1 Outline for Today

1

©2008 Foley & Lardner LLP • Attorney Advertising • Prior results do not guarantee a similar outcome • Models used are not clients but may be representative of clients • 321 N. Clark Street, Suite 2800, Chicago, IL 60654 • 312.832.4500

Key California Health Laws 2009Web ConferenceFoley & Lardner LLPDecember 2, 2008

Shirley P. Morrigan, PA, JDFoley & Lardner LLP555 S. Flower Street, 35th FloorLos Angeles, California 90071-2411telephone: 213.972.4668fax: 213.486.0065e-mail: [email protected]

Ms. Morrigan gratefully acknowledges the assistance of new Foley & Lardner LLP attorney Anil Shankar in the preparation of this outline.

1

©2008 Foley & Lardner LLP

Outline for TodayEthics– AB 3000– AB 2747– AB 2565

Peer Review– AB 1922

HIV– AB 1894– AB 2737– SB 1184

2

2


Outline for Today (cont’d)Hospital licensing– AB 2400– SB 1260

Health care service plans– AB 1203

Coroners– SB 1196

Child abuse– AB 2337

Infection– SB 158

3


3

4


A.B. 3000: Health Care Decisions: Life-sustaining Treatment

Sponsor: Wolk (D)Proponents:– California American College of Emergency

Physicians – California Association of Health Facilities– California Medical Association

Opposed by:– None on record

5


A.B. 3000: Current LawCalifornia Probate Code recognizes DNR orders– DNR orders, when signed by an individual (or legally

recognized surrogate) and a physician, are “requests to forgo resuscitative measures.”

– The law regulates requests to forgo resuscitative measuresHealth care providers may presume them valid and unrevoked, if they lack knowledge to the contraryMust contain language for surrogates to certify consistency with intent and best interest of the individual

4

6


7


A.B. 3000: New LawIntroduces Physician Orders for Life Sustaining Treatment (POLST) – POLST are filled out by individuals with their

physician– POLST may be executed by legally recognized

health care decisionmakers only if the individual lacks capacity or has designated the authority

– POLST must be explained and signed by a health care provider (broad definition)

– POLST can be revoked by individuals with capacity

5

8


A.B. 3000: New Law (cont’d)The definition of “health care provider” is broad, and includes (but is not limited to):– individuals licensed to provide health care– emergency response employees– firefighters– law enforcement officers– EMTs (I and II), paramedics– employees and volunteer members of legally recognized

volunteer organizations who are trained in accordance with legal standards to respond to medical emergencies in the course of their volunteer or employment duties

9


POLST have same legal status as DNRs– Provisions which referenced “requests to forgo

resuscitative measures” now refer to “requests regarding resuscitative measures,” which includes both POLST and DNRs

– No liability for providers who honor POLST in good faith

– Must contain language for surrogates certifying consistency with intent and best interest of individual

– Providers may presume them valid and unrevoked if they lack knowledge to the contrary

A.B. 3000: New Law (cont’d)

6

10


A.B. 3000: New Law (cont’d)Health care providers must treat individuals in accordance with a POLST, unless:– Doing so requires medically ineffective health care or care

contrary to generally accepted standards applicable to the provider or institution

– The individual has capacity and requests a change, or– The legally recognized health care

decisionmaker of an individual without capacity requests a modification after consulting with the treating physician

11


A.B. 3000: New Law (cont’d)A physician may issue a new order consistent with the most current information available about the individual’s health status and goals of care – The physician must first evaluate the individual and, if

possible, consult with the individual or his/her legally recognized health care decisionmaker

– The intended scope of this option is unclear

7

12


A.B. 3000: General Legal IssuesLegislative intent – particularly useful for– Frail– Elderly– “Compromised medical condition”– Prognosis of one year of life– Terminal illness– [Transfer SNF – hospital]

But the bill applies to all California residentsEstate planning attorneys may choose to advise use of the POLST

13


A.B. 3000: AFLAll-Facilities letter (AFL) from DPH Licensing and Certification says:– “The POLST form seeks to help patients

inform health care providers what life-sustaining medical interventions a patient would like to receive if they are frail and elderly or have a compromised medical condition, a prognosis of one year of life or a terminal illness.”

Not true!

