2007 California Business and Professions Code Article 11.5. Surgery In Certain Outpatient Settings

CA Codes (bpc:2215-2217)

2215.  The Legislature finds and declares that in this state,
significant surgeries are being performed in unregulated
out-of-hospital settings.  The Legislature further finds and declares
that without appropriate oversight, some of these settings may be
operating in a manner which is injurious to the public health,
welfare, and safety.  Although the health professionals delivering
health care services in these settings are licensed, further quality
assurance is needed to ensure that health care services are safely
and effectively performed in these settings.  The Legislature further
recognizes that there is a wide range of surgical procedures safely
performed in a myriad of outpatient settings, and the degree of
patient risk varies greatly.  It is the intent of the Legislature to
create regulations that directly impact patient safety.  It is not
the intent of the Legislature to require standards in excess of those
requirements in Section 1248.15, or to require physical
modifications to facilities unless the modifications or standards
directly impact patient safety and are cost-effective.  The cost
effectiveness of any modifications shall be taken into consideration
by the Division of Licensing of the Medical Board of California, and
shall ensure that the least costly and effective method of achieving
patient safety is required.


2216.  On or after July 1, 1996, no physician and surgeon shall
perform procedures in an outpatient setting using anesthesia, except
local anesthesia or peripheral nerve blocks, or both, complying with
the community standard of practice, in doses that, when administered,
have the probability of placing a patient at risk for loss of the
patient's life-preserving protective reflexes, unless the setting is
specified in Section 1248.1.  Outpatient settings where anxiolytics
and analgesics are administered are excluded when administered, in
compliance with the community standard of practice, in doses that do
not have the probability of placing the patient at risk for loss of
the patient's life-preserving protective reflexes.
   The definition of "outpatient settings" contained in subdivision
(c) of Section 1248 shall apply to this section.



2216.1.  On and after July 1, 2000, it is unprofessional conduct for
a physician and surgeon to perform procedures in any outpatient
setting except in compliance with Section 2216, unless the setting
has a minimum of two staff persons on the premises, one of whom shall
either be a licensed physician and surgeon or a licensed health care
professional with current certification in advanced cardiac life
support (ACLS), as long as a patient is present who has not been
discharged from supervised care.



2216.2.  (a) It is unprofessional conduct for a physician and
surgeon to fail to provide adequate security by liability insurance,
or by participation in an interindemnity trust, for claims by
patients arising out of surgical procedures performed outside of a
general acute care hospital as defined in subdivision (a) of Section
1250 of the Health and Safety Code.
   (b) For purposes of this section, the board shall determine what
constitutes adequate security.
   (c) Nothing in this section shall require an insurer admitted to
transact liability insurance in this state to provide coverage to a
physician and surgeon.
   (d) The security required by this section shall be acceptable only
if provided by any one of the following:
   (1) An insurer admitted pursuant to Section 700 of the Insurance
Code to transact liability insurance in this state.
   (2) An insurer that appears on the list of eligible surplus line
insurers pursuant to subdivision (f) of Section 1765.1 of the
Insurance Code.
   (3) A cooperative corporation authorized by Section 1280.7 of the
Insurance Code.
   (4) An insurer licensed to transact liability insurance in at
least one state of the United States.



2217.  The Division of Licensing of the Medical Board of California
may adopt regulations to implement this article and Chapter 1.3
(commencing with Section 1248) of Division 2 of the Health and Safety
Code.