Chapter 2.76 DEPARTMENT OF HEALTH SERVICES*

* Editor’s note: For statutory provisions on county medical facilities, see Health & Saf. Code § 1440 et seq., for charter provisions on the director of hospitals see Charter § 22.

2.76.010 Continuation of department and director.

The office of director of health services and the department of health services as they existed on March 1, 1973 are continued, but subject to the provisions of this chapter. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150, 1942.)

2.76.020 References to superseded offices.

All references now or hereafter made by the Charter of this county, any statute, regulation, seal or document of any kind, or any ordinance of this county except this chapter to “director of hospitals,” shall be deemed to refer to the director of health services. (Ord. 2006-0040 § 1, 2006: Ord. 11744 § 2, 1978: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.2, 1942.)

2.76.030 Definitions.

As used in this chapter:
A. “Department” means the department of health services.
B. “Director” means the director of health services. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.4, 1942.)

2.76.040 Director--Duties generally.

The director of health services shall perform all duties delegated to him now or hereafter by Ordinance 4099 or any other ordinance of this county. (Ord. 2006-0040 § 2, 2006: Ord. 87-0105 §§ 1--3, 1987; Ord. 11744 § 1, 1978: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.1, 1942.)

2.76.045 Authority to collect on delinquent health services accounts.

Under the direction and supervision of the board and subject to its direction, the director of health services shall have the following authority as to delinquent accounts arising from the provision of medical care in county medical and health facilities:
A. To provide collection services;
B. To develop and maintain a billing and collection system;
C. To develop and keep an automated recordkeeping system;
D. To establish payment plans as necessary to effect collection;
E. To represent the county in small claims court collection cases falling within the jurisdiction of said court;
F. To reduce claims by an amount equal to the current monetary jurisdiction of the small claims court when necessary to facilitate small claims actions.
G. In his discretion, the director shall have the authority to permit the treasurer to exercise all or any part of the authority set forth in this section 2.76.045 when the director believes such action to be in the best interests of the department of health services.
H. Nothing in this Section 2.76.045 shall be construed as divesting the treasurer of authority to continue any delinquent account collection activities begun on delinquent accounts arising from the provision of medical care in county medical and health facilities prior to the effective date of the ordinance codified in this section. (Ord. 2001-0030 § 2, 2001.)

2.76.046 Director--Reducing patient account liabilities.

A. Notwithstanding the provisions of Section 2.52.040 relating to the duties of the treasurer, and subject to the limitations and exceptions set forth in subparagraphs B and E below, the director of the department of health services shall have the authority to reduce the amount of liability for the following accounts, where the anticipated cost of administering a collection procedure would exceed the amount of revenue which might reasonably be anticipated would be recovered:
(i) Any account which results from the provision of medical care in county medical and health facilities; or,
(ii) Any account which results from medical care provided by a third party for which the county is contractually obligated to pay and for which the county has reimbursement or subrogation rights.
The authority set forth in this provision shall be exercised only on the condition that the director undertakes appropriate collection efforts as to the accounts specified above and on the further condition that those collection efforts are undertaken in accordance with written policies and procedures;
B. The director may reduce the amount of liability for any account by the greater of:
(i) $15,000; or
(ii) $75,000 or 50% of the account balance, whichever is less;
C. The director shall report to the board of supervisors, in writing and on a quarterly basis, the amount of liability reduced for each account for that quarter and the reason(s) for such reduction for each account;
D. In his discretion, the director shall have the authority to permit the treasurer to exercise all or any part of the authority set forth in this Section 2.76.046 when the director believes such action to be in the best interests of the department of health services;
E. The authority granted in this provision shall not extend to any account which is the subject of litigation in which the county is a party or for which a claim has been filed with the county pursuant to the California Tort Claims Act, nor shall it apply where the director or his designee has negotiated patient-specific payment rates for inpatient and/or outpatient services and entered into single-instance, per-admission and/or per course of outpatient care agreements with private payors for the provision of medical care in county medical and health facilities. (Ord. 2005-0093 § 1, 2005: Ord. 2002-0004 § 2, 2002.)

2.76.050 Director--Accounts to be kept.

The director shall keep or cause to be kept books of accounts for all receipts and disbursements in the department. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.38, 1942.)

