SB 687 (Skinner): Health Facilities: Emergency Centers: Attorney General
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Last Amend: |
05/03/2017 |
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Disposition: |
Pending |
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Location: |
Senate Appropriations Committee |
The text of the bill can be found at: http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB687
The Senate Judiciary Committee analysis is provided below:
2017 CA S 687: Bill Analysis - 04/24/2017 - Senate Judiciary Committee, Hearing Date 04/25/2017
SENATE JUDICIARY COMMITTEE
Senator Hannah-Beth Jackson, Chair
2017-2018 Regular Session
Bill No: SB 687 (Skinner)
Version: April 6, 2017
Hearing Date: April 25, 2017
Fiscal: Yes
Urgency: No
Consultant: MS
SUBJECT
Health facilities: emergency centers: Attorney General
DESCRIPTION
This bill would require any nonprofit public benefit corporation provide written notice to and obtain the written consent of the Attorney General prior to agreeing to sell, transfer, lease, exchange, option, convey, or otherwise dispose of the assets resulting from the reduction or elimination of emergency medical services provided at a licensed emergency center after the Attorney General gives a specified consent or conditional consent. This bill, except as specified, would also require any nonprofit public benefit corporation that operates or controls a health facility or operates or controls a facility that provides similar health care and that provides emergency services at a licensed emergency center to provide written notice to, and obtain written consent of, the Attorney General prior to a reduction of the level of emergency medical services provided or their elimination. This bill would require the Attorney General to notify the public benefit corporation of the decision to provide consent, or conditional consent, or withhold consent to the reduction in or elimination of emergency medical services within specified periods of time. Before the Attorney General issues written notice, this bill would require the Attorney General to conduct one or more public hearings after providing public notice.
Additionally, this bill would prohibit the State Department of Public Health from licensing a stand-alone emergency room or freestanding emergency center that is not part of a general acute care hospital facility providing 24-hour inpatient care with basic services. This bill would require the above-described notice to also be given to the agency in charge of the provision of health services. This bill would apply retroactively to decisions to close or reduce capacity of emergency rooms operated by non-profit health centers since 2015.
BACKGROUND
Since 1997, California law has required nonprofit health facilities that are subject to public benefit corporation law to obtain written consent from the Attorney General prior to entering into an agreement to sell, transfer, lease, exchange, option, convey, or otherwise dispose of assets, or transfer control or governance of assets. Additionally, the Attorney General is required to conduct at least one public meeting in the county where the health facility is located before issuing a written opinion making the determination whether to consent to, give conditional consent to, or not consent to any elimination or reduction of emergency medical services. The Attorney General has also had the ability to contract with experts regarding information needed to make this determination and obtain reimbursement for the costs of this contract from the health facilities being reviewed since 1997 (AB 3101, Isenberg, Ch. 1105, Stats. 1996).
This bill would extend these requirements to a nonprofit health facilities' decision to close or reduce capacity of their emergency departments. In its current form, this bill is also retroactive to 2015, allowing it to potentially impact the closure of the Saddleback Memorial San Clemente Hospital and possible closure of Alta Bates Medical Center.
The Saddleback Memorial Medical Center in San Clemente was a 73 bed hospital that was part of MemorialCare Health System, which is a non-profit health care delivery system with six hospitals, as well as a number of surgical centers and outpatient services, including an advanced urgent care facility. In response to community concerns about the loss of the emergency room, in particular, MemorialCare sought the ability, via SB 787 (Bates, 2015) to maintain just the emergency room on the hospital campus as a satellite extension of its hospital in Laguna Hills which is 14 miles away. SB 787 ultimately failed passage in Senate Health Committee in January of 2016, and the San Clemente Hospital closed on May 30, 2016. However, in an attempt to ensure hospital and emergency room access for its residents, the City of San Clemente rezoned the property to require that the property be used for a hospital with an emergency room, which prompted MemorialCare to file a lawsuit against the city regarding the zoning decision. In the meantime, the hospital buildings are fenced off and sit idle. The provisions of this bill that would require the Attorney General's consent prior to a non-profit selling or otherwise disposing of the assets resulting from the reduction or elimination of an emergency room, and making this provision retroactive to January 1, 2015, could give the Attorney General the ability to have a say in how the assets of San Clemente Hospital are used in the future.