8

14


15


A.B. 3000: AFL (cont’d)

AFL states that the POLST form:– is a standardized form that is brightly colored

and clearly identifiable– can be revoked by an individual or their

representative at any time– is legally sufficient as a physician order and

not an advance directive– is recognized, adopted and honored

across treatment settings

9

16


A.B. 3000: AFL (cont’d)– Provides statutory immunity from:

criminal prosecutioncivil liabilitydiscipline for unprofessional conductadministrative sanction or any other sanction to a healthcare provider who relies in good faith on the request and honors it

– Allows an individual with capacity to, at any time, request alternative treatment to that in the POLST

– Does not require health care providers to use a POLST form, but requires that health care providers honor POLST orders

17


A.B. 3000: Issues (cont’d)

When/how/who can override?– MD after evaluation and “changed

circumstances,” may issue a new “order”In consultation with patient or surrogate, if possible

– SurrogateShall consult with doctor

– How binding is this, anyway?– Law says health care providers “must follow”

POLST form

10

18


POLST FormIn fluxFirst sentence:– “First follow these orders, then contact

physician.”

Documents from elsewhere omit– Patient’s signature– Physician’s license number– PAHC agent– Court appointed conservator

Says, about artificially administered nutrition – “Always offer food by mouth if feasible.”

19


POLST FormCalifornia Changes (Proposed)Add physician license numberAdd signature of patientFor DNR, add “allow natural death”For limited medical interventions, add– CPAP & BIPAP unless specifically refused

For nutrition, change:– Always offer food by mouth if

feasible desired and safe

11

20


A.B. 2747: End of Life Care DiscussionsSponsor: Berg (D)

Proponents:– Compassion & Choice (sponsor)– AIDS Project Los Angeles– Alzheimer’s Foundation of America– American Civil Liberties Union – California Commission on Aging

21


A.B. 2747 Proponents– California Commission on the Status of Women – California Nurses Association – California Psychological Association– Congress of California Seniors– Gray Panthers– Mendocino County Board of Supervisors– National Association of Social Workers,

California Chapter

12

22


A.B. 2747: End of Life Care DiscussionsOpponents:– California Disability Alliance – California Family Council– California League of United Latin American

Citizens– California Nurses for Ethical Standards – California ProLife Council, Inc.– Catholics for the Common Good– Catholic Healthcare West– Capitol Resource Family Impact

23


A.B. 2747 Opponents– Christian Medical and Dental Association of Southern

California– Concerned Women for America– Crusade for Life, Inc. – Disability Rights Education and Defense Fund, Inc.– Grossmont Family Medical Group– International Life Services– Life Priority Network– Several Hospitals (Bakersfield Memorial, Mark Twain

St. Joseph’s, Mercy Medical Center Redding, Northridge Hospital Medical Center, Sequoia Hospital, Sierra Nevada Memorial Hospital, St. Elizabeth Community Hospital, St. Mary’s Medical Center San Francisco)

13

24


A.B. 2747: Current LawCalifornia allows patients to provide advance health care instructions at or near the end-of-life

California medical school curricula must include end-of-life issues, and every physician in California must complete end-of-life care continuing education

End-of-life care is a covered Medicare benefit

U.S. Supreme Court decisions have affirmed the right of patients to refuse treatment, even if the intention is to hasten death

25


14

26


A.B. 2747: New LawWhen a health care provider makes a diagnosis that a patient has a terminal illness, the provider shall, on the patient’s request, inform and counsel the patient about end-of-life options or refer or transfer the patient to another provider willing to do so– “Health care provider” means an attending physician or

surgeon, or authorized nurse practitioner (NP) or physician assistant (PA)

– If the terminally ill patient is in a health care facility, the patient’s physician (or the medical director if the physician is unavailable) may refer the patient to a hospice provider

27



The information and counseling to be provided (on the patient’s request) includes:– Hospice care at home or in a health care setting– A prognosis with and without the continuation of

disease-targeted treatment– The patient’s right to refusal of or withdrawal

from life-sustaining treatment

15

28


A.B. 2747: New Law (cont’d)– The patient’s right to continue to pursue disease-

targeted treatment, with or without concurrent palliative care

– Patient’s right to comprehensive pain and symptom management at the end of life

– The patient’s right to provide advance written health care instruction or to appoint a legally recognized decision maker

The information need not be in writing. Providers may utilize fact sheets or websites that convey the information

29



No requirement to discuss physician-assisted suicide– Many opponents worried that this was “back

door” for assisted suicideIllegal in CaliforniaPenal Code prohibits

Cal. Penal Code § 401. Every person who deliberately aids, or advises, or encourages another to commit suicide, is guilty of a felony

16

30


A.B. 2565: Brain Death

Author: Eng (D)

Proponents:– California Nurses Association– California Church Impact– California Black Health Network

