BILL ANALYSIS
AB 271
Page 1
Date of Hearing: March 23, 1999
ASSEMBLY COMMITTEE ON HEALTH
Martin Gallegos, Chair
AB 271 (Gallegos) - As Amended: March 17, 1999
SUBJECT : Cosmetic and Outpatient Surgery Patient Protection
Act.
SUMMARY : Increases patient protection at outpatient surgery
settings by requiring physicians to carry malpractice insurance,
requiring minimum staffing levels, and requiring physicians to
report any death or serious hospitalization of a patient to the
Medical Board of California (Board). Specifically, this bill :
1)Provides that it is unprofessional conduct for a physician to
fail to provide adequate security by liability insurance for
claims by patients arising out of surgical procedures
performed outside of a general acute care hospital, as
defined.
2)Provides that it is unprofessional conduct for a physician to
perform procedures in any outpatient setting using anesthesia,
except local anesthesia, minor blocks, or minimal oral
tranquilization, unless the setting has a minimum of two staff
persons on the premises, one of whom is a licensed health care
professional with current certification in basic life support,
as long as a patient is present who has not been discharged
from supervised care.
3)Requires any physician who performs a scheduled medical
procedure outside of a general acute care hospital that
results in the death or removal of a patient to a hospital or
emergency center for medical treatment for a period exceeding
24 hours, to report that occurrence in writing to the board
within 15 days after the occurrence.
4)Requires outpatient surgery settings to post their certificate
of accreditation in a location readily visible to patients and
staff, and to post the name and phone number of the
accrediting agency with instructions on the submission of
complaints in a location readily visible to patients and
staff.
5)Requires outpatient surgery settings to have written discharge
AB 271
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criteria, and provides that it is unprofessional conduct to
transfer a patient who does not meet this criteria to an
unlicensed setting.
6)Eliminates a requirement that outpatient surgery settings
submit a plan for handling medical emergencies for approval by
an accrediting agency.
EXISTING LAW
1)Requires outpatient surgery settings, with some exceptions, to
be accredited by an accreditation agency approved by the
Board.
2)Requires the Board to adopt standards for accreditation,
including a requirement that there be onsite equipment,
medication, and trained personnel to facilitate handling of
services sought or provided and to facilitate handling of any
medical emergency that may arise.
3)Defines outpatient surgery settings as any setting not part of
a general acute care facility where anesthesia, except local
anesthesia or peripheral nerve blocks, is used in doses that
have the probability of placing a patient at risk for loss of
the patient's life-preserving protective reflexes.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . The author introduced this bill at the
request of the Medical Board to increase patient safety when
elective procedures such as plastic or cosmetic surgery are
performed in outpatient surgery settings. According to the
Board, there has been an increase in cosmetic surgery, in part
because of the impact managed care has had on physician
incomes. Because elective surgery is not typically covered by
insurance, patients usually pay out of pocket. In addition,
recent advances in medical technology have made it possible to
perform a larger variety of surgeries outside of an acute care
hospital. The Board states that some of the physicians now
offering outpatient plastic or cosmetic surgery have not
received proper training, and in some cases exceed acceptable
limits for the extent or type of surgery they undertake.
AB 271
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The Board formed a Plastic/Cosmetic Surgery Committee to
identify problem areas and propose solutions aimed at patient
protection, and this bill represents the work of this
committee. The Board states that this bill will provide
stronger patient safeguards by requiring physicians performing
these procedures to carry malpractice insurance, require
minimum staffing levels, and require physicians to report
deaths and serious hospitalizations resulting from these
procedures in order to gather better data on the problem in
California.
2)SUPPORT . This bill is supported by the California Society of
Plastic Surgeons, which states that this bill provides
important and enhanced safety measures for patients who
receive medical care in outpatient settings. The California
Nurses Association supports this bill with an amendment to
require one of the staff persons required to be on premises at
the outpatient surgery setting to be a licensed nurse, rather
than a licensed health care professional.
3)PRIOR LEGISLATION . AB 595 (Speier), Chapter 1276, Statutes of
1994, required outpatient surgery centers to be accredited,
and set up an accreditation process. AB 595 defined
outpatient surgery settings as any setting not part of a
general acute care facility where anesthesia, except local
anesthesia or peripheral nerve blocks, is used in doses that
have the probability of placing a patient at risk for loss of
the patient's life-preserving protective reflexes. This bill
was the result of a growing trend toward moving procedures
that previously required hospitalization to outpatient surgery
environments, which had very little oversight. AB 595 was an
effort to establish better patient protection in these
settings.
4)RELATED LEGISLATION . Several bill have been introduced this
session to address cosmetic and outpatient surgery issues. SB
835 (Figueroa) requires physicians who perform cosmetic
surgery to meet the education, training and experience
requirements for performing cosmetic surgery established by
the Board. SB 836 (Figueroa) prohibits physicians from
modifying or enhancing images used for advertising, and
prohibits misleading "before and after" advertisements. SB
837 (Figueroa) requires cosmetic surgery to be performed in a
licensed health care facility or in an accredited outpatient
facility. These bills are pending in the Senate Business and
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Professions Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
Medical Board of California (sponsor)
California Nurses Association (with amendments)
California Society of Plastic Surgeons
United Nurses Association of California
Opposition
None on file
Analysis Prepared by : Vincent D. Marchand / HEALTH / (916)
319-2097