1-1 By: Cuellar of Hidalgo, et al. H.B. No. 1483 1-2 (Senate Sponsor - Lucio) 1-3 (In the Senate - Received from the House May 3, 1993; 1-4 May 4, 1993, read first time and referred to Committee on Health 1-5 and Human Services; May 19, 1993, reported favorably by the 1-6 following vote: Yeas 8, Nays 0; May 19, 1993, sent to printer.) 1-7 COMMITTEE VOTE 1-8 Yea Nay PNV Absent 1-9 Zaffirini x 1-10 Ellis x 1-11 Madla x 1-12 Moncrief x 1-13 Nelson x 1-14 Patterson x 1-15 Shelley x 1-16 Truan x 1-17 Wentworth x 1-18 A BILL TO BE ENTITLED 1-19 AN ACT 1-20 relating to the regulation of women's service centers; providing 1-21 civil and criminal penalties. 1-22 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-23 SECTION 1. Subtitle B, Title 4, Health and Safety Code, is 1-24 amended by adding Chapter 249 to read as follows: 1-25 CHAPTER 249. WOMEN'S SERVICE CENTER 1-26 Sec. 249.001. DEFINITION. In this chapter, "women's service 1-27 center" means a facility that offers services, facilities, and beds 1-28 for two or more unrelated individuals who may require a stay of 1-29 longer than 24 hours but not longer than three days and who are 1-30 solely admitted, treated, and discharged for women's services 1-31 related to education, outreach, support services, nursery, 1-32 obstetrical care, gynecological care, and surgery. 1-33 Sec. 249.002. LICENSE REQUIRED. (a) A person may not 1-34 establish or operate a women's service center in this state without 1-35 an appropriate license issued under this chapter. 1-36 (b) Each women's service center must have a separate 1-37 license. 1-38 (c) A license is not transferable or assignable. 1-39 (d) The department may issue a temporary license pending the 1-40 completion of the application procedures under Section 249.004 if 1-41 the issuance is appropriate to safeguard the health and safety of 1-42 the patients in the women's service center. 1-43 Sec. 249.003. EXEMPTIONS FROM LICENSING REQUIREMENT. The 1-44 following facilities need not be licensed under this chapter: 1-45 (1) a hospital licensed under Chapter 241; 1-46 (2) an ambulatory surgical center licensed under 1-47 Chapter 243; 1-48 (3) a birthing center licensed under Chapter 244; 1-49 (4) an office or clinic of a licensed physician, 1-50 certified nurse midwife, or certified nurse practitioner; 1-51 (5) a facility maintained or operated by the federal 1-52 government or an agency of the federal government; or 1-53 (6) a facility maintained or operated by this state or 1-54 an agency of this state. 1-55 Sec. 249.004. LICENSE APPLICATION AND ISSUANCE. (a) An 1-56 applicant for a women's service center license must submit an 1-57 application to the department on a form prescribed by the 1-58 department. 1-59 (b) Each application must be accompanied by a nonrefundable 1-60 license fee in an amount set by the board. 1-61 (c) The department shall issue the appropriate license if, 1-62 after inspection and investigation, it finds that the applicant and 1-63 the center meet the requirements of this chapter and the standards 1-64 adopted under this chapter. 1-65 (d) The license fee shall be paid annually on renewal of the 1-66 license. 1-67 Sec. 249.005. INSPECTIONS. The department may inspect a 1-68 women's service center at reasonable times as necessary to assure 2-1 compliance with this chapter. 2-2 Sec. 249.006. FEES. The board shall set fees imposed by 2-3 this chapter in amounts reasonable and necessary to defray the cost 2-4 of administering this chapter. 2-5 Sec. 249.007. PROVISIONS RELATING TO PATIENTS. (a) A 2-6 women's service center may require a patient to stay in the center 2-7 longer than three days if a physician determines that a longer stay 2-8 is medically necessary and appropriate for that patient. A women's 2-9 service center that requires a longer stay under this subsection 2-10 does not thereby lose its status as a women's service center and is 2-11 not required to obtain any additional licenses based solely on that 2-12 fact. 2-13 (b) A woman who has received prenatal care at a women's 2-14 service center is eligible for delivery services at that center. 2-15 However, emergency delivery services shall not be denied. 2-16 Sec. 249.008. ADOPTION OF RULES. (a) The board shall adopt 2-17 rules necessary to implement this chapter. 2-18 (b) The board shall adopt rules that provide requirements 2-19 for the issuance, renewal, denial, suspension, and revocation of a 2-20 license. 2-21 Sec. 249.009. MINIMUM STANDARDS. The board shall adopt 2-22 rules that provide minimum standards for a women's service center, 2-23 including standards that relate to: 2-24 (1) the protection of the health and safety of a 2-25 patient; 2-26 (2) the construction and design, including plumbing, 2-27 heating, lighting, ventilation, and other design standards 2-28 necessary to ensure the health and safety of patients; 2-29 (3) construction plan approval and inspection; 2-30 (4) the sanitary and hygienic conditions in the center 2-31 and its surroundings; 2-32 (5) the equipment essential to the health and safety 2-33 of the patients; 2-34 (6) the qualifications of the professional staff and 2-35 other personnel; 2-36 (7) minimum requirements for staffing by physicians 2-37 and nurses; 2-38 (8) a quality assurance program for patient care; 2-39 (9) the organizational structure, including the lines 2-40 of authority and delegation of responsibility; 2-41 (10) clinical records of care and services, including 2-42 the disposal or destruction of those records; 2-43 (11) written agreements for contractual services with 2-44 general hospitals; 2-45 (12) the provision and coordination of treatment and 2-46 services; 2-47 (13) minimum requirements for entering into a written 2-48 agreement with a general hospital for an immediate transfer of 2-49 patients when special services are needed but are not available at 2-50 the women's service center; 2-51 (14) the issuance, renewal, denial, suspension, 2-52 emergency suspension, and revocation of a license required by this 2-53 chapter; and 2-54 (15) any other aspect of the operation of a women's 2-55 service center that the board considers necessary to protect the 2-56 public. 