Opposed by:– Alliance of Catholic Health Care

31


A.B. 2565: Current Law

Current law defines a person as “dead” when they have sustained irreversible cessation of all functions of the entire brain, including the brain stem

This determination must be confirmed by a second physician and made in accordance with accepted medical standards

17

32


A.B. 2565: New LawA.B. 2565 requires general acute hospitals to adopt a policy providing a “reasonably brief period of accommodation” between the time of irreversible cessation of brain function (brain death) and the discontinuation of cardiopulmonary support– The “reasonably brief” accommodation period is

the amount of time afforded to gather family or kin at the patient’s bedside. In determining what is reasonable, the hospital shall consider the needs of other patients and prospective patients in urgent need of care

33



– Previously ordered cardiopulmonary support must be provided during this time. No other treatment is required

– A written copy of the policy must be provided to patient’s family/next of kin/legally recognized surrogate, in the event of brain death

– If patient’s family or kin voice any special religious or cultural practices or concerns surrounding the death, the hospital shall make reasonable efforts to accommodate them

– Violation of the provision by a general acute hospital constitutes a crime. No private right of action is available

18

34


A.B. 1922: Peer Review Hearings and AppealsSponsor: Hernandez (D)Proponents:– California Association of Marriage and Family

Therapists– American Association for Marriage and Family

Therapy– American Federation of State, County and

Municipal Employees

Opponents:– None on file

35


A.B. 1922: Current LawIn California, “licentiates” are entitled to peer review procedures– The term “licentiate” includes physicians and

surgeons, podiatrists, clinical psychologists, and dentists [Medical Staff]

19

36


A.B. 1922: Current LawReportable actions that give rise to right to hearing:– summary suspension;– termination of, or denial of an application for, staff

privileges or membership for a medical disciplinary cause or reason;

– restrictions for more than 30 days in a 12-month period for a medical disciplinary cause or reason; or

– resignation, leave of absence, withdrawal or abandonment of an application for staff privileges or request for renewal of staff privileges, as a result of either an impending investigation or a rejection of the application for a medical disciplinary cause or reason

37


A.B. 1922: Current Law (cont’d)

“Licentiates” have procedural rights in peer review actions, including, but not limited to:– notice of action;– the ability to request a hearing before an unbiased

arbitrator or panel of licentiates and the deadline for such request;

– reportability of action;– notice of charges (reasons) and notice of time and

place (not less than 30 days or more than 60 days after request unless waived);

– discovery of documents relevant to charges;

20

38


A.B. 1922: Current Law (cont’d)– list of witnesses;– right to call witnesses, cross-examine other

side’s witnesses;– no statutory right to legal representation;– receipt of a written decision of the trier of fact,

including findings of fact and reasons for the decision; and

– procedures for requesting appeal (if offered by entity):

in person and with legal representativereceive decision.

39


A.B. 1922: New Law Extends Peer Review Hearings and Appeals

Makes only one change to the law: adds clinical social workers and marriage and family therapists to the list of “licentiates”– Clinical social workers and marriage and family

therapists now have the same procedural rights and reporting requirements for peer review decisions as other licentiates

21

40


41


A.B. 1894: HIV testingAuthor: Krekorian (D)Proponents:– AIDS Healthcare Foundation– AIDS Project Los Angeles– California Medical Association– California Nurses Association/National Nurses Organization

Committee– Center for AIDS Research, Education and Services– Lambda Letters Project

Opponents:– America’s Health Insurance Plans– Association of California Life and Health Insurance

Companies– California Association of Health Plans– California Chamber of Commerce

22

42


A.B. 1894: HIV Testing: New LawMakes two additions to existing law that apply to contracts and insurance policies issued, amended, or renewed after Jan. 1, 2009– Every individual or group service health

care plan contract that covers hospital, medical, or surgery expenses shall provide coverage for HIV testing, regardless of whether the testing is related to a primary diagnosis

– Every insurer that covers hospital, medical, or surgical expenses shall provide coverage for HIV testing, regardless of whether the testing is related to a primary diagnosis

43


A.B. 2737: Communicable DiseaseAuthor: Feuer (D)Proponents:– Association for Los Angeles Deputy Sheriffs– Los Angeles County Probation Officers Union– Riverside Sheriffs’ Association– American Federation of State, County and

Municipal Employees– American Nurses Association/California– California Professional Firefighters– California State Sheriffs’ Association– City of Los Angeles– Los Angeles County Sheriff’s Department– Los Angeles Police Protective League– Peace Officers Research Association of California


