2005 California Health and Safety Code Sections 1250-1264 Article 1. General

HEALTH AND SAFETY CODE
SECTION 1250-1264

1250.  As used in this chapter, "health facility" means any
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, and includes
the following types:
   (a) "General acute care hospital" means 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. A general acute care
hospital may include more than one physical plant maintained and
operated on separate premises as provided in Section 1250.8. A
general acute care hospital that exclusively provides acute medical
rehabilitation center services, including at least physical therapy,
occupational therapy, and speech therapy, may provide for the
required surgical and anesthesia services through a contract with
another acute care hospital. In addition, a general acute care
hospital that, on July 1, 1983, provided required surgical and
anesthesia services through a contract or agreement with another
acute care hospital may continue to provide these surgical and
anesthesia services through a contract or agreement with an acute
care hospital. The general acute care hospital operated by the State
Department of Developmental Services at Agnews Developmental Center
may, until June 30, 2007, provide surgery and anesthesia services
through a contract or agreement with another acute care hospital.
Notwithstanding the requirements of this subdivision, a general acute
care hospital operated by the Department of Corrections and
Rehabilitation or the Department of Veterans Affairs may provide
surgery and anesthesia services during normal weekday working hours,
and not provide these services during other hours of the weekday or
on weekends or holidays, if the general acute care hospital otherwise
meets the requirements of this section
   A "general acute care hospital" includes a "rural general acute
care hospital." However, a "rural general acute care hospital" shall
not be required by the department to provide surgery and anesthesia
services. A "rural general acute care hospital" shall meet either of
the following conditions:
   (1) The hospital meets criteria for designation within peer group
six or eight, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982.
   (2) The hospital meets the criteria for designation within peer
group five or seven, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982, and has
no more than 76 acute care beds and is located in a census dwelling
place of 15,000 or less population according to the 1980 federal
census.
   (b) "Acute psychiatric hospital" means 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 for mentally disordered, incompetent,
or other patients referred to in Division 5 (commencing with Section
5000) or Division 6 (commencing with Section 6000) of the Welfare
and Institutions Code, including the following basic services:
medical, nursing, rehabilitative, pharmacy, and dietary services.
   (c) "Skilled nursing facility" means a health facility that
provides skilled nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care on an
extended basis.
   (d) "Intermediate care facility" means a health facility that
provides inpatient care to ambulatory or nonambulatory patients who
have recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of continuous
skilled nursing care.
   (e) "Intermediate care facility/developmentally disabled
habilitative" means a facility with a capacity of 4 to 15 beds that
provides 24-hour personal care, habilitation, developmental, and
supportive health services to 15 or fewer developmentally disabled
persons who have intermittent recurring needs for nursing services,
but have been certified by a physician and surgeon as not requiring
availability of continuous skilled nursing care.
   (f) "Special hospital" means a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical or dental staff
that provides inpatient or outpatient care in dentistry or maternity.
   (g) "Intermediate care facility/developmentally disabled" means a
facility that provides 24-hour personal care, habilitation,
developmental, and supportive health services to developmentally
disabled clients whose primary need is for developmental services and
who have a recurring but intermittent need for skilled nursing
services.
   (h) "Intermediate care facility/developmentally disabled--nursing"
means a facility with a capacity of 4 to 15 beds that provides
24-hour personal care, developmental services, and nursing
supervision for developmentally disabled persons who have
intermittent recurring needs for skilled nursing care but have been
certified by a physician and surgeon as not requiring continuous
skilled nursing care. The facility shall serve medically fragile
persons who have developmental disabilities or demonstrate
significant developmental delay that may lead to a developmental
disability if not treated.
   (i) (1)  "Congregate living health facility" means a residential
home with a capacity, except as provided in paragraph (4), of no more
than 12 beds, that provides inpatient care, including the following
basic services: medical supervision, 24-hour skilled nursing and
supportive care, pharmacy, dietary, social, recreational, and at
least one type of service specified in paragraph (2). The primary
need of congregate living health facility residents shall be for
availability of skilled nursing care on a recurring, intermittent,
extended, or continuous basis. This care is generally less intense
than that provided in general acute care hospitals but more intense
than that provided in skilled nursing facilities.
   (2) Congregate living health facilities shall provide one of the
following services:
   (A) Services for persons who are mentally alert, physically
disabled persons, who may be ventilator dependent.
   (B) Services for persons who have a diagnosis of terminal illness,
a diagnosis of a life-threatening illness, or both. Terminal illness
means the individual has a life expectancy of six months or less as
stated in writing by his or her attending physician and surgeon. A
"life-threatening illness" means the individual has an illness that
can lead to a possibility of a termination of life within five years
or less as stated in writing by his or her attending physician and
surgeon.
   (C) Services for persons who are catastrophically and severely
disabled. A catastrophically and severely disabled person means a
person whose origin of disability was acquired through trauma or
nondegenerative neurologic illness, for whom it has been determined
that active rehabilitation would be beneficial and to whom these
services are being provided. Services offered by a congregate living
health facility to a catastrophically disabled person shall include,
but not be limited to, speech, physical, and occupational therapy.
   (3) A congregate living health facility license shall specify
which of the types of persons described in paragraph (2) to whom a
facility is licensed to provide services.
   (4) (A)  A facility operated by a city and county for the purposes
of delivering services under this section may have a capacity of 59
beds.
   (B) A congregate living health facility not operated by a city and
county servicing persons who are terminally ill, persons who have
been diagnosed with a life-threatening illness, or both, that is
located in a county with a population of 500,000 or more persons may
have not more than 25 beds for the purpose of serving terminally ill
persons.
   (C) A congregate living health facility not operated by a city and
county serving persons who are catastrophically and severely
disabled, as defined in subparagraph (C) of paragraph (2) that is
located in a county of 500,000 or more persons may have not more than
12 beds for the purpose of serving catastrophically and severely
disabled persons.
   (5) A congregate living health facility shall have a
noninstitutional, homelike environment.
   (j) (1) "Correctional treatment center" means a health facility
operated by the Department of Corrections, the Department of the
Youth Authority, or a county, city, or city and county law
enforcement agency that, as determined by the state department,
provides inpatient health services to that portion of the inmate
population who do not require a general acute care level of basic
services. This definition shall not apply to those areas of a law
enforcement facility that houses inmates or wards that may be
receiving outpatient services and are housed separately for reasons
of improved access to health care, security, and protection. The
health services provided by a correctional treatment center shall
include, but are not limited to, all of the following basic services:
physician and surgeon, psychiatrist, psychologist, nursing,
pharmacy, and dietary. A correctional treatment center may provide
the following services:  laboratory, radiology, perinatal, and any
other services approved by the state department.
   (2) Outpatient surgical care with anesthesia may be provided, if
the correctional treatment center meets the same requirements as a
surgical clinic licensed pursuant to Section 1204, with the exception
of the requirement that patients remain less than 24 hours.
   (3) Correctional treatment centers shall maintain written service
agreements with general acute care hospitals to provide for those
inmate physical health needs that cannot be met by the correctional
treatment center.
   (4) Physician and surgeon services shall be readily available in a
correctional treatment center on a 24-hour basis.
   (5) It is not the intent of the Legislature to have a correctional
treatment center supplant the general acute care hospitals at the
California Medical Facility, the California Men's Colony, and the
California Institution for Men.  This subdivision shall not be
construed to prohibit the Department of Corrections from obtaining a
correctional treatment center license at these sites.
   (k) "Nursing facility" means a health facility licensed pursuant
to this chapter that is certified to participate as a provider of
care either as a skilled nursing facility in the federal Medicare
Program under Title XVIII of the federal Social Security Act or as a
nursing facility in the federal Medicaid Program under Title XIX of
the federal Social Security Act, or as both.
   (l) Regulations defining a correctional treatment center described
in subdivision (j) that is operated by a county, city, or city and
county, the Department of Corrections, or the Department of the Youth
Authority, shall not become effective prior to, or if effective,
shall be inoperative until January 1, 1996, and until that time these
correctional facilities are exempt from any licensing requirements.
1250.02.  Article 9 (commencing with Section 70901) of Chapter 1 of
Division 5 of Title 22 of the California Code of Regulations, as
adopted to implement the requirements of Section 2 of Chapter 67 of
the Statutes of 1988, shall apply to a rural general acute care
hospital as defined in Section 1250.  Any reference in those
provisions to the Office of Statewide Health Planning and Development
shall instead refer to the department.  Any reference in those
provisions to a small and rural hospital shall instead refer to a
rural general acute care hospital.  The department may adopt
regulations to implement or administer this action.
1250.03.  A rural general acute care hospital that does not provide
surgical and anesthesia services shall maintain written transfer
agreements with one or more general acute care hospitals that provide
surgical and anesthesia services.
1250.05.  (a) All general acute care hospitals licensed under this
chapter shall maintain a medical records system, based upon current
standards for medical record retrieval and storage, that organizes
all medical records for each patient under a unique identifier.
   (b) This section shall not require electronic records or require
that all portions of patients' records be stored in a single
location.
   (c) In addition, all general acute care hospitals shall have the
ability to identify the location of all portions of a patient's
medical record that are maintained under the general acute care
hospital's license.
   (d) All general acute care hospitals, including those holding a
consolidated general acute care license pursuant to Section 1250.8,
shall develop and implement policies and procedures to ensure that
relevant portions of patients' medical records can be made available
within a reasonable period of time to respond to the request of a
treating physician, other authorized medical professionals,
authorized representatives of the department, or any other person
authorized by law to make such a request, taking into consideration
the physical location of the records and hours of operation of the
facility where those records are located, as well as the best
interests of the patients.
1250.1.  (a) The state department shall adopt regulations that
define all of the following bed classifications for health
facilities:
   (1) General acute care.
   (2) Skilled nursing.
   (3) Intermediate care-developmental disabilities.
   (4) Intermediate care--other.
   (5) Acute psychiatric.
   (6) Specialized care, with respect to special hospitals only.
   (7) Chemical dependency recovery.
   (8) Intermediate care facility/developmentally disabled
habilitative.
   (9) Intermediate care facility/developmentally disabled nursing.
   (10) Congregate living health facility.
   (11) Pediatric day health and respite care facility, as defined in
Section 1760.2.
   (12) Correctional treatment center.  For correctional treatment
centers that provide psychiatric and psychological services provided
by county mental health agencies in local detention facilities, the
State Department of Mental Health shall adopt regulations specifying
acute and nonacute levels of 24-hour care.  Licensed inpatient beds
in a correctional treatment center shall be used only for the purpose
of providing health services.
   (b) Except as provided in Section 1253.1, beds classified as
intermediate care beds, on September 27, 1978, shall be reclassified
by the state department as intermediate care--other.  This
reclassification shall not constitute a "project" within the meaning
of Section 127170 and shall not be subject to any requirement for a
certificate of need under Chapter 1 (commencing with Section 127125)
of Part 2 of Division 107, and regulations of the state department
governing intermediate care prior to the effective date shall
continue to be applicable to the intermediate care--other
classification unless and until amended or repealed by the state
department.
1250.2.  (a) As defined in Section 1250, "health facility" includes
a "psychiatric health facility," defined to mean a health facility,
licensed by the State Department of Mental Health, that provides
24-hour inpatient care for mentally disordered, incompetent, or other
persons described in Division 5 (commencing with Section 5000) or
Division 6 (commencing with Section 6000) of the Welfare and
Institutions Code.  This care shall include, but not be limited to,
the following basic services:  psychiatry, clinical psychology,
psychiatric nursing, social work, rehabilitation, drug
administration, and appropriate food services for those persons whose
physical health needs can be met in an affiliated hospital or in
outpatient settings.
   It is the intent of the Legislature that the psychiatric health
facility shall provide a distinct type of service to psychiatric
patients in a 24-hour acute inpatient setting.  The State Department
of Mental Health shall require regular utilization reviews of
admission and discharge criteria and lengths of stay in order to
assure that these patients are moved to less restrictive levels of
care as soon as appropriate.
