SB 1076

Title: General Acute Care Hospitals: Observation Services

Overview of the health problem

Patients in California suffered resulting to demonstrations from nurses and patients since patients placed under observation were discriminated and not treated well compared to other patients from other units (Lake & Booker, 2005). This discrimination led to introduction of SB 1076 which would solve this problem by clearly defining the observation services. SB 1076 clearly defines observation services since they have been neglected by many hospitals because patients put under investigation do not receive the necessary care and attention compared to outpatient and admitted patients (Barr, 2016). The bill suggests that observation services are outpatient services provided by the acute care hospitals to patients who got unstable conditions or rather serious conditions that warrant them to be placed under observation by nurses and doctors. However the conditions are rather not very serious to place the patients under admission hence they only need to be observed by doctors and nurses to judge whether an admission will be necessary incase the conditions fails to stabilize. The bill requires that patients placed under observation need to be given beds and need regular checkups from nurses and other hospital staffs as well (Barr, 2016). The patients should be given all the necessary care and support so that they feel comfortable and safe before the doctors, judge whether they need admissions or not (Lake  & Booker, 2005). These patients need to get monitored by nurses so that if their condition stabilizes they do not get admitted in the acute care hospitals. Most are the times where such patients do not get observation services.

Overview of the bill and stakeholders

SB1076 is one of the health bills in California which came up in order to reform the health policies in California and other states throughout the US. The bill was introduced in senate on 16^th February 2016, heard on april13th 2016 and will be effective starting from January 1^st 2017 (Barr, 2016). The bill was supported by California nurses association and national nurses united since most of the patients have suffered since many hospitals have been reported to exploit observation status. Most patients are held in hospitals over long periods of time and this limits the numbers of needy patients getting admissions in hospitals. All patients needs to be kept safe and observed from time to time by nurses which SB 1076 is aiming to maintain since rights of patients have been violated (Barr, 2016). Observation status see to it that patients stay for long without being checked and protected which put them at risk both financially and health wise since they will pay more without much protection. SB 1076 will ensure that patients put under observation do not spend long hours without getting attention so that they can receive treatments and go back home without necessarily remaining admitted in hospitals.

SB1076 comes up with new observation services that hospitals should provide to their patients without compromising the requirements (Barr, 2016). Nurse to patient ratios provided in the emergency units should be equal to the ratios provided in the observation units since for many years observation units have had less ratios compared to other units in hospitals. Mostly, observation services are provided in the outpatient unit. SB1076 requires that hospitals provide separate observation services data with other outpatient services where patients put under observation need a written document immediately so that they can be handled with care so that they can receive protection just like other admitted patients. Observation data need to be separate from the other outpatient services so that the statewide health planning and development office can plan for patients put under observation as well (Barr, 2016). Patients have in the past suffered from lack of attention from doctors since they are kept to wait for long hours and days because they are not in the doctor’s schedule. SB1076 aims at ensuring all patients placed under observation get the necessary protection and care since they require medical support and need not to remain burdened financially (Barr, 2016).

The existing law gives licenses to the general acute care hospitals in California. The law defines the hospitals as hospitals that work under 24 hours therefore provide care, protection to patients and therefore known to provide basic services to patients such as pharmacy, dietary facilities, laboratory services, anesthesia, surgical services, nursing services and the necessary medical services. In addition, the law additionally permits the general acute care hospitals provision of special services such as radiation therapy services, emergency centers, hemodialysis units, psychiatric services, newborn nurseries which are intensive, cardiac surgeries, special laboratories such as cardiac catheterization labs and lastly they are allowed to perform renal transplants. The law also gives permits to the acute care hospitals so that they can make application to the California Department of Public Health (CDPH) for them to receive approval of providing supplemental services such as outpatient clinics (Donough & Milbank Memorial Fund, 2011). The existing law limits provision of outpatient services to patients who remain in the outpatient clinics for periods not exceeding 24hours. The law therefore requires all the acute care hospitals to have reliable nurse to patient ratios so that patients can get medical attention from nurses since hospitals are defined by the law as critical care centers which should handle patients with intensive care.

Promoters of SB 1076

Most of the patients and nurses in California complained because observation patients did not get medical services just like those enjoyed by other patients (Shi & Singh, 2010). SB1076 is a bill that came up in order to save such patients who need to get medical attention since they pay to get the services. The bill advocates for observation patients to be treated equally with other patients therefore ensuring that the nurse to patient ratio in the observation unit is observed. Nurses should be enough in order to cater for the needs of these patients whose conditions are serious and unstable. The patients need to get monitored by nurses regularly, which is one theme of the bill. SB1076 pushes hard for this reform to take place so that nurses can be employed in most acute care hospitals not only in California but other states as well so that patients placed under observation can be well taken care of (Barr, 2016). All hospitals need to get permits so that the health department in all states can check whether they comply with the laid down requirements. All hospitals need to be safe and thus provide medical services to the patients at all times since health of people comes first always (Shi & Singh, 2010). SB1076 bill was welcomed by many people including patients and nurses who felt that observation units needed to provide enough care to the people.

Stakeholders of SB 1076

The bill focuses on a number of stakeholders such as the government, hospitals, hospital staffs, patients and the California health department (Emanuel, 2014). Therefore all these stakeholders need to work together so that the bill can be implemented since it will start being effective as a law from January 1^st 2017 (Barr, 2016). The health department should ensure it monitors the acute hospitals so that they give quality services to all patients and ensure the patients remain protected and safe all the time. Hospitals should only place patient under observation where necessary and incase the nurse to patients ratios allow so that patients cannot be placed under observation for longer durations of time. Observation services should be possible where patients can get monitored by nurses regularly and hence patients should not spend long hours in the observation units. This implies that hospitals will be required to give observation patients beds and other necessary materials that will ensure they remain comfortable. Unlike earlier where patients were not given good observation services SB1076 will ensure that patients remain comfortable and feel free while at the observation units (Barr, 2016). The patients will no longer be placed under observation for long hours.