23

44


A.B. 2737: Current LawCalifornia law allows peace officers, firefighters, and emergency personnel to petition a court for an order requiring blood testing of a person charged with any criminal complaint or charge in juvenile court– If probable cause exists to believe a transfer

of blood, saliva, semen, or other bodily fluid took place between the defendant and the petitioner, the court shall order the defendant to provide 2 specimens of blood for AIDS testing

– Copies of the test results shall be sent to the defendant, each peace officer, firefighter, and emergency medical provider named in the petition and his/her employing agency, and to the officer and chief medical officer in charge of the facility (if any) where the defendant is detained

45


A.B. 2737: New LawRewrites the current statute. (Health & Safety § 121060-65)Any peace officer, firefighter, or emergency medical personnel who, while acting in the scope of his/her duties, is exposed to an arrestee’s blood or bodily fluids shall:– Notify the arrestee of the exposure and make a good faith

attempt to obtain written, voluntary informed consent to perform a blood test

– If consent is withheld, the affected individual may petition, ex parte, the court for an order that requires testing. The petition must include a written certification from a health care professional

24

46


A.B. 2737: New Law (cont’d)– The scope of exposures for which the order will be

granted is clarified to mean a percutaneous injury or contact of nonintact skin or mucous membranes with any of a list of bodily fluid

– If the order is granted, the defendant must provide three specimens. The blood is now tested for HIV as well as hepatitis B and C

– Defendant will now be notified of the test results only if he/she so wishes

Except as otherwise provided, confidentiality requirements for medical records apply to the test results. The specimens and test results are not admissible in any criminal or juvenile proceeding

47


S.B. 1184: Public HealthAuthor: Kuehl (D)Proponents:– AIDS Project Los Angeles– County of Los Angeles– San Francisco AIDS Foundation– AIDS Healthcare Foundation– AltaMed– American Federation of State, County and Municipal Employees,

AFL-CIO– California Conference of Local AIDS Directors– California Nurses Association/National Nurses Organizing Committee– California State Association of Counties– Center for AIDS Research, Education and Services– Congress of California Seniors– County Health Executives Association of California– County of San Diego– Health Officers Association of California– Southern California HIV Advocacy Coalition


25

48


S.B. 1184: Former LawNo tissue could be transferred into the body of another person by means of transplantation, unless the tissue had been screened and found nonreactive for evidence of HIV, viral hepatitis (HBV and HCV), human T lymphotrophic virus-1 (HTLV-1), and syphilisSperm donors had to be screened and found nonreactive for the same infections, unless the donor was the spouse/partner/designated donor for the recipient and the recipient signed an informed consentHealth care providers and labs had to report cases of HIV infection to local public health officers using patient names

49


26

50


S.B. 1184: New LawS.B. 1184 took immediate effect as an urgency statute on September 26, 2008If a sperm donor tests reactive for HIV or HTLV-1, then physicians who provide insemination or advanced reproductive techniques must verify that the sperm donor is under the care of a physician managing the HIV or HTLV-1 to minimize the risk of transmission. The physician must document this in the recipient’s medical record and recommend monitoring during treatment and pregnancyAll clinical labs must report all CD4+ T-Cell test results within 7 days of completion of the test. If the test is related to a case of HIV infection, the local health officer must report the case to the Department of Public Health (DPH) within 45 days or receipt of the lab report. If it is not, the test results shall be destroyedThe test results are considered confidential health records. They shall not be disclosed, discoverable, or compelled to be produced in any legal proceeding

51


A.B. 2400 : Hospital ClosuresAuthor: Price (D)Proponents:– American Federation of State, County and Municipal

Employees– County Health Executives Association of California– Health Access of California– Organization of SMUD Employees– San Bernardino Public Employees Association– San Diego County Court Employees Association– San Luis Obispo County Employees Association– Santa Rosa City Employees Association– Service Employees International Union

Opponents:– California Hospital Association

27

52


A.B. 2400: Current LawHospitals which plan to reduce or eliminate emergency medical coverage must notify various entities as soon as possible, and not later than 90 days before taking the action– Entities to be notified are DPH, 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

– Must also provide public notice of the intended change in a manner likely to reach a significant number of residents in the community serviced

Notice requirements do not apply if keeping the emergency services open substantially threatens the stability of the hospital as a whole, or if the emergency center has been cited for unsafe staffing practices

