By Cuellar of Hidalgo, Gutierrez, H.B. No. 1483 De La Garza, Munoz, et al. A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the regulation of women's service centers; providing 1-3 civil and criminal penalties. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Subtitle B, Title 4, Health and Safety Code, is 1-6 amended by adding Chapter 249 to read as follows: 1-7 CHAPTER 249. WOMEN'S SERVICE CENTER 1-8 Sec. 249.001. DEFINITION. In this chapter, "women's service 1-9 center" means a facility that offers services, facilities, and beds 1-10 for two or more unrelated individuals who may require a stay of 1-11 longer than 24 hours but not longer than three days and who are 1-12 solely admitted, treated, and discharged for women's services 1-13 related to education, outreach, support services, nursery, 1-14 obstetrical care, gynecological care, and surgery. 1-15 Sec. 249.002. LICENSE REQUIRED. (a) A person may not 1-16 establish or operate a women's service center in this state without 1-17 an appropriate license issued under this chapter. 1-18 (b) Each women's service center must have a separate 1-19 license. 1-20 (c) A license is not transferable or assignable. 1-21 (d) The department may issue a temporary license pending the 1-22 completion of the application procedures under Section 249.004 if 1-23 the issuance is appropriate to safeguard the health and safety of 1-24 the patients in the women's service center. 2-1 Sec. 249.003. EXEMPTIONS FROM LICENSING REQUIREMENT. The 2-2 following facilities need not be licensed under this chapter: 2-3 (1) a hospital licensed under Chapter 241; 2-4 (2) an ambulatory surgical center licensed under 2-5 Chapter 243; 2-6 (3) a birthing center licensed under Chapter 244; 2-7 (4) an office or clinic of a licensed physician, 2-8 certified nurse midwife, or certified nurse practitioner; 2-9 (5) a facility maintained or operated by the federal 2-10 government or an agency of the federal government; or 2-11 (6) a facility maintained or operated by this state or 2-12 an agency of this state. 2-13 Sec. 249.004. LICENSE APPLICATION AND ISSUANCE. (a) An 2-14 applicant for a women's service center license must submit an 2-15 application to the department on a form prescribed by the 2-16 department. 2-17 (b) Each application must be accompanied by a nonrefundable 2-18 license fee in an amount set by the board. 2-19 (c) The department shall issue the appropriate license if, 2-20 after inspection and investigation, it finds that the applicant and 2-21 the center meet the requirements of this chapter and the standards 2-22 adopted under this chapter. 2-23 (d) The license fee shall be paid annually on renewal of the 2-24 license. 2-25 Sec. 249.005. INSPECTIONS. The department may inspect a 2-26 women's service center at reasonable times as necessary to assure 2-27 compliance with this chapter. 3-1 Sec. 249.006. FEES. The board shall set fees imposed by 3-2 this chapter in amounts reasonable and necessary to defray the cost 3-3 of administering this chapter. 3-4 Sec. 249.007. PROVISIONS RELATING TO PATIENTS. (a) A 3-5 women's service center may require a patient to stay in the center 3-6 longer than three days if a physician determines that a longer stay 3-7 is medically necessary and appropriate for that patient. A women's 3-8 service center that requires a longer stay under this subsection 3-9 does not thereby lose its status as a women's service center and is 3-10 not required to obtain any additional licenses based solely on that 3-11 fact. 3-12 (b) A woman who has received prenatal care at a women's 3-13 service center is eligible for delivery services at that center. 3-14 However, emergency delivery services shall not be denied. 3-15 Sec. 249.008. ADOPTION OF RULES. (a) The board shall adopt 3-16 rules necessary to implement this chapter. 3-17 (b) The board shall adopt rules that provide requirements 3-18 for the issuance, renewal, denial, suspension, and revocation of a 3-19 license. 3-20 Sec. 249.009. MINIMUM STANDARDS. The board shall adopt 3-21 rules that provide minimum standards for a women's service center, 3-22 including standards that relate to: 3-23 (1) the protection of the health and safety of a 3-24 patient; 3-25 (2) the construction and design, including plumbing, 3-26 heating, lighting, ventilation, and other design standards 3-27 necessary to ensure the health and safety of patients; 4-1 (3) construction plan approval and inspection; 4-2 (4) the sanitary and hygienic conditions in the center 4-3 and its surroundings; 4-4 (5) the equipment essential to the health and safety 4-5 of the patients; 4-6 (6) the qualifications of the professional staff and 4-7 other personnel; 4-8 (7) minimum requirements for staffing by physicians 4-9 and nurses; 4-10 (8) a quality assurance program for patient care; 4-11 (9) the organizational structure, including the lines 4-12 of authority and delegation of responsibility; 4-13 (10) clinical records of care and services, including 4-14 the disposal or destruction of those records; 4-15 (11) written agreements for contractual services with 4-16 general hospitals; 4-17 (12) the provision and coordination of treatment and 4-18 services; 4-19 (13) minimum requirements for entering into a written 4-20 agreement with a general hospital for an immediate transfer of 4-21 patients when special services are needed but are not available at 4-22 the women's service center; 4-23 (14) the issuance, renewal, denial, suspension, 4-24 emergency suspension, and revocation of a license required by this 4-25 chapter; and 4-26 (15) any other aspect of the operation of a women's 4-27 service center that the board considers necessary to protect the 5-1 public. 