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State of California—Health and Human Services Agency
California Department of Public Health

AFL 21-43
November 15, 2021

General Acute Care Hospitals (GACHs)
Acute Psychiatric Facilities (APHs)

Assembly Bill (AB) 451 - Treatment of Psychiatric Emergency Medical Conditions

All Facilities Letter (AFL) Summary

This AFL notifies GACHs and APHs of the chaptering of AB 451 (Chapter 438, Statutes of 2021) that requires a psychiatric unit within a GACH, an APH, or a psychiatric health facility (PHF), to accept a transfer of a person with a psychiatric emergency medical condition if specified conditions are met.

Effective January 1, 2022, AB 451 requires an APH, a psychiatric unit within a GACH, or a PHF with more than 16 beds, regardless of whether the facility maintains an emergency department (ED), to accept a transfer of a person with a psychiatric emergency medical condition from a licensed health facility with an ED and provide emergency services and care to that person if the receiving facility has an available bed, appropriate facilities and qualified personnel available to provide the services or care, and the treating physician at the sending facility has determined that the patient is medically stable and appropriate for treatment in a psychiatric setting and has included this determination in the patient's file.

A psychiatric emergency medical condition is a mental disorder that manifests itself by acute symptoms of sufficient severity that it renders the patient as being an immediate danger to himself or herself or to others or immediately unable to provide for, or use, food, shelter, or clothing, due to the mental disorder.

Emergency services and care must include a screening, examination, and evaluation by a physician or other qualified personnel to determine if a psychiatric emergency medical condition exists and the related care and treatment that is necessary, within the capability of the facility.

A facility accepting a transfer of a patient with a psychiatric emergency medical condition is prohibited from basing emergency services and care on specified patient characteristics, including, but not limited to, the person's ethnicity, age, or ability to pay for medical services, except to the extent that a circumstance is medically significant to the provision of appropriate medical care. A facility accepting a transfer must render emergency services and care without first questioning the patient or any other person as to their ability to pay. Additionally, a GACH or APH is prohibited from requiring a patient voluntarily seeking care to be in custody pursuant to section 5150 of the Welfare and Institutions Code as a condition of accepting the transfer if the person's consent is documented or if probable cause for detention is absent.

Facilities operated by the Department of State Hospitals and PHFs with 16 beds or fewer or that are county owned and operated are exempted from this emergency services requirement. PHFs are licensed and regulated by the Department of Health Care Services (DHCS). For questions regarding PHFs specifically, please contact DHCS' Mental Health Licensing Section by email at

CDPH's failure to expressly notify facilities of statutory or regulatory requirements does not relieve facilities of their responsibility for following all laws and regulations. Facilities

should refer to the full text of all applicable sections of Health and Safety Code and the California Code of Regulations to ensure compliance.

For any other questions about this AFL, please contact your local district office.



Original signed by Cassie Dunham

Cassie Dunham

Acting Deputy Director

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