   (b) The State Department of Mental Health may issue a special
permit to a psychiatric health facility for it to provide structured
outpatient services (commonly referred to as SOPS) consisting of
morning, afternoon, or full daytime organized programs, not exceeding
10 hours, for acute daytime care for patients admitted to the
facility.  This subdivision shall not be construed as requiring a
psychiatric health facility to apply for a special permit to provide
these alternative levels of care.
   The Legislature recognizes that, with access to structured
outpatient services, as an alternative to 24-hour inpatient care,
certain patients would be provided with effective intervention and
less restrictive levels of care.  The Legislature further recognizes
that, for certain patients, the less restrictive levels of care
eliminate the need for inpatient care, enable earlier discharge from
inpatient care by providing a continuum of care with effective
aftercare services, or reduce or prevent the need for a subsequent
readmission to inpatient care.
   (c) Any reference in any statute to Section 1250 of the Health and
Safety Code shall be deemed and construed to also be a reference to
this section.
   (d) Notwithstanding any other provision of law, and to the extent
consistent with federal law, a psychiatric health facility shall be
eligible to participate in the medicare program under Title XVIII of
the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.), and
the medicaid program under Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.), if all of the following conditions
are met:
   (1) The facility is a licensed facility.
   (2) The facility is in compliance with all related statutes and
regulations enforced by the State Department of Mental Health,
including regulations contained in Chapter 9 (commencing with Section
77001) of Division 5 of Title 22 of the California Code of
Regulations.
   (3) The facility meets the definitions and requirements contained
in subdivisions (e) and (f) of Section 1861 of the federal Social
Security Act (42 U.S.C. Sec. 1395x (e) and (f)), including the
approval process specified in Section 1861(e)(7)(B) of the Social
Security Act (42 U.S.C. Sec. 1395x(e)(7)(B)), which requires that the
state agency responsible for licensing hospitals has assured that
the facility meets licensing requirements.
   (4) The facility meets the conditions of participation for
hospitals pursuant to Part 482 of Title 42 of the Code of Federal
Regulations.
1250.3.  (a) As defined in Section 1250, "health facility" includes
the following type:  "Chemical dependency recovery hospital" means a
health facility which provides 24-hour inpatient care for persons who
have a dependency on alcohol or other drugs, or both alcohol and
other drugs.  Such care shall include, but not be limited to, the
following basic services:  patient counseling, group therapy,
physical conditioning, family therapy, outpatient services, and
dietetic services.  Each facility shall have a medical director who
is a physician and surgeon licensed to practice in this state.
   (b) The Legislature finds and declares that problems related to
the inappropriate use of alcohol or other drugs, or both alcohol and
other drugs are widespread and adversely affect the general welfare
of the people of the State of California.  It is the intent of the
Legislature that the chemical dependency recovery hospital will
provide an innovative inpatient treatment program for persons who
have a dependency on alcohol or drugs, or both alcohol and other
drugs.  The Legislature further finds and declares that significant
cost reductions can be achieved by chemical dependency recovery
hospitals when both of the following conditions exist:
   (1) Architectural requirements established by the state department
encourage a flexible and open construction approach which
significantly reduce capital construction costs.
   (2) Programs are designed to provide comprehensive inpatient
treatment yet permit substantial flexibility in the use of qualified
personnel to meet the specific needs of the patients of the facility.
   (c) Beds classified as chemical dependency recovery beds in a
general acute care hospital or acute psychiatric hospital or a
freestanding facility which is owned or leased by the general acute
care hospital or the acute psychiatric hospital and which is located
on the same premises or adjacent premises thereof, not to exceed a
15-mile radius within the same health facility planning area, as
defined January 1, 1981, by the Office of Statewide Health Planning
and Development and is under the administrative control of the
general acute care hospital or the acute psychiatric hospital, shall
be used exclusively for alcohol or other drug dependency treatment,
or both alcohol and other drug dependency treatment.  No general
acute care hospital or acute psychiatric hospital or a freestanding
facility, as defined in this subdivision, shall, without fulfilling
the requirements of the licensing laws and health planning laws,
convert beds classified as chemical dependency recovery beds to any
other bed classification or provide new chemical dependency recovery
beds by increasing bed capacity.
   (d) Chemical dependency recovery services may be provided as a
supplemental service in existing general acute care beds and acute
psychiatric beds in a general acute care hospital or in existing
acute psychiatric beds in an acute psychiatric hospital or in
existing beds in a freestanding facility, as defined in subdivision
(c).  When providing chemical dependency recovery services as a
supplemental service, the general acute care hospital, acute
psychiatric hospital, or freestanding facility, as defined in
subdivision (c), shall provide the supplemental services in a
distinct part of the hospital or freestanding facility, provided that
the distinct part satisfies the criteria established by law and
regulation for approval as a chemical dependency recovery
supplemental service.  A distinct part means an identifiable unit of
a hospital or a freestanding facility, as defined in subdivision (c),
accommodating beds, and related services, including, but not limited
to, contiguous rooms, a wing, a floor or a building that is approved
by the State Department of Health Services for a specific purpose.
Notwithstanding any other provisions of this subdivision, an acute
psychiatric hospital which provides all of the basic services
specified in subdivison (b) of Section 1250 may, subject to the
approval of the state department, have all of its licensed acute
psychiatric beds approved for chemical dependency recovery services.
Chemical dependency recovery services provided under this
subdivision shall not require a separate license or reclassification
of beds under the health planning laws.
   (e) If the chemical dependency recovery hospital is not a
supplemental service of a general acute care hospital, it shall have
agreements with one or more general acute care hospitals providing
for 24-hour emergency service and pharmacy, laboratory, and such
other services as the state department may require.
   (f) Any reference in any statute to Section 1250 shall be deemed
and construed to also be a reference to this section.
1250.4.  (a) As used in this section:
   (1) "Department" means the Department of Corrections or the
Department of the Youth Authority.
   (2) "Communicable, contagious, or infectious disease" means any
disease that is capable of being transmitted from person to person
with or without contact and as established by the State Department of
Health Services pursuant to Section 120130, and Section 2500 et seq.
of Title 17 of the California Code of Regulations.
   (3) "Inmate or ward" means any person incarcerated within the
jurisdiction of the Department of Corrections or the Department of
the Youth Authority, with the exception of a person on parole.
   (4) "Institution" means any state prison, camp, center, office, or
other facility under the jurisdiction of the Department of
Corrections or the Department of the Youth Authority.
   (5) "Medical director," "chief of medical services," or "chief
medical officer" means the medical officer, acting medical officer,
medical director, or the physician designated by the department to
act in that capacity, who is responsible for directing the medical
treatment programs and medical services for all health services and
services supporting the health services provided in the institution.
   (b) Each health care facility in the Department of Corrections and
in the Department of the Youth Authority shall have a medical
director in charge of the health care services of that facility who
shall be a physician and surgeon licensed to practice in California
and who shall be appointed by the directors of the departments.  The
medical director shall direct the medical treatment programs for all
health services and services supporting the health services provided
in the facility.
   (c) The medical director, chief of medical services, chief medical
officer, or the physician designated by the department to act in
that capacity, shall use every available means to ascertain the
existence of, and to immediately investigate, all reported or
suspected cases of any communicable, contagious, or infectious
disease and to ascertain the source or sources of the infections and
prevent the spread of the disease.  In carrying out these
investigations, the medical director, chief of medical services,
chief medical officer, or the physician designated by the department
to act in that capacity, is hereby invested with full powers of
inspection, examination, and quarantine or isolation of all inmates
or wards known to be, or reasonably suspected to be, infected with a
communicable, contagious, or infectious disease.
   (d) The medical director, chief of medical services, chief medical
officer, or the physician designated by the department to act in
that capacity, shall order an inmate or ward to receive an
examination or test, or may order an inmate or ward to receive
treatment if the medical director, chief of medical services, chief
medical officer, or the physician designated by the department to act
in that capacity, has reasonable suspicion that the inmate or ward
has, has had, or has been exposed to a communicable, contagious, or
infectious disease and the medical director, chief of medical
services, chief medical officer, or the physician designated by the
department to act in that capacity, has reasonable grounds to believe
that it is necessary for the preservation and protection of staff
and inmates or wards.
   (e) Notwithstanding Section 2600 or 2601 of the Penal Code, or any
other provision of law, any inmate or ward who refuses to submit to
an examination, test, or treatment for any communicable, contagious,
or infectious disease or who refuses treatment for any communicable,
contagious, or infectious disease, or who, after notice, violates, or
refuses or neglects to conform to any rule, order, guideline, or
regulation prescribed by the department with regard to communicable
disease control shall be tested involuntarily and may be treated
involuntarily.  This inmate or ward shall be subject to disciplinary
action as described in Title 15 of the California Code of
Regulations.
   (f) This section shall not apply to HIV or AIDS.  Testing,
treatment, counseling, prevention, education, or other procedures
dealing with HIV and AIDS shall be conducted as prescribed in Title 8
(commencing with Section 7500) of Part 3 of the Penal Code.
   (g) This section shall not apply to tuberculosis.  Tuberculosis
shall be addressed as prescribed in Title 8.7 (commencing with
Section 7570) of the Penal Code.
1250.5.  "Council" means the Advisory Health Council.
1250.6.  Any requirement placed upon, or reference to, a corporation
in this chapter, shall also apply to a limited liability company.
1250.7.  (a) (1) With respect to each hospital designated by the
department as a critical access hospital, and certified as such by
the Secretary of the United States Department of Health and Human
Services under the federal Medicare Rural Hospital Flexibility
Program, the department may develop criteria to waive any
requirements of Division 5 (commencing with Section 70001) of Title
22 of the California Code of Regulations that are in conflict with
the federal requirements for designation in the federal program, if
the department finds that it is in the public interest to do so, and
the department determines that the waiver would not negatively affect
the quality of patient care.
   (2) The criteria established pursuant to this subdivision shall
not be considered regulations within the meaning of Section 11342 of
the Government Code, and shall not be subject to adoption as
regulations pursuant to Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code.
   (b) Nothing in this section shall be construed to mean that a
critical access hospital is not a general acute care hospital.  Every
hospital designated by the department as a critical access hospital
and certified as such by the United States Department of Health and
Human Services shall be deemed to be a general acute care hospital,
as defined in subdivision (a) of Section 1250, even if the department
waives regulatory requirements otherwise applicable to general acute
care hospitals pursuant to this section.
1250.8.  (a) Notwithstanding subdivision (a) of Section 437.10, the
state department, upon application of a general acute care hospital
which meets all the criteria of subdivision (b), and other applicable
requirements of licensure, shall issue a single consolidated license
to a general acute care hospital which includes more than one
physical plant maintained and operated on separate premises or which
has multiple licenses for a single health facility on the same
premises.  A single consolidated license shall not be issued where
the separate freestanding physical plant is a skilled nursing
facility or an intermediate care facility, whether or not the
location of the skilled nursing facility or intermediate care
facility is contiguous to the general acute care hospital unless the
hospital is exempt from the requirements of subdivision (b) of
Section 1254, or the facility is part of the physical structure
licensed to provide acute care.
   (b) The issuance of a single consolidated license shall be based
on the following criteria:
   (1) There is a single governing body for all of the facilities
maintained and operated by the licensee.
   (2) There is a single administration for all of the facilities
maintained and operated by the licensee.
   (3) There is a single medical staff for all of the facilities
maintained and operated by the licensee, with a single set of bylaws,
rules, and regulations, which prescribe a single committee
structure.
   (4) Except as provided otherwise in this paragraph, the physical
plants maintained and operated by the licensee which are to be
covered by the single consolidated license are located not more than
15 miles apart.  If an applicant provides evidence satisfactory to
the department that it can comply with all requirements of licensure
and provide quality care and adequate administrative and professional
supervision, the director may issue a single consolidated license to
a general acute care hospital that operates two or more physical
plants located more than 15 miles apart under any of the following
circumstances:
   (A) One or more of the physical plants is located in a rural area,
as defined by regulations of the director.
   (B) One or more of the physical plants provides only outpatient
services, as defined by the department.