5-2 Sec. 249.010. MINIMUM STANDARDS FOR PATIENT TRANSFERS. 5-3 (a) The board shall adopt rules to implement the minimum standards 5-4 governing the transfer of patients from women's service centers to 5-5 hospitals. 5-6 (b) The rules must provide that patient transfers to 5-7 hospitals be accomplished through women's service center policies 5-8 that result in medically appropriate transfers from physician to 5-9 physician and from women's service centers to hospitals by 5-10 providing: 5-11 (1) for notification to the receiving hospital before 5-12 the patient is transferred and confirmation by the receiving 5-13 hospital that the patient meets the receiving hospital's admissions 5-14 criteria relating to appropriate bed, physician, and other services 5-15 necessary to treat the patient; 5-16 (2) for the use of medically appropriate life support 5-17 measures that a reasonable and prudent physician exercising 5-18 ordinary care in the same or a similar locality would use to 5-19 stabilize the patient before the transfer and to sustain the 5-20 patient during the transfer; 5-21 (3) for the provision of appropriate personnel and 5-22 equipment that a reasonable and prudent physician exercising 5-23 ordinary care in the same or a similar locality would use for the 5-24 transfer; 5-25 (4) for the transfer of all necessary records for 5-26 continuing the care for the patient; and 5-27 (5) that the transfer of a patient not be predicated 6-1 on arbitrary, capricious, or unreasonable discrimination because of 6-2 race, religion, national origin, age, sex, physical condition, or 6-3 economic status. 6-4 Sec. 249.011. DENIAL, SUSPENSION, OR REVOCATION OF LICENSE. 6-5 (a) The department may deny, suspend, or revoke a license for a 6-6 violation of this chapter or a rule adopted under this chapter. 6-7 (b) The denial, suspension, or revocation of a license by 6-8 the department and the appeal from that action are governed by the 6-9 procedures for a contested case hearing under the Administrative 6-10 Procedure and Texas Register Act (Article 6252-13a, Vernon's Texas 6-11 Civil Statutes). 6-12 Sec. 249.012. INJUNCTION. (a) The department may petition 6-13 a district court for a temporary restraining order to restrain a 6-14 continuing violation of the standards or licensing requirements 6-15 provided under this chapter if the department finds that the 6-16 violation creates an immediate threat to the health and safety of 6-17 the patients of a women's service center. 6-18 (b) A district court, on petition of the department and on a 6-19 finding by the court that a person is violating the standards or 6-20 licensing requirements provided under this chapter, may by 6-21 injunction: 6-22 (1) prohibit a person from continuing a violation of 6-23 the standards or licensing requirements provided under this 6-24 chapter; 6-25 (2) restrain or prevent the establishment or operation 6-26 of a women's service center without a license issued under this 6-27 chapter; or 7-1 (3) grant any other injunctive relief warranted by the 7-2 facts. 7-3 (c) The attorney general shall institute and conduct a suit 7-4 authorized by this section at the request of the department. 7-5 (d) Venue for a suit brought under this section is in the 7-6 county in which the women's service center is located or in Travis 7-7 County. 7-8 Sec. 249.013. CRIMINAL PENALTY. (a) A person commits an 7-9 offense if the person violates Section 249.002. 7-10 (b) An offense under this section is a Class C misdemeanor. 7-11 (c) Each day of a continuing violation constitutes a 7-12 separate offense. 7-13 Sec. 249.014. CIVIL PENALTY. (a) A person who violates 7-14 this chapter or who fails to comply with a rule adopted under this 7-15 chapter is liable for a civil penalty of not less than $100 or more 7-16 than $500 for each violation if the department determines the 7-17 violation threatens the health and safety of a patient. 7-18 (b) Each day of a continuing violation constitutes a 7-19 separate ground for recovery. 7-20 SECTION 2. The importance of this legislation and the 7-21 crowded condition of the calendars in both houses create an 7-22 emergency and an imperative public necessity that the 7-23 constitutional rule requiring bills to be read on three several 7-24 days in each house be suspended, and this rule is hereby suspended, 7-25 and that this Act take effect and be in force from and after its 7-26 passage, and it is so enacted.