General Acute Care Hospitals Explained
General Acute Care Hospitals (GACHs) play a pivotal role in California’s healthcare system, delivering a broad range of services, including emergency care, surgery, diagnostic imaging, and specialized treatments. Given their responsibility to treat vulnerable populations, GACHs are often the focus of elder abuse lawsuits.
A GACH is defined in Health and Safety Code §1250(a) as a facility providing “24-hour inpatient care, including… medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.” Their function is to manage patients with acute medical conditions requiring immediate, intensive treatment. Many facilities provide specialized units, such as ICUs and trauma services.
Types and Operational Models
Acute care facilities are considerably diverse in terms of size, scope, and modus operandi. They range from small community hospitals serving local populations to large urban medical centers. In addition to providing specialized care services, many larger facilities function as teaching hospitals.
Let’s look at some of the most common types of GACH, and how they may impact patient care:
For-Profit. Many GACHs operate as for-profit institutions, where financial performance is the primary consideration. As the dominant operational model, the corporatized, for-profit framework is often cited in elder abuse litigation and by elder rights advocates as a root cause of lapses in care.
Non-Profit. The non-profit model emphasizes community-based healthcare services. Both for-profit and non-profit models are bound to comply with state and federal healthcare standards.
Publicly Operated. Some GACHs are publicly operated by local or state governments. They often serve a broader population, including indigent and underserved communities.
Privately Owned. Private hospitals may focus on specialized services and higher-paying insurance groups. Many are owned by private equity firms – a business model that has been shown to negatively impact outcomes for residents. Many large GACHs – both private and public – are involved in medical research and advanced medical care, endeavors which can result in different care standards and increased operational complexities.
Specialty Units. Large hospitals with ICUs, neonatal units, oncology wards, trauma centers and other specialty units often require higher levels of staffing and specialized equipment to tackle specific medical needs.
Departmental Structures
Acute care facilities typically consist of similar departmental units, including administrative and clinical components. Here’s a brief summary of the most common departments, their core functions, and how this can affect your loved one’s care:
Emergency Department. Responsible for providing immediate care for acute or life-threatening conditions.
Intensive Care Units (ICU). Offers specialized care for critically ill patients requiring round-the-clock monitoring.
Medical/Surgical Units. Inpatient care facilitating recovery from surgeries, illnesses, or injuries.
Telemetry Units. Specializes in continuous heart monitoring for patients with arrhythmias or other cardiac issues, and for those recovering from heart surgery. Telemetry units monitor vital signs like heart rate and blood pressure, allowing for a quick response to any sudden changes in a patient’s condition.
Post-Anesthesia Care Unit. Monitors patients recovering from anesthesia immediately after surgery.
Operating Rooms/Surgical Services. Responsible for managing both emergency and scheduled surgeries.
Labor and Delivery Unit. Manages childbirth and neonatal care. L&D units may include a Neonatal Intensive Care Unit (NICU) for critically ill and premature newborns.
Pharmacy/Medication Management. Handles the preparation and distribution of medications.
Diagnostic and Imaging Services. Provides essential diagnostic services such as MRIs and CT scans.
Administrative and Support Services. Handles admissions, discharges, insurance, billing, insurance, and HR support.
Staffing Structures
Acute care facilities are staffed by a wide range of clinical and administrative professionals. A typical hierarchy looks something like this:
CEO. At the top of the hierarchy, the CEO (or Hospital Administrator) oversees all administrative, financial, and strategic operations.
CMO/CCO. The Chief Medical Officer (CMO) or Chief Clinical Officer (CCO) is responsible for all clinical services, including the supervision of medical directors and heads of department.
CNO. The Chief Nursing Officer (CNO) oversees all nursing services.
Nurse Managers. Reporting to the CNO, Nurse Managers are responsible for the day-to-day supervision of nursing staff across a facility’s various specialist units.
Registered Nurses. RNs are responsible for administering medication, conducting patient assessments, and anything else related to direct patient care. In some facilities, they are supported by Licensed Vocational Nurses (LVNs) and Certified Nursing Assistants (CNAs), and hospitalists – clinicians specializing in general inpatient care.
Support Staff. Support staff typically includes occupational and physical therapists, dietitians, pharmacists, social workers, and administrative personnel.
Elder Abuse & Patients’ Rights in Acute Care Facilities
In California, the rights of patients in General Acute Care Hospitals are covered by the Code of Regulations. These include the right to choose a facility or physician they believe can give them the best care, the right to respect and non-discrimination, the right to emergency treatment and the right to refuse treatment.
If you believe those rights are being violated, an elder neglect attorney can help you navigate the legal system and fight for justice for your loved one. For a free consultation with an elder neglect attorney in Los Angeles, San Francisco, or Sacramento, contact Dudensing Law here.