BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Sheila J . Kuehl, Chair
BILL NO: AB 371
A
AUTHOR: Huffman
B
AMENDED: June 1, 2007
HEARING DATE: July 11, 2007
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FISCAL: Appropriations
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CONSULTANT:
Diaz/Hansel/sh
SUBJECT
Health facilities
SUMMARY
Requires general acute care hospitals that apply for
tax-exempt public bond financing to provide a copy of the
hospital's injury and illness prevention program, which
must include a zero lift/safe handling policy, as defined.
Provides that if the hospital does not have such a program,
the application must include a description of how the
applicant will allocate its financial resources for the
planning, purchase, construction, and installation of
equipment to implement a zero lift/safe patient handling
policy.
CHANGES TO EXISTING LAW
Existing law:
Existing law requires every employer to establish,
implement, and maintain an effective injury prevention
program that includes, but is not limited to, the following
elements: (1) identification of the person or persons
responsible for implementing the program; (2) a system for
Continued---
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identifying and evaluating workplace hazards; (3) an
occupational health and safety training program designed to
instruct employees in general safe and healthy work
practices and to provide specific instructions with respect
to job hazards; and (4) the employer's methods and
procedures for correcting unsafe or unhealthy conditions
and work practices in a timely manner.
Existing law establishes the California Health Facilities
Financing Authority (CHFFA) to provide financial assistance
to eligible health institutions through loans funded by
tax-exempt bonds for construction, remodeling, renovation,
land and facility acquisition, equipment, refinancing prior
debt, working capital for startup, and other related
purposes.
Existing law states that a willful or repeated violation of
occupational safety and health standards constitutes a
crime and is subject to civil and criminal penalties.
Existing law allows any person to file a claim with the
California Division of Occupational Safety and Health
(DOSH) within the Department of Industrial Relations if he
or she believes that an employer is violating occupational
safety and health standards.
This bill:
This bill would require every general acute care hospital
that applies for tax-exempt bonds from the CHFFA, or any
other public entity, to provide a copy of the hospital's
injury and illness prevention program, as specified, and
provides that the injury and illness prevention program
must include a zero lift/safe handling policy, as defined.
The bill provides that if the hospital does not have such a
program, the application must include a description of how
the applicant will allocate its financial resources for the
planning, purchase, construction, and installation of
equipment to implement a zero lift/safe patient handling
policy.
The bill would define a "zero lift/safe patient handling
policy" to mean replacing unassisted manual lifting,
repositioning, and transferring of patients with the use of
patient lift, repositioning, or transfer devices and lift
teams. This bill also specifies that a zero lift/safe
patient handling policy does not require the use of a
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patient lift, repositioning, or transfer devices if an
individual's own needs assessment indicates that it is safe
for the patient and employee to utilize techniques that do
not require the use of those devices.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, there would be significant costs for DOSH to
administer the program, offset by fees. Potential
compliance costs ranging from $400,000 to $1 million
annually to the University of California, depending on a
needs assessment of their medical institutions.
BACKGROUND AND DISCUSSION
Purpose of bill
According to the author, California nurses lead the nation
in musculoskeletal disorders (MSDs), more than truck
drivers and construction workers, due to the manual lifting
of patients. The author states that, currently, Kaiser,
the University of California, and some private hospitals
are implementing zero lift policies as a result of
voluntary action or collective bargaining agreements.
Kaiser reports that, after only two years of implementing
their zero lift program, they experienced a 46 percent
reduction in injuries. The author believes that AB 371
would provide hospitals with the financial incentives
through tax-exempt bond funding to implement nurse lift
policies to reduce injuries and improve workplace safety.
Worker injuries
A report published by DOSH, "A Back Injury Prevention Guide
for Health Care Workers," found that nursing aides,
orderlies, and attendants have a risk of injury about three
and a half times that of the average private industry
worker from the manual lifting and transferring of patients
or residents. In California, back injuries account for the
largest proportion of direct costs to the state in workers'
compensation claims, totaling as much as $25,000 per case.
In addition, injured health care workers result in indirect
costs to the health care industry in lost workdays and
labor turnover when these workers find that they cannot
work to their full potential and must leave the profession.
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Zero lift policies
"Zero lift" or "lift free" policies generally refer to
written policies or agreements between a health facility
and its staff to reduce or eliminate the need for manual
patient lifting by using trained professional lift teams
and lifting equipment. San Francisco General Hospital has
implemented its own zero lift policy that prohibits manual
lifting by nursing staff. Instead, a specially trained
lifting team performs all patient lifting or moving of
patients using mechanical lifting devices for transfers.
In the six years since the program began, workers'
compensation costs dropped by approximately 90 percent.
The cost for using a lift team was $70,000 per year.
New York, Ohio, Rhode Island, Texas, and Washington state
have enacted safe patient handling legislation to reduce
worker injuries and to provide financial incentives for
health facilities to invest in lifting equipment and lift
teams. Ohio, for example, created an interest-free loan
program for nursing homes to purchase and install lifts, as
well as to support staff training to achieve a
no-manual-lift policy. Washington state requires hospitals
to acquire lifting equipment and, to provide staff
training, and makes hospitals eligible to receive a tax
credit for purchasing such equipment.
