or to others.
(B) Immediately unable to provide for, or utilize, food, shelter,
or clothing, due to the mental disorder.
(2) This subdivision does not expand, restrict, or otherwise
affect the scope of licensure or clinical privileges for clinical
psychologists or medical personnel.
1317.2. No person needing emergency services and care may be
transferred from a hospital to another hospital for any nonmedical
reason (such as the person's inability to pay for any emergency
service or care) unless each of the following conditions are met:
(a) The person is examined and evaluated by a physician and
surgeon, including, if necessary, consultation, prior to transfer.
(b) The person has been provided with emergency services and care
so that it can be determined, within reasonable medical probability,
that the transfer or delay caused by the transfer will not create a
medical hazard to the person.
(c) A physician and surgeon at the transferring hospital has
notified and has obtained the consent to the transfer by a physician
and surgeon at the receiving hospital and confirmation by the
receiving hospital that the person meets the hospital's admissions
criteria relating to appropriate bed, personnel, and equipment
necessary to treat the person.
(d) The transferring hospital provides for appropriate personnel
and equipment which a reasonable and prudent physician and surgeon in
the same or similar locality exercising ordinary care would use to
effect the transfer.
(e) All the person's pertinent medical records and copies of all
the appropriate diagnostic test results which are reasonably
available are transferred with the person.
(f) The records transferred with the person include a "Transfer
Summary" signed by the transferring physician and surgeon which
contains relevant transfer information. The form of the "Transfer
Summary" shall, at a minimum, contain the person's name, address,
sex, race, age, insurance status, and medical condition; the name and
address of the transferring physician and surgeon or emergency
department personnel authorizing the transfer; the time and date the
person was first presented at the transferring hospital; the name of
the physician and surgeon at the receiving hospital consenting to the
transfer and the time and date of the consent; the time and date of
the transfer; the reason for the transfer; and the declaration of the
signor that the signor is assured, within reasonable medical
probability, that the transfer creates no medical hazard to the
patient. Neither the transferring physician and surgeon nor
transferring hospital shall be required to duplicate, in the
"Transfer Summary," information contained in medical records
transferred with the person.
(g) The transfer conforms with regulations established by the
state department. These regulations may prescribe minimum protocols
for patient transfers.
(h) Nothing in this section shall apply to a transfer of a patient
for medical reasons.
(i) Nothing in this section shall prohibit the transfer or
discharge of a patient when the patient or the patient's
representative requests a transfer or discharge and gives informed
consent to the transfer or discharge against medical advice.
1317.2a. (a) A hospital which has a legal obligation, whether
imposed by statute or by contract, to the extent of that contractual
obligation, to any third-party payor, including, but not limited to,
a health maintenance organization, health care service plan,
nonprofit hospital service plan, insurer, or preferred provider
organization, a county, or an employer to provide care for a patient
under the circumstances specified in Section 1317.2 shall receive
that patient to the extent required by the applicable statute or by
the terms of the contract, or, when the hospital is unable to accept
a patient for whom it has a legal obligation to provide care whose
transfer will not create a medical hazard as specified in Section
1317.2, it shall make appropriate arrangements for the patient's
care.
(b) A county hospital shall accept a patient whose transfer will
not create a medical hazard as specified in Section 1317.2 and who is
determined by the county to be eligible to receive health care
services required under Part 5 (commencing with Section 17000) of
Division 9 of the Welfare and Institutions Code, unless the hospital
does not have appropriate bed capacity, medical personnel, or
equipment required to provide care to the patient in accordance with
accepted medical practice. When a county hospital is unable to accept
a patient whose transfer will not create a medical hazard as
specified in Section 1317.2, it shall make appropriate arrangements
for the patient's care. The obligation to make appropriate
arrangements as set forth in this subdivision does not mandate a
level of service or payment, modify the county's obligations under
Part 5 (commencing with Section 17000) of Division 9 of the Welfare
and Institutions Code, create a cause of action, or limit a county's
flexibility to manage county health systems within available
resources. However, the county's flexibility shall not diminish a
county's responsibilities under Part 5 (commencing with Section
17000) of Division 9 of the Welfare and Institutions Code or the
requirements contained in Chapter 2.5 (commencing with Section 1440).
