BILL ANALYSIS Ó
AB 1136
Page 1
Date of Hearing: May 4, 2011
ASSEMBLY COMMITTEE ON LABOR AND EMPLOYMENT
Sandre Swanson, Chair
AB 1136 (Swanson) - As Amended: April 26, 2011
SUBJECT : Employment safety: health facilities.
SUMMARY : Establishes the Hospital Patient and Health Care
Worker Injury Protection Act (Act) to require hospitals to adopt
a safe patient handling policy. Specifically, this bill :
1)Establishes the Act to require all general acute care
hospitals (hospitals) to do the following:
a) Maintain a safe patient handling policy at all times for
all patient care unites;
b) Provide trained life teams or other support staff
trained in safe lifting techniques; and,
c) Provide training to health care workers on the
appropriate use of lifting devices and equipment to handle
patients safely and the five areas of body exposure:
vertical, lateral, bariatric, repositioning, and
ambulation.
2)Requires all hospitals to develop a written safe patient
handling policy by January 1, 2013.
3)Requires all hospitals to purchase enough safe patient
handling equipment to eliminate the need to conduct manual
patient handling and transfers.
4)Requires all hospitals, after January 1, 2013, to document
each use of a manual lift.
5)Requires a registered nurse, as the coordinator of care, to be
responsible for the observation and direction of patient lifts
and mobilization and participate as needed in patient handling
in accordance with the nurses job description
6)Defines "lift team" as hospital employees specifically trained
to handle patient lifts, repositioning, and transfers using
patient transfer, repositioning or lifting devices as
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appropriate for the specific patient.
7)Defines "safe patient handling policy" as a policy that
requires replacement of manual lifting and transferring of
patients with powered patient transfer devices, lifting
devices, or lift teams, consistent with the employer's safety
policies and the professional judgment and clinical assessment
of a registered nurse.
8)Requires employers to adopt a patient protection and health
care worker back and musculoskeletal injury prevention plan as
part of their injury and illness prevention program.
a) Requires the plan to include a safe patient handling
policy component as reflected in the professional
occupational safety guidelines for the protection of
patients and health care workers in health care facilities.
9)Prohibits a hospital from taking disciplinary action against a
health care worker who refuses to lift, reposition, or
transfer a patient due to the worker's concerns about his or
her patient's safety and his or her own personal safety and
the lack of available trained lift team personnel or
appropriate lifting equipment.
EXISTING LAW
1)Creates the Division of Occupational Safety and Health (DOSH),
better known as Cal/OSHA, within the Department of Industrial
Relations (DIR) to, among other duties, protect workers and
the public from safety hazards through its Occupational Safety
and Health inspection program.
2)Requires all employers to establish, implement, and maintain
an effective injury prevention program.
3)Requires all employers to train their employees in the proper
use of the injury prevention program and keep appropriate
records of the program's implementation and maintenance.
4)Prohibits employers from failing to or neglecting to do any of
the following:
a) To provide and use safety devices and safeguards
reasonably adequate to render the employment and place of
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employment safe;
b) To adopt and use methods and processes reasonably
adequate to render the employment and place of employment
safe; and,
c) To do every other thing reasonably necessary to protect
the life, safety, and health of employees.
FISCAL EFFECT : Unknown
COMMENTS : According to the author, registered nurses (RNs)
manually lift an estimated 1.8 tons, or 3,600 pounds, per shift.
Each time an RN lifts a patient, the RN has a 75 percent chance
of injuring his or her back. The author notes that nursing
surveys reveal that 83 percent of RNs work in spite of back
pain, while 52 percent report chronic back pain and 12 percent
leave the profession citing back injuries as the main or
significant reason. The author states that, when RNs leave,
their employers spend $40,000 to $60,000 to train and orient
their replacements.
