AB-0451: Health facilities: emergency services and care

Session: 2017-2018
Author: Arambula
Status: Dead
AAP-CA Position: Support
To view the status of this bill on the State Website, click here.

AB 451 (Arambula) would specify that an acute psychiatric hospital, regardless of whether it maintains an emergency department, is required to provide emergency care and services to relieve or eliminate a psychiatric emergency medical condition. It also clarifies that hospitals may not require a patient be on a 5150 (involuntary) hold in order to be transferred from the emergency department to a general acute care hospital or acute psychiatric hospital.

AAP Positional Letter

March 27, 2017

The Honorable Joaquin Arambula
State Capitol
P.O. Box 942849
Sacramento, CA 94249-0031
Fax: (916) 319-2131

RE: AB 451 (Arambula): Health facilities: emergency services and care

Dear Assemblymember Arambula:

I am writing on behalf of the American Academy of Pediatrics, California (AAP-CA), representing over 5,000 California pediatricians, to strongly support your proposed legislation AB 451 (Arambula). This bill would clarify that acute psychiatric hospitals are required to provide emergency care and services for the treatment of psychiatric emergencies, and that hospitals may not require patients to be on involuntary hold before transfer from an emergency room to a general acute care hospital or an acute psychiatric hospital.

About 1 in 20 Californians, including 1 in 13 children, suffer from a serious mental illness that makes it difficult to carry out major life activities, according to the California Health Care Foundation. Many of these Californians present to hospital emergency rooms when they sense that their symptoms are becoming especially threatening to their safety and well-being. However, it is often difficult for those who voluntarily seek emergency mental health care to receive effective treatment, because many hospitals require a patient to be placed on an involuntary 5150 hold before they can be transferred to a psychiatric hospital. That is, they must be deemed a threat to themselves or others before they are allowed to receive treatment. This discourages people who suffer from mental illness from seeking treatment before this dangerous point is reached, and further stigmatizes them by assuming they are unable to read their own body’s warning signs. Additionally, someone seeking emergency treatment at a psychiatric hospital may be transferred to an emergency room for hours or days before they are deemed eligible for a 5150 hold, only to then be transferred back to the same psychiatric hospital. These unnecessary steps are not only detrimental to the health and well-being of the person seeking treatment, who must spend excessive amounts of time in the stressful environment of a hospital emergency room, but they also create inefficiencies and delays that negatively impact other patients seeking emergency treatment.

AB 451 (Arambula) would remedy this issue by stating that psychiatric hospitals must provide emergency care for psychiatric emergencies, and that no patient may be required to be on a 5150 hold before being transferred to the treatment they seek and require. This would be greatly beneficial both to sufferers of mental illness and to emergency room patients.

Pediatricians across the state support AB 451 (Arambula). We thank you for your leadership on behalf of the health and well-being of children, youth, and families in California.


Susan Wu, M.D., Fellow of the American Academy of Pediatrics
State Government Affairs Committee, American Academy of Pediatrics, California

CC: Kris Calvin, CEO; AAP-CA Leadership; Lydia Bourne