(c) The receiving hospital shall provide personnel and equipment
reasonably required in the exercise of good medical practice for the
care of the transferred patient.
(d) Any third-party payor, including, but not limited to, a health
maintenance organization, health care service plan, nonprofit
hospital service plan, insurer, or preferred provider organization,
or employer which has a statutory or contractual obligation to
provide or indemnify emergency medical services on behalf of a
patient shall be liable, to the extent of the contractual obligation
to the patient, for the reasonable charges of the transferring
hospital and the treating physicians for the emergency services
provided pursuant to this article, except that the patient shall be
responsible for uncovered services, or any deductible or copayment
obligation. Notwithstanding this section, the liability of a
third-party payor which has contracted with health care providers for
the provision of these emergency services shall be set by the terms
of that contract. Notwithstanding this section, the liability of a
third-party payor that is licensed by the Insurance Commissioner or
the Director of the Department of Managed Health Care and has a
contractual obligation to provide or indemnify emergency medical
services under a contract which covers a subscriber or an enrollee
shall be determined in accordance with the terms of that contract and
shall remain under the sole jurisdiction of that licensing agency.
(e) A hospital which has a legal obligation to provide care for a
patient as specified by subdivision (a) of Section 1317.2a to the
extent of its legal obligation, imposed by statute or by contract to
the extent of that contractual obligation, which does not accept
transfers of, or make other appropriate arrangements for, medically
stable patients in violation of this article or regulations adopted
pursuant thereto shall be liable for the reasonable charges of the
transferring hospital and treating physicians for providing services
and care which should have been provided by the receiving hospital.
(f) Subdivisions (d) and (e) do not apply to county obligations
under Section 17000 of the Welfare and Institutions Code.
(g) Nothing in this section shall be interpreted to require a
hospital to make arrangements for the care of a patient for whom the
hospital does not have a legal obligation to provide care.
1317.3. (a) As a condition of licensure, each hospital shall adopt,
in consultation with the medical staff, policies and transfer
protocols consistent with this article and regulations adopted
hereunder.
(b) As a condition of licensure, each hospital shall adopt a
policy prohibiting discrimination in the provision of emergency
services and care based on ethnicity, citizenship, age, preexisting
medical condition, insurance status, economic status, ability to pay
for medical services, or any characteristic listed or defined in
subdivision (b) or (e) of Section 51 of the Civil Code, except to the
extent that a circumstance such as age, sex, preexisting medical
condition, or physical or mental disability is medically significant
to the provision of appropriate medical care to the patient. Transfer
by a hospital of a patient who requires evaluation for involuntary
psychiatric treatment, as determined by the receiving hospital or
other receiving health facility, based upon the decision of a
professional person duly authorized by law to make that decision,
shall not constitute discrimination for the purposes of this section,
if the transferring hospital has not been designated as an
evaluation facility by a county pursuant to Section 5150 of the
Welfare and Institutions Code, and if the transfer is in compliance
with Section 1317.2.
(c) As a condition of licensure, each hospital shall require that
physicians and surgeons who serve on an "on-call" basis to the
hospital's emergency room cannot refuse to respond to a call on the
basis of the patient's ethnicity, citizenship, age, preexisting
medical condition, insurance status, economic status, ability to pay
for medical services, or any characteristic listed or defined in
subdivision (b) or (e) of Section 51 of the Civil Code, except to the
extent that a circumstance such as age, sex, preexisting medical
condition, or physical or mental disability is medically significant
to the provision of appropriate medical care to the patient. If a
contract between a physician and surgeon and hospital for the
provision of emergency room coverage presently prevents the hospital
from imposing those conditions, the conditions shall be included in
the contract as soon as is legally permissible. Nothing in this
section shall be construed as requiring that any physician serve on
an "on-call" basis.
