BILL ANALYSIS
AB 773
Page 1
Date of Hearing: April 28, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 773 (Lieu) - As Amended: April 14, 2009
SUBJECT : Health facilities: fines.
SUMMARY : Increases fines the Department of Public Health (DPH)
may assess against long-term health care facilities for
violations of classes "AA," "A," and "B" citations.
Specifically, this bill :
1)Increases the civil penalty for a class "AA" citation from the
current level of $25,000 - $100,000 to $50,000 - $125,000 for
each citation to a nursing home. Authorizes DPH to revoke a
facility's license for a second "AA" citation within a two
year period.
2)Increases the civil penalty for a class "A" citation from the
current level of $2,000 - $20,000, to $5,000 - $50,000 for
each citation.
3)Increases the civil penalties for a class "B" citation from
the current level of $100 - $1,000, to $1,000 - $5,000 for
each citation.
4)Requires a cited facility, within 30 days of the issuance of a
citation for class "AA" or "A," to send to the families or to
the contacts of all current residents or patients written
disclosure of the violation for which the citation was issued.
Permits an additional assessment of a $1,000 fine for failure
to comply with this provision.
5)Makes legislative findings and declarations on the need to
improve nursing home care in California, as specified.
EXISTING LAW :
1)The Long-Term, Health, Safety, and Security Act of 1973
authorizes DPH to administer various requirements related to
long-term care facilities. Violations of these provisions are
punishable by specified citations and penalties, and in
determining the amount of a civil penalty requires DPH to
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consider all relevant facts, including the severity of the
risk to the patient, the patient's medical condition or
disability, the good faith efforts of the facility to prevent
violations, and the facility's history of compliance.
Requires DPH to meet the burden of proof to impose a penalty;
a licensee may argue that its behavior was consistent with
actions reasonably expected of a licensee under similar
circumstances.
2)Defines class "AA" citations as violations which DPH
determines have been a direct proximate cause of death to a
patient or resident of a long-term care facility. Class "AA"
civil penalties range from $25,000 - $100,000 for each
citation.
3)Defines class "A" citations as violations which DPH determines
present either imminent danger of death or serious harm to
residents or which may result in a substantial probability of
death or serious physical harm. Class "A" civil penalties
range from $2,000 - $20,000 for each citation.
4)Defines class "B" citations as violations which DPH determines
have a direct relationship to the health, safety, or security
of long-term health facility residents. Class "B" violations
are subject to civil penalties of $100 to $1,000 for each
violation.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL : This bill, according to the author, is
intended to provide additional protection and improved quality
of life to California residents of long-term care facilities.
The author note that increased funding and administrative
oversight have not reduced the number of citations in nursing
facilities and the supporters believe stricter penalties will
result in fewer violations.
2)OFFICE OF INSPECTOR GENERAL . The federal Department of Health
and Human Services, Office of the Inspector General (OIG),
annually surveys national information on nursing home
deficiencies. In the most recent (2008) report, "Trends in
Nursing Home Deficiency and Complaints," OIG found that in
each of the past three years, over 91% of nursing homes
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surveyed were cited for deficiencies and a greater percentage
of for-profit nursing homes were cited than were
not-for-profit and government nursing homes. The most common
deficiency categories were quality of care, resident
assessment, and quality of life. Additionally, 17% of nursing
homes surveyed in 2007 were cited for actual harm or immediate
jeopardy deficiencies, and 3.6% were cited for substandard
quality of care deficiencies, representing a slight increase
since 2005. Since 2005, the number of substantiated
complaints decreased nearly 3%. Almost all California
long-term care facilities (99.1%) were cited during 2007.
3)SUPPORT . The Alzheimer's Association, California Council,
writes in support of this bill that there are a number of
strategies for improving nursing home quality of care,
including technical assistance and linking rates to citation
history, but when a determination is made that a violation has
occurred, fines should be assessed and they should be in an
amount sufficient to deter irresponsible behavior.
4)OPPOSITION . The California Association of Health Facilities
(CAHF), opposed to the bill, argues there is little evidence
to suggest that higher state fines promote additional facility
compliance or better equip DPH to deal with a problem
facility. CAHF argues federal requirements drive most nursing
home operations and the federal process provides a
comprehensive menu of sanctions which include federal fines of
up to $10,000 per day per violation. CAHF notes that
California is one of only a very few states which have opted
to maintain a state sanctioning process and that nearly one
half of all citations/fines originate from "self-reported"
incidents in which facilities report their own violations.
5)AUTHORS AMENDMENTS. The author intends to address the
concerns raised by opponents by accepting the following
amendment:
On pages 4, 5, and 6, strike all proposed changes in
penalties for "AA", "A", and "B" citations and restore the
penalties consistent with existing law.
6)COMMENT . As proposed to be amended by the author, this bill
will be limited to the requirement that facilities cited for
class "AA" or class "A" violations send specified written
notification to the contact for all current residents and
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patients within 30 days of the citation. The notification
will disclose the violation which caused the citation, a DHS
source which can provide additional information regarding the
citation, and notice if the facility is appealing the
citation. The amendment will also authorize DHS to impose an
administrative penalty of $1000 for each day the notice is
delayed beyond 30 days.
REGISTERED SUPPORT / OPPOSITION :
Support
Alzheimer's Association
American Federation of State, County and Municipal Employees,
AFL-CIO
California Retired Teachers Association
Professional Fiduciary Association of California
Opposition
Aging Services of California
California Association of Health Facilities
California Hospital Association
Country Care Convalescent Hospital
Crestwood Behavioral Health, Inc.
Vista Healthcare Center
Analysis Prepared by : John D. Miller/ HEALTH / (916) 319-2097