In 2015, SB 787 (Bates) would have permitted Saddleback Memorial Medical Center to operate an emergency department at its San Clemente campus, subject to approval by the California Department of Public Health (CDPH), even if the San Clemente campus stopped providing acute care services, thereby permitting a freestanding emergency department, subject to specified conditions. This bill before this Committee, would prohibit the State Department of Public Health from licensing a stand-alone emergency room or freestanding emergency center that is not a part of a general acute care hospital facility providing 24-hour inpatient care with basic services, including, but not limited to, medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services. This issue is not the subject of the pending lawsuit.
CHANGES TO EXISTING LAW
Existing law provides that any nonprofit corporation that operates or controls a health facility shall be required to provide written notice to, and obtain the written consent of, the Attorney General prior to entering into any agreement or transaction to do either of the following:
* sell, transfer, lease, exchange, option, convey, or otherwise dispose of, its assets to a for-profit corporation or entity or to a mutual benefit corporation or entity when a material amount of the assets of the nonprofit corporation are involved in the agreement or transaction; and/or
* transfer control, responsibility, or governance of a material amount of the assets or operations of the nonprofit corporation to any for-profit corporation or entity or to any mutual benefit corporation or entity. (Corp. Code Sec. 5914(a)(1).)
Existing law deems the substitution of a new corporate member or members that transfers the control of, responsibility for, or governance of the nonprofit corporation a transfer for the purposes of this article. Additionally, the substitution of one or more members of the governing body, or the arrangement, written or oral, that would transfer voting control of the members of the governing body, shall also be deemed a transfer for purposes of this article. (Corp. Code Sec. 5914(a)(2).)
Existing law provides for the notice provided to the Attorney General to include and contain the information the Attorney General determines is required. The notice and any other information provided to the Attorney General, and in the public file, shall be made available to the public in written form by the Attorney General as soon as is practicable. (Corp. Code Sec. 5914(b).)
Existing law provides for the Attorney General to give a corporation a written waiver of this section as to a proposed agreement or transition and shall not apply to a nonprofit corporation if the agreement or transaction is in the usual and regular course of its activities. (Corp. Code Sec. 5914(c).)
Existing law provides for the same notice requirements that apply to any agreement or transaction regarding the transfer or sale of a nonprofit health facility's assets also apply to the transfer or sale of a nonprofit health facility's assets to another nonprofit corporation. (Corp. Code Sec. 5920.)
Existing law provides for an exception from these notice requirements for an agreement or transaction if the other party to the agreement or transaction is an affiliate of the transferring nonprofit corporation or entity, and the nonprofit corporation or entity has given the Attorney General 20 days of advance notice of the agreement or transaction. (Corp. Code Sec. 5920(e).)
Existing law defines "health facility" as meaning a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, physical or mental, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, to which the persons are admitted for a 24-hour stay or longer. The following types of facilities are included:
* general acute care hospital;
* acute psychiatric hospital;
* skilled nursing facility;
* intermediate care facility;
* intermediate care facility/developmentally disabled habilitative;
* special hospital;
* intermediate care facility/developmentally disabled;
* intermediate care facility/developmentally disabled-nursing;
* congregate living health facility;
* correctional treatment center;
* nursing facility;
* intermediate care facility/developmentally disabled-continuous nursing; and
* hospice facility. (Health & Saf. Code Sec. 1250.)
Existing law defines "general acute care hospital" as meaning a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services. (Health & Saf. Code Sec. 1250(a).)
Existing law provides for the state department to inspect and license health facilities. The state department shall license facilities to provide their respective basic services specified in Section 1250, as well as inspecting and approving a general acute care hospital to provide special services. (Health & Saf. Code Sec. 1254(a).)
Existing law provides for the state department to issue a separate license for the provision of services, as specified, in acute care hospitals, as well as specified for requirements as to the number of beds licensed to an acute care hospital. (Health & Saf. Code Sec. 1254.)
Existing law provides for a range of additional services an acute care hospital may be licensed to provide, including an emergency center. (Health & Saf. Code Sec. 1255.)
Existing law provides that any hospital that provides emergency medical services shall, no later than 90 days prior to a planned reduction or elimination of the level of emergency medical services, provide notice of the intended change to the state department, the local government entity in charge of the provision of health services, and all health care service plans or other entities under contract with the hospital to provide services to enrollees of the plan or other entity. (Health & Saf. Code Sec. 1255.1(a).)
