New Law Allows Physicians To Move Children From Acute Care

Physicians in California are not allowed to transfer children who are under care of the state and in acute care facilities, even if moving them to a subacute facility would be a better option for them.

Assembly member Holly Mitchell (D-Los Angeles) wanted to change that with AB 667. Yesterday, Gov. Jerry Brown (D) agreed and signed that bill into law.

“AB 667 basically updates state law,” Charles Stewart in Mitchell’s office said. “In a number of cases, when a child [under the state’s care] is in an acute facility, the physician did not have the option to say this child doesn’t need to be in the ICU. Being in the ICU can be very restrictive — it’s harder for family members to visit, it’s very restrictive on the child.”

The law does not affect many children, Stewart said — about 400 of them would qualify for consideration of transfer, if a physician feels it’s medically beneficial.

California statute requires the Department of Health Care Services to establish the regulation governing these transfers, and it was a complicated process to change the rule within the department, Stewart said. “It was just faster to change the regulation by statute,” he said.

Stewart said the new law made sense on several levels. “A child who has had a tracheotomy, for instance, it may be that child doesn’t necessarily need constant hookup to machinery and that high-level, intensive nursing care in the ICU,” he said. “But that child still does need to be monitored, and in some cases, a child can, in fact, thrive in a less intensive medical situation.”

Another level is money. It’s expensive to have children in the intensive care unit — from about $500 to $700 a day per child, potentially indefinitely. Stewart said financial considerations made passage of the bill even easier.

“When there’s an opportunity to enhance and improve treatment that’s humane and competent,” Stewart said, “and it saves the state money, that’s something we not only want to do, but we feel obliged to do.”

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