53


A.B. 2400: New LawNot less than 30 days prior to closing a health facility, eliminating a supplemental service, or relocating the provision of a supplemental service to a different campus, the facility shall provide notice– to the public, including a notice posted at the

entrance of all affected facilities– to DPH and the local county board of supervisors

where the facility is located

Does not apply to county facilities, which are subject to existing law

28

54


A.B. 2400: New Law (cont’d)The notice shall include:– A description of the proposed action. The

description can be limited to publicly available data, including the number of beds eliminated, the probable decrease in the number of personnel, and a summary of the service eliminated

– A description of the three nearest available comparable services in the community. If the facility serves Medi-Cal or Medicare patients, specify if the other facilities serve these patients

– Telephone number and address of the facility, CEO, and parent entity (if any)

55


A.B. 2400: County RulesA.B. 2400 does not apply to county facilities, which are already subject to Health & Safety Code § 1442.5.Prior to (1) closing, (2) eliminating or reducing the level of medical services provided, or (3) leasing, selling or transferring management, county facilities must provide public notice of public hearings to be held by the board prior to its decision to proceed at least 14 days before the hearing.

29

56


A.B. 2400: County Rules (cont’d)County facilities must continue to fulfill duty to provide care to all indigent people, either directly through county facilities or indirectly through alternative means. – All facilities or individuals which contract to provide

services to indigent people assume the full obligation to provide care to those who can’t afford it, and must make services available to Medi-Cal and Medicare recipients.

– The county board of supervisors must arrange for all such facilities to be listed under county listings in the local telephone directory

– The county board of supervisors must designate an agency to provide 24-hour immediate information about available services, and an agency to receive and respond to complaints

57


S.B. 1260: Hospital LicensingAuthor: Runner (R)

Proponents:– California Hospital Association– Catholic Healthcare West


30

58


S.B. 1260: Current LawAcute care hospitals, acute psychiatric hospitals, and “special hospitals” that provide inpatient or outpatient care in dentistry or maternity, must be licensed by the DPH

59


S.B. 1260: New LawOn issuance and renewal of license for a general acute hospital, acute psychiatric hospital, or “special hospital,” the DPH shall separately identify on the license each supplemental service, including the address of where each outpatient service is provided, and the types of service provided at each locationOn or before July 1, 2010, the DPH shall make available on its website a listing of all supplemental outpatient services of licensed hospitals – The listing shall include the name and physical address

of where the outpatient service is provided, and a disclaimer that the information is limited to outpatient service information reported by licensed hospitals

31

60


A.B. 1203: Health Care Service PlansAuthor: Salas (D)Proponents:– American Federation of State, County and Municipal Employees– Association of California Life and Health Insurance Companies– Blue Cross of California– Blue Shield of California– California Alliance for Retired Americans– California Association of Health Plans– California Association of Physician Groups– California Nurses Association– CALPIRG– Congress of California Seniors– Health Access California– Health Net– Service Employees International Union– Western Center on Law and Poverty

61


A.B. 1203 OpponentsOpponents:– California Hospital Association (removed

after amendments)– Scripps Health

32

62


A.B. 1203: Current Law (Part 1)Patients are considered “stabilized” when, in the opinion of the treating provider, the patient’s medical condition is such that, within reasonable probability, no material deterioration of the patient’s condition is likely to result from, or occur during, a transfer of the patient

63


A.B. 1203: New Law (Part 1)Patients are now considered “stabilized”when, in the opinion of the treating provider, no material deterioration of the patient’s condition is likely to result from, or occur, during the transfer or release of the patient

33

64


A.B. 1203: Current Law (Part 2)A noncontracting hospital must contact an enrollee’s health care service plan prior to admitting a patient for poststabilization care, transferring an enrollee to a noncontracting hospital for poststabilization care, or providing poststabilization care to an enrollee admitted for medically necessary care– Failure to contact as required prohibits the hospital

from billing for poststabilization care

65


A.B. 1203: Current Law (Part 2) (cont’d)

When contacted under these circumstances, health care service plans must discuss the enrollee’s medical record and transmit any appropriate and requested portion of that record– Health care service plans must provide

24-hour access for providers to obtain authorization for medically necessary care in specific circumstances

34

66


A.B. 1203: Current Law (Part 2) (cont’d)

Originally the bill, before amended– A non-contracting hospital can’t bill unless it

receives authorization for post-stabilization care

Amendments → CHA removed opposition– Requires efforts to contact, not authorization– Added the ability to do minor treatment

procedures and releasee.g., stop bleeding (former proposal)now, can stop bleeding, suture and release without contacting plan

