1317.4
. (a) All hospitals shall maintain records of each transfer
made or received, including the "Memorandum of Transfer" described in
subdivision (f) of Section 1317.2, for a period of three years.
(b) All hospitals making or receiving transfers shall file with
the state department annual reports on forms prescribed by the
department which shall describe the aggregate number of transfers
made and received according to the person's insurance status and
reasons for transfers.
(c) The receiving hospital, and all physicians, other licensed
emergency room health personnel, and certified prehospital emergency
personnel at the receiving hospital who know of apparent violations
of this article or the regulations adopted hereunder shall, and the
corresponding personnel at the transferring hospital and the
transferring hospital may, report the apparent violations to the
state department on a form prescribed by the state department within
one week following its occurrence. The state department shall
promptly send a copy of the form to the hospital administrator and
appropriate medical staff committee of the transferring hospital and
the local emergency medical services agency, unless the state
department concludes that the complaint does not allege facts
requiring further investigation, or is otherwise unmeritorious, or
the state department concludes, based upon the circumstances of the
case, that its investigation of the allegations would be impeded by
disclosure of the form. When two or more persons required to report
jointly have knowledge of an apparent violation, a single report may
be made by a member of the team selected by mutual agreement in
accordance with hospital protocols. Any individual, required to
report by this section, who disagrees with the proposed joint report
has a right and duty to separately report.
A failure to report under this subdivision shall not constitute a
violation within the meaning of Section 1290 or 1317.6.
(d) No hospital, government agency, or person shall retaliate
against, penalize, institute a civil action against, or recover
monetary relief from, or otherwise cause any injury to a physician or
other personnel for reporting in good faith an apparent violation of
this article or the regulations adopted hereunder to the state
department, hospital, medical staff, or any other interested party or
government agency.
(e) No hospital, government agency, or person shall retaliate
against, penalize, institute a civil action against, or recover
monetary relief from, or otherwise cause any injury to a physician
who refused to transfer a patient when the physician determines,
within reasonable medical probability, that the transfer or delay
caused by the transfer will create a medical hazard to the person.
(f) Any person who violates subdivision (d) or (e) of Section
1317.4 is subject to a civil money penalty of no more than ten
thousand dollars ($10,000) per violation. The remedy specified in
this section shall be in addition to any other remedy provided by
law.
(g) The state department shall on an annual basis publish and
provide to the Legislature a statistical summary by county on the
extent of economic transfers of emergency patients, the frequency of
medically hazardous transfers, the insurance status of the patient
populations being transferred and all violations finally determined
by the state department describing the nature of the violations,
hospitals involved, and the action taken by the state department in
response. These summaries shall not reveal the identity of individual
persons transferred.
(h) Proceedings by the state department to impose a fine under
Section 1317.3 or 1317.6, and proceedings by the board to impose a
fine under Section 1317.6, shall be conducted as follows:
(1) If a hospital desires to contest a proposed fine, the hospital
shall within 15 business days after service of the notice of
proposed fine notify the director in writing of its intention to
contest the proposed fine. If requested by the hospital, the director
or the director's designee, shall hold, within 30 business days, an
informal conference, at the conclusion of which he or she may affirm,
modify, or dismiss the proposed fine. If the director or the
director's designee affirms, modifies, or dismisses the proposed
fine, he or she shall state with particularity in writing his or her
reasons for that action, and shall immediately transmit a copy
thereof to the hospital. If the hospital desires to contest a
determination made after the informal conference, the hospital shall
inform the director in writing within 15 business days after it
receives the decision by the director or director's designee. The
hospital shall not be required to request an informal conference to
contest a proposed fine, as specified in this section. If the
hospital fails to notify the director in writing that it intends to
protest the proposed fine within the times specified in this
subdivision, the proposed fine shall be deemed a final order of the
state department and shall not be subject to further administrative
review.
(2) If a hospital notifies the director that it intends to contest
a proposed fine, the director shall immediately notify the Attorney
General. Upon notification, the Attorney General shall promptly take
all appropriate action to enforce the proposed fine in a court of
competent jurisdiction for the county in which the hospital is
located.
(3) A judicial action to enforce a proposed fine shall be filed by
the Attorney General after a hospital notifies the director of its
intent to contest the proposed fine. If a judicial proceeding is
prosecuted under the provisions of this section, the state department
shall have the burden of establishing by a preponderance of the
evidence that the alleged facts supporting the proposed fine
occurred, that the alleged facts constituted a violation for which a
fine may be assessed under Section 1317.3, 1317.4, or 1317.6, and the
proposed fine is appropriate. The state department shall also have
the burden of establishing by a preponderance of the evidence that
the assessment of the proposed fine should be upheld. If a hospital
timely notifies the state department of its decision to contest a
proposed fine, the fine shall not be due and payable unless and until
the judicial proceeding is terminated in favor of the state
department.
(4) Action brought under the provisions of this section shall be
set for trial at the earliest possible date and shall take precedence
on the court calendar over all other cases except matters to which
equal or superior precedence is specifically granted by law. Times
for responsive pleading and for hearing any such proceeding shall be
set by the judge of the court with the object of securing a decision
as to subject matters at the earliest possible time.
(5) If the proposed fine is dismissed or reduced, the state
department shall take action immediately to ensure that the public
records reflect in a prominent manner that the proposed fine was
dismissed or reduced.
(6) In lieu of a judicial proceeding, the state department and the
hospital may jointly elect to submit the matter to binding
arbitration, in which case, the department shall initiate arbitration
proceedings. The parties shall agree upon an arbitrator designated
by the American Arbitration Association in accordance with the
Association's established rules and procedures. The arbitration
hearing shall be set within 45 days of the parties' joint election,
but in no event less than 28 days from the date of selection of an
arbitrator. The arbitration hearing may be continued up to 15 days if
necessary at the arbitrator's discretion. The decision of arbitrator
shall be based upon substantive law and shall be binding on all
parties, subject to judicial review. This review shall be limited to
whether there was substantial evidence to support the decision of the
arbitrator.
(7) Proceedings by the board to impose a fine under Section 1317.6
shall be conducted in accordance with Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code.