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AB-1795 Emergency medical services: behavioral health facilities and sobering centers.(2017-2018)

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Date Published: 04/19/2018 09:00 PM
AB1795:v97#DOCUMENT

Amended  IN  Assembly  April 19, 2018
Amended  IN  Assembly  April 02, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 1795


Introduced by Assembly Member Gipson
(Principal coauthor: Assembly Member Ting)
(Coauthors: Assembly Members Acosta, Bigelow, Burke, Chiu, and Gallagher)
(Coauthor: Senator Wiener)

January 09, 2018


An act to amend Sections 1797.52 and 1797.218 of, and to add Sections 1797.98, 1797.119, 1797.205, and 1797.260 to, the Health and Safety Code, relating to emergency medical services.


LEGISLATIVE COUNSEL'S DIGEST


AB 1795, as amended, Gipson. Emergency medical services: behavioral health facilities and sobering centers.
Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, establishes the Emergency Medical Services Authority, which is responsible for the coordination and integration of all state agencies concerning emergency medical services. Among other duties, the authority is required to develop planning and implementation guidelines for emergency medical services systems, provide technical assistance to existing agencies, counties, and cities for the purpose of developing the components of emergency medical services systems, and receive plans for the implementation of emergency medical services and trauma care systems from local EMS agencies.
The act also authorizes each county to develop an emergency medical services program and requires local EMS agencies to plan, implement, and evaluate an emergency medical services system. Existing law requires local EMS agencies to be responsible for the implementation of advanced life support systems, limited advanced life support systems, and for the monitoring of specified training programs for emergency personnel. Existing law defines advanced life support as special services designed to provide definitive prehospital emergency medical care, as specified, at the scene of an emergency, during transport to an acute care hospital, during interfacility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by that hospital. Existing law makes it a crime to violate the act, or the rules or regulations adopted under the act.
This bill would authorize a local emergency medical services agency to submit, as part of its emergency medical services plan, a plan to transport specified patients who meet triage criteria to a behavioral health facility or a sobering center, as defined. The bill would make conforming changes to the definition of advanced life support to include prehospital emergency care provided before and during, during transport to a behavioral health facility or a sobering center. The bill would authorize a city, county, or city and county to designate, and contract with, a sobering center to receive patients, and would establish sobering center standards. standards that apply to sobering centers, as specified.
This bill would also require the authority to adopt guidelines for the triage criteria and assessment procedures by July 1, 2020, and would require the authority to annually analyze the administration of the local plans and to report, issue certain reports, as specified.
By expanding an existing crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1797.52 of the Health and Safety Code is amended to read:

1797.52.
 “Advanced life support” means special services designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system at the scene of an emergency, during transport to an acute care hospital, during interfacility transfer, while in the emergency department of an acute care hospital until responsibility is assumed by the emergency or other medical staff of that hospital, and during transport to a behavioral health facility or to a sobering center.

SEC. 2.

 Section 1797.98 is added to the Health and Safety Code, immediately following Section 1797.97, to read:

1797.98.
 (a) “Behavioral health facility” means a designated facility as set forth in subdivision (n) of Section 5008 of the Welfare and Institutions Code.
(b) “Sobering center” means a noncorrectional facility designated by a city, county, or city and county, to provide a safe, supportive environment for intoxicated individuals to become sober as set forth in Section 1797.205.

SEC. 3.

 Section 1797.119 is added to the Health and Safety Code, immediately following Section 1797.118, to read:

1797.119.
 (a) The authority shall, by July 1, 2020, develop and, after approval by the commission, adopt guidelines for the triage criteria and assessment procedures as set forth in paragraph (1) of subdivision (a) of Section 1797.260, and for the collection and reporting of data as set forth in paragraph (5) of subdivision (a) of Section 1797.260.
(b) The authority shall annually do all of the following:
(1) Work in partnership with the local EMS agencies to review and analyze the data reported pursuant to paragraph (5) of subdivision (a) of Section 1797.260.
(2) Analyze EMT-P training provided pursuant to paragraph (6) of subdivision (a) of Section 1797.260. including, but not limited to a statewide analysis of the data to provide feedback to local EMS agencies.
(3) Issue a report that includes at least all of the following:
(A) A provision setting forth the analyses required pursuant to paragraphs (1) and (2).
(B) Detailed findings on the past and current status of local EMS agency plans submitted pursuant to Section 1797.260.
(C) An assessment of patient outcomes in the aggregate resulting from services provided under approved plans pursuant to Section 1797.260.
(D) Policy recommendations for improvement of administration of local plans and for the improvement of patient outcomes.
(c) The first annual report pursuant to paragraph (3) of subdivision (b) shall be issued by January 1, 2021.
(d) The reports are public records within the meaning of the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code). The reports shall be retained by the authority and made available to the public by posting on the authority’s Internet Web site.

SEC. 4.