2.76.060 Purchasing--Items for aid to indigents.

The director shall request the purchasing agent to procure such articles as are found necessary for aid to indigents. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.36, 1942.)

2.76.070 Purchasing--Transportation for indigents.

Transportation on public carriers other than local bus or electric transit lines shall be exclusively purchased through the county auditor-controller. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.37, 1942.)

2.76.080 Cemetery--Orders for cremation or interment--Records required.

The director or his designee may issue orders for interment or cremation of indigent dead in the County Cemetery. The cemetery shall be maintained as a place for burial or cremation of the indigent dead of Los Angeles County, and shall be under the general supervision of the director. No bodies shall be received for burial or cremation at the cemetery except upon his written order or his designated subordinates, and he shall keep or cause to keep accurate data covering burials or cremations in the cemetery and shall include on the plot of the cemetery the location of every burial and the name of the deceased, age, date of death and burial, and he shall obtain and file or cause to be obtained and filed with the proper authorities necessary burial permits and reports as to such permits as required by law. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.11, 1942.)

2.76.120 County medical facilities--Chapter applicability--Exception.

The provisions of this chapter, except Section 2.76- .130, shall not apply to any person seeking admission to any county hospital or other county medical or health facility, provided such person is entitled to medical care or treatment under the provisions of either Title XVIII or XIX of Public Law 89-97, 42 U.S.C.A. 1395--1398g (i.e., the Social Security Amendments of 1965), or under Chapters 6.5 or 7 of Part 3, Division 9 of the Welfare and Institutions Code of the state of California; rather, the provisions of said Title XVIII or XIX of Public Law 89-97, 42 U.S.C.A. 1395--1398g (i.e., the Social Security Amendments of 1965), or of Chapters 6.5 or 7 or Part 3, Division 9 of the Welfare and Institutions Code of the state of California, and any regulations adopted pursuant thereto, as any of them may be amended from time to time, shall apply to such person. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.7, 1942.)

2.76.130 County medical facilities--Priority of admission.

The provisions of this chapter which limit the admission of patients to county hospitals shall not be applicable to those county hospitals designated by resolution of the board of supervisors, pursuant to Welfare and Institutions Code Section 14000.2, as a community hospital. The following priority shall govern the admission of patients to community hospitals:
A. Emergencies: any person who because of accident or sudden illness is in need of emergency medical treatment, for so long as the emergency exists;
B. Admissions required by law;
C. Medicare and Medi-Cal: persons entitled to medical care and treatment under provisions of either Title XVIII or XIX of Public Law 89-97, or under Chapters 6.5 or 7 of Part 3, Division 9 of the Welfare and Institutions Code of the state of California, and any regulations adopted pursuant thereto;
D. Services unavailable elsewhere: those persons in need of care who, for whatever reason, cannot receive it elsewhere in the community;
E. Other persons needing hospital care. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.47, 1942.)

2.76.140 County medical facilities--Pay patients accepted in certain instances.

If any person shall have sufficient property or income so that such person does not qualify for medical and hospital care from the county as an indigent person, but is otherwise eligible for such care pursuant to the priority of admissions, the county shall be entitled to full reimbursement for any such care furnished, except as otherwise provided in this chapter. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.26, 1942.)

2.76.150 County medical facilities--Case histories required when.

There shall be maintained in the department a full history, as required by statute or regulation, of persons admitted to any of its facilities, such history to be kept confidential and for the use only of the authorized officers and employees of the department and others as authorized by law. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.5, 1942.)

2.76.160 County medical facilities--Disclosure re aliens.

When application for care, aid or services of the department is made by or for any alien and it shall appear that such alien is or has been a public charge within five years after entry into the United States, or where it shall appear that such alien may be subject to deportation from the United States for any other reason, the director shall disclose such facts in connection therewith, as is authorized or required by law. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.6, 1942.)

2.76.170 County medical facilities--Alcoholic beverage restrictions.

A person, whether as patient, inmate, employee, visitor or otherwise, shall not enter or be in any facility maintained by the department if transporting or having in his possession any alcoholic beverage, unless he received permission to transport or have same in his possession from the person in charge thereof. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.23, 1942.)