(d) As a condition of licensure, all hospitals shall inform all
persons presented to an emergency room or their representatives if
any are present and the person is unable to understand verbal or
written communication, both orally and in writing, of the reasons for
the transfer or refusal to provide emergency services and care and
of the person's right to emergency services and care prior to
transfer or discharge without regard to ability to pay. Nothing in
this subdivision requires notification of the reasons for the
transfer in advance of the transfer where a person is unaccompanied
and the hospital has made a reasonable effort to locate a
representative, and because of the person's physical or mental
condition, notification is not possible. All hospitals shall
prominently post a sign in their emergency rooms informing the public
of their rights. Both the posted sign and written communication
concerning the transfer or refusal to provide emergency services and
care shall give the address of the department as the government
agency to contact in the event the person wishes to complain about
the hospital's conduct.
(e) If a hospital does not timely adopt the policies and protocols
required in this article, the hospital, in addition to denial or
revocation of any of its licenses, shall be subject to a fine not to
exceed one thousand dollars ($1,000) each day after expiration of 60
days' written notice from the state department that the hospital's
policies or protocols required by this article are inadequate unless
the delay is excused by the state department upon a showing of good
and sufficient cause by the hospital. The notice shall include a
detailed statement of the state department's reasons for its
determination and suggested changes to the hospital's protocols which
would be acceptable to the state department.
(f) Each hospital's policies and protocols required in or under
this article shall be submitted for approval to the state department
by December 31, 1988.
1317.4. (a) All hospitals shall maintain records of each transfer
made or received, including the "Memorandum of Transfer" described in
subdivision (f) of Section 1317.2, for a period of three years.
(b) All hospitals making or receiving transfers shall file with
the state department annual reports on forms prescribed by the
department which shall describe the aggregate number of transfers
made and received according to the person's insurance status and
reasons for transfers.
(c) The receiving hospital, and all physicians, other licensed
emergency room health personnel, and certified prehospital emergency
personnel at the receiving hospital who know of apparent violations
of this article or the regulations adopted hereunder shall, and the
corresponding personnel at the transferring hospital and the
transferring hospital may, report the apparent violations to the
state department on a form prescribed by the state department within
one week following its occurrence. The state department shall
promptly send a copy of the form to the hospital administrator and
appropriate medical staff committee of the transferring hospital and
the local emergency medical services agency, unless the state
department concludes that the complaint does not allege facts
requiring further investigation, or is otherwise unmeritorious, or
the state department concludes, based upon the circumstances of the
case, that its investigation of the allegations would be impeded by
disclosure of the form. When two or more persons required to report
jointly have knowledge of an apparent violation, a single report may
be made by a member of the team selected by mutual agreement in
accordance with hospital protocols. Any individual, required to
report by this section, who disagrees with the proposed joint report
has a right and duty to separately report.
A failure to report under this subdivision shall not constitute a
violation within the meaning of Section 1290 or 1317.6.
(d) No hospital, government agency, or person shall retaliate
against, penalize, institute a civil action against, or recover
monetary relief from, or otherwise cause any injury to a physician or
other personnel for reporting in good faith an apparent violation of
this article or the regulations adopted hereunder to the state
department, hospital, medical staff, or any other interested party or
government agency.
(e) No hospital, government agency, or person shall retaliate
against, penalize, institute a civil action against, or recover
monetary relief from, or otherwise cause any injury to a physician
who refused to transfer a patient when the physician determines,
within reasonable medical probability, that the transfer or delay
caused by the transfer will create a medical hazard to the person.
(f) Any person who violates subdivision (d) or (e) of Section
1317.4 is subject to a civil money penalty of no more than ten
thousand dollars ($10,000) per violation. The remedy specified in
this section shall be in addition to any other remedy provided by
law.