 Section 1797.205 is added to the Health and Safety Code, immediately following Section 1797.204, to read:

1797.205.
 (a) A city, county, or city and county may designate, and contract with, one or more sobering centers for the receipt of intoxicated individuals for the purposes of providing a safe environment for the individuals to regain their sobriety, and shall enter into a written agreement with the center to monitor safety and programmatic implementation pursuant to the agreement.
(b) The sobering center shall, pursuant to the agreement, develop a plan to access emergency medical services at one or more facilities providing emergency-level care.
(c) A sobering center shall comply with all of the following:
(1) It shall provide one bed or mat per individual.
(2) It shall be equipped with, and shall maintain, an automated external defibrillator.
(3) It shall be adequately staffed, and have at least one registered nurse. nurse present at all times.
(4) It shall be equipped to monitor and treat intoxicated persons who do not require emergency medical care at a general acute care hospital.
(5) It shall establish medical and nursing standardized procedures for its nursing staff.
(6) It shall have sufficient bathroom and shower facilities to serve the projected caseload, including at least one ADA-accessible option.
(7) It shall be a clinic as described in subdivision (b) of Section 1206.

SEC. 5.

 Section 1797.218 of the Health and Safety Code is amended to read:

1797.218.
 (a) Any local EMS agency may authorize an advanced life support or limited advanced life support program which provides services utilizing EMT-II or EMT-P, or both, for the delivery of emergency medical care to the sick and injured at the scene of an emergency, during transport to a general acute care hospital, during interfacility transfer, while in the emergency department of a general acute care hospital until care responsibility is assumed by the regular staff of that hospital, and during training within the facilities of a participating general acute care hospital.
(b) Any local EMS agency may authorize an advanced life support program that provides services utilizing an EMT-P to transport patients to a behavioral health facility or to a sobering center pursuant to Section 1797.260.

SEC. 6.

 Section 1797.260 is added to the Health and Safety Code, immediately following Section 1797.258, to read:

1797.260.
 (a) A local EMS agency may submit, as part of its emergency medical services plan, a plan to transport patients, who meet the triage criteria, to a behavioral health facility or to a sobering center. The plan shall include at least all of the following:
(1) Standardized triage criteria and assessment procedures based on peer-reviewed data to be used by EMT-Ps to identify patients to be transported to a behavioral health facility or to a sobering center. The local EMS agency shall revise the triage criteria and the assessment procedures to adhere to guidelines developed by the authority pursuant to Section 1797.119.
(2) One or more policies for the treatment of patients being transported to a behavioral health facility or to a sobering center.
(3) One or more policies for the prompt transfer of patient care between prehospital care personnel and medical personnel at a behavioral health facility or at a sobering center, including, but not limited to, an assessment to determine if the patient’s condition requires transport to an emergency department of a general acute care hospital.
(4) A list of behavioral health facilities and of sobering centers that have agreed to participate and their hours of operation, including the hours when they are available to receive patients.
(5) A quality improvement plan that includes, notwithstanding Sections 4514 and 5328 of the Welfare and institutions Code, the submission of service data to the local EMS agency and the EMS authority by participating behavioral health facilities and sobering centers, as necessary to ensure the quality of the EMS services being provided. The data shall be redacted as necessary to ensure patient confidentiality and shall be reported in aggregate form only, with no personally identifiable patient information.
(6) (A) For transport to a behavioral health facility, a training component as follows:
(i) A requirement that a participating EMT-P complete at least 32 hours of instruction on all of the following:
(I) Behavioral health crisis intervention, provided by a licensed physician and surgeon with experience in the emergency department of a general acute care hospital.
(II) Assessment and treatment of intoxicated patients.
(III) Local EMS agency policies for the triage, treatment, transport, and transfer of care, of patients to a behavioral health facility.
(ii) A requirement that the local EMS agency verify that the participating EMT-P has completed training in all of the following topics meeting the standards of the United States Department of Transportation National Highway Traffic Safety Administration National Emergency Medical Services Education Standards:
(I) Psychiatric disorders.
(II) Neuropharmacology.
(III) Alcohol and substance abuse.
(IV) Patient consent.
(V) Patient documentation.
(VI) Medical quality improvement.
(B) For transport to a sobering center, a training component that requires a participating EMT-P to complete at least 8 hours of instruction, with a 4-hour online didactic portion and a 4-hour classroom portion, on all of the following:
(i) The impact of alcohol intoxication on the local public health and emergency medical services system.
(ii) Alcohol and substance use disorders.
(iii) Triage and transport parameters.
(iv) Health risks and interventions in stabilizing acutely intoxicated persons.
(v) Common conditions with presentations similar to intoxication.
(vi) Disease process, behavioral emergencies, and injury patterns common to those with chronic alcohol use disorders.
(7) A policy requiring that a patient who meets the triage criteria for transport to behavioral health facility or to a sobering center, but who requests to be transported to the emergency department of a general acute care hospital, shall be transported to the emergency department of a general acute care hospital.
(8) A policy requiring that a patient who is transported to a behavioral health facility or to a sobering center and, upon assessment, is found to no longer meet the criteria for admission to a behavioral health facility or to a sobering center shall be immediately transported to the emergency department of a general acute care hospital.

(8)

(9) A provision setting forth the recommendations of the appropriate county agency or director, including the county mental health director, for the transport of persons to a behavioral health facility, in support of the plan to transport patients meeting triage criteria to a behavioral health facility or to a sobering center.

(9)

(10) Provisions setting forth procedures for notification of next of kin and for the protection of the confidentiality of patient records consistent with applicable law, including, but not limited to, the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), Sections 4514 and 5328 of the Welfare and Institutions Code, and the privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).
(b) This section does not authorize a local EMS agency to adopt policies authorizing an EMT-P to initiate an involuntary detention or hold of a patient under Division 5 (commencing with Section 5000) of the Welfare and Institutions Code.

SEC. 7.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.