2.76.180 County medical facilities--Admission policy.

No person shall be admitted into the facilities of the department who, either through themselves or through their legally responsible relatives, can supply themselves with equally sufficient care and treatment in private institutions, unless in cases of emergency, quarantine, public disaster, or where such person is a participant in a health care delivery system approved by the board of supervisors. A person in need of hospitalization is to be admitted into any of the facilities of the department if he cannot himself or through legally responsible relatives pay the charges for a private institution after providing for those who legally claim his support. (Ord. 87-0021 § 1, 1987: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.20, 1942.)

2.76.190 County medical facilities--Persons ineligible for admission.

A. No person shall be entitled to other than emergency medical care through any of the facilities of the health services department if such a person has made a voluntary transfer of property for the purpose of qualifying for medical aid or to avoid the giving of security for repayment of public medical aid advanced or to be advanced.
B. Any applicant for, or recipient of public medical aid, who has made a voluntary transfer of property as provided herein shall remain ineligible until the value of the property has been utilized by budgetary needs.
C. Whenever any such person has knowingly obtained public medical aid in an amount greater than the amount to which he is entitled, and, he is not able to repay the county for the medical aid thus obtained, he shall not be eligible for further medical aid until the value of the property has been utilized by budgetary needs. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.12, 1942.)

2.76.200 County medical facilities--Investigation of persons transferring property to avoid payment.

Whenever any person has knowingly made a voluntary transfer of property to avoid payment to the county of Los Angeles for service furnished by the health services department, the department shall investigate the facts and consult with the county counsel to determine if such transfer may be set aside and reimbursement accomplished by appropriate action. The board of supervisors, upon recommendation of the department, in appropriate cases may authorize the grant or continued grant of aid from the facilities of the department even though it reasonably appears that the applicant or recipient is otherwise ineligible as provided in this chapter. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.13, 1942.)

2.76.210 County medical facilities--Applicant deemed not indigent--For certain conditions.

A. No person shall be considered to be an indigent person so as to be entitled to care from any of the facilities of the department who shall be otherwise able to provide for such care, or so as to be entitled to public assistance, who shall have an income in excess of the regular charity budget for such a case as approved by the board of supervisors.
B. No person in any of the following classes shall be entitled to care or treatment as an indigent person if he shall be otherwise able to provide for such care or treatment, or if provision therefor can otherwise be made:
1. Persons afflicted with and seeking care or treatment for tuberculosis; or
2. Post-poliomyelitis; or
3. Psychiatric disorders; or
4. Persons seeking care or treatment under the crippled children’s services program; or
5. Persons seeking care or treatment under the Renal Dialysis (artificial kidney) Center.
C. In the event of a conflict between the provisions of this section, with respect to the care and treatment of psychiatric disorders, and the provisions of Section 5718 of the Welfare and Institutions Code, the provisions of the latter shall prevail. (Ord. 87-0021 § 2, 1987: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.14, 1942.)

2.76.220 County medical facilities--Applicant to make written declaration of assets.

Before medical or hospital care, except emergency care, shall be given to or for any person claimed to be an indigent person, or to or for any person seeking post-poliomyelitis care and treatment, or to or for any person seeking tuberculosis inpatient services, or psychiatric services, or to or for any person seeking care and treatment under the crippled children’s services program, such person shall make a written declaration of all moneys and income which such person is to receive each month; and of any insurance policy or policies or organizational membership which may furnish medical care or hospitalization, or provide for payment thereof; and the nature, location and value of all property in which such person has any interest, legal, equitable or otherwise; and the names, places of residence and income of all kindred of the applicant to the degree of husband, wife, child, father or mother. (Ord. 11649 § 2, 1978: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.25, 1942.)

2.76.230 County medical facilities--Transportation of indigent patients to other counties, states and countries authorized when.

The director may incur all necessary expenses for the purpose of transporting an indigent patient to another state, county or country if he finds either that such patient thereby would cease to become a public charge, or that friends or relatives of such patient agree to assume the cost and expense of the care and maintenance of such patient if transported to such place, or that such patient is a legal public charge in the place to which he is to be transported, or that such patient has a legal residence in such state, county or country, based upon information at hand reasonably tending to so indicate. (Ord. 12001 § 1, 1979: Ord. 4099 Art. 9-A § 150.59, 1942.)

2.76.240 County medical facilities--Applicant’s legally responsible relatives to be contacted.

The director shall give written notice to all legally responsible relatives of the applicant resident in this state, informing them of their liability for the support of the applicant. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.19, 1942.)