Existing law provides that in addition to the notice requirement, the hospital shall provide public notice of the intended change in a manner that is likely to reach a significant number of residents of the community services by that facility. (Health & Saf. Code Sec. 1255.1(b).)
Existing law exempts a hospital from providing this notice regarding a change to emergency services, if the state department does either of the following:
* determines that the use of resources to keep the emergency center open substantially threatens the stability of the hospital as a whole; or
* cites the emergency center for unsafe staffing practices. (Health & Saf. Code Sec. 1255.1(c).)
This bill would require any nonprofit corporation that operates or controls a health facility to provide written notice to, and to obtain the written consent of, the Attorney General prior to entering into any agreement or transaction to either sell, transfer, lease, exchange, option, convey, or otherwise dispose of the assets resulting from the reduction or elimination of emergency medical services provided at an emergency center licensed pursuant to Sections 1255 and 1277 of the Health and Safety Code to a for-profit corporation or entity, or to a mutual benefit corporation or entity, or to another nonprofit corporation or entity after the Attorney General gives, pursuant to Section 5940, consent or conditional consent to the reduction or elimination of emergency medical services.
This bill would provide for a nonprofit corporation that operates or controls a health facility to provide written notice to, and obtain the written consent of, the Attorney General prior to a planned reduction in the level of emergency medical services provided or elimination of those services, unless:
* the Attorney General has given the corporation a written waiver of this section as to the planned elimination or reduction of the level of emergency medical services; or
* the State Department of Public Health determines that the use of resources to keep the emergency center open substantially threatens the stability of the hospital as a whole, or cites the emergency center for unsafe staffing practices.
This bill would provide for the notice provided to the Attorney General regarding a planned reduction in the capacity of emergency medical services shall include and contain the information the Attorney General determines is required to make a decision in the public interest pursuant to this section. The notice and other information in the public file shall be made available to the public by the Attorney General as soon as practicable.
This bill would provide for the Attorney General to notify the nonprofit corporation in writing of the decision to consent to, give conditional consent to, or not consent to the reduction or elimination in emergency medical services within 90 days of the receipt of notice from the nonprofit corporation. The Attorney General may extend this period for one additional 45-day period if either of the following conditions is satisfied:
* the extension is necessary to obtain information to make a determination that the planned elimination or reduction in the level of emergency medical services is consistent with the charitable trust on which the assets are held by the health facility or by the affiliated nonprofit health system; or
* the plan to reduce or eliminate emergency medical services is substantially modified after the first public meeting conducted by the Attorney General.
This bill would provide for the Attorney General to conduct one or more public meetings, one of which shall be in the county in which the facility is located, to hear comments from interested parties, prior to issuing any written decision. The Attorney General shall provide written notice of the time and place of the public meeting at least 14 days before conducting the public meeting through publication in one or more newspapers of general circulation in the affected community and to the board of supervisors of the county in which the facility is located.
This bill would provide for the Attorney General to conduct an additional public meeting if a substantive change in the plan to eliminate or reduce emergency medical services is submitted to the Attorney General after the initial public meeting.
This bill would provide the Attorney General with the discretion to consent to, give conditional consent to, or not consent to any elimination or reduction of emergency medical services. In making the determination the Attorney General shall consider any factors that the Attorney General deems relevant, including, but not limited to, whether any of the following apply:
* the planned elimination or reduction in the level of emergency medical services is consistent with the charitable trust on which the assets are held by the health facility or by the affiliated nonprofit health system;
* the planned elimination or reduction involves or constitutes any breach of trust;
* the Attorney General has been provided, pursuant to Section 5250, with sufficient information and data by the nonprofit corporation to adequately evaluate the reduction or elimination of emergency medical services, or effect thereof on the public;
* the reduction or elimination of emergency medical services may create a significant effect on the availability or accessibility of health care services to the affected community; and
* the proposed reduction or elimination of emergency medical services to the affected community.
This bill would provide that if the Attorney General gives consent or conditional consent to the reduction or elimination of emergency medical services pursuant to this section, and the assets resulting from the reduction or elimination are sold, transferred, leased, exchanged, optioned, conveyed or otherwise disposed of, the disposal of those assets shall be subject to Sections 5914 or 5920 of the Corporations Code.
This bill would provide for the Attorney General to contract with, consult, and receive advice from any state agency on those terms and conditions that the Attorney General deems appropriate, as well as any experts or consultants to assist in reviewing the proposed changes to the level of emergency services provided to aid the Attorney General in making the determination whether to consent to, give conditional consent to, or not consent to any elimination or reduction of emergency medical services.