   (C) If Section 14105.986 of the Welfare and Institutions Code is
implemented and the applicant meets all of the following criteria:
   (i) The applicant is a nonprofit corporation.
   (ii) The applicant is a children's hospital listed in Section
10727 of the Welfare and Institutions Code.
   (iii) The applicant is affiliated with a major university medical
school, and located adjacent thereto.
   (iv) The applicant operates a regional tertiary care facility.
   (v) One of the physical plants is located in a county that has a
consolidated and county government structure.
   (vi) One of the physical plants is located in a county having a
population between 1 million and 2 million.
   (vii) The applicant is located in a city with a population between
50,000 and 100,000.
   (c) In issuing the single consolidated license, the state
department shall specify the location of each supplemental service
and the location of the number and category of beds provided by the
licensee.  The single consolidated license shall be renewed annually.
   (d) To the extent required by Part 1.5 (commencing with Section
437) of Division 1, a general acute care hospital which has been
issued a single consolidated license:
   (1) Shall not transfer from one facility to another a special
service described in Section 1255 without first obtaining a
certificate of need.
   (2) Shall not transfer, in whole or in part, from one facility to
another, a supplemental service, as defined in regulations of the
director pursuant to this chapter, without first obtaining a
certificate of need, unless the licensee, 30 days prior to the
relocation, notifies the Office of Statewide Health Planning and
Development, the applicable health systems agency, and the state
department of the licensee's intent to relocate the supplemental
service, and includes with this notice a cost estimate, certified by
a person qualified by experience or training to render the estimates,
which estimates that the cost of the transfer will not exceed the
capital expenditure threshold established by the Office of Statewide
Health Planning and Development pursuant to Section 437.10.
   (3) Shall not transfer beds from one facility to another facility,
without first obtaining a certificate of need unless, 30 days prior
to the relocation, the licensee notifies the Office of Statewide
Health Planning and Development, the applicable health systems
agency, and the state department of the licensee's intent to relocate
health facility beds, and includes with this notice both of the
following:
   (A) A cost estimate, certified by a person qualified by experience
or training to render the estimates, which estimates that the cost
of the relocation will not exceed the capital expenditure threshold
established by the Office of Statewide Health Planning and
Development pursuant to Section 437.10.
   (B) The identification of the number, classification, and location
of the health facility beds in the transferor facility and the
proposed number, classification, and location of the health facility
beds in the transferee facility.
   Except as otherwise permitted in Part 1.5 (commencing with Section
437) of Division 1, or as authorized in an approved certificate of
need pursuant to that part, health facility beds transferred pursuant
to this section shall be used in the transferee facility in the same
bed classification as defined in Section 1250.1, as the beds were
classified in the transferor facility.
   Health facility beds transferred pursuant to this section shall
not be transferred back to the transferor facility for two years from
the date of the transfer, regardless of cost, without first
obtaining a certificate of need pursuant to Part 1.5 (commencing with
Section 437) of Division 1.
   (e) All transfers pursuant to subdivision (d) shall satisfy all
applicable requirements of licensure and shall be subject to the
written approval, if required, of the state department.  The state
department may adopt regulations which are necessary to implement the
provisions of this section.  These regulations may include a
requirement that each facility of a health facility subject to a
single consolidated license have an onsite full-time or part-time
administrator.
   (f) As used in this section, "facility" means any physical plant
operated or maintained by a health facility subject to a single,
consolidated license issued pursuant to this section.
   (g) For purposes of selective provider contracts negotiated under
the Medi-Cal program, the treatment of a health facility with a
single consolidated license issued pursuant to this section shall be
subject to negotiation between the health facility and the California
Medical Assistance Commission.  A general acute care hospital which
is issued a single consolidated license pursuant to this section may,
at its option, receive from the state department a single Medi-Cal
program provider number or separate Medi-Cal program provider numbers
for one or more of the facilities subject to the single consolidated
license.  Irrespective of whether the general acute care hospital is
issued one or more Medi-Cal provider numbers, the state department
may require the hospital to file separate cost reports for each
facility pursuant to Section 14170 of the Welfare and Institutions
Code.
   (h) For purposes of the Annual Report of Hospitals required by
regulations adopted by the state department pursuant to this part,
the state department and the Office of Statewide Health Planning and
Development may require reporting of bed and service utilization data
separately by each facility of a general acute care hospital issued
a single consolidated license pursuant to this section.
   (i) The amendments made to this section during the 1985-86 Regular
Session of the California Legislature pertaining to the issuance of
a single consolidated license to a general acute care hospital in the
case where the separate physical plant is a skilled nursing facility
or intermediate care facility shall not apply to the following
facilities:
   (1) Any facility which obtained a certificate of need after August
1, 1984, and prior to February 14, 1985, as described in this
subdivision.  The certificate of need shall be for the construction
of a skilled nursing facility or intermediate care facility which is
the same facility for which the hospital applies for a single
consolidated license, pursuant to subdivision (a).
   (2) Any facility for which a single consolidated license has been
issued pursuant to subdivision (a), as described in this subdivision,
prior to the effective date of the amendments made to this section
during the 1985-86 Regular Session of the California Legislature.
   Any facility which has been issued a single consolidated license
pursuant to subdivision (a), as described in this subdivision, shall
be granted renewal licenses based upon the same criteria used for the
initial consolidated license.
   (j) If the state department issues a single consolidated license
pursuant to this section, the state department may take any action
authorized by this chapter, including, but not limited to, any action
specified in Article 5 (commencing with Section 1294), with respect
to any facility, or any service provided in any facility, which is
included in the consolidated license.
   (k) The eligibility for participation in the Medi-Cal program
(Chapter 7 (commencing with Section 14000), Part 3, Division 9,
Welfare and Institutions Code) of any facility that is included in a
consolidated license issued pursuant to this section, provides
outpatient services, and is located more than 15 miles from the
health facility issued the consolidated license shall be subject to a
determination of eligibility by the state department.  This
subdivision shall not apply to any facility that is located in a
rural area and is included in a consolidated license issued pursuant
to subparagraphs (A), (B), and (C) of paragraph (4) of subdivision
(b).  Regardless of whether a facility has received or not received a
determination of eligibility pursuant to this subdivision, this
subdivision shall not affect the ability of a licensed professional,
providing services covered by the Medi-Cal program to a person
eligible for Medi-Cal in a facility subject to a determination of
eligibility pursuant to this subdivision, to bill the Medi-Cal
program for those services provided in accordance with applicable
regulations.
   (l) Notwithstanding any other provision of law, the director may
issue a single consolidated license for a general acute care hospital
to Children's Hospital Oakland and San Ramon Regional Medical
Center.
1250.11.  The State Department of Health Services shall develop
written guidelines and regulations as necessary to minimize the risk
of transmission of blood-borne infectious diseases from health care
worker to patient, from patient to patient, and from patient to
health care worker.  In so doing, the state department shall consider
the recommendations made by the federal Centers for Disease Control
for preventing transmission of HIV and Hepatitis B.  The state
department shall also take into account existing regulations of the
state department as well as standards, guidelines, and regulations
pursuant to the California Occupational Safety and Health Act of 1973
(Part 1 (commencing with Section 6300), Division 5, Labor Code)
regarding infection control to prevent infection or disease as a
result of the transmission of blood-borne pathogens. In so doing, the
state department shall consult with the Medical Board of California,
the Board of Dental Examiners, and the Board of Registered Nursing
as well as associations representing health care professions,
associations of licensed health facilities, organizations which
advocate on behalf of those infected with HIV and organizations
representing consumers of health care.  The department shall complete
its review of the need for guidelines and regulations by January 1,
1993.
1251.  "License" means a basic permit to operate a health facility
with an authorized number and classification of beds.  A license
shall not be transferable.
1251.3.  A health facility licensed as a general acute care
hospital, providing alcohol recovery services, may convert its
licensure category to an acute psychiatric hospital and it may
reclassify all of its general acute care beds to acute psychiatric
without first obtaining a certificate of need pursuant to Section
127170 if all of the following conditions are met:
   (a) The health facility notifies, in writing, the State Department
and the Office of Statewide Health Planning and Development on or
before September 3, 1982.
   (b) The project would reclassify all of the facility's general
acute care beds to acute psychiatric.
   (c) The total licensed capacity of the facility to be converted
does not exceed 31 beds.
1251.5.  A "special permit" is a permit issued in addition to a
license, authorizing a health facility to offer one or more of the
special services specified in Section 1255 when the state department
has determined that the health facility has met the standards for
quality of care established by state department pursuant to Article 3
(commencing with Section 1275).
1252.  "Special service" means a functional division, department, or
unit of a health facility which is organized, staffed and equipped
to provide a specific type or types of patient care and which has
been identified by regulations of the state department and for which
the state department has established special standards for quality of
care.
1253.  (a) No person, firm, partnership, association, corporation,
or political subdivision of the state, or other governmental agency
within the state shall operate, establish, manage, conduct, or
maintain a health facility in this state, without first obtaining a
license therefor as provided in this chapter, nor provide, after July
1, 1974, special services without approval of the state department.
However, any health facility offering any special service on the
effective date of this section shall be approved by the state
department to continue those services until the state department
evaluates the quality of those services and takes permitted action.
   (b) This section shall not apply to a receiver appointed by the
court to temporarily operate a long-term health care facility
pursuant to Article 8 (commencing with Section 1325).
1253.1.  (a) Any skilled nursing facility or intermediate care
facility that on the effective date of this section is providing care
for the developmentally disabled may utilize beds designated for
that purpose to provide intermediate care for the developmentally
disabled without obtaining a certificate of need, a change in
licensure category, or a change in bed classification pursuant to
subdivision (c) of Section 1250.1, provided the facility meets and
continues to meet the following criteria:
   (1) The facility was surveyed on or before July 18, 1977, by the
State Department of Health for certification under the federal ICF/MR
program pursuant to Section 449.13 of Title 42 of the Code of
Federal Regulations, and the beds designated for intermediate care
for the developmentally disabled were certified by the state
department, either before or after that date, to meet the standards
set forth in Section 449.13 of Title 42 of the Code of Federal
Regulations.
   (2) Not less than 95 percent of the beds so certified for
intermediate care for the developmentally disabled are utilized
exclusively for provision of care to residents with a developmental
disability, as defined in subdivision (a) of Section 4512 of the
Welfare and Institutions Code.  Nothing in this paragraph shall
require continuous bed occupancy, but a bed certified for
intermediate care for the developmentally disabled shall be deemed to
be converted to another use if occupied by a resident who is not
developmentally disabled.
   (3) On and after the effective date of regulations implementing
this section, no change of ownership has occurred with respect to the
facility requiring issuance of a new license, except a change
occurring because of a decrease in the number of partners of a
licensed partnership or a reorganization of the governing structure
of a licensee in which there is no change in the relative ownership
interests.
   (b) Any facility receiving an exemption under subdivision (a)
shall, with respect to beds designated for intermediate care for the
developmentally disabled, be subject to regulations of the state
department applicable to that level of care, rather than the level of
care for which the beds are licensed.  The state department shall
indicate on the license of any facility receiving an exemption
pursuant to subdivision (a) that the licensee has been determined by
the state department to meet the criteria of subdivision (a).
   (c) The licensee of any facility receiving an exemption under this
section shall notify the state department not less than 30 days
prior to taking action that will cause the facility to cease meeting
the criteria specified in paragraph (2) or (3) of subdivision (a).
   (d) Upon a change of ownership of the facility or change in
ownership interests not meeting the criterion for continued exemption
specified in paragraph (3) of subdivision (a), the applicant for
relicensure shall elect as follows:
   (1) To reclassify all skilled nursing beds that have been exempted
under this section to the intermediate care-developmental
disabilities classification, or to continue the skilled nursing
classification with respect to skilled nursing beds that have
received the exemption.
   (2) To reclassify intermediate care beds that have been exempted
under this section to the intermediate care-developmental
disabilities classification, or to reclassify intermediate care beds
that have received the exemption to the intermediate care-other
classification.