2-57 Sec. 249.010. MINIMUM STANDARDS FOR PATIENT TRANSFERS. 2-58 (a) The board shall adopt rules to implement the minimum standards 2-59 governing the transfer of patients from women's service centers to 2-60 hospitals. 2-61 (b) The rules must provide that patient transfers to 2-62 hospitals be accomplished through women's service center policies 2-63 that result in medically appropriate transfers from physician to 2-64 physician and from women's service centers to hospitals by 2-65 providing: 2-66 (1) for notification to the receiving hospital before 2-67 the patient is transferred and confirmation by the receiving 2-68 hospital that the patient meets the receiving hospital's admissions 2-69 criteria relating to appropriate bed, physician, and other services 2-70 necessary to treat the patient; 3-1 (2) for the use of medically appropriate life support 3-2 measures that a reasonable and prudent physician exercising 3-3 ordinary care in the same or a similar locality would use to 3-4 stabilize the patient before the transfer and to sustain the 3-5 patient during the transfer; 3-6 (3) for the provision of appropriate personnel and 3-7 equipment that a reasonable and prudent physician exercising 3-8 ordinary care in the same or a similar locality would use for the 3-9 transfer; 3-10 (4) for the transfer of all necessary records for 3-11 continuing the care for the patient; and 3-12 (5) that the transfer of a patient not be predicated 3-13 on arbitrary, capricious, or unreasonable discrimination because of 3-14 race, religion, national origin, age, sex, physical condition, or 3-15 economic status. 3-16 Sec. 249.011. DENIAL, SUSPENSION, OR REVOCATION OF LICENSE. 3-17 (a) The department may deny, suspend, or revoke a license for a 3-18 violation of this chapter or a rule adopted under this chapter. 3-19 (b) The denial, suspension, or revocation of a license by 3-20 the department and the appeal from that action are governed by the 3-21 procedures for a contested case hearing under the Administrative 3-22 Procedure and Texas Register Act (Article 6252-13a, Vernon's Texas 3-23 Civil Statutes). 3-24 Sec. 249.012. INJUNCTION. (a) The department may petition 3-25 a district court for a temporary restraining order to restrain a 3-26 continuing violation of the standards or licensing requirements 3-27 provided under this chapter if the department finds that the 3-28 violation creates an immediate threat to the health and safety of 3-29 the patients of a women's service center. 3-30 (b) A district court, on petition of the department and on a 3-31 finding by the court that a person is violating the standards or 3-32 licensing requirements provided under this chapter, may by 3-33 injunction: 3-34 (1) prohibit a person from continuing a violation of 3-35 the standards or licensing requirements provided under this 3-36 chapter; 3-37 (2) restrain or prevent the establishment or operation 3-38 of a women's service center without a license issued under this 3-39 chapter; or 3-40 (3) grant any other injunctive relief warranted by the 3-41 facts. 3-42 (c) The attorney general shall institute and conduct a suit 3-43 authorized by this section at the request of the department. 3-44 (d) Venue for a suit brought under this section is in the 3-45 county in which the women's service center is located or in Travis 3-46 County. 3-47 Sec. 249.013. CRIMINAL PENALTY. (a) A person commits an 3-48 offense if the person violates Section 249.002. 3-49 (b) An offense under this section is a Class C misdemeanor. 3-50 (c) Each day of a continuing violation constitutes a 3-51 separate offense. 3-52 Sec. 249.014. CIVIL PENALTY. (a) A person who violates 3-53 this chapter or who fails to comply with a rule adopted under this 3-54 chapter is liable for a civil penalty of not less than $100 or more 3-55 than $500 for each violation if the department determines the 3-56 violation threatens the health and safety of a patient. 3-57 (b) Each day of a continuing violation constitutes a 3-58 separate ground for recovery. 3-59 SECTION 2. The importance of this legislation and the 3-60 crowded condition of the calendars in both houses create an 3-61 emergency and an imperative public necessity that the 3-62 constitutional rule requiring bills to be read on three several 3-63 days in each house be suspended, and this rule is hereby suspended, 3-64 and that this Act take effect and be in force from and after its 3-65 passage, and it is so enacted. 3-66 * * * * * 3-67 Austin, 3-68 Texas 3-69 May 19, 1993 3-70 Hon. Bob Bullock 4-1 President of the Senate 4-2 Sir: 4-3 We, your Committee on Health and Human Services to which was 4-4 referred H.B. No. 1483, have had the same under consideration, and 4-5 I am instructed to report it back to the Senate with the 4-6 recommendation that it do pass and be printed. 4-7 Truan, 4-8 Acting Chair 4-9 * * * * * 4-10 WITNESSES 4-11 FOR AGAINST ON 4-12 ___________________________________________________________________ 4-13 Name: Julia R. Bechinor x 4-14 Representing: TDH 4-15 City: Austin 4-16 ------------------------------------------------------------------- 4-17 Name: Harold Freeman x 4-18 Representing: Texas Medical Associates 4-19 City: Austin 4-20 -------------------------------------------------------------------