(g) The state department shall on an annual basis publish and
provide to the Legislature a statistical summary by county on the
extent of economic transfers of emergency patients, the frequency of
medically hazardous transfers, the insurance status of the patient
populations being transferred and all violations finally determined
by the state department describing the nature of the violations,
hospitals involved, and the action taken by the state department in
response. These summaries shall not reveal the identity of individual
persons transferred.
(h) Proceedings by the state department to impose a fine under
Section 1317.3 or 1317.6, and proceedings by the board to impose a
fine under Section 1317.6, shall be conducted as follows:
(1) If a hospital desires to contest a proposed fine, the hospital
shall within 15 business days after service of the notice of
proposed fine notify the director in writing of its intention to
contest the proposed fine. If requested by the hospital, the director
or the director's designee, shall hold, within 30 business days, an
informal conference, at the conclusion of which he or she may affirm,
modify, or dismiss the proposed fine. If the director or the
director's designee affirms, modifies, or dismisses the proposed
fine, he or she shall state with particularity in writing his or her
reasons for that action, and shall immediately transmit a copy
thereof to the hospital. If the hospital desires to contest a
determination made after the informal conference, the hospital shall
inform the director in writing within 15 business days after it
receives the decision by the director or director's designee. The
hospital shall not be required to request an informal conference to
contest a proposed fine, as specified in this section. If the
hospital fails to notify the director in writing that it intends to
protest the proposed fine within the times specified in this
subdivision, the proposed fine shall be deemed a final order of the
state department and shall not be subject to further administrative
review.
(2) If a hospital notifies the director that it intends to contest
a proposed fine, the director shall immediately notify the Attorney
General. Upon notification, the Attorney General shall promptly take
all appropriate action to enforce the proposed fine in a court of
competent jurisdiction for the county in which the hospital is
located.
(3) A judicial action to enforce a proposed fine shall be filed by
the Attorney General after a hospital notifies the director of its
intent to contest the proposed fine. If a judicial proceeding is
prosecuted under the provisions of this section, the state department
shall have the burden of establishing by a preponderance of the
evidence that the alleged facts supporting the proposed fine
occurred, that the alleged facts constituted a violation for which a
fine may be assessed under Section 1317.3, 1317.4, or 1317.6, and the
proposed fine is appropriate. The state department shall also have
the burden of establishing by a preponderance of the evidence that
the assessment of the proposed fine should be upheld. If a hospital
timely notifies the state department of its decision to contest a
proposed fine, the fine shall not be due and payable unless and until
the judicial proceeding is terminated in favor of the state
department.
(4) Action brought under the provisions of this section shall be
set for trial at the earliest possible date and shall take precedence
on the court calendar over all other cases except matters to which
equal or superior precedence is specifically granted by law. Times
for responsive pleading and for hearing any such proceeding shall be
set by the judge of the court with the object of securing a decision
as to subject matters at the earliest possible time.
(5) If the proposed fine is dismissed or reduced, the state
department shall take action immediately to ensure that the public
records reflect in a prominent manner that the proposed fine was
dismissed or reduced.
(6) In lieu of a judicial proceeding, the state department and the
hospital may jointly elect to submit the matter to binding
arbitration, in which case, the department shall initiate arbitration
proceedings. The parties shall agree upon an arbitrator designated
by the American Arbitration Association in accordance with the
Association's established rules and procedures. The arbitration
hearing shall be set within 45 days of the parties' joint election,
but in no event less than 28 days from the date of selection of an
arbitrator. The arbitration hearing may be continued up to 15 days if
necessary at the arbitrator's discretion. The decision of arbitrator
shall be based upon substantive law and shall be binding on all
parties, subject to judicial review. This review shall be limited to
whether there was substantial evidence to support the decision of the
arbitrator.
(7) Proceedings by the board to impose a fine under Section 1317.6
shall be conducted in accordance with Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code.