2.76.250 County medical facilities--Applicant deemed not indigent--Property ownership restriction.

No person shall be construed to be an indigent person, so as to be entitled to medical or hospital care from the health services department who shall own an interest in real property, which real property shall have a county assessed valuation of $5,000.00 or more. In specific cases wherein it is determined by the board of supervisors to be financially advantageous to the county, the board may authorize the grant of care to indigent persons who own an interest in real property which real property shall have a county-assessed valuation of $5,000.00 or more. This section does not apply to persons entitled to be admitted into a county hospital pursuant to Section 1447 of the Health and Safety Code. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.15, 1942.)

2.76.260 County medical facilities--Payment for services--Title search made when.

The director shall furnish the county engineer with the legal description of all real property located in this county in which applicant claims any interest, and the county engineer shall make a search of the title to such property and report his findings to the director. If there be any doubts as to the propriety of accepting any property from any applicant, the director may request the advice and recommendation of the county counsel. All conveyances proper for acceptance by the county shall be forwarded to the board of supervisors by the director, with his recommendation, and if accepted by the board of supervisors, the board shall cause such documents to be placed on record, and such documents and any other documents evidencing or affecting the title to any such property shall remain in the files of the board of supervisors. Mortgages shall be recorded by the director. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art.9-A § 150.18, 1942.)

2.76.270 County medical facilities--Payment for services--Lien on property required when.

A. Every person admitted into the facilities of the hospitals of the county of Los Angeles pursuant to Section 2.74.250 shall be required, as a condition of treatment, to:
1. Create a lien by proper written instrument upon his property as security for all medical and hospital care advanced by the county; or
2. Convey by proper written instrument the real or personal property in his possession to the county, if the acceptance of said property will not require the county to assume any pecuniary obligation in relation to said property.
B. This section shall not be applicable to:
1. Persons seeking post-poliomyelitis care or treatment; or
2. Persons seeking tuberculosis inpatient services; or
3. Persons seeking care or treatment under the crippled children’s services; or
4. Persons seeking care or treatment for psychiatric disorders; or
5. The real or personal property and interment plots owned by recipients of:
a. Old-age Security, or
b. Aid to the blind, or
c. Aid to the potentially self-supporting blind, or
d. Aid to the needy disabled, or
e. Aid to needy children or the needy relative thereof, or
f. Persons seeking care in the Renal Dialysis (artificial kidney) Center; or
6. The real or personal property and interment plots owned by persons, the assessed value of which is less than $1,000.00. The term “personal property” shall include a policy or policies of insurance owned by the applicant which have been in effect at least five years prior to the date of the application. The value of the policy or policies shall be the cash surrender value thereof. (Ord. 11649 § 3, 1978: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.27, 1942.)

2.76.280 County medical facilities--Payment for services--Sum secured by mortgage.

In cases where mortgage liens are procured as provided in this chapter, such mortgage shall cover services provided within four years of the date of any such mortgage and shall cover such services extended thereafter. In any such mortgage created, it shall be provided that if the mortgagor, prior to the time of his death, is incapacitated due to old age or to chronic or incurable mental or physical disease of such nature and degree as to require long-term care, and if expenses have been or are incurred for the burial of any such mortgagor (which burial expense shall not exceed $500.00 for each and every mortgagor), and if such mortgagor has no insurance or other means of burial except by the county, the lien of any such mortgage shall not attach to such of the proceeds of the real property covered by said mortgage as are required to pay burial expenses of the mortgagor, not exceeding, however, said sum of $500.00 for each and every mortgagor hereinabove specified. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.16, 1942.)

2.76.290 County medical facilities--Payment for service--Taking of lien may be waived.

The board of supervisors may waive the taking of a lien or deed, as provided in this chapter, upon recommendation of the director setting forth reasons why such lien or deed should not be taken. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.17, 1942.)

2.76.300 County medical facilities--False statements by applicant.

Wherever it is determined that an affidavit or declaration of an applicant contains false statements, the director or his designated agent shall report all of the circumstances to the district attorney. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.22, 1942.)