A report from the Centers for Disease Control and Prevention
(CDC), titled "Safe Lifting and Movement of Nursing Home
Residents," (CDC Report) asserts that, even in ideal lifting
conditions, the weight of any adult far exceeds the lifting
capacity of most caregivers, 90 percent of whom are female. The
CDC Report notes that safe lifting programs have reduced
worker's compensation injury rates by 61 percent, lost workday
injury rates by 66 percent, restricted workdays by 38 percent
and the number of workers suffering repeat injuries.
According to 2009 data from the federal Bureau of Labor
Statistics (BLS), the overall rate of nonfatal occupational
injury and illness cases that required days away from work to
recuperate decreased by 9 percent to 1,238,490 cases for private
industry, state government and local government. Despite this
decrease, however, BLS notes that several occupations -
including delivery service truck drivers, landscapers,
restaurant cooks and registered nurses - had an increase in
their rates of injuries and illness.
BLS data also show that, in the private industry, 18 percent
(172,820 cases) of all occupational injuries and illnesses
occurred in health care and social assistance industries at a
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higher incidence rate than all other private industry
occupations. In addition, BLS data show that nurses have the
second highest rate of missed work days due to workplace
injuries. The most common injuries suffered by nurses include
musculoskeletal disorders (MSDs) and overexertion. The BLS notes
that, 59.2 percent of all MSDs suffered by nurses were back
related injuries. In addition, BLS data show that hospitals and
nursing and residential facilities have some of the highest
rates of nonfatal occupational injuries in California.
A report on Kaiser's Labor Management Partnership Workplace
Safety Initiative (Kaiser Report) revealed that Kaiser developed
a worker comprehensive initiative to eliminate injuries within
their organization. According to the Kaiser Report, the
organization's California Division spent $75 million for
workers' compensation claims in 1998. In 1999, the cost for the
same division increased to $81.1 million. In addition, the
Kaiser Report notes that the organization's internal an injury
analysis of patient care services showed that there were 4,230
injuries to workers and patients that cost Kaiser $31.7 million
in direct cost and additional $66.6 million in indirect costs.
For Kaiser, indirect cost included replacement workers, sick
leave, accident investigation, triage and record keeping. The
Kaiser Report notes that of these 4,230 injuries, approximately
1,731were attributed to patient handling injuries for which
Kaiser paid approximately $17 million in direct cost and $35.6
million in indirect costs.
In an effort to address the high rate and the high cost of
workplace injuries, Kaiser Permanente implemented a lift team
policy for the first in 2000 and began implementing additional
lift teams in 2003. The organization created a "Standards of
Care" policy to identify "high risk" criteria to assess the
situations for which a "Lift Team" should be contacted. These
situations included, but were not limited to, patients over 150
pounds, quadriplegic and paraplegic patients, patients hat
require total assistance in movement or limited weight bearing
and /or mobility status, and patients who have fallen. The
Kaiser Report notes that, in addition to training lift teams,
Kaiser implemented standards around lift equipment, including
recommendations for a ratio of one piece of equipment for every
24-56 hospital beds. According to the Kaiser Report, within the
first quarter of 2003, one service area that consisted of 3
Kaiser Medical Centers saw a 12 percent reduction in patient and
worker injuries overall and a 23.6 percent decrease in their
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Adult Acute Care Nursing department.
Other States
Six states - Maryland, Minnesota, New Jersey, Rhode Island,
Texas and Washington - have laws that mandate a form of safe
patient handling or the use of lifting equipment. For example,
in 2005, Texas became the first state to require both hospitals
and nursing homes to establish a policy for safe patient
handling and movement. In addition, the state's law requires
hospitals and nursing homes to evaluate alternative methods from
manual lifting, including equipment and patient care
environment, and restrict, to the extent feasible with existing
equipment, manual handling of all or most of a patient's weight
to emergency, life-threatening, or exceptional circumstances.
Texas law also allows a nurse to refuse to perform patient
handling tasks if he or she believes, in good faith, that doing
so would involve unacceptable risks of injury a patient or to
the nurse.