1317.4a. (a) Notwithstanding subdivision (j) of Section 1317.1, a
patient may be transferred for admission to a psychiatric unit within
a general acute care hospital, as defined in subdivision (a) of
Section 1250, or an acute psychiatric hospital, as defined in
subdivision (b) of Section 1250, for care and treatment that is
solely necessary to relieve or eliminate a psychiatric emergency
medical condition, as defined in subdivision (k) of Section 1317.1,
provided that, in the opinion of the treating provider, the patient's
psychiatric emergency medical condition is such that, within
reasonable medical probability, no material deterioration of the
patient's psychiatric emergency medical condition is likely to result
from, or occur during, a transfer of the patient. A provider shall
notify the patient's health care service plan, or the health plan's
contracting medical provider of the need for the transfer if
identification of the plan is obtained pursuant to paragraph (1) of
subdivision (b).
(b) A hospital that transfers a patient pursuant to subdivision
(a) shall do both of the following:
(1) Seek to obtain the name and contact information of the patient'
s health care service plan. The hospital shall document its attempt
to ascertain this information in the patient's medical record. The
hospital's attempt to ascertain the information shall include
requesting the patient's health care service plan member card, asking
the patient, the patient's family member, or other person
accompanying the patient if he or she can identify the patient's
health care service plan, or using other means known to the hospital
to accurately identify the patient's health care service plan.
(2) Notify the patient's health care service plan or the health
plan's contracting medical provider of the transfer, provided that
the identification of the plan was obtained pursuant to paragraph
(1). The hospital shall provide the plan or its contracting medical
provider with the name of the patient, the patient's member
identification number, if known, the location and contact
information, including a telephone number, for the location where the
patient will be admitted, and the preliminary diagnosis.
(c) (1) A hospital shall make the notification described in
paragraph (2) of subdivision (b) by either following the instructions
on the patient's health care service plan member card or by using
the contact information provided by the patient's health care service
plan. A health care service plan shall provide all noncontracting
hospitals in the state to which one of its members would be
transferred pursuant to paragraph (1) of subdivision (b) with
specific contact information needed to make the contact required by
this section. The contact information provided to hospitals shall be
updated as necessary, but no less than once a year.
(2) A hospital making the transfer pursuant to subdivision (a)
shall not be required to make more than one telephone call to the
health care service plan, or its contracting medical provider,
provided that in all cases the health care service plan, or its
contracting medical provider, shall be able to reach a representative
of the provider upon returning the call, should the plan, or its
contracting medical provider, need to call back. The representative
of the hospital who makes the telephone call may be, but is not
required to be, a physician and surgeon.
(d) If a transfer made pursuant to subdivision (a) is made to a
facility that does not have a contract with the patient's health care
service plan, the plan may subsequently require and make provision
for the transfer of the patient receiving services pursuant to this
section and subdivision (a) of Section 1317.1 from the noncontracting
facility to a general acute care hospital, as defined in subdivision
(a) of Section 1250, or an acute psychiatric hospital, as defined in
subdivision (b) of Section 1250, that has a contract with the plan
or its delegated payer, provided that in the opinion of the treating
provider the patient's psychiatric emergency medical condition is
such that, within reasonable medical probability, no material
deterioration of the patient's psychiatric emergency medical
condition is likely to result from, or occur during, the transfer of
the patient.
(e) Upon admission, the hospital to which the patient was
transferred shall notify the health care service plan of the
transfer, provided that the facility has the name and contact
information of the patient's health care service plan. The facility
shall not be required to make more than one telephone call to the
health care service plan, or its contracting medical provider,
provided that in all cases the health care service plan, or its
contracting medical provider, shall be able to reach a representative
of the facility upon returning the call, should the plan, or its
contracting medical provider, need to call back. The representative
of the facility who makes the telephone call may be, but is not
required to be, a physician and surgeon.
(f) Nothing in this subdivision shall be construed to require
providers to seek authorization to provide emergency services and
care, as defined in paragraph (2) of subdivision (a) of Section
1317.1, to a patient who has a psychiatric emergency medical
condition, as defined in subdivision (k) of Section 1317.1, that is
not otherwise required by law.