2.76.310 County medical facilities--Applicant examination and hospital placement.

A. Whenever a person applies for hospital care who, in the opinion of the officer or employee receiving the application, cannot be cared for in his home, it shall be the duty of such officer or employee to notify or cause the director to be notified of such an application and opinion. The director shall cause a thorough physical examination of the applicant to be made and, if he deems it necessary, may also cause a mental examination to be made. The report of such examination or examinations shall also include a recommendation by the examiners as to the necessity of hospital care, and shall suggest what county hospital is best adapted for the care of the applicant, but such recommendation shall be advisory only. The report of such examination or examinations shall be submitted to the director, and if in his judgment hospital care is indicated, it shall be his duty to place such person in the hospital most suitable for his best care.
B. If the offer of placement in a hospital is refused by the applicant, or his parents or guardian if the applicant be a minor or incompetent, it shall be the duty of the director to order that all other hospital aid for the applicant be denied until such time as the applicant, or his parents or guardian, aforesaid, is willing to accept the hospital aid thus offered. Voluntary abandonment of the hospital, after actual admittance thereto, or such abandonment by the consent, approval or procurements of applicant’s parents or guardian, shall be construed as such refusal. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.24, 1942.)

2.76.320 County medical facilities--Long-term patients--Allowance for certain expenses.

A. There shall be established in each of the facilities of the department a patients trust account in order that persons incapacitated due to chronic or incurable physical disease of such nature and degree as to require long-term care in any of said facilities or in any of the contractual facilities of the department may be allowed to accumulate from periodic income or other sources not to exceed $100.00 for personal expenditures. Such funds are to be deposited in the patients trust account established at the facility where the patient is confined, except that in the case of a patient confined in a contractual facility, such funds shall be deposited at such county facility as may be designated by the director. These funds may be withdrawn at a rate not to exceed the amount allowed to recipients of Old-age Security for personal incidental expenses; provided, however, that in the case of persons domiciled in the ambulatory wards of any facility, the amount to be withdrawn for personal expenditures may not exceed $6.00 a month.
B. Such patients shall also be allowed to accumulate in said trust account an additional sum not to exceed $500.00 for burial purposes, provided they have no insurance or other means for burial except by the county.
C. Any funds received by an indigent for services performed at any of said facilities, while a patient therein, shall be exempt from the provisions of this chapter.
D. This section does not apply to persons seeking care or treatment for post- poliomyelitis, tuberculosis, psychiatric services, or to recipients of old-age security, aid to the blind, or aid to the needy disabled. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.28, 1942.)

2.76.330 County medical facilities--Agreement to pay for tuberculosis, post-poliomyelitis, psychiatric disorder, crippled children’s services, or Renal Dialysis Center services.

A. The director shall, as a condition of care or treatment, in cases of:
1. Tuberculosis inpatient services; or
2. Post-poliomyelitis; or
3. Psychiatric disorders; or
4. Persons seeking care under the crippled children’s services program; or
5. Persons seeking care under the Renal Dialysis (artificial kidney) Center;
And from time to time thereafter as changes in his or their ability to pay occur, cause the applicant and all relatives of the applicant of the degree of spouse, parent and adult child, to be contacted to secure a written agreement or agreements from them to pay to the county monthly the cost of the care and treatment of such applicant, or so much thereof as they are able to pay, the amounts to be paid to be set out in the agreement or agreements.
B. In determining their ability to pay with respect to assets and resources, consideration shall be given only to those assets and resources over and above those deemed necessary to provide for those legally claiming his or their support and specifically excepting a home with necessary furniture and other necessities of life.
C. In the event of a conflict between the provisions of this section, with respect to the care and treatment of psychiatric disorders, and the provisions of Section 5718 of the Welfare and Institutions Code, the provisions of the latter shall prevail. (Ord. 11649 § 4, 1978: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.29, 1942.)

2.76.350 Medical care, hospital care and public assistance--Costs to be collected by county--Reduced-cost plan/no-cost plan pilot projects.