67


A.B. 1203: New Law (Part 2)Repeals and rewrites the previous lawIf a patient with an emergency medical condition is covered by a health care service plan that requires prior authorization for poststabilization care, a noncontracting hospital shall contact the health care service plan (plan) or the health plan’s contracting medical provider (provider) for authorization to provide poststabilization care

35

68


A.B. 1203: New Law (Part 2)– The noncontracting hospital shall not bill the patient

for poststabilization care, other than applicable copayments, coinsurance, and deductibles, unlessthe patient (or patient’s spouse or legal guardian) refuses a transfer to a contracting hospital and thereby assumes financial responsibility for the care, or the hospital is unable to obtain the health care service plan’s name and contact information

– No more than one telephone call is required as long as someone is available to take the plan’s/provider’s return call

69


A.B. 1203: New Law (Part 2) (cont’d)

Within 30 minutes of being contacted by a noncontracting hospital with a request for authorization of poststabilization care, the plan/provider shall either authorize the care or inform the hospital it will arrange for a transfer to another hospital– The health care service plan must pay for either the

specifically authorized care or the transfer to another hospital

– Plans/providers must provide 24-hour access for noncontracting hospitals to obtain timely authorization for poststabilization care

36

70


A.B. 1203: New Law (Part 2) (cont’d)If the plan/provider doesn’t tell the hospital of its decision within 30 minutes, poststabilization care is deemed authorized and the plan/provider shall pay until transferIf poststabilization care has been authorized, the noncontracting hospital shall request the patient’s medical record from the plan/provider– The plan/provider shall transmit any appropriate

part of the medical record if in its possession

– Plan/provider that requires authorization for poststabilization care must provide all non-contracting hospitals in the state with specific contact information

71


A.B. 1203: New Law (Part 2) (cont’d)If the plan/provider decides to assume management by prompt transfer, the plan/provider shall do ALL:– Arrange and pay for transfer;– Pay for all of immediately required medically

necessary care rendered to a patient prior to transfer to maintain the patient’s stability; and

– Be responsible for making all arrangements for the patient’s transfer, including, but not limited to, finding an available contracted facility

37

72



In the event of refusal of transfer by the patient, spouse or legal guardian, the hospital must provide written notice to the patient, spouse or legal guardian that indicates the patient will be financially responsible for poststabilization care– (language at Health and Safety Code

Section 1262.8(f))

If the patient, spouse, or legal guardian refuses to sign the notice, the hospital shall document the refusal

73


A.B. 1203: New Law (Part 2) (cont’d)Minor treatment procedures exception– All of the above does not apply to minor

treatment procedures as long as ALL are true:provided in treatment area of ED;procedure concludes the treatment of the presenting emergency medical condition of a patient and is related to that condition, even though the treatment may not resolve the underlying medical condition;the procedure is performed according to accepted standards of practice; ANDthe procedure would result in the direct discharge or release of the patient from the ED following the care

38

74



Nothing in this section shall authorize a provider of health care services to bill a Medi-Cal beneficiary enrolled in a Medi-Cal managed care plan.

75



Violations of these provisions constitutes grounds for disciplinary action, such as suspension or revocation of a license. Willful violation may constitute a crime.

39

76


S.B. 1196: Coroners’ DutiesAuthor: Runner (R)Proponents:– California Advocates for Nursing Home Reform– California Hospice and Palliative Care Association– California Peace Officers’ Association– California State Coroner’s Association– Compassion and Choices– L.A. County District Attorney’s Office– Hospice Services of Lake County– Sheriff-Coroner of San Bernardino County– 225 private citizens


77


S.B. 1196: Current LawCoroners must inquire into and determine the circumstances, manner, and cause of all deaths wherein the deceased has not been attended by a physician in the 20 days before deathCoroners must perform, or cause to be performed, an autopsy on a decedent if the surviving spouse makes a written request– If there is no surviving spouse, a surviving

child or parent can request an autopsy. If there is no surviving child or parent, the next of kin may request an autopsy

40

78


S.B. 1196: New LawCoroners need not inquire into deaths where the deceased has been treated by a registered nurse who is a member of a hospice care interdisciplinary team, even if the deceased was not attended by a physicianCoroners may perform an autopsy on a decedent for whom an autopsy has already been performed, if the surviving spouse requests another autopsy in writing– If there is no surviving spouse, a surviving child or parent

may request an autopsy. If there is no surviving child or parent, the next of kin may request an autopsy

– The person who requests an autopsy must pay for it

79


A.B. 2337: Child Abuse ReportingAuthor: Beall (D)Proponents:– California Association for Alcohol/Drug Educators– American Federation of State, County and