1317.5. (a) All alleged violations of this article and the
regulations adopted hereunder shall be investigated by the state
department. The state department, with the agreement of the local EMS
agency, may refer violations of this article to the local EMS agency
for investigation. The investigation shall be conducted pursuant to
procedures established by the state department and shall be completed
no later than 60 days after the report of apparent violation is
received by the state department.
(b) At the conclusion of its investigation, the state department
or the local EMS agency shall refer any alleged violation by a
physician to the Medical Board of California unless it is determined
that the complaint is without a reasonable basis.
1317.5. (a) All alleged violations of this article and the
regulations adopted hereunder shall be investigated by the state
department. The state department, with the agreement of the local EMS
agency, may refer violations of this article to the local EMS agency
for investigation. The investigation shall be conducted pursuant to
procedures established by the state department and shall be completed
no later than 60 days after the report of apparent violation is
received by the state department.
(b) At the conclusion of its investigation, the state department
or the local EMS agency shall refer any alleged violation by a
physician to the Medical Board of California unless it is determined
that the complaint is without a reasonable basis.
1317.6. (a) Hospitals found by the state department to have
committed or to be responsible for a violation of this article or the
regulations adopted pursuant thereto shall be subject to a civil
penalty by the state department in an amount not to exceed
twenty-five thousand dollars ($25,000) for each hospital violation.
In determining the amount of the fine for a hospital violation, the
state department shall take into account all of the following:
(1) Whether the violation was knowing or unintentional.
(2) Whether the violation resulted or was reasonably likely to
result in a medical hazard to the patient.
(3) The frequency or gravity of the violation.
(4) Other civil fines which have been imposed as a result of the
violation under Section 1395 of Title 42 of the United States Code.
(b) Notwithstanding this section, the director shall refer any
alleged violation by a hospital owned and operated by a health care
service plan involving a plan member or enrollee to the Department of
Managed Health Care unless the director determines the complaint is
without reasonable basis. The Department of Managed Health Care shall
have sole authority and responsibility to enforce this article with
respect to violations involving hospitals owned and operated by
health care service plans in their treatment of plan members or
enrollees.
(c) Physicians and surgeons found by the board to have committed,
or to be responsible for, a violation of this article or the
regulations adopted pursuant thereto shall be subject to any and all
penalties which the board may lawfully impose and may be subject to a
civil penalty by the board in an amount not to exceed five thousand
dollars ($5,000) for each violation. A civil penalty imposed under
this subdivision shall not duplicate federal fines, and the board
shall credit any federal fine against a civil penalty imposed under
this subdivision.
(d) The board may impose fines when it finds any of the following:
(1) The violation was knowing or willful.
(2) The violation was reasonably likely to result in a medical
hazard.
(3) There are repeated violations.
(e) It is the intent of the Legislature that the state department
has primary responsibility for regulating the conduct of hospital
emergency departments and that fines imposed under this section
should not be duplicated by additional fines imposed by the federal
government as a result of the conduct which constituted a violation
of this section. To effectuate the Legislature's intent, the Governor
shall inform the Secretary of the federal Department of Health and
Human Services of the enactment of this section and request the
federal department to credit any penalty assessed under this section
against any subsequent civil monetary penalty assessed pursuant to
Section 1395dd of Title 42 of the United States Code for the same
violation.
(f) There shall be a cumulative maximum limit of thirty thousand
dollars ($30,000) in fines assessed against hospitals under this
article and under Section 1395dd of Title 42 of the United States
Code for the same circumstances. To effectuate this cumulative
maximum limit, the state department shall do both of the following:
(1) As to state fines assessed prior to the final conclusion,
including judicial review, if available, of an action against a
hospital by the federal Department of Health and Human Services under
Section 1395dd of Title 42 of the United States Code (for the same
circumstances finally deemed to have been a violation of this article
or the regulations adopted hereunder, because of the state
department action authorized by this article), remit and return to
the hospital within 30 days after conclusion of the federal action,
that portion of the state fine necessary to assure that the
cumulative maximum limit is not exceeded.