   Reclassification of beds pursuant to this subdivision shall not
constitute a "project" within the meaning of Section 127170 and shall
not be subject to any requirement for a certificate of need under
Chapter 1 (commencing with Section 127125) of Part 2 of Division 107.
1254.  (a) Except as provided in subdivision (e), the state
department shall inspect and license health facilities.  The state
department shall license health facilities to provide their
respective basic services specified in Section 1250.  Except as
provided in Section 1253, the state department shall inspect and
approve a general acute care hospital to provide special services as
specified in Section 1255.  The state department shall develop and
adopt regulations to implement the provisions contained in this
section.
   (b) Upon approval, the state department shall issue a separate
license for the provision of the basic services enumerated in
subdivision (c) or (d) of Section 1250 whenever these basic services
are to be provided by an acute care hospital, as defined in
subdivision (a), (b), or (f) of that section, where the services
enumerated in subdivision (c) or (d) of Section 1250 are to be
provided in any separate freestanding facility, whether or not the
location of the separate freestanding facility is contiguous to the
acute care hospital.  The same requirement shall apply to any new
freestanding facility constructed for the purpose of providing basic
services, as defined in subdivision (c) or (d) of Section 1250, by
any acute care hospital on or after January 1, 1984.
   (c) (1) Those beds licensed to an acute care hospital which, prior
to January  1, 1984, were separate freestanding beds and were not
part of the physical structure licensed to provide acute care, and
which beds were licensed to provide those services enumerated in
subdivision (c) or (d) of Section 1250, are exempt from the
requirements of subdivision (b).
   (2) All beds licensed to an acute care hospital and located within
the physical structure in which acute care is provided are exempt
from the requirements of  subdivision (b) irrespective of the date of
original licensure of the beds, or  the licensed category of the
beds.
   (3) All beds licensed to an acute care hospital owned and operated
by the State of California or any other public agency are exempt
from the requirements of subdivision (b).
   (4) All beds licensed to an acute care hospital in a rural area as
defined by  Chapter 1010, of the Statutes of 1982, are exempt from
the requirements of subdivision (b), except where there is a
freestanding skilled nursing facility or intermediate care facility
which has experienced an occupancy rate of 95 percent or less during
the past 12 months within a 25-mile radius or which may be reached
within 30 minutes using a motor vehicle.
   (5) All beds licensed to an acute care hospital which meet the
criteria for designation within peer group six or eight, as defined
in the report entitled Hospital Peer Grouping for Efficiency
Comparison, dated December 20, 1982, and published by the California
Health Facilities Commission, and all beds in hospitals which have
fewer than 76 licensed acute care beds and which are located in a
census designation place of 15,000 or less population, are exempt
from the requirements of subdivision (b), except where there is a
free-standing skilled nursing facility or intermediate care facility
which has experienced an occupancy rate of 95 percent or less during
the past 12 months within a 25-mile radius or which may be reached
within 30 minutes using a motor vehicle.
   (6) All beds licensed to an acute care hospital which has had a
certificate of need approved by a health systems agency on or before
July 1, 1983, are exempt from the requirements of subdivision (b).
   (7) All beds licensed to an acute care hospital are exempt from
the requirements of subdivision (b), if reimbursement from the
Medi-Cal program for beds licensed for the provision of services
enumerated in subdivision (c) or (d) of Section 1250 and not
otherwise exempt does not exceed the reimbursement which would be
received if the beds were in a separately licensed facility.
   (d) Except as provided in Section 1253, the state department shall
inspect and approve a general acute care hospital to provide special
services as specified  in Section 1255.  The state department shall
develop and adopt regulations to implement subdivisions (a) to (d),
inclusive, of this section.
   (e) The State Department of Mental Health shall inspect and
license psychiatric health facilities.  The State Department of
Mental Health shall license psychiatric health facilities to provide
their basic services specified in Section 1250.2.  The State
Department of Mental Health shall develop and adopt regulations to
implement this subdivision.
1254.1.  (a) The State Department of Mental Health shall license
psychiatric health facilities to provide their basic services
specified in Section 1250.
   (b) Any reference in any statute to Section 1254 shall be deemed
and construed to also be a reference to this section.
1254.2.  (a) The state department, in addition to the licensing
duties imposed by Section 1254, shall license chemical dependency
recovery hospitals to provide the basic services specified in
subdivision (a) of Section 1250.3.
   (b) Any reference in any statute to Section 1254 shall be deemed
and construed to also be a reference to this section.
1254.5.  (a) The Legislature finds and declares that the disease of
eating disorders is not simply medical or psychiatric, but involves
biological, sociological, psychological, family, medical, and
spiritual components.  In addition, the Legislature finds and
declares that the treatment of eating disorders is multifaceted, and
like the treatment of chemical dependency, does not fall neatly into
either the traditional medical or psychiatric milieu.
   (b) The inpatient treatment of eating disorders shall be provided
only in state licensed hospitals, which may be general acute care
hospitals  as defined in subdivision (a) of Section 1250, acute
psychiatric hospitals as defined in subdivision (b) of Section 1250,
or any other licensed health facility designated by the State
Department of Health Services.
   (c) "Eating disorders," for the purposes of this section, means
anorexia nervosa and bulimia as defined by the 1980 Diagnostic and
Statistical Manual of Mental Disorders (DSM-III) published by the
American Psychiatric Association.
1254.6.  (a) A hospital shall provide, free of charge, information
and instructional materials regarding sudden infant death syndrome,
as described in Section 1596.847, explaining the medical effects upon
infants and young children and emphasizing measures that may reduce
the risk.
   (b) The information and materials described in subdivision (a)
shall be provided to parents or guardians of each newborn, upon
discharge from the hospital.  In the event of home birth attended by
a licensed midwife, the midwife shall provide the information and
instructional materials to the parents or guardians of the newborn.
   (c) To the maximum extent practicable, the materials provided to
parents or guardians of each newborn shall substantially reflect the
information contained in materials approved by the state department
for public circulation.  The state department shall make available to
hospitals, free of charge, information in camera-ready typesetting
format.  Nothing in this section prohibits a hospital from obtaining
free and suitable information from any other public or private
agency.
1254.7.  (a) It is the intent of the Legislature that pain be
assessed and treated promptly, effectively, and for as long as pain
persists.
   (b) Every health facility licensed pursuant to this chapter shall,
as a condition of licensure, include pain as an item to be assessed
at the same time as vital signs are taken.  The health facility shall
ensure that pain assessment is performed in a consistent manner that
is appropriate to the patient.  The pain assessment shall be noted
in the patient's chart in a manner consistent with other vital signs.
1255.  In addition to the basic services offered under the license,
a general acute care hospital may be approved in accordance with
subdivision (c) of Section 1277 to offer special services, including,
but not limited to, the following:
   (a) Radiation therapy department.
   (b) Burn center.
   (c) Emergency center.
   (d) Hemodialysis center (or unit).
   (e) Psychiatric.
   (f) Intensive care newborn nursery.
   (g) Cardiac surgery.
   (h) Cardiac catheterization laboratory.
   (i) Renal transplant.
   (j) Other special services as the department may prescribe by
regulation.
   A general acute care hospital that exclusively provides acute
medical rehabilitation center services may be approved in accordance
with subdivision (b) of Section 1277 to offer special services not
requiring surgical facilities.
   The state department shall adopt standards for special services
and other regulations as may be necessary to implement this section.
For cardiac catheterization laboratory service, the state department
shall, at a minimum, adopt standards and regulations that specify
that only diagnostic services, and what diagnostic services, may be
offered by an acute care hospital or a multispecialty clinic as
defined in subdivision (l) of Section 1206 that is approved to
provide cardiac catheterization laboratory service but is not also
approved to provide cardiac surgery service, together with the
conditions under which the cardiac catheterization laboratory service
may be offered.
   A cardiac catheterization laboratory service shall be located in a
general acute care hospital that is either licensed to perform
cardiovascular procedures requiring extracorporeal coronary artery
bypass that meets all of the applicable licensing requirements
relating to staff, equipment, and space for service, or shall, at a
minimum, have a licensed intensive care service and coronary care
service and maintain a written agreement for the transfer of patients
to a general acute care hospital that is licensed for cardiac
surgery or shall be located in a multispecialty clinic as defined in
subdivision (l) of Section 1206.  The transfer agreement shall
include protocols that will minimize the need for duplicative cardiac
catheterizations at the hospital in which the cardiac surgery is to
be performed.
   For purposes of this section, "multispecialty clinic," as defined
in subdivision (l) of Section 1206, includes an entity in which the
multispecialty clinic holds at least a 50-percent general partner
interest and maintains responsibility for the management of the
service, if all of the following requirements are met:
   (1) The multispecialty clinic existed as of March 1, 1983.
   (2) Prior to March 1, 1985, the multispecialty clinic did not
offer cardiac catheterization services, dynamic multiplane imaging,
or other types of coronary or similar angiography.
   (3) The multispecialty clinic creates only one entity that
operates its service at one site.
   (4) These entities shall have the equipment and procedures
necessary for the stabilization of patients in emergency situations
prior to transfer and patient transfer arrangements in emergency
situations that shall be in accordance with the standards established
by the Emergency Medical Services Authority, including the
availability of comprehensive care and the qualifications of any
general acute care hospital expected to provide emergency treatment.
   Except as provided in Sections 128525 and 128530, under no
circumstances shall cardiac catheterizations be performed outside of
a general acute care hospital or a multispecialty clinic, as defined
in subdivision (l) of Section 1206, that qualifies for this
definition as of March 1, 1983.
1255.1.  (a) Any hospital that provides emergency medical services
under Section 1255 shall, as soon as possible, but not 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.
   (b) In addition to the notice required by subdivision (a), the
hospital shall, within the time limits specified in subdivision (a),
provide public notice of the intended change in a manner that is
likely to reach a significant number of residents of the community
serviced by that facility.
   (c) A hospital shall not be subject to this section or Section
1255.2 if the state department does either of the following:
   (1) Determines that the use of resources to keep the emergency
center open substantially threatens the stability of the hospital as
a whole.
   (2) Cites the emergency center for unsafe staffing practices.
1255.2.  A health facility implementing a downgrade or change shall
make reasonable efforts to ensure that the community served by its
facility is informed of the downgrade or closure.  Reasonable efforts
may include, but not be limited to, advertising the change in terms
likely to be understood by a layperson, soliciting media coverage
regarding the change, informing patients of the facility of the
impending change, and notifying contracting health care service plans
as required in Section 1255.1.
1255.3.  On or before June 30, 1999, with the state department as
the lead agency, the state department and the Emergency Medical
Services Authority, in consultation with hospitals and other health
care providers and local emergency medical services agencies, shall
designate signage requirements for a health facility holding a
special permit for a standby emergency medical service located in an
urban area.  The signage shall not include the word "emergency" and
shall reflect the type of emergency services provided by the
facility, and be easily understood by the average person.  The
facility shall not post signs, distribute literature, or advertise
that emergency services are available at the facility.  Nothing in
this section shall be construed to mean that a facility is no longer
providing emergency services for purposes of billing or
reimbursement.  A small and rural hospital, as defined in Section
124840, is not subject to the requirements of this section.
1255.5.  For purposes of Section 1255, the following definitions
apply:
   (a) "Cardiac catheterization" includes an intravascular insertion
of a catheter into the heart for the primary definition and diagnosis
of an anatomic cardiac lesion.  For the purposes of this definition,
the insertion of a Swan-Ganz thermodilution cardiac output catheter,
a venous line, and a temporary pacemaking electrode catheter are
excluded.
   (b) "Cardiac surgery" means surgery on the heart or great vessels
requiring a thoracotomy and extracorporeal circulation.
   (c)  "Cardiovascular surgery service" means a program of a general
acute care hospital which has the capability of performing cardiac
catheterizations and cardiac surgery as defined in this section.
Under no circumstances shall there exist in a general acute care
hospital a cardiac surgery service without a cardiac catheterization
laboratory service.