Municipal Employees, AFL-CIO– California Association of Alcoholism & Drug Abuse

Counselors– California District Attorneys Association– California Peace Officers Association– California Perinatal Treatment Network– California Police Chiefs Association

41

80


A.B. 2337 Proponents (cont’d)Proponents (cont’d):– California Probation, Parole and Correctional Association– California Society of Addiction Medicine– California State Association of Counties– California State Sheriff’s Association– County Alcohol and Drug Program Administrators

Association– Crime Victims United of California– County of Santa Clara– County Welfare Directors Association of California– Crime Victims Action Alliance– Prevent Child Abuse California

81


A.B. 2337 OpponentsOpponents:– American Civil Liberties Union

42

82


A.B. 2337: Current Law“Mandated reporters” must report whenever the reporter, in his/her professional capacity or within the scope of his/her employment, has knowledge of or observes a child whom the mandated reporter knows or reasonably suspects has been the victim of child abuse or neglect– Mandated reporters include (among others): teachers;

teacher’s aides; camp administrators; social workers; parole officers; non-volunteer firefighters; paramedics; marriage, family, and child therapist trainees; coroners; commercial film and photographic print processors; and clergy

– Reports shall be made to the police department or sheriff’s department, some county probation departments, or the county welfare department

– Employers of mandated reporters are “strongly encouraged”to offer training in these duties

83


A.B. 2337: New LawAdds “alcohol and drug counselors” to the list of individuals who are mandated reporters– Alcohol and drug counselors are persons who

provide counseling, therapy, or other clinical services for a state licensed or certified drug, alcohol, or drug and alcohol treatment program

– Drug and/or alcohol abuse is an insufficientground to report child abuse or neglect

43

84


S.B. 158: Infection ControlAuthor: Florez (D)Proponents:– American Federation of State, County and Municipal

Employees– California Metals Coalition– California Pan-Ethnic Health Network– Consumers Union– Department of Public Health– Insure the Uninsured Project– Kaiser Permanente– Pacific Business Group on Health– Service Employees International Union


85


S.B. 158: Current Law (Part 1)General acute hospitals, acute psychiatric hospitals, skilled nursing facilities, and special hospitals that provide inpatient or outpatient care in dentistry or maternity must be licensed by the DPH. Violation of health facility regulation may constitute a crime.

44

86


S.B. 158: New Law (Part 1)Creates new regulation of health facilities, designed to improve public safetyGeneral acute care hospitals, acute psychiatric hospitals, skilled nursing facilities, and special hospitals:– Shall implement a facility-wide hand hygiene

program– Beginning January 1, 2011, are prohibited from

using an intravenous connection, epidural connection, or enteral feeding connection that would fit into a connection port other than the type it was intended for, unless necessary in an emergency

87


S.B. 158: New Law (Part 1) (cont’d)General acute care hospitals, acute psychiatric hospitals, skilled nursing facilities, and special hospitals shall develop, implement, and comply with a patient safety plan. The plan must establish:– A patient safety committee of health care

professionals that reviews and approves the plan, receives and reviews reports of patient safety events, makes recommendations to improve safety, and revises the plan at least once a year

– A reporting system for patient safety events that allows anyone, including patients and visitors, to make a report

– A process for a team of facility staff to conduct analyses, including root cause analyses, of patient safety events

– A process for providing ongoing patient safety training for facility personnel and health care practitioners

45

88


S.B. 158: New Law (Part 1) (cont’d)Patient safety events are to be defined by the patient safety plan, but shall include all preventable “adverse events”listed in Health & Safety Code § 1279.1, which include:– Surgery on the wrong body part that is inconsistent with the

patient’s documented informed consent– Surgery on the wrong patient– Performing the wrong surgical procedure– Retention of foreign object after surgery– Death during or up to 24 hours after induction of anesthesia

after surgery of a normal, healthy patient who has no organic, physiologic, biochemical, or psychiatric disturbance and for whom the pathologic processes for which the operation is to be performed are localized and do not entail a systemic disturbance

– Patient death or serious disability associated with a contaminated drug, device, or biologic provided by the health facility, regardless of the source of the contaminant

89


S.B. 158: New Law (Part 1) (cont’d)

– Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended

– Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a facility, excluding deaths associated with neurosurgical procedures known to present a high risk of intravascular air embolism

– Infants discharged to the wrong person– Patient death or serious disability associated with patient

disappearance for more than four hours, excluding events involving competent adults