(2) Immediately credit against state fines assessed after the
final conclusion, including judicial review, if available, of an
action against a hospital by the federal Department of Health and
Human Services under Section 1395dd of Title 42 of the United States
Code, which results in a fine against a hospital (for the same
circumstances finally deemed to have been a violation of this article
or the regulations adopted hereunder, because of the state
department action authorized by this article), the amount of the
federal fine, necessary to assure the cumulative maximum limit is not
exceeded.
(g) Any hospital found by the state department pursuant to
procedures established by the state department to have committed a
violation of this article or the regulations adopted hereunder may
have its emergency medical service permit revoked or suspended by the
state department.
(h) Any administrative or medical personnel who knowingly and
intentionally violates any provision of this article, may be charged
by the local district attorney with a misdemeanor.
(i) Notification of each violation found by the state department
of the provisions of this article or the regulations adopted
hereunder shall be sent by the state department to the Joint
Commission for the Accreditation of Hospitals, the state emergency
medical services authority, and local emergency medical services
agencies.
(j) Any person who suffers personal harm and any medical facility
which suffers a financial loss as a result of a violation of this
article or the regulations adopted hereunder may recover, in a civil
action against the transferring or receiving hospital, damages,
reasonable attorney's fees, and other appropriate relief.
Transferring and receiving hospitals from which inappropriate
transfers of persons are made or refused in violation of this article
and the regulations adopted hereunder shall be liable for the
reasonable charges of the receiving or transferring hospital for
providing the services and care which should have been provided. Any
person potentially harmed by a violation of this article or the
regulations adopted hereunder, or the local district attorney or the
Attorney General, may bring a civil action against the responsible
hospital or administrative or medical personnel, to enjoin the
violation, and if the injunction issues, the court shall award
reasonable attorney's fees. The provisions of this subdivision are in
addition to other civil remedies and do not limit the availability
of the other remedies.
(k) The civil remedies established by this section do not apply to
violations of any requirements established by any county or county
agency.
1317.7. This article does not preempt any county or any other
governmental agency acting within its authority from regulating
emergency care or patient transfers, including the imposition of more
specific duties, consistent with the requirements of this article
and its implementing regulations. Any inconsistent requirements
imposed by the Medi-Cal program shall preempt this article with
respect to Medi-Cal beneficiaries. To the extent hospitals and
physicians enter into contractual relationships with county or other
governmental agencies which impose more stringent transfer
requirements, those contractual agreements shall control.
1317.8. If any provision of this article is declared unlawful or
unconstitutional in any judicial action, the remaining provisions of
this chapter shall remain in effect.
1317.9a. (a) This article shall not be construed as altering or
repealing Section 2400 of the Business and Professions Code.
(b) Nothing in Sections 1317 et seq. and 1798.170 et seq. shall
prevent a physician from exercising his or her professional judgment
in conflict with any state or local regulation adopted pursuant to
Section 1317 et seq. or 1798.170 et seq., so long as the judgment
conforms with Sections 1317, 1317.1, and, except for subdivision (g),
Section 1317.2, and acting in compliance with the state or local
regulation would be contrary to the best interests of the patient.
1318. (a) The director shall require as a condition precedent to
the issuance, or renewal, of any license for a health facility, if
the licensee handles or will handle any money of patients within the
health facility, that the applicant for the license or the renewal of
the license file or have on file with the state department a bond
executed by an admitted surety insurer in a sum to be fixed by the
state department based upon the magnitude of the operations of the
applicant, but which sum shall not be less than one thousand dollars
($1,000), running to the State of California and conditioned upon the
licensee's faithful and honest handling of the money of patients
within the health facility.
(b) Every person injured as a result of any improper or unlawful
handling of the money of a patient of a health facility may bring an
action in a proper court on the bond required to be posted by the
licensee pursuant to this section for the amount of damage the person
suffered as a result thereof to the extent covered by the bond.