Consequences resulting from SB 1076

SB1076 differentiates between inpatient services and outpatient services. Inpatient services are those services given to patients after patients get formal admission in the hospital where they will need to spend at least one night in the hospital (Leichter, 1997). On the other hand outpatient services are those services given to patients within periods not exceeding twenty four hours. However, most hospitals feel that they cannot count patients who are neither admitted nor outpatient patients but rather place them under observation. Such patients do not have formal admissions in the hospitals therefore do not enjoy the services given to the admitted patients. This has been posed many challenges since most patients placed under observation end up paying huge sums of money since they are compared with the admitted patients while in real sense they were not admitted. During early 2014, most patients placed under observation complained since they ended up paying huge bills yet they did not enjoy inpatient services (Barr, 2016). Therefore SB1076 aims at specifying between patients placed under observation and inpatients so that patients placed under observation cannot end up paying huge sums of money (Barr, 2016). In addition patients placed under observation need to enjoy certain services such as getting beds and attention from the hospital staff.

SB1076 is now a new law that needs to be implemented so that patients can enjoy their stay in hospitals and they can feel protected since without protection their heath conditions can even worsen. Through implementing this law the observation unit will now have similar standards with emergency unit since the emergency rooms are well equipped. The new law will ensure that observation rooms are well equipped so that patients can feel safe and protected since they should not be discriminated in the first place (Barr, 2016). The law will ensure that hospitals notify patients that observation services are part of the outpatient services where patients should know clearly that they are not part of the inpatients. The hospitals should clearly mark observation units as outpatient service areas so that patients cannot confuse and end up paying much money which they did not have to pay. The new law requires direct hospitals to report all observation services directly to the office of Statewide Health Planning and Development (Barr, 2016). This department will in turn monitor the observation units and ensure patients are getting the right treatment and care without discrimination and without paying much money compared to admitted patients.

SB1076 will ensure that patients placed under observation get medical attention from various hospitals. The law prohibits hospitals from evading all the necessary requirements by giving observation units other names (Daniels, 1998). The law requires that hospitals name observation units as the name suggest so that patients cannot confuse the observation units with other units. Patients placed under observation in most cases are not told their hospital status therefore they are kept in the dark. They are not monitored more often since the nurse patient ration does not allow for them to get monitored. All patients regardless of the unit they are in need to be monitored and well treated so that they can improve health wise as well (Engs, 2003). The law if well implemented will see to it that patients do not incur extra costs especially those placed under observation. Patients placed under observation need care and should not be charged similar charges with the admitted patients. The government should ensure that through the heath department on more complains will be received from patients placed under observation in terms of financial complains. In addition the governments should ensure that SB1076 is implemented in all hospitals so that excellent health services are provided to the people.

Opposers of SB 1076

Most of the insurance company opposed the bill since they feel that they cannot provide insurance services to patients placed under observation. They provide insurance services to the common outpatient patients and those admitted in hospitals. This discriminates patients placed under observation since they need to get insured by the various insurance companies they require more money compared to the other outpatient patients (Sparer, 1996). The bill was not opposed by many people since it ensured that the health rights of patients were respected. The bill finally became a law and will be enacted starting from 1^st January 2016 whereby patients will enjoy good observation services.  Most nurses and patients who advocated for the bill to be passed will now remain happy since the assembly in conjunction with the senate passed the bill which needs to be implemented starting from next year.

Recommendation resulting from SB 1076

Passing the bill brought happiness to many patients who had suffered since the observation unit was not appropriately handled. Recommendations that would ensure the bill is implemented include;

• The government should ensure that through the department of health the law is implemented so that cases of patients being mishandled can be prevented (Mechanic, 2006).
• The hospitals should ensure that nurse to patient ratio is maintained so that nurses can handle and monitor all patients without neglecting the observation unit.
• The government should provide funds to the hospitals so that observation rooms can be well equipped just like other rooms are equipped so that exceelentr services can be given to the patients.
• The hospitals should employ more nurses so that all patients can get monitored since it will make them feel better and comfortable.
• The government should ensure even patients who are placid under observation get medical covers and insurances to prevent them from spending much money.

References

Daniels, M. R. (1998). Medicaid reform and the American States: Case studies on the politics of managed care. Westport, Conn: Auburn House.

Barr, D. A. (2016). Introduction to US health policy: The organization, financing, and delivery    of health care in America.

Leichter, H. M. (1997). Health policy reform in America: Innovations from the states. Armonk,   Ny: M.E. Sharpe.

Emanuel, E. J. (2014). Reinventing American health care: How the Affordable Care Act will        improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system.

Shi, L., & Singh, D. A. (2010). Essentials of the U.S. health care system. Sudbury, Mass: Jones   and Bartlett Publishers.

Mechanic, D. (2006). The truth about health care: Why reform is not working in America. New   Brunswick, N.J: Rutgers University Press.

Lake, C. L., & Booker, P. D. (2005). Pediatric cardiac anesthesia. Philadelphia: Lippincott         Williams & Wilkins.

Donough, J. E., & Milbank Memorial Fund. (2011). Inside national health reform. Berkeley:       University of California Press.

Sparer, M. S. (1996). Medicaid and the limits of state health reform. Philadelphia: Temple           University Press.

Engs, R. C. (2003). The progressive era's health reform movement: A historical dictionary.          Westport, CT: Praeger.