This bill would provide that these contract costs shall not exceed an amount that is reasonable and necessary to conduct the review and evaluation, and any contract entered into under this section shall be on a noncompetitive bid basis and shall be exempt from Chapter 2 of Part 2 of Division 2 of the Public Contract Code. The nonprofit corporation, upon request, shall pay the Attorney General promptly for all contract costs.
This bill would provide for the Attorney General to be entitled to reimbursement from the nonprofit corporation for all actual, reasonable, direct costs incurred in reviewing, evaluating, and making the determination referred to in this chapter, including administrative costs. The nonprofit corporation shall promptly pay the Attorney General, upon request, for all of those costs.
This bill would not provide a method allowing the nonprofit corporation to dispute the costs requested by the Attorney General.
This bill would provide for the Attorney General to be able to contract with experts and consultants to assist the Attorney General in monitoring effectively ongoing compliance with any terms and conditions the Attorney General may impose pursuant to decisions to consent to, give conditional consent to, or not consent to any elimination or reduction of emergency medical services. These contracts would face the same limitations as those entered into to aid the Attorney General in making a determination.
This bill would provide for the Attorney General to adopt regulations to implement this section. It would not provide for the Attorney General to be able to authorize emergency medical services be provided by a facility that does not meet the requirements of the Health and Safety Code, or to authorize a nonprofit general acute care hospital to reduce operations to provide emergency medical services without providing 24-hour inpatient care with basic services, including, but not limited to, medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
This bill would clarify that it shall not be construed to authorize, allow for, or permit operation of a stand-alone emergency room or freestanding emergency center, except as provided in subdivision (b) of Section 1798.101 of the Health and Safety Code.
This bill would provide that the state department shall not license a stand-alone emergency room or freestanding emergency center that is not part of a general acute care hospital facility providing 24-hour inpatient care with basic services, including, but not limited to, medical nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
This bill would be retroactive, applying to closures of emergency rooms or reduction in emergency services since January 1, 2015.
COMMENT
1. Stated need for this bill
According to the Author:
California experienced a 12% reduction in hospital emergency departments from 1996 to 2009 despite a 27% increase in visits. Studies evaluating the impacts of hospital closures show that loss of hospital emergency departments increases the risk of death by 15% for patients in the affected area who have a stroke or heart attack.
As of 2014, California had the lowest number of emergency departments per capita in the nation - 6.7 per 1 million people. As a result, California received an 'F' for lacking emergency room beds in a 2014 national report by the American College of Emergency Physicians.
Hospital and emergency department closures have had a particularly large impact on California's rural areas. The Central Valley and rural regions north of Sacramento to the Oregon border have experienced more than a dozen hospital closures since the early 2000s. Within Senate District 9, the 2015 closure of San Pablo's Doctors Medical left over 250,000 residents of West Contra Costa County with only one full service hospital, the 50-bed Kaiser Richmond facility. Closures of full service hospitals has resulted in overcrowding, longer waits, and diverted ambulances, which can lead to lower quality patient care and outcomes.
Under current law, the Attorney General has oversight on the sale or transfer of nonprofit hospitals. However there are currently no checks and balances in place on the closure of nonprofit hospitals. These facilities can make the decision to reduce or eliminate vital services without having to assess impacts to the community and region.
Given the statistics on California's emergency service shortage, decisions to further reduce hospital or emergency services deserve to be reviewed to ensure that necessary lifesaving services remain accessible.
Support also points to the Alta Bates Medical Center's potential closure as a reason why this bill is needed. The Alta Bates Medical Center is a 347 bed hospital located in Berkeley. Alta Bates merged with Summit in 1999, which is part of Sutter Health, a non-profit hospital chain. Sutter has stated that it does not plan to bring the Alta Bates campus up to seismic safety standards that would be required by 2030, and therefore intends to close the Alta Bates campus sometime prior to 2030. Sutter states that it intends to consolidate services at its Summit campus in Oakland a few miles away, which has a new 238 bed tower that is compliant with the 2030 deadline, with future plans for another tower and upgraded and expanded emergency services. However, Berkeley officials and many community members are especially concerned about the potential loss of the only emergency department in Berkeley, and fear increased transport time and emergency room overcrowding throughout the East Bay region. Obviously, should this bill become law, any closure of the Alta Bates campus would also necessitate a closure of its emergency room, which would trigger the Attorney General review process.