(c) The failure of any licensee under this section to maintain on
file with the state department a bond in the amount prescribed by the
director or who embezzles any patient's trust funds shall constitute
cause for the revocation of the license.
(d) The provisions of this section shall not apply if the licensee
handles less than twenty-five dollars ($25) per patient and less
than five hundred dollars ($500) for all patients in any month.
(e) The director may exempt licensed health facilities of the
types specified in subdivisions (a), (b), (c), and (f) of Section
1250 from the requirements of this section. However, the exemption
from the bond purchase requirements of this section shall not affect
the financial liability of such health facilities.
1319. The rules of a health facility may include provisions that
require every member of the medical staff to have professional
liability insurance as a condition to being on the medical staff of
the health facility.
1320. A skilled nursing facility or intermediate care facility
shall not require patients to purchase drugs, or rent or purchase
medical supplies or equipment, from any particular pharmacy or other
source.
This section shall not preclude a skilled nursing facility or
intermediate care facility from requiring that the patient's pharmacy
or other source comply with the facility's policies and procedures
reasonably necessary for the care of the patient or policies and
procedures required to meet the intent of state or federal
regulations. Nothing in this section shall preclude a skilled nursing
facility or intermediate care facility from requiring that
controlled substances which are periodically counted by the facility
on at least a daily basis be dispensed by the patient's pharmacy in
containers suitable for that purpose.
1321. No health facility shall advertise or represent in any way
that it provides occupational therapy services unless such services
are provided under the administrative control of the health facility
by an occupational therapist or occupational therapy assistant within
the meaning of Section 2570 of the Business and Professions Code.
1322. A hospital which contracts with an insurer, nonprofit
hospital service plan, or health care service plan shall not
determine or condition medical staff membership or clinical
privileges upon the basis of a physician and surgeon's or podiatrist'
s participation or nonparticipation in a contract with that insurer,
hospital service plan, or health care service plan.
1323. (a) A health facility, as defined by subdivisions (c) to (g),
inclusive, of Section 1250, which has a significant beneficial
interest in an ancillary health service provider or which knows that
an ancillary health service provider has a significant beneficial
interest in the health facility shall disclose that interest in
writing to the patients of the health facility, or their
representatives, and advise the patients, or their representatives,
that they may choose to have another ancillary health service
provider provide any supplies or services ordered by a member of the
medical staff of the health facility.
(b) If supplies or services are provided on an outpatient basis by
an ancillary health service provider which is not on the same site
as, or which is not on a site which is adjacent to, a health
facility, as defined by subdivision (a) or (b) of Section 1250, which
has a significant beneficial interest in the ancillary health
service provider, or if the ancillary health service provider has a
significant beneficial interest in the health facility, the ancillary
health service provider shall disclose that interest in writing to
the customers of the ancillary health service provider, or their
representatives, and advise the customers, or their representatives,
that they may choose to have another ancillary health service
provider provide any supplies or services ordered by a member of the
medical staff of the health facility.
(c) A health facility, as defined by Section 1250, shall not
charge, bill, or otherwise solicit payment from a patient on behalf
of, or refer a patient to, another health facility in which the
health facility has a significant beneficial interest unless the
health facility first discloses in writing to the patient, or his or
her representative, that the patient may choose to have another
health facility provide any supplies or services ordered by a member
of the medical staff of the health facility.
(d) (1) Except as provided in paragraph (2), "significant
beneficial interest" means any financial interest that is equal to or
greater than the lesser of the following:
(A) Five percent of the whole.
(B) Five thousand dollars ($5,000).
(2) "Significant beneficial interest" does not include any of the
following interests:
(A) A lease agreement between a health facility, ancillary health
service provider, another health facility, or a parent corporation of
the health facility, or any combination thereof.
(B) Any financial interest held by a health facility or ancillary
health service provider in the stock of a publicly held health
facility or ancillary health service provider, or any parent
corporation of a health facility or ancillary health service
provider, if that financial interest does not exceed 5 percent of any
class of equity securities of the health facility, ancillary health
service provid