CHFFA and other public financing programs for hospitals
CHFFA is a nine-member body, consisting of the State
Treasurer, Director of Finance, the State Controller, and
six other members appointed by the Governor and
Legislature. CHFFA is responsible for issuing revenue
bonds to assist qualified public hospitals, private
nonprofit corporations, and associations authorized to
provide or operate a health facility and undertake the
financing or refinancing of a project. These bonds may be
used for construction, remodeling, and renovation of health
facilities; land acquisition or acquisition of existing
health facilities; purchase or lease of equipment;
refinancing or refunding prior debt; working capital for
start-up facilities; and reimbursement for costs of bond
issuance and feasibility studies. CHFFA administers
several programs, such as the Tax-Exempt Equipment
Financing program, which funds qualifying health facility
equipment purchases of $500,000 or more. Qualifying
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equipment includes, but is not limited to, medical and
diagnostic equipment, computers, and telecommunications
equipment.
The California Statewide Communities Development Authority
(CSCDA), also known as "California Communities" is a joint
powers authority sponsored by the League of California
Cities and the California State Association of Counties.
CSCDA provides its members low-cost, tax-exempt financing
for projects that demonstrate a "tangible public benefit"
to local communities. There are currently 463 California
local public agencies, including 325 cities, 58 counties,
63 special districts, and 17 redevelopment/water agencies
that are members of CSCDA.
The California Health Facility Construction Loan Insurance
Program, referred to as the Cal-Mortgage program, within
the Office of Statewide Health Planning and Development
(OSHPD), provides low-interest loans for eligible
healthcare facilities to insure the financing or
refinancing of the construction of new facilities; to
acquire, expand, modernize, or renovate existing buildings;
and to finance fixed or moveable equipment needed to
operate the facility.
Related legislation
SB 171 (Perata), 2007-2008 session, would require hospitals
to establish a patient protection and health care worker
back injury prevention plan and would require hospitals to
use lift teams and train health care workers on the
appropriate use of lift, repositioning, and transfer
devices. This bill is pending in the Assembly
Appropriations Committee.
Previous legislation
SB 1204 (Perata) of 2006, SB 363 (Perata) of 2005, and AB
2532 (Hancock) of 2004. All vetoed. These bills would
have required hospitals to implement a "zero lift policy"
for all shifts, utilize lift teams and lift devices, and
train health care workers on the appropriate use of lifting
devices and equipment. The governor's veto message for SB
1204 (Perata) stated that allowing hospitals the
flexibility to implement lift policies that meet their
individual needs is far more effective than imposing a
one-size-fits-all mandate on all hospitals. The veto
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message for SB 363 (Perata) stated that some hospitals have
already been implementing aggressive lift team policies and
are experiencing success in reducing workplace injuries.
The governor also expressed concerns that including these
provisions in the Labor Code could make hospitals victims
of frivolous lawsuits under the "sue your boss law." The
veto message for AB 2532 (Hancock) stated that this mandate
posed too much of a financial burden on hospitals and that
the bill was unnecessary because procedures to limit
injuries caused by the lifting of patients should already
be part of a hospital's mandatory injury and illness
prevention plan (IIPP). Furthermore, the governor stated
that if an individual believes that a hospital's IIPP is
insufficient, they may file a claim with DOSH.
AB 2716 (Strickland) of 2006, would have required
hospitals, beginning January 1, 2008, to include a patient
lift policy as part of their injury and illness prevention
program. This bill did not include language on a zero lift
policy. The hearing of AB 2716 in the Assembly Labor and
Employment Committee was cancelled at the request of the
author.
Arguments in support
The California Nurses Association, the sponsor of AB 371,
states that requiring hospitals applying for financing from
the CHFFA to show proof of an injury and illness prevention
program and a zero lift/safe policy helps ensure savings to
the public by reducing work-related injuries. The
California Applicants' Attorneys Association supports AB
371 because it would lower costs resulting from civil
liability, workers' compensation claims, and other
consequences of injuries. Worksafe writes that nurses and
other health care workers are injured at alarming rates and
lead the nation in musculoskeletal disorders. Worksafe
further states that providing tax-exempt bond funding for
hospitals to purchase lift equipment would alleviate the
financial barriers that hospitals face to make their
workplace safer.
Arguments in opposition
The California Hospital Association (CHA) states that
requiring hospitals to adopt a zero lift policy is
unnecessary and may be detrimental to patient care. CHA
contends that the bill vaguely defines "zero lift" and some
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health care workers could interpret it to mean that they
may not be able to lift a patient, even in an emergency.
Furthermore, CHA states that public financing authorities
do not have expertise in evaluating lift policies and the
bill provides no guidance on what a public financing
authority is required to do with the information it
receives.
PRIOR ACTIONS
Assembly Health: 11-4
Assembly Labor and Employment:5-2
Assembly Appropriations: 12-5
Assembly Floor: 45-32
COMMENTS
1. Suggested technical amendments.
a. On page 2, lines 14-19:
If a general acute care hospital hospital's injury and
illness prevention plan does not include a zero lift/safe
handling policy, does not have a hospital patient and
health care worker injury prevention program described in
subdivision (a) , the application in (a) shall include a
description of how the applicant will allocate its
financial resources for the planning, purchase,
construction and installation of equipment to implement a
zero lift/safe patient handling policy.
b. On page 3, line 2 of the bill the word "hospital" was
left out as the result of a drafting error. The Committee
staff recommend the following technical amendment:
On page 3, line 2, strike out "individual's" and insert
"individual hospital's"
POSITIONS
Support: California Nurses Association (sponsor)
American Federation of State, County and
Municipal Employees
American Nurses Association of California
California Applicants' Attorneys Association
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Consumer Attorney's of California
United Nurses Association of California
Worksafe!
Oppose: California Hospital Association
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