2. Existing oversight of stopping or reduction of emergency services
Writing in opposition, the California Hospital Association notes "that there are existing procedures in place for hospitals to notify the California Department of Public Health (CDPH) and local county governments prior to downgrading or closing emergency services." They go onto state that because existing law requires this, additional oversight by the Attorney General would be unnecessary and duplicative.
The California Hospital Association appears to be referencing Section 1255.1 of the Health and Safety Code. This section does require any hospital that provides emergency medical services to notify CDPH no later than 90 days prior to a planned reduction or elimination of the level of emergency services. Additionally, this section requires the hospital to provide public notice in a manner that is likely to reach the residents of the affected community. Yet, nothing in this code section enables any oversight of this decision. Should CDPH or the residents of the affected community raise concerns regarding the closure or reduction, existing law provides no method for the hospital's decision to be prevented or even modified.
By providing the Attorney General with the ability to make a determination whether to consent to, give conditional consent to, or not consent to any elimination or reduction of emergency medical services prior to this action taking place, the bill provides actual oversight to the reduction of these services. Additionally, the requirement for a public hearing provides a venue for the public to voice their concerns over the impact this change will have on them, rather than just provide them with notice of upcoming changes.
Writing in support, Lowell Hurst, the Mayor Pro-Tempore of the City of Watsonville, writes:
There are currently few restrictions in place on the closure of emergency services; hospitals decide to reduce or eliminate them without a robust review of the impact to the surrounding community. Nonprofit hospitals are heavily subsidized by taxpayers and have an obligation to their communities. Given the startling statistics on California's emergency service shortage, hospital decisions to further reduce emergency services should be heavily scrutinized. The Attorney General already possesses supervisory authority over nonprofit hospitals, as a matter of common law and statute. The Corporations Code provides that the Attorney General reviews and supervises nonprofit sales closely to protect the community's interest; this bill would expand on that power. SB 687 gives the Attorney General the authority to oversee the reduction or closure of emergency services and act on the public's behalf by assessing the impacts that a closure or reduction would have on the community, and deciding whether to approve such proposed closures or reductions.
3. Retroactive application
This bill would apply the Attorney General's oversight of the reduction or elimination of emergency medical services retroactively to changes in non-profit corporation's operation of health facility's emergency medical services on, and after, January 15, 2015.
"Generally, statutes operate prospectively only." (McClung v. Employment Dev. Dept. (2004) 34 Cal.4th 467, 475.)
[T]he presumption against retroactive legislation is deeply rooted in our jurisprudence, and embodies a legal doctrine centuries older than our Republic. Elementary considerations of fairness dictate that individuals should have an opportunity to know what the law is and to conform their conduct accordingly; settled expectations should not be lightly disrupted. For that reason, the principle that the legal effect of conduct should ordinarily be assessed under the law that existed when the conduct took place has timeless and universal appeal. (Landgraf v. USI Film Products (1994) 511 U.S. 244, 265 (internal citations omitted).)
"A statute does not operate [retroactively] merely because it is applied in a case arising from conduct antedating the statute's enactment, or upsets expectations based in prior law. Rather, the court must ask whether the new provision attaches new legal consequences to events completed before its enactment." (Landgraf, 511 U.S. at 269-70 (internal citations omitted).) "This is not to say," however, "that a statute may never apply retroactively." (McClung, 34 Cal.4th at 475.) In California, "[a] statute's retroactivity is, in the first instance, a policy determination for the Legislature and one to which courts defer absent some constitutional objection to retroactivity." (Id., at 475.) Under California law, "a statute may be applied retroactively only if it contains express language of retroactivity or if other sources provide a clear and unavoidable implication that the Legislature intended retroactive application." (Myers v. Philip Morris Companies, Inc. (2002) 28 Cal.4th 828, 844.)
On the other hand, legislation that merely clarifies existing law may be found not retroactive in effect. (See, e.g., Colmenares v. Braemar Country Club, Inc. (2003) 29 Cal.4th 1019, 1028). "Courts are not to infer that legislation merely clarifies existing law unless (1) the nature of the amendment clearly demonstrates such an intent or (2) the legislature has itself stated that the particular amendment is merely declaratory of existing law." (Goldman v. Standard Ins. Co. (9th Cir. 2003) 341 F.3d 1023, 1029.)