A. General Provisions.
1. In accordance with the authority set for in Section 2.76.045, the director shall cause collection of the amounts advanced by the county, or in the case of patients covered by the provisions of Section 2.76.330, that portion of the amounts advanced as agreed upon, for the support of any person as to medical and hospital care and public assistance to be made from the persons or property legally liable therefor.
2. This section shall be inapplicable to the department of children and family services and all persons who are provided material assistance through said department, or medical or hospital care pursuant to the program of said department. This section shall also be inapplicable to California Children’s Services, and except as otherwise provided for persons seeking care or treatment for post-poliomyelitis, tuberculosis inpatient services, psychiatric services, or renal dialysis services.
B. Ability-to-Pay Plan. Notwithstanding any other provision of this chapter, and in accordance with the authority set forth in Section 2.76.045 the director shall cause collection of the amounts advanced by the county as to medical and hospital care in accordance with the Ability-to-Pay Plan adopted by the board of supervisors, as such Plan now exists or may hereafter be amended by the board, which shall be implemented in all the department’s health care facilities, or in the case of patients covered by the provisions of Section 2.76.330, that portion of the amounts advanced as agreed upon, for the support of any person as to medical and hospital care and public assistance to be made from the persons or property legally liable therefor.
C. Reduced-Cost Plan/No-Cost Plan Pilot Projects. In addition to or as an option under the Ability-to-Pay Plan referenced in subsection B of this section, upon prior approval by the board of supervisors, the director may also implement Reduced-Cost Plan/No-Cost Plan Pilot Projects for those patients seeking medical care in the department’s facilities. The Reduced-Cost Plan/No-Cost Plan Pilot Projects shall be offered for a period not to exceed three years, in any or all of the department’s facilities as selected by the director in his sole discretion and in accordance with the prior approval of the board of supervisors. (Ord. 2002-0004 § 3, 2002: Ord. 99-0047 § 1, 1999: Ord. 12234 § 1, 1980: Ord. 12010 § 1, 1979: Ord. 12006 § 1, 1979: Ord. 11649 § 1, 1978: Ord. 11557 § 1, 1977: Ord. 10656 § 2(part), 1973: Ord.4099 Art. 9-A § 150.21, 1942.)

2.76.380 School of nursing—Administration and operation.

There shall be administered by the Department of Health Services a school of nursing which shall be known as the “Los Angeles County College of Nursing and Allied Health,” and which shall be operated on a California state-accredited basis. (Ord. 2008-0028 § 1, 2008: Ord. 98-0065 § 1, 1998: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.30, 1942.)

2.76.390 School of nursing--Admission, tuition and graduation fees.

The board may establish admission, tuition and graduation fees to be paid by students of the Los Angeles County College of Nursing and Allied Health. Each person enrolled in the school of nursing shall pay, at the beginning of each semester or summer session, the admission or tuition fee so prescribed. Prior to the beginning of the last semester, each person enrolled in said school of nursing shall pay the graduation fee so prescribed. (Ord. 98-0065 § 2, 1998: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.31, 1942.)

2.76.400 School of nursing--Fee for transcript of records.

A reasonable fee shall be charged and collected for each transcript of record or similar report containing the record of any student nurse in excess of one such transcript or report; provided, however, that such fee shall not exceed the actual cost of providing such transcript or record. All such fees shall be deposited in the county treasury as required by law. (Ord. 11488 § 5, 1977: Ord. 11359 § 4, 1976: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.32, 1942.)

2.76.410 School of nursing--Diploma and other items awarded to graduates.

Any person who shall satisfactorily complete the prescribed course and shall be graduated from the Los Angeles County College of Nursing and Allied Health shall be entitled to a diploma and a school pin of the style and quality generally given by schools of nursing to their graduates. (Ord. 98-0065 § 3, 1998: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150-39, 1942.)

2.76.420 School of nursing--Certificate for vocational nurses.

Any person who shall satisfactorily complete the prescribed course in vocational nursing shall be entitled to a certificate of completion. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.40, 1942.)

2.76.430 Interns or resident physicians--Diploma for service.

Any intern or resident physician who satisfactorily completes the appointed term of service shall be entitled to a diploma of the style and quality generally given by public hospitals in recognition of such service. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.41, 1942.)

2.76.440 Attending medical staff--Certificate of merit upon retirement.

Upon retirement in good standing, members of the attending medical staffs of the Los Angeles County+University of Southern California Medical Center, Harbor-UCLA Medical Center, Rancho Los Amigos National Rehabilitation Center and Olive View-UCLA Medical Center, shall each be entitled a certificate of merit. Such certificates shall be without cost to such members. (Ord. 99-0036 § 1, 1999: Ord. 11807 § 1, 1978: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.42, 1942.)