– A patient suicide or attempted suicide resulting in serious disability while being cared for in a health facility due to patient actions after admission to the health facility, excluding deaths resulting from self-inflicted injuries that were the reason for admission to the health facility

46

90



– A patient death or serious disability associated with a medication error, including, but not limited to, an error involving the wrong drug, the wrong dose, the wrong patient, the wrong time, the wrong rate, the wrong preparation, or the wrong route of administration, excluding reasonable differences in clinical judgment on drug selection and dose

– A patient death or serious disability associated with a hemolytic reaction due to the administration of ABO-incompatible blood or blood products

– Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a facility, including events that occur within 42 days postdelivery and excluding deaths from pulmonary or amniotic fluid embolism, acute fatty liver of pregnancy, or cardiomyopathy

– Patient death or serious disability directly related to hypoglycemia, the onset of which occurs while the patient is being cared for in a health facility

91



– Death or serious disability, including kernicterus, associated with failure to identify and treat hyperbilirubinemia in neonates during the first 28 days of life. For purposes of this subparagraph, "hyperbilirubinemia" means bilirubin levels greater than 30 milligrams per deciliter

– A Stage 3 or 4 ulcer, acquired after admission to a health facility, excluding progression from Stage 2 to Stage 3 if Stage 2 was recognized upon admission

– A patient death or serious disability due to spinal manipulative therapy performed at the health facility

– A patient death or serious disability associated with an electric shock while being cared for in a health facility, excluding events involving planned treatments, such as electric countershock

– Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by a toxic substance

47

92



– A patient death or serious disability associated with a burn incurred while being cared for in a health facility

– A patient death associated with a fall while being cared for in a health facility

– A patient death or serious disability associated with the use ofrestraints or bedrails while being cared for in a health facility

– Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed health care provider

– The abduction of a patient of any age– The sexual assault on a patient within or on the grounds of a

health facility– The death or significant injury of a patient or staff member

resulting from a physical assault that occurs within or on the grounds of a facility

– An adverse event or series of adverse events that cause the death or serious disability of a patient, personnel, or visitor

93


S.B. 158: Current Law (Part 2)The Healthcare Associated Infection (HAI) Advisory Committee is a legislatively mandated advisory committee charged with making recommendations to the DPH on the prevention of HAIs At least once every three years, each general acute hospital must collaborate with infection prevention and control professionals to prepare a written report that examines the hospital’s resources and evaluates the quality and effectiveness of the hospital’s infection surveillance and prevention program

48

94


S.B. 158: New Law (Part 2)Amends statute authorizing the HAI Advisory Committee to require quarterly meetings and clarify lack of compensation for members. Adds additional responsibilities related to the oversight of HAI programs, such as making recommendations for training programs, methods for evaluating hospital programs, and methods for identifying HAIsAdds specific requirements for both DPH and physicians related to preventing HAIs

95


49

96


DPH shall establish an infection surveillance, prevention, and control program to:– Designate professionals to serve as consultants– Provide education and training to DPH health facility

evaluator nurses and consultants to survey hospitals for compliance

– Provide current infection prevention and control information online

– In consultation with the HAI Advisory Committee, develop a scientifically valid electronic reporting system to transmit reports of HAIs by January 1, 2011

– Provide online an annual report of each hospital’s risk-adjusted HAI incidence rates, beginning January 1, 2011


97


Beginning January 1, 2010, the following training is required:– For physicians designated as a hospital epidemiologist or

infection surveillance, prevention, and control committee chairperson: participate in a CME training program specific to infection surveillance, prevention, and control

– For all staff and contract physicians and other licensed independent contractors (including NPs and PAs): training in the methods to prevent transmission of HAIs. Includes MRSA and Clostridium difficile infection


50

98



– For all permanent and temporary hospital employees and contractual staff (including students): annual training in hospital-specific infection prevention and control policies. Includes hand hygiene, isolation procedures, patient hygiene, and environmental sanitation procedures

– For environmental services staff: training in compliance with hospital sanitation measures. Training occurs at the start of employment, when new measures are adopted, or annually thereafter

99


51

100


A.B. 211 and S.B. 541: Privacy and Security

See October outline on website– http://www.foley.com/news/event_detail.aspx?ev

entid=2417

101


52

102


Questions?

Shirley P. Morrigan, PA, JDFoley & Lardner LLP

555 S. Flower Street, 35th FloorLos Angeles, CA 90071-2411

tel: (213) 972-4668fax: (213) 486-0065cell: (310) 488-8788

email: [email protected]