To address concerns regarding retroactivity, the Author suggests the following amendments to narrow the retroactivity clause while still ensuring the goals of this legislation are still met:
Proposed amendments:
On page 4, strike line 26 through 27.
On page 4, between line 21 and line 22, insert:
(i) The changes made to this section by the act adding this subdivisions shall apply to the sale, transfer, lease, exchange, option, conveyance or disposal of any assets resulting from a qualifying nonprofit corporation's reduction or elimination of emergency medical services that occurred between January 1, 2016 and the effective date of this section, provided those assets remain under the control of the qualifying nonprofit corporation as of the effective date of this section, notwithstanding the fact that the Attorney General did not review or consent to the closure or reduction pursuant to section 5940. If such assets no longer remain in the control of the qualifying nonprofit corporation, but were sold transferred, leased, optioned, conveyed, or disposed of between January 1, 2017 and the effective date of this section, the qualifying nonprofit corporation shall notify the Attorney General of the details of the transaction and the Attorney General shall review whether the transaction, in whole or in part, was intended to avoid the application of this section. If the Attorney General makes such a determination, the Attorney General may assess a civil penalty upon the qualifying nonprofit corporation in an amount not to exceed the value of such assets.
On page 5, between line 31 and line 32, insert:
The changes made to this section by the act adding this subdivisions shall apply to the sale, transfer, lease, exchange, option, conveyance or disposal of any assets resulting from a qualifying nonprofit corporation's reduction or elimination of emergency medical services that occurred between January 1, 2016 and the effective date of this section, provided those assets remain under the control of the qualifying nonprofit corporation as of the effective date of this section, notwithstanding the fact that the Attorney General did not review or consent to the closure or reduction pursuant to section 5940. If such assets no longer remain in the control of the qualifying nonprofit corporation, but were sold transferred, leased, optioned, conveyed, or disposed of between January 1, 2017 and the effective date of this section, the qualifying nonprofit corporation shall notify the Attorney General of the details of the transaction and the Attorney General shall review whether the transaction, in whole or in part, was intended to avoid the application of this section. If the Attorney General makes such a determination, the Attorney General may assess a civil penalty upon the qualifying nonprofit corporation in an amount not to exceed the value of such assets.
One page 6, strike line 1 through line 2.
4. Author's Amendments
The Author has worked with the California Nurses Association (CNA) to address their concerns, as raised prior to and during the Senate Health Committee Hearing. These discussions resulted in the following proposed amendments, primarily focusing on "freestanding emergency departments."
As discussed in Senate Health Committee, there are currently no freestanding emergency departments licensed in California, although they do operate in other states. In California, in order to offer emergency medical services, a facility must provide certain services, such as intensive care, radiology, and surgical services that are immediately available for life-threatening situations. These requirements have the effect of preventing a freestanding emergency department, because the requirements ensure the emergency department be part of a full-fledged hospital. This bill contains language highlighting that these changes do not grant the Attorney General the authority to approve a freestanding emergency department. The following amendments proposed by the author further clarify this, while addressing additional CNA concerns.
Proposed amendments:
On page 3, line 22, insert "1254," between "Sections" and "1255"
On page 4, on line 21, after "transaction" insert:
except that this subdivision shall not apply to (a)(1)(c).
On page 4, after line 25, insert:
(e) This section shall not be construed to allow the Attorney General to authorize emergency medical services to be provided by a facility that does not meet the requirements of Section 1798.175 of the Health and Safety Code or is not licensed to provide emergency medical services pursuant to Sections 1254, 1255, and 1277 of the Health and Safety Code or to authorize a nonprofit general acute care hospital to reduce operations to provide emergency medical services without providing 24-hour inpatient care with basic services, including, but not limited to, medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services. This section shall not be construed to authorize, allow for, or permit operation of a stand-alone emergency room or freestanding emergency center, except as provided in subdivision (b) of Section 1798.101 of the Health and Safety Code.
On page 5, line 7, insert "1254," between "Sections" and "1255"
On page 5, on line 31, after "transaction" insert:
except that this subdivision shall not apply to (a)(1)(c).
On page 5, after line 40, insert:
(f) This section shall not be construed to allow the Attorney General to authorize emergency medical services to be provided by a facility that does not meet the requirements of Section 1798.175 of the Health and Safety Code or is not licensed to provide emergency medical services pursuant to Sections 1254, 1255, and 1277 of the Health and Safety Code or to authorize a nonprofit general acute care hospital to reduce operations to provide emergency medical services without providing 24-hour inpatient care with basic services, including, but not limited to, medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services. This section shall not be construed to authorize, allow for, or permit operation of a stand-alone emergency room or freestanding emergency center, except as provided in subdivision (b) of Section 1798.101 of the Health and Safety Code.