2.76.450 X-ray film and other records--Conditions for use by attending medical staff.

Subject to the supervision and direction of the administrator of any county hospital, X-ray films and other records of patients may be used by members of the attending staffs of the hospitals in connection with teaching, lecturing and illustrating for general medical instruction, provided such use will not be a source of revenue to the staff member other than received by him for teaching, lecturing or illustrating articles for general medical instruction; and provided further that they are used as hospital records and not as records in an identifiable case, by name or otherwise; and provided further that such use does not disclose in any manner to any person other than members of the staffs of the hospitals the identity of the patient. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.33, 1942.)

2.76.460 Employees--Uniforms furnished when.

A. Persons in the following classifications in the department shall be entitled to receive uniforms:
1. Dental intern;
2. Dental resident;
3. Intern;
4. Resident physician, M.D.
B. Employees entitled to receive uniforms under the provisions of this section may use such uniforms only during their term of service. Such employees shall return to the department all uniforms received upon completion of active duties for the county, and at such other times as may be required by the director. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.43, 1942.)

2.76.470 Transportation for house calls--Conditions.

Transportation for house calls shall be furnished by the physician or dentist; provided, however, that any physician or dentist who may be called upon to render service involving a round trip of 10 or more miles, shall be entitled to mileage from his respective office to the place of call and return at the rate prescribed and allowed for officers and employees of the county when traveling in performance of their duty. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.44, 1942.)

2.76.480 Employees--Compensation from approved medical school permitted when.

Notwithstanding any of the provisions of Ordinance 4099, county employees assigned to the department of health services may receive for their personal use, compensation from any approved medical school which is accepted as an affiliate of any hospital, under the jurisdiction of the department, for services rendered. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.10, 1942.)

2.76.490 Employees--Compensation from the National Polio Foundation.

Notwithstanding any of the provisions of Ordinance 4099, county employees assigned to the department of health services may receive for their personal use, compensation from the National foundation for Infantile Paralysis, for services rendered during poliomyelitis epidemics. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.9, 1942.)

2.76.500 Expenses of physicians and dentists--For treating indigent sick.

Any duly qualified or appointed physician or dentist under the director whose duty it is to treat the indigent sick outside the Los Angeles County hospitals shall be entitled to allowances fixed under a schedule prescribed by resolution of the board of supervisors. The said schedule shall specify the allowances for:
A. A visit by a patient to the office of a physician or dentist, such visit to be known as an office visit;
B. A call by a physician or dentist to a patient at his home or at any other place, not the office of a physician or dentist, such call to be known as a house call; and
C. Medication, surgery, furnishing of surgical dressings, X-ray, laboratory, or other special services, and medical and surgical supplies.
The said schedule of allowances prescribed by resolution shall be based upon recommendation of the director or his agent. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.45, 1942.)

2.76.510 Expenses of physicians and dentists--For extraordinary services.

A. In the case of extraordinary services not provided for in the resolution mentioned in Section 2.74.500, the board of supervisors shall allow a reasonable sum therefor. Any physician’s or dentist’s claim for such extraordinary services shall be accompanied by a written statement, signed by the director or his agent, stating that he examined the said claim and that in his opinion the charge therefor is reasonable in amount; provided, however, that if the director or his agent does not approve of the claim as made, he shall state in writing the amount which in his opinion is reasonable and proper therefor.
B. No sum shall be allowed or paid under this rule for any services or supplies of any kind whatsoever unless the services or supplies for which the claim is made are approved by the director or his duly authorized and designated agent, and such authorization shall be in addition to any other approval or authorization which is required by this rule.
C. It is the intention of this chapter that the allowance and payments herein authorized, or as fixed by the schedule adopted by the board of supervisors, are fixed and made as reimbursement to the physician or dentist for the expenses incurred, and such allowances and payments are not fixed or allowed as fees or compensation for personal services, nor shall anything herein contained be deemed to authorize the care of the indigent sick by contract contrary to the provisions of Section 1451 of the Health and Safety Code or other provisions of law. (Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.46, 1942.)