   (d) "Cardiac catheterization laboratory service" means a program
of a general acute care hospital which has the capability of
performing cardiac catheterization.  Cardiac catheterization
laboratory service does not include pediatric cardiac catheterization
laboratory service.
   (e) "Pediatric cardiac surgery service" means a program of a
general acute care hospital which has the capability of performing
cardiac catheterization and cardiac surgery, as defined in this
section, for the diagnosis and treatment of congenital defects in
children.  Cardiac catheterization for pediatric patients shall be
performed only in a general acute care hospital that has the
capability to perform cardiac surgery on pediatric patients.
   (f) "Intensive care newborn nursery services" means the provision
of comprehensive and intensive care for all contingencies of the
newborn infant, including intensive, intermediate, and continuing
care.  Policies, procedures, and space requirements for intensive,
intermediate, and continuing care services shall be based upon the
standards and recommendations of the American Academy of Pediatrics
Guidelines for Perinatal Care, 1983.
1255.6.  During cardiovascular surgery, a perfusionist, as defined
by Chapter 5.67 (commencing with Section 2590) of Division 2 of the
Business and Professions Code, shall operate the extracorporeal
equipment under the immediate supervision of the cardiovascular
surgeon or anesthesiologist.  The determination of the qualifications
and competence of a perfusionist, and the awarding of appropriate
privileges, shall be the responsibility of the general acute care
hospital or its medical staff.
1255.7.  (a) (1) For purposes of this section, "safe-surrender site"
means either of the following:
   (A) A location designated by the board of supervisors of a county
to be responsible for accepting physical custody of a minor child who
is 72 hours old or younger from a parent or individual who has
lawful custody of the child and who surrenders the child pursuant to
Section 271.5 of the Penal Code.
   (B) A location within a public or private hospital that is
designated by that hospital to be responsible for accepting physical
custody of a minor child who is 72 hours old or younger from a parent
or individual who has lawful custody of the child and who surrenders
the child pursuant to Section 271.5 of the Penal Code.
   (2) For purposes of this section, "parent" means a birth parent of
a minor child who is 72 hours old or younger.
   (3) For purposes of this section, "personnel" means any person who
is an officer or employee of a safe-surrender site or who has staff
privileges at the site.
   (4) A hospital and any safe-surrender site designated by the
county board of supervisors shall post a sign utilizing a statewide
logo that has been adopted by the State Department of Social Services
that notifies the public of the location where a minor child 72
hours old or younger may be safely surrendered pursuant to this
section.
   (b) Any personnel on duty at a safe-surrender site shall accept
physical custody of a minor child 72 hours old or younger pursuant to
this section if a parent or other individual having lawful custody
of the child voluntarily surrenders physical custody of the child to
personnel who are on duty at the safe-surrender site. Safe-surrender
site personnel shall ensure that a qualified person does all of the
following:
   (1) Places a coded, confidential ankle bracelet on the child.
   (2) Provides, or makes a good faith effort to provide, to the
parent or other individual surrendering the child a copy of a unique,
coded, confidential ankle bracelet identification in order to
facilitate reclaiming the child pursuant to subdivision (f). However,
possession of the ankle bracelet identification, in and of itself,
does not establish parentage or a right to custody of the child.
   (3) Provides, or makes a good faith effort to provide, to the
parent or other individual surrendering the child a medical
information questionnaire, which may be declined, voluntarily filled
out and returned at the time the child is surrendered, or later
filled out and mailed in the envelope provided for this purpose. This
medical information questionnaire shall not require any identifying
information about the child or the parent or individual surrendering
the child, other than the identification code provided in the ankle
bracelet placed on the child. Every questionnaire provided pursuant
to this section shall begin with the following notice in no less than
12-point type:
   NOTICE: THE BABY YOU HAVE BROUGHT IN TODAY MAY HAVE SERIOUS
MEDICAL NEEDS IN THE FUTURE THAT WE DON'T KNOW ABOUT TODAY. SOME
ILLNESSES, INCLUDING CANCER, ARE BEST TREATED WHEN WE KNOW ABOUT
FAMILY MEDICAL HISTORIES. IN ADDITION, SOMETIMES RELATIVES ARE NEEDED
FOR LIFE-SAVING TREATMENTS. TO MAKE SURE THIS BABY WILL HAVE A
HEALTHY FUTURE, YOUR ASSISTANCE IN COMPLETING THIS QUESTIONNAIRE
FULLY IS ESSENTIAL. THANK YOU.
   (c) Personnel of a safe-surrender site that has physical custody
of a minor child pursuant to this section shall ensure that a medical
screening examination and any necessary medical care is provided to
the minor child.  Notwithstanding any other provision of law, the
consent of the parent or other relative shall not be required to
provide that care to the minor child.
   (d) (1) As soon as possible, but in no event later than 48 hours
after the physical custody of a child has been accepted pursuant to
this section, personnel of the safe-surrender site that has physical
custody of the child shall notify child protective services or a
county agency providing child welfare services pursuant to Section
16501 of the Welfare and Institutions Code, that the safe-surrender
site has physical custody of the child pursuant to this section. In
addition, any medical information pertinent to the child's health,
including, but not limited to, information obtained pursuant to the
medical information questionnaire described in paragraph (3) of
subdivision (b) that has been received by or is in the possession of
the safe-surrender site shall be provided to that child protective
services or county agency.
   (2) Any personal identifying information that pertains to a parent
or individual who surrenders a child that is obtained pursuant to
the medical information questionnaire is confidential and shall be
exempt from disclosure by the child protective services or county
agency under the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code). Any personal identifying information that pertains
to a parent or individual who surrenders a child shall be redacted
from any medical information provided to child protective services or
the county agency providing child welfare services.
   (e) Child protective services or the county agency providing child
welfare services pursuant to Section 16501 of the Welfare and
Institutions Code shall assume temporary custody of the child
pursuant to Section 300 of the Welfare and Institutions Code
immediately upon receipt of notice under subdivision (d). Child
protective services or the county agency providing child welfare
services pursuant to Section 16501 of the Welfare and Institutions
Code shall immediately investigate the circumstances of the case and
file a petition pursuant to Section 311 of the Welfare and
Institutions Code. Child protective services or the county agency
providing child welfare services pursuant to Section 16501 of the
Welfare and Institutions Code shall immediately notify the State
Department of Social Services of each child to whom this subdivision
applies upon taking temporary custody of the child pursuant to
Section 300 of the Welfare and Institutions Code. As soon as
possible, but no later than 24 hours after temporary custody is
assumed, child protective services or the county agency providing
child welfare services pursuant to Section 16501 of the Welfare and
Institutions Code shall report all known identifying information
concerning the child, except personal identifying information
pertaining to the parent or individual who surrendered the child, to
the California Missing Children Clearinghouse and to the National
Crime Information Center.
   (f) If, prior to the filing of a petition under subdivision (e), a
parent or individual who has voluntarily surrendered a child
pursuant to this section requests that the safe-surrender site that
has physical custody of the child pursuant to this section return the
child and the safe-surrender site still has custody of the child,
personnel of the safe-surrender site shall either return the child to
the parent or individual or contact a child protective agency if any
personnel at the safe-surrender site knows or reasonably suspects
that the child has been the victim of child abuse or neglect. The
voluntary surrender of a child pursuant to this section is not in and
of itself a sufficient basis for reporting child abuse or neglect.
The terms "child abuse," "child protective agency," "mandated
reporter," "neglect," and "reasonably suspects" shall be given the
same meanings as in Article 2.5 (commencing with Section 11164) of
Title 1 of Part 4 of the Penal Code.
   (g) Subsequent to the filing of a petition under subdivision (e),
if within 14 days of the voluntary surrender described in this
section, the parent or individual who surrendered custody returns to
claim physical custody of the child, the child welfare agency shall
verify the identity of the parent or individual, conduct an
assessment of his or her circumstances and ability to parent, and
request that the juvenile court dismiss the petition for dependency
and order the release of the child, if the child welfare agency
determines that none of the conditions described in subdivisions (a)
to (d), inclusive, of Section 319 of the Welfare and Institutions
Code currently exist.
   (h) A safe-surrender site, or personnel of the safe-surrender
site, that accepts custody of a surrendered child pursuant to this
section shall not be subject to civil, criminal, or administrative
liability for accepting the child and caring for the child in the
good faith belief that action is required or authorized by this
section, including, but not limited to, instances where the child is
older than 72 hours or the parent or individual surrendering the
child did not have lawful physical custody of the child. This
subdivision does not confer immunity from liability for personal
injury or wrongful death, including, but not limited to, injury
resulting from medical malpractice.
   (i) (1) In order to encourage assistance to persons who
voluntarily surrender physical custody of a child pursuant to this
section or Section 271.5 of the Penal Code, no person who, without
compensation and in good faith, provides assistance for the purpose
of effecting the safe surrender of a minor 72 hours old or younger
shall be civilly liable for injury to or death of the minor child as
a result of any of his or her acts or omissions. This immunity does
not apply to any act or omission constituting gross negligence,
recklessness, or willful misconduct.
   (2) For purposes of this section, "assistance" means transporting
the minor child to the safe-surrender site as a person with lawful
custody, or transporting or accompanying the parent or person with
lawful custody at the request of that parent or person to effect the
safe surrender, or performing any other act in good faith for the
purpose of effecting the safe surrender of the minor.
   (j) For purposes of this section, "lawful custody" means physical
custody of a minor 72 hours old or younger accepted by a person from
a parent of the minor, who the person believes in good faith is the
parent of the minor, with the specific intent and promise of
effecting the safe surrender of the minor.
   (k) Any identifying information that pertains to a parent or
individual who surrenders a child pursuant to this section, that is
obtained as a result of the questionnaire described in paragraph (3)
of subdivision (b) or in any other manner, is confidential, shall be
exempt from disclosure under the California Public Records Act
(Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1
of the Government Code), and shall not be disclosed by any personnel
of a safe-surrender site that accepts custody of a child pursuant to
this section.
1256.  (a) The use of the name or title "hospital" by any person or
persons to identify or represent a facility for the diagnosis, care,
and treatment of human illness other than a facility subject to or
specifically exempted from the licensure provisions of this chapter
is prohibited. Notwithstanding any other provisions of the laws of
this state, the name or title "hospital" shall not be used by any
sanitarium, nursing home, convalescent home, or maternity home,
unless preceded by some qualifying descriptive word such as
convalescent, geriatric, rehabilitation, or nursing.
   (b) This section shall not prohibit the use of the word "hospital"
to identify or represent an approved pediatric supplemental service
of a general acute care hospital that is either of the following:
   (1) A children's hospital as defined by Section 10727 of the
Welfare and Institutions Code.
   (2) A University of California children's hospital as defined by
Section 10728 of the Welfare and Institutions Code.
1256.1.  No general acute care hospital shall hold itself out
directly or indirectly by any sign, brochure, or advertisement as
providing any service or services which require a supplemental or
special service unless that general acute care hospital has first
obtained a supplemental or special service approval from the State
Department of Health Services to operate such a service.
1256.2.  (a) (1) No general acute care hospital may promulgate
policies or implement practices that determine differing standards of
obstetrical care based upon a patient's source of payment or ability
to pay for medical services.
   (2) Each hospital holding an obstetrical services permit shall
provide the licensing and certification division of the department
with a written policy statement reflecting paragraph (1) and shall
post written notices of this policy in the obstetrical admitting
areas of the hospital by July 1, 1999.  Notices posted pursuant to
this section shall be posted in the predominant language or languages
spoken in the hospital's service area.
   (b) It shall constitute unprofessional conduct within the meaning
of the Medical Practice Act, Chapter 5 (commencing with Section 2000)
of Division 2 of the Business and Professions Code, for a physician
or surgeon to deny, or threaten to withhold pain management services
from a woman in active labor, based upon that patient's source of
payment, or ability to pay for medical services.
1257.  The state department may delegate to local health departments
the authority to verify compliance with the licensing and approval
provisions of this chapter, to provide consultation, and to recommend
disciplinary action by the department against those licensed or
approved under the provisions of this chapter.  In exercising the
authority so delegated, the local health department shall conform to
the requirements of this chapter and to the rules and regulations of
the state department.  Payment to the local health departments for
services performed pursuant to this section shall be in accordance
with a budget submitted by the local health department and approved
by the state department.  Such expenditures shall not exceed amounts
appropriated by the Legislature for the purpose of such inspection
and enforcement.