On page 6, on line 17, after "services," insert:
The written notice required by this section shall be provided to the Attorney General as soon as possible, but in no case later than 135 days before the planned reduction in the level of emergency medical services provided or elimination of those services.
On page 6, strike lines 18 to 27.
On page 9, on line 16, after "code" insert:
, or is not licensed to provide emergency medical services pursuant to Section 1245, 1255, and 1277 of the Health and Safety code,
On page 9, on line 23, after "emergency room" insert:
, or freestanding emergency department,
On page 9, on line 39, after "emergency room" insert:
, or freestanding emergency department,
Support: Al Austin, Council Member, Eighth District, City of Long Beach; City of Berkeley; City of Oakland; City of San Clemente; Felipe Hernandez, Council Member, District One, City of Watsonville; John Gioia, Supervisor, District One, Contra Costa County; Lowell Hurt, Mayor Pro-Tempore, City of Watsonville; Marilyn Sanabria, Mayor, City of Huntington Park; Multi-faith ACTION Coalition; Santa Clara County Board of Supervisors; SEIU California
Opposition: California Hospital Association
HISTORY
Source: Author
Related Pending Legislation:
AB 651 (Muratsuchi, 2017) extends the time frame that the AG has to approve or reject the proposed sale of a non-profit health facility from 60 to 90 days, requires that public notice of a hearing regarding the proposed sale be provided in English and any other language that is widely spoken in the county where the facility is located, and requires the AG to consider whether the sale will have an adverse impact on the significant cultural interests in the affected community. AB 651 passed the Assembly Judiciary Committee on April 18, 2017 with 10 "aye" votes.
Prior Legislation:
SB 787 (Bates, 2015) would have permitted Saddleback Memorial Medical Center to operate an emergency department at its San Clemente campus, subject to approval by the California Department of Public Health (CDPH), even if the San Clemente campus stopped providing acute care services, thereby permitting a freestanding emergency department, subject to specified conditions. SB 787 failed passage in the Senate Health Committee.
SB 1094 (Lara, 2014) would have provided an additional 30 days for the AG to review proposed transactions involving non-profit health facilities. This bill would also have allowed the AG to enforce the conditions of an approved agreement, and to amend the conditions of an agreement or transaction involving a non-profit health facility if a party to the transaction or agreement made material misrepresentations to the AG. Finally, this bill would have required the AG, prior to imposing an amended condition, to provide the parties to the agreement written notice of the proposed condition and allowed the parties 30 days to respond. SB 1094 was vetoed by the Governor.
SB 932 (Bowen, Ch. 65, Stats. 2003) prohibits the Attorney General from consenting to an agreement or transaction involving the sale, transfer, lease, or other disposition of a health facility owned by a non-profit corporation to a for-profit corporation, a mutual benefit corporation or another non-profit corporation, if the seller restricts the type or level of medical services that may be provided at the facility.
AB 890 (Cedillo, Ch. 427, Stats. 2002) subjects health facilities owned by religious corporations to the same requirements as other non-profit hospitals with regard to obtaining the consent of the Attorney General prior to transferring hospital ownership. The bill also adds to the factors that may be considered by the Attorney General when considering transfers of a health facility from one non-profit to another non-profit, and clarifies that the Attorney General may collect the costs of the review from either the transferring or receiving entity.
AB 254 (Cedillo, Ch. 850, Stats. 1999) requires non-profit health facilities to obtain the consent of the Attorney General prior to the sale, transfer, or lease of a material amount of assets to another non-profit corporation.
AB 3101 (Isenberg, Ch. 1105, Stats. 1996) requires non-profit health facilities that are subject to public benefit corporation law to obtain written consent from the Attorney General prior to entering into an agreement to (1) sell, transfer, lease, exchange, option, convey, or otherwise dispose of assets, or (2) transfer control or governance of assets. AB 3101 requires the Attorney General to conduct at least one public meeting in the county where the facility is located, to contract with experts, and to obtain reimbursement for the costs from health facilities being reviewed.
Prior Vote: Senate Health (Ayes 6, Noes 2) |