2.76.530 Emergency transfer or maintenance of patients--Payment of physicians and hospitals.

In addition to the catastrophe provisions of Section 2.130.010, et seq., of this code, whenever the chief administrative officer or the director of health services finds that an emergency exists, or has reasonable cause to believe that some emergency is imminent with respect to the continuation of medical care of patients in, or admissible to, the county hospital, he may transfer such patients to, or require them to be maintained in, private hospitals. The cost of such hospital care, and necessary professional care provided by physicians licensed to practice medicine in the state of California to patients transferred or maintained pursuant to this section, shall be reimbursed either at the provider’s current Medi-Cal rate or in the amount of the provider’s charges, whichever sum is less. (Ord. 86-0214 § 1, 1986: Ord. 11268 § 1, 1975: Ord. 4099 Art. 9-A § 150.58, 1942.)

2.76.540 Hospitals--Professional staff organization--Membership and privileges.

A. The professional staffs (physicians and dentists) of county hospitals shall form self-governing professional staff organizations which shall act in a purely advisory capacity to the hospital administrator and the director of health services in matters of medical and dental staff appointments, patient care, professional organization, standards and requirements. The director of health services shall have sole authority to act in all matters concerning the department of health services, including the above.
B. The professional staff organization shall function in accordance with bylaws which have been approved by the board of supervisors. Amendments to such bylaws shall also be approved by the board of supervisors before they become effective.
C. Physicians and dentists in the county classified service shall not be required to join the professional staff organization. All other physicians and dentists seeking to practice in county hospitals shall be required to apply for and become a member of the professional staff organization in accordance with the procedures set forth in said bylaws.
D. Irrespective of the recommendations of the professional staff organization, the director of health services may, in his sole discretion, reject or appoint physicians and dentists to the staff of county hospitals. Such an appointment automatically qualifies such persons for membership in the professional staff organization. The director of health services shall also have sole authority to limit the scope of practice of such persons, and to terminate their staff appointments. (Ord. 12412 § 2, 1981: Ord. 10656 § 2 (part), 1973: Ord. 4099 Art. 9-A § 150.48, 1942.)

2.76.590 Risk management protocol--Quality improvement program.

A. Purpose. The purpose of the ordinance codified in this section is to improve the delivery of medical services and reduce risks of county liability by assuring the continued maintenance of appropriate risk management and quality assurance protocols established by the department of health services relating to incidents of potential liability, claims, and lawsuits arising out of the provision of medical services.
B. Quality Improvement Program. The department of health services shall continue to maintain a quality improvement program that includes reporting, investigating, and initiating corrective action related to incidents involving potential liability, claims, and lawsuits as they arise out of the provision of medical services. Under the quality improvement program, risk management personnel shall be responsible for taking the necessary actions to ensure prompt reporting, complete investigation, and timely implementation of corrective action regarding these events.
C. Policy. It shall be the policy of the county of Los Angeles for the department of health services to:
1. Maintain a quality improvement program that continues to include the prompt reporting and investigation of incidents of potential liability, claims, and lawsuits arising out of the provision of medical services, along with recommending and ensuring the timely implementation of corrective action;
2. Create and maintain a risk management reporting form and procedure for the reporting of events involving quality, risk, safety, or personnel issues;
3. Assign risk management personnel to receive and review risk management reporting forms, review claims or lawsuits, and perform and direct appropriate responses;
4. Review and analyze, with attention to quality, risk, safety, and personnel issues, all risk management investigations, applicable third party administrator’s investigations, and database information for the purpose of recommending and ensuring timely implementation of corrective action to prevent the reoccurrence of the same or similar type of event involving risk of county liability;
5. Maintain an inspection and audit division that independently verifies the implementation of corrective action;
6. Prepare a corrective action report to accompany any recommended settlement of a claim or lawsuit presented to the board of supervisors for approval where the department participates in the settlement;
7. Include in any contract with a third party administrator regarding claim and litigation management services language requiring the performance of an early investigation and report of incidents, claims, or lawsuits, and the development and maintenance of a database for tracking all reported incidents, claims, and lawsuits.
D. Implementation and Administration. The director, with the consultation and advice of the chief administrative officer and county counsel, shall prepare and issue appropriate instructions, guidelines, forms, protocols, and other documents necessary to carry out the purposes and requirements of this section with regard to the quality improvement program, and shall administer and enforce such program. The director shall include appropriate provisions to maintain confidentiality and applicable privileges relating to any information or documents which may be permitted or required by law. Copies of such instructions, guidelines, forms, protocols, and other documents, and any amendments thereto, shall be provided to all staff involved in the delivery of medical services. (Ord. 99-0030 § 1, 1999.)

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