1257.7.  (a) By July 1, 1995, all hospitals licensed pursuant to
subdivisions (a), (b), and (f) of Section 1250 shall conduct a
security and safety assessment and, using the assessment, develop a
security plan with measures to protect personnel, patients, and
visitors from aggressive or violent behavior.  The security and
safety assessment shall examine trends of aggressive or violent
behavior at the facility.  These hospitals shall track incidents of
aggressive or violent behavior as part of the quality assessment and
improvement program and for the purposes of developing a security
plan to deter and manage further aggressive or violent acts of a
similar nature.  The plan may include, but shall not be limited to,
security considerations relating to all of the following:
   (1) Physical layout.
   (2) Staffing.
   (3) Security personnel availability.
   (4) Policy and training related to appropriate responses to
violent acts.
   In developing this plan, the hospital shall consider any
guidelines or standards on violence in health care facilities issued
by the state department, the Division of Occupational Safety and
Health, and the federal Occupational Safety and Health
Administration.  As part of the security plan, a hospital shall adopt
security policies including, but not limited to, personnel training
policies designed to protect personnel, patients, and visitors from
aggressive or violent behavior.
   (b) The individual or members of a hospital committee responsible
for developing the security plan shall be familiar with all of the
following:
   (1) The role of security in hospital operations.
   (2) Hospital organization.
   (3) Protective measures, including alarms and access control.
   (4) The handling of disturbed patients, visitors, and employees.
   (5) Identification of aggressive and violent predicting factors.
   (6) Hospital safety and emergency preparedness.
   (7) The rudiments of documenting and reporting crimes, including,
by way of example, not disturbing a crime scene.
   (c) The hospital shall have sufficient personnel to provide
security pursuant to the security plan developed pursuant to
subdivision (a).  Persons regularly assigned to provide security in a
hospital setting shall be trained regarding the role of security in
hospital operations, including the identification of aggressive and
violent predicting factors, and management of violent disturbances.
   (d) Any act of assault, as defined in Section 240 of the Penal
Code, or battery, as defined in Section 242 of the Penal Code, that
results in injury or involves the use of a firearm or other dangerous
weapon, against any on-duty hospital personnel shall be reported to
the local law enforcement agency within 72 hours of the incident.
Any other act of assault, as defined in Section 240 of the Penal
Code, or battery as defined in Section 242 of the Penal Code, against
any on-duty hospital personnel may be reported to the local law
enforcement agency within 72 hours of the incident.  No health
facility or employee of a health facility who reports a known or
suspected instance of assault or battery pursuant to this section
shall be civilly or criminally liable for any report required by this
section.  No health facility or employee of a health facility who
reports a known or suspected instance of assault or battery that is
authorized, but not required, by this section, shall be civilly or
criminally liable for the report authorized by this section unless it
can be proven that a false report was made and the health facility
or its employee knew that the report was false or was made with
reckless disregard of the truth or falsity of the report, and any
health facility or employee of a health facility who makes a report
known to be false or with reckless disregard of the truth or falsity
of the report shall be liable for any damages caused.  Any individual
knowingly interfering with or obstructing the lawful reporting
process shall be guilty of a misdemeanor.  "Dangerous weapon," as
used in this section, means any weapon the possession or concealed
carrying of which is prohibited by Section 12020 of the Penal Code.
1257.8.  (a) All hospital employees regularly assigned to the
emergency department shall receive, by July 1, 1995, and thereafter,
on a continuing basis as provided for in the security plan developed
pursuant to Section 1257.7, security education and training relating
to the following topics:
   (1) General safety measures.
   (2) Personal safety measures.
   (3) The assault cycle.
   (4) Aggression and violence predicting factors.
   (5) Obtaining patient history from a patient with violent
behavior.
   (6) Characteristics of aggressive and violent patients and
victims.
   (7) Verbal and physical maneuvers to diffuse and avoid violent
behavior.
   (8) Strategies to avoid physical harm.
   (9) Restraining techniques.
   (10) Appropriate use of medications as chemical restraints.
   (11) Any resources available to employees for coping with
incidents of violence, including, by way of example, critical
incident stress debriefing or employee assistance programs.
   (b) As provided in the security plan developed pursuant to Section
1257.7, members of the medical staff of each hospital and all other
practitioners, including, but not limited to, nurse practitioners,
physician assistants, and other personnel, who are regularly assigned
to the emergency department or other departments identified in the
security plan shall receive the same training as that provided to
hospital employees or, at a minimum, training determined to be
sufficient pursuant to the security plan.
   (c) Temporary personnel shall be oriented as required pursuant to
the security plan.  This section shall not be construed to preempt
state law or regulations generally affecting temporary personnel in
hospitals.
1258.  No health facility which permits sterilization operations for
contraceptive purposes to be performed therein, nor the medical
staff of such health facility, shall require the individual upon whom
such a sterilization operation is to be performed to meet any
special nonmedical qualifications, which are not imposed on
individuals seeking other types of operations in the health facility.
  Such prohibited nonmedical qualifications shall include, but not be
limited to, age, marital status, and number of natural children.
   Nothing in this section shall prohibit requirements relating to
the physical or mental condition of the individual or affect the
right of the attending physician to counsel or advise his patient as
to whether or not sterilization is appropriate.  This section shall
not affect existing law with respect to individuals below the age of
majority.
1259.  (a) The Legislature finds and declares that California is
becoming a land of people whose languages and cultures give the state
a global quality.  The Legislature further finds and declares that
access to basic health care services is the right of every resident
of the state, and that access to information regarding basic health
care services is an essential element of that right.
   Therefore, it is the intent of the Legislature that  where
language or communication barriers exist between patients and the
staff of any general acute care hospital, arrangements shall be made
for interpreters or bilingual professional staff to ensure adequate
and speedy communication between patients and staff.
   (b) As used in this section:
   (1) "Interpreter" means a person fluent in English and in the
necessary second language, who can accurately speak, read, and
readily interpret the necessary second language, or a person who can
accurately sign and read sign language.  Interpreters shall have the
ability to translate the names of body parts and to describe
competently symptoms and injuries in both languages.  Interpreters
may include members of the medical or professional staff.
   (2) "Language or communication barriers" means:
   (A) With respect to spoken language, barriers which are
experienced by individuals who are limited-English-speaking or
non-English-speaking individuals who speak the same primary language
and who comprise at least 5 percent of the population of the
geographical area served by the hospital or of the actual patient
population of the hospital.  In cases of dispute, the state
department shall determine, based on objective data, whether the 5
percent population standard applies to a given hospital.
   (B) With respect to sign language, barriers which are experienced
by individuals who are deaf and whose primary language is sign
language.
   (c) To ensure access to health care information and services for
limited-English-speaking or non-English-speaking residents and deaf
residents, licensed general acute care hospitals shall:
   (1) Review existing policies regarding interpreters for patients
with limited-English proficiency and for patients who are deaf,
including the availability of staff to act as interpreters.
   (2) Adopt and review annually a policy for providing language
assistance services to patients with language or communication
barriers.  The policy shall include procedures for providing, to the
extent possible, as determined by the hospital, the use of an
interpreter whenever a language or communication barrier exists,
except where the patient, after being informed of the availability of
the interpreter service, chooses to use a family member or friend
who volunteers to interpret.  The procedures shall be designed to
maximize efficient use of interpreters and minimize delays in
providing interpreters to patients.  The procedures shall ensure, to
the extent possible, as determined by the hospital, that interpreters
are available, either on the premises or accessible by telephone, 24
hours a day.  The hospital shall annually transmit to the state
department a copy of the updated policy and shall include a
description of its efforts to ensure adequate and speedy
communication between patients with language or communication
barriers and staff.
   (3) Develop, and post in conspicuous locations, notices that
advise patients and their families of the availability of
interpreters, the procedure for obtaining an interpreter and the
telephone numbers where complaints may be filed concerning
interpreter service problems, including, but not limited to, a T.D.D.
number for the hearing impaired.  The notices shall be posted, at a
minimum, in the emergency room, the admitting area, the entrance, and
in outpatient areas.  Notices shall inform patients that interpreter
services are available upon request, shall list the languages for
which interpreter services are available, shall instruct patients to
direct complaints regarding interpreter services to the state
department, and shall provide the local address and telephone number
of the state department, including, but not limited to, a T.D.D.
number for the hearing impaired.
   (4) Identify and record a patient's primary language and dialect
on one or more of the following:  patient medical chart, hospital
bracelet, bedside notice, or nursing card.
   (5) Prepare and maintain as needed a list of interpreters who have
been identified as proficient in sign language and in the languages
of the population of the geographical area serviced who have the
ability to translate the names of body parts, injuries, and symptoms.
   (6) Notify employees of the hospital's commitment to provide
interpreters to all patients who  request them.
   (7) Review all standardized written forms, waivers, documents, and
informational materials available to patients upon admission to
determine which to translate into languages other than English.
   (8) Consider providing its nonbilingual staff with standardized
picture and phrase sheets for use in routine communications with
patients who have language or communication barriers.
   (9) Consider developing community liaison groups to enable the
hospital and the limited-English-speaking and deaf communities to
ensure the adequacy of the interpreter services.
   (d) Noncompliance with this section shall be reportable to
licensing authorities.
   (e) Section 1290 shall not apply to this section.
1259.5.  By January 1, 1995, each general acute care hospital, acute
psychiatric hospital, special hospital, psychiatric health facility,
and chemical dependency recovery hospital shall establish written
policies and procedures to screen patients routinely for the purpose
of detecting spousal or partner abuse.  The policies shall include
guidelines on all of the following:
   (a) Identifying, through routine screening, spousal or partner
abuse among patients.
   (b) Documenting patient injuries or illnesses attributable to
spousal or partner abuse.
   (c) Educating appropriate hospital staff about the criteria for
identifying, and the procedures for handling, patients whose injuries
or illnesses are attributable to spousal or partner abuse.
   (d) Advising patients exhibiting signs of spousal or partner abuse
of crisis intervention services that are available either through
the hospital facility or through community-based crisis intervention
and counseling services.
   (e) Providing to patients who exhibit signs of spousal or partner
abuse information on domestic violence and a referral list, to be
updated periodically, of private and public community agencies that
provide, or arrange for, evaluation of and care for persons
experiencing spousal or partner abuse, including, but not limited to,
hot lines, local battered women's shelters, legal services, and
information about temporary restraining orders.
1260.  (a) Except as provided in subdivision (b), any member of the
board of directors of a nonprofit corporation that is subject to
Section 5914 of the Corporations Code, who negotiates the terms and
conditions of a sale or transfer of assets, as described in Section
5914 of the Corporations Code, is prohibited from receiving, directly
or indirectly, any salary, compensation, payment, or other form of
remuneration from the for-profit corporation or entity or mutual
benefit corporation following the close of the sale or other transfer
of assets.  This prohibition shall not apply to any reimbursement or
payment made to a member of the board of directors, who is a
physician or other health care provider, for direct patient care
services provided to patients covered by a health insurer, health
care service plan, employer, or other entity that provides health
care coverage, and that is owned, operated, or affiliated with the
purchasing for-profit corporation or entity, provided that the
amounts payable for the services rendered are no greater than the
amounts payable to other physicians or health care providers
providing the same or similar services.
   For the purpose of this section, "direct patient care services"
mean health care services provided directly to a patient, and do not
include services provided through an intermediary.  Further, in order
to qualify for the exemption in this subdivision, the direct patient
care services must be health care services that are regularly
provided by other physicians or other health care providers in the
community who are also receiving reimbursements or payments from the
same health insurer, health care service plan, employer, or other
entity that is owned or operated by, or affiliated with, the
purchasing for-profit corporation or entity.
   (b) After a period of two years following the close of the sale or
other transfer of assets, a person who was a member of the board of
directors of the nonprofit corporation who is prohibited from
receiving any remuneration from the for-profit corporation or entity
or mutual benefit corporation under subdivision (a) may enter into
usual and customary business transactions with the for-profit
corporation or entity or mutual benefit corporation so long as the
following facts are established:
   (1) Prior to authorizing or approving the transaction, the
representative of the for-profit corporation or entity or mutual
benefit corporation considered and in good faith determined after
reasonable investigation under the circumstances that the corporation
could not have obtained a more advantageous arrangement with
reasonable effort under the circumstances.
   (2) The for-profit corporation or entity or mutual benefit
corporation, in fact could not have obtained a more advantageous
arrangement with reasonable effort under the circumstances.
   (c) Any person who is a member of management of the nonprofit
corporation and who presents information or opinions to the board
regarding the sale or other transfer of assets as described in
subdivision (a) that are relied upon, or considered by, any of the
board members in making decisions regarding the sale or transfer, may
make a written affirmative declaration that he or she will not work
for, or receive any form of remuneration from, the for-profit
corporation or entity or the mutual benefit corporation in the
future.
   (d) In making any decision regarding the sale or other transfer of
the nonprofit corporation's assets, as described in Section 5914 of
the Corporations Code, the board of the nonprofit corporation is
prohibited from substantially relying on any information presented by
any person to whom subdivision (c) applies who has not made a
written affirmative declaration pursuant to subdivision (c).  This
subdivision shall not apply to any person whose only role in the sale
or transfer is to provide to the nonprofit corporation exclusively
factual information about the nonprofit corporation, community,
financial status, or other similar data.
   (e) In performing those duties of a director set forth in
subdivision (d), the board of directors may contract with independent
counsel, accountants, financial analysts, or other professionals
whom the board believes to be reliable and competent in the matters
presented, to review and evaluate information and advice presented by
an employee who has not signed an affirmative declaration pursuant
to subdivision (c).  Any director who substantially relies on
information and advice presented by such an independent professional
shall be deemed to have not violated subdivision (d).
1260.1.  (a) Except as provided in subdivision (b), any member of
the board of directors of a nonprofit corporation that is subject to
Section 5920 of the Corporations Code, who negotiates the terms and
conditions of a sale or transfer of assets, as described in Section
5920 of the Corporations Code, is prohibited from receiving, directly
or indirectly, any salary, compensation, payment, or other form of
remuneration from the purchasing public benefit corporation or entity
following the close of the sale or other transfer of assets.  This
prohibition shall not apply to any reimbursement or payment made to a
member of the board of directors, who is a physician or other health
care provider, for direct patient care services provided to patients
covered by a health insurer, health care service plan, employer, or
other entity that provides health care coverage, and that is owned,
operated, or affiliated with the purchasing public benefit
corporation or entity, provided that the amounts payable for the
services rendered are no greater than the amounts payable to other
physicians or health care providers providing the same or similar
services.
   For the purpose of this section, "direct patient care services"
means health care services provided directly to a patient, and does
not include services provided through an intermediary.  Further, in
order to qualify for the exemption in this subdivision, the direct
patient care services must be health care services that are regularly
provided by other physicians or other health care providers in the
community who are also receiving reimbursements or payments from the
same health insurer, health care service plan, employer, or other
entity that is owned or operated by, or affiliated with, the
purchasing public benefit corporation or entity.
   (b) After a period of two years following the close of the sale or
other transfer of assets, a person who was a member of the board of
directors of the selling nonprofit corporation who is prohibited from
receiving any remuneration from the purchasing public benefit
corporation or entity under subdivision (a) may enter into usual and
customary business transactions with the purchasing public benefit
corporation or entity so long as the following facts are established:
   (1) Prior to authorizing or approving the transaction, the
representative of the purchasing public benefit corporation or entity
considered and in good faith determined after reasonable
investigation under the circumstances that the purchasing public
benefit corporation could not have obtained a more advantageous
arrangement with reasonable effort under the circumstances.
   (2) The purchasing public benefit corporation or entity, in fact,
could not have obtained a more advantageous arrangement with
reasonable effort under the circumstances.
   (c) Any person who is a member of management of the selling
nonprofit corporation and who presents information or opinions to the
board regarding the sale or other transfer of assets as described in
subdivision (a) that are relied upon, or considered by, any of the
board members in making decisions regarding the sale or transfer, may
make a written affirmative declaration that he or she will not work
for, or receive any form of remuneration from, the purchasing public
benefit corporation or entity in the future.
   (d) In making any decision regarding the sale or other transfer of
the nonprofit corporation's assets, as described in Section 5920 of
the Corporations Code, the board of the selling nonprofit corporation
is prohibited from substantially relying on any information
presented by any person to whom subdivision (c) applies who has not
made a written affirmative declaration pursuant to subdivision (c).
This subdivision shall not apply to any person whose only role in the
sale or transfer is to provide to the selling nonprofit corporation
exclusively factual information about the selling nonprofit
corporation, community, financial status, or other similar data.
   (e) In performing those duties of a director set forth in
subdivision (d), the board of directors may contract with independent
counsel, accountants, financial analysts, or other professionals
whom the board believes to be reliable and competent in the matters
presented, to review and evaluate information and advice presented by
an employee who has not signed an affirmative declaration pursuant
to subdivision (c).  Any director who substantially relies on
information and advice presented by the independent professional
shall be deemed to have not violated subdivision (d).
1261.  (a) A health facility shall allow a patient's domestic
partner, the children of the patient's domestic partner, and the
domestic partner of the patient's parent or child to visit, unless
one of the following is met:
   (1) No visitors are allowed.
   (2) The facility reasonably determines that the presence of a
particular visitor would endanger the health or safety of a patient,
member of the health facility staff, or other visitor to the health
facility, or would significantly disrupt the operations of a
facility.
   (3) The patient has indicated to health facility staff that the
patient does not want this person to visit.
   (b) This section may not be construed to prohibit a health
facility from otherwise establishing reasonable restrictions upon
visitation, including restrictions upon the hours of visitation and
number of visitors.
   (c) For purposes of this section, "domestic partner" has the same
meaning as that term is used in Section 297 of the Family Code.
1261.3.  (a) Notwithstanding any other provision of law, for a
patient aged 50 years or older, a registered nurse or licensed
pharmacist may administer in a skilled nursing facility, as defined
in subdivision (c) of Section 1250, influenza and pneumococcal
immunizations pursuant to standing orders and without
patient-specific orders if all of the following criteria are met:
   (1) The skilled nursing facility medical director, as defined in
Section 72305 of Title 22 of the California Code of Regulations, has
approved the immunization standing orders established by the
facility.
   (2) The standing orders meet the recommendations of the Advisory
Committee on Immunization Practices (ACIP) of the federal Centers for
Disease Control and Prevention.
   (b) Nothing in this section amends, alters, or restricts the scope
of registered nurse practice including, but not limited to, the
scope of practice set forth in Article 2 (commencing with Section
2725) of Chapter 6 of Division 2 of the Business and Professions
Code, the implementing regulations, and interpretative bulletins or
practice advisories issued by the Board of Registered Nursing.
1261.5.  (a) The number of oral dosage form or suppository form
drugs provided by a pharmacy to a health facility licensed pursuant
to subdivision (c) or (d), or both (c) and (d), of Section 1250 for
storage in a secured emergency supplies container, pursuant to
Section 4119 of the Business and Professions Code, shall be limited
to 24.  The State Department of Health Services may limit the number
of doses of each drug available to not more than four doses of any
separate drug dosage form in each emergency supply.
   (b) Any limitations established pursuant to subdivision (a) on the
number and quantity of oral dosage or suppository form drugs
provided by a pharmacy to a health facility licensed pursuant to
subdivision (c), (d), or both (c) and (d), of Section 1250 for
storage in a secured emergency supplies container shall not apply to
an automated drug delivery system, as defined in Section 1261.6, when
a pharmacist controls access to the drugs.
1261.6.  (a) (1) For purposes of this section and Section 1261.5, an
"automated drug delivery system" means a mechanical system that
performs operations or activities, other than compounding or
administration, relative to the storage, dispensing, or distribution
of drugs. An automated drug delivery system shall collect, control,
and maintain all transaction information to accurately track the
movement of drugs into and out of the system for security, accuracy,
and accountability.
   (2) For purposes of this section, "facility" means a health
facility licensed pursuant to subdivision (c), (d), or both, of
Section 1250 that has an automated drug delivery system provided by a
pharmacy.
   (3) For purposes of this section, "pharmacy services" means the
provision of both routine and emergency drugs and biologicals to meet
the needs of the patient as prescribed by a physician.
   (b) Transaction information shall be made readily available in a
written format for review and inspection by individuals authorized by
law. These records shall be maintained in the facility for a minimum
of three years.
   (c) Individualized and specific access to automated drug delivery
systems shall be limited to facility and contract personnel
authorized by law to administer drugs.
   (d) (1) The facility and the pharmacy shall develop and implement
written policies and procedures to ensure safety, accuracy,
accountability, security, patient confidentiality, and maintenance of
the quality, potency, and purity of stored drugs. Policies and
procedures shall define access to the automated drug delivery system
and limits to access to equipment and drugs.
   (2) All policies and procedures shall be maintained at the
pharmacy operating the automated drug delivery system and the
location where the automated drug delivery system is being used.
   (e) When used as an emergency pharmaceutical supplies container,
drugs removed from the automated drug delivery system shall be
limited to the following:
   (1) A new drug order given by a prescriber for a patient of the
facility for administration prior to the next scheduled delivery from
the pharmacy, or 72 hours, whichever is less. The drugs shall be
retrieved only upon authorization by a pharmacist and after the
pharmacist has reviewed the prescriber's order and the patient's
profile for potential contraindications and adverse drug reactions.
   (2) Drugs that a prescriber has ordered for a patient on an
as-needed basis, if the utilization and retrieval of those drugs are
subject to ongoing review by a pharmacist.
   (3) Drugs designed by the patient care policy committee or
pharmaceutical service committee of the facility as emergency drugs
or acute onset drugs. These drugs may be retrieved from an automated
drug delivery system pursuant to the order of a prescriber for
emergency or immediate administration to a patient of the facility.
Within 48 hours after retrieval under this paragraph, the case shall
be reviewed by a pharmacist.
   (f) When used to provide pharmacy services pursuant to Section
4119.1 of the Business and Professions Code, the automated drug
delivery system shall be subject to all of the following
requirements:
   (1) Drugs removed from the automated drug delivery system for
administration to a patient shall be in properly labeled units of
administration containers or packages.
   (2) A pharmacist shall review and approve all orders prior to a
drug being removed from the automated drug delivery system for
administration to a patient. The pharmacist shall review the
prescriber's order and the patient's profile for potential
contraindications and adverse drug reactions.
   (3) The pharmacy providing services to the facility pursuant to
Section 4119.1 of the Business and Professions Code shall control
access to the drugs stored in the automated drug delivery system.
   (4) Access to the automated drug delivery system shall be
controlled and tracked using an identification or password system or
biosensor.
   (5) The automated drug delivery system shall make a complete and
accurate record of all transactions which will include all users
accessing the system and all drugs added to or removed from the
system.
   (6) After the pharmacist reviews the prescriber's order, access by
licensed personnel to the automated drug delivery system shall be
limited only to the drug as ordered by the prescriber and reviewed by
the pharmacist and that is specific to the patient. When the
prescriber's order requires a dosage variation of the same drug,
licensed personnel shall only have access to the drug ordered for
that scheduled time of administration.
   (g) The stocking of an automated drug delivery system shall be
performed by a pharmacist. If the automated drug delivery system
utilizes removable pockets or drawers, or similar technology, the
stocking system may be done outside of the facility and be delivered
to the facility if all of the following conditions are met:
   (1) The task of placing drugs into the removable pockets or
drawers is performed by a pharmacist or by an intern pharmacist or a
pharmacy technician working under the direct supervision of a
pharmacist.
   (2) The removable pockets or drawers are transported between the
pharmacy and the facility in a secure tamper-evident container.
   (3) The facility, in conjunction with the pharmacy, has developed
policies and procedures to ensure that the pockets or drawers are
properly placed into the automated drug delivery system.
   (h) Review of the drugs contained within, and the operation and
maintenance of, the automated drug delivery system shall be done in
accordance with law and shall be the responsibility of the pharmacy.
The review shall be conducted on a monthly basis by a pharmacist and
shall include a physical inspection of the drugs in the automated
drug delivery system, an inspection of the automated drug delivery
system machine for cleanliness, and a review of all transaction
records in order to verify the security and accountability of the
system.
   (i) Drugs dispensed from an automated drug delivery system that
meets the requirements of this section shall not be subject to the
labeling requirements of Section 4076 of the Business and Professions
Code or Section 111480 of this code if the drugs to be placed into
the automated drug delivery system are in unit dose packaging or unit
of use and if the information required by Section 4076 of the
Business and Professions Code and Section 111480 of this code is
readily available at the time of drug administration.
1262.  (a) When a mental health patient is being discharged from one
of the facilities specified in subdivision (c), the patient and the
patient's conservator, guardian, or other legally authorized
representative shall be given a written aftercare plan prior to the
patient's discharge from the facility.  The written aftercare plan
shall include, to the extent known, all of the following components:
   (1) The nature of the illness and followup required.
   (2) Medications including side effects and dosage schedules.  If
the patient was given an informed consent form with his or her
medications, the form shall satisfy the requirement for information
on side effects of the medications.
   (3) Expected course of recovery.
   (4) Recommendations regarding treatment that are relevant to the
patient's care.
   (5) Referrals to providers of medical and mental health services.
   (6) Other relevant information.
   (b) The patient shall be advised by facility personnel that he or
she may designate another person to receive a copy of the aftercare
plan.  A copy of the aftercare plan shall be given to any person
designated by the patient.
   (c) Subdivision (a) applies to all of the following facilities:
   (1) A state mental hospital.
   (2) A general acute care hospital as described in subdivision (a)
of Section 1250.
   (3) An acute psychiatric hospital as described in subdivision (b)
of Section 1250.
   (4) A psychiatric health facility as described in Section 1250.2.
   (5) A mental health rehabilitation center as described in Section
5675 of the Welfare and Institutions Code.
   (6) A skilled nursing facility with a special treatment program,
as described in Section 51335 and Sections 72443 to 72475, inclusive,
of Title 22 of the California Code of Regulations.
   (d) For purposes of this section, "mental health patient" means a
person who is admitted to the facility primarily for the diagnosis or
treatment of a mental disorder.
1262.5.  (a) Each hospital shall have a written discharge planning
policy and process.
   (b) The policy required by subdivision (a) shall require that
appropriate arrangements for posthospital care, including, but not
limited to, care at home, in a skilled nursing or intermediate care
facility, or from a hospice, are made prior to discharge for those
patients who are likely to suffer adverse health consequences upon
discharge if there is no adequate discharge planning.  If the
hospital determines that the patient and family members or interested
persons need to be counseled to prepare them for posthospital care,
the hospital shall provide for that counseling.
   (c) The process required by subdivision (a) shall require that the
patient be informed, orally or in writing, of the continuing health
care requirements following discharge from the hospital.  The right
to information regarding continuing health care requirements
following discharge shall apply to the person who has legal
responsibility to make decisions regarding medical care on behalf of
the patient, if the patient is unable to make those decisions for
himself or herself.  In addition, a patient may request that friends
or family members be given this information, even if the patient is
able to make his or her own decisions regarding medical care.
   (d) (1) A transfer summary shall accompany the patient upon
transfer to a skilled nursing or intermediate care facility or to the
distinct part-skilled nursing or intermediate care service unit of
the hospital.  The transfer summary shall include essential
information relative to the patient's diagnosis, hospital course,
pain treatment and management, medications, treatments, dietary
requirement, rehabilitation potential, known allergies, and treatment
plan, and shall be signed by the physician.
   (2) A copy of the transfer summary shall be given to the patient
and the patient's legal representative, if any, prior to transfer to
a skilled nursing or intermediate care facility.
   (e) A hospital shall establish and implement a written policy to
ensure that each patient receives, at the time of discharge,
information regarding each medication dispensed, pursuant to Section
4074 of the Business and Professions Code.
   (f) A contract between a general acute care hospital and a health
care service plan that is issued, amended, renewed, or delivered on
or after January 1, 2002, may not contain a provision that prohibits
or restricts any health care facility's compliance with the
requirements of this section.
1262.6.  (a) Each hospital shall provide each patient, upon
admission or as soon thereafter as reasonably practical, written
information regarding the patient's right to the following:
   (1) To be informed of continuing health care requirements
following discharge from the hospital.
   (2) To be informed that, if the patient so authorizes, that a
friend or family member may be provided information about the patient'
s continuing health care requirements following discharge from the
hospital.
   (3) Participate actively in decisions regarding medical care.  To
the extent permitted by law, participation shall include the right to
refuse treatment.
   (4) Appropriate pain assessment and treatment consistent with
Sections 124960 and 124961.
   (b) A hospital may include the information required by this
section with other notices to the patient regarding patient rights.
If a hospital chooses to include this information along with existing
notices to the patient regarding patient rights, this information
shall be provided when the hospital exhausts its existing inventory
of written materials and prints new written materials.
1262.7.  (a) A skilled nursing facility, as defined in subdivision
(c) of Section 1250, shall admit a patient only upon a physician's
order and only if the facility is able to provide necessary care for
the patient.
   (b) The administrator or designee of a skilled nursing facility
shall be responsible for screening patients for admission to the
facility to ensure that the facility admits only those patients for
whom it can provide necessary care.  The administrator, or his or her
designee, shall conduct preadmission personal interviews as
appropriate with the patient's physician, the patient, the patient's
next of kin or sponsor, or the representative of the facility from
which the patient is being transferred.  A telephone interview may be
conducted when a personal interview is not feasible.
1262.8.  (a) A hospital shall contact an enrollee's health care
service plan to obtain the enrollee's medical record information
prior to admitting the enrollee for poststabilization care as an
inpatient, or prior to transferring the enrollee for
poststabilization care to a noncontracting hospital, or prior to
providing poststabilization care to an enrollee who was admitted to a
noncontracting hospital for medically necessary care prior to
stabilization of an emergency medical condition, if all of the
following apply:
   (1) The hospital is able to obtain the name of the enrollee's
health care service plan.
   (2) The hospital is a noncontracting California hospital with a
noncontracting physician and surgeon who wants to do any of the
following:
   (A) Admit the enrollee as an inpatient in a noncontracting
hospital for poststabilization care following the provision of
emergency services and care.
   (B) Transfer the enrollee to a noncontracting hospital for
poststabilization care following the provision of emergency services
and care.
   (C) Provide poststabilization care to an enrollee who was admitted
to a noncontracting hospital for medically necessary care prior to
stabilization of an emergency medical condition.
   (3) The health care service plan has a physician and surgeon who
is regularly assigned to provide emergency services and care in a
basic or comprehensive emergency department, who is available within
30 minutes of the time the hospital contacts the health care service
plan by telephone, and who has all of the following:
   (A) Has immediate access to the enrollee's medical records.
   (B) Has the ability to promptly discuss the enrollee's records
with the noncontracting physician and surgeon or appropriate hospital
representative, if the noncontracting physician and surgeon or
appropriate hospital representative requests that discussion.
   (C) Has the ability to transmit the appropriate portion of the
records requested by the noncontracting physician and surgeon or
appropriate hospital representative to the hospital via facsimile
transmission or electronic mail in a manner that complies with all
legal requirements to protect the enrollee's privacy.
   (4) The health care service plan can provide authorization for
poststabilization care and provide information concerning cost
sharing that the noncontracting hospital may charge the enrollee
under the enrollee's coverage.
   (b) A hospital required to contact an enrollee's health care
service plan pursuant to this section shall do so as soon as
reasonably possible, but not until the enrollee's medical condition
is stabilized, as determined by the noncontracting physician and
surgeon at the time the emergency services and care are rendered.
   (c) If a hospital required to contact an enrollee's health care
service plan pursuant to this section fails to do so, the hospital
shall not bill the enrollee for poststabilization care.
   (d) Subdivisions (a), (b), and (c) do not apply to a physician and
surgeon providing medical services at the hospital.
   (e) For purposes of this section, a representative of the hospital
or noncontracting physician and surgeon is not required to make more
than one telephone call to the number provided in advance by the
health care service plan.  The representative of the hospital who
makes the telephone call may be, but is not required to be, a
physician and surgeon.
   (f) For purposes of this section, "poststabilization care" means
necessary medical care following stabilization of an emergency
medical condition.
1263.  (a) This section shall be known and may be cited as the
Dementia Training Standards Act of 2001.
   (b) (1) Any certified nurse assistant employed by a skilled
nursing facility or intermediate care facility shall have completed
at least two hours of initial dementia-specific training  as part of
the facility's orientation program.  The training shall be completed
within the first 40 hours of employment.
   (2) The facility shall develop a dementia-specific training
component within the existing orientation program, to be implemented
no later than July 1, 2002.
   (3) The facility's modified orientation program shall be reviewed
by the department in a phasein schedule that begins no later than
July 1, 2002, and is completed no later than July 1, 2005.
   (c) Any certified nursing assistant employed by a skilled nursing
facility or intermediate care facility shall participate in a
minimum of five hours of dementia-specific in-service training per
year, as part of the facility's in-service training.
   (d) Freestanding and hospital-based pediatric skilled nursing
facilities with exclusively pediatric occupancy shall be exempt from
the requirements set forth in this section.
1264.  (a) Any health facility licensed under Section 1250 that
provides prenatal screening ultrasound to detect congenital heart
defects shall require that the ultrasound be performed by a
sonographer who is nationally certified in obstetrical ultrasound by
the American Registry for Diagnostic Medical Sonography (ARDMS),
nationally certified in cardiac sonography by Cardiovascular
Credentialing International (CCI), or credentialed in sonography by
the American Registry of Radiologic Technologists (ARRT).
   (b) For purposes of this section, the following shall apply:
   (1) A sonographer is also known as an "ultrasound technologist" or
"sonologist."
   (2) "Sonographer" means any nonphysician who is qualified by
national certification or academic or clinical experience to perform
diagnostic medical ultrasound, with a subspecialty in obstetrical
ultrasound.
   (c) (1) Any sonographer who is certified as required in
subdivision (a) or otherwise meets the requirements of this section,
shall, in performing a prenatal ultrasound to detect congenital heart
defects, perform the work under the supervision of a licensed
physician and surgeon.
   (2) For purposes of this section, licensed physician and surgeon
means any physician and surgeon, licensed pursuant to Chapter 5
(commencing with Section 2000) of Division 2 of the Business and
Professions Code.
   (d) Any person with a minimum of two years of full-time work
experience in this state as a sonographer in prenatal ultrasound and
has obtained, or is in the process of obtaining, 30 continuing
medical education credits over a three-year period in ultrasound
shall be deemed to be in compliance with the requirements of this
section.
   (e) A health facility shall develop policies and procedures to
implement the requirements of this section.
   (f) This section and policies and procedures adopted pursuant to
this section shall not prohibit any physician and surgeon licensed
pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of
the Business and Professions Code from performing a prenatal
ultrasound nor in any other way limit the ability of a licensed
physician and surgeon to practice medicine in a manner consistent
with that license.
   (g) This section and policies and procedures adopted pursuant to
this section shall not apply to any physician and surgeon,
sonologist, certified nurse-midwife, or nurse practitioner who
performs limited prenatal ultrasounds for the purpose of obtaining an
amniotic fluid index, fetal position, a biophysical profile or
dating a pregnancy prior to 20 weeks gestation.
   (h) Article 4 (commencing with Section 1235) and any other
provision relating to criminal sanctions for violations of this
chapter shall not apply to any person who violates this section or
any regulation adopted pursuant to this section.
   (i) This section shall become operative on July 1, 2006.


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