In 2006, Washington became the first state to mandate the use of
lift equipment by hospitals. The state also uses tax credits and
reduced workers' compensation premiums to financial assist
hospitals with the purchasing of lift equipment. In addition,
hospitals in Washington may choose either one readily-available
lift per acute care unit on the same floor, one lift for every
ten acute care inpatient beds, or lift equipment for use by
specially-trained lift teams. The state's law also allows
employees to refuse to engage in patient handling activities if
the employee believes in good faith that doing so would impose
an unacceptable risk of injury to the employee or his or her
patient. In contrast to Texas, Washington's law does not cover
nursing homes.
ARGUMENTS IN SUPPORT :
In a letter expressing sponsorship of the bill, the California
Nurses Association (CNA) asserts that over 12 percent of the
nursing workforce leaves the occupation because of back injuries
each year. CAN states that California's nursing workforce is
aging at the same time that patient acuity and obesity is on the
rise. They note that it is imperative that registered nurses
and other health care workers be protected from injury and
provide patients with safe and appropriate care. CNA writes that
the lift team policy is not new; it has passed the legislature
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each legislative session between 2004 and 2008. They note that
this bill is a triple win policy; it safely cares for patients,
saves the state's nursing workforce and saves hospitals money.
The United Nurses Association of California/Union of Health Care
Professionals (UNAC/UHCP) writes that this bill is a reasonable
solution to a very critical work place and quality life issue.
They note that injuries are costly to the employers and have a
severe impact on a worker's quality of life, result in a loss of
income for workers, and, in many cases, result in health care
workers and registered nurses leaving the workforce. In their
letter of support, the Association of California Healthcare
Districts (ACHD) writes that patient transfers are the number
one loss driver for hospitals through workers' compensation
claims. They note that District Hospitals cannot afford to lose
valuable health care workers as a result of transporting or
lifting patients. ACHD asserts that preventing turnover from
lift related injuries will save hospitals money in the long run
and this bill will help prevent work related injuries in
District Hospitals.
ARGUMENTS IN OPPOSITION :
In a letter that expresses their oppose unless amended position,
the California Hospital Association (CHA) writes that several
key provisions of the bill are ambiguous and, if interpreted
narrowly, would prove problematic and potentially interfere with
hospitals' ability to provide quality patient care. For example,
CHA notes that the provision to provide trained lift teams or
other support staff trained in safe lifting techniques, as
written, suggests that the hospital must utilize lift teams and
or other staff and may not require nurses to perform lifts. CHA
also states the provision that would requires "safe patient
handling policy" is vague and could be interpreted in one of two
ways. It either gives the hospital discretion to develop the
policy "consistent with the employer's safety policies, or it
significantly curtails the hospital's discretion by requiring
replacement of manual lifting and transferring of patients with
powered transfer devices, lifting devices or lift teams. In
addition, CHA writes that the implementation date of January 1,
2003 would be difficult for hospitals because their 2012 budgets
would not account for any additional cost that may be associated
with this bill. The California Children's Hospital Association
(CCHA), write that this bill does not allow any flexibility and
its one-size- fits -all approach is problematic for children's
hospital because they differ greatly from all other hospitals in
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terms of patient population, staffing and resources. CCHA also
notes that this bill fails to recognize much of the lifting done
in children's hospitals, including that of newborns, infants and
young children.
PRIOR LEGISLATION :
SB 1152 (Perata) of 2008 would have required acute care
hospitals to establish a patient protection and health care
worker back injury prevention plan that would have included a
safe patient handling policy. This bill was vetoed by the
Governor. In his veto message, the Governor wrote that the bill
was unnecessary because the current laws and regulations that
were in place to address the workplace health and safety needs
of health care workers. The Governor stated that existing
statutes were flexible and allow employers to exercise
discretion in determining what combination of lift teams and
equipment is necessary to have an effective Injury and Illness
Prevention Program.
SB 171 (Perata) of 2007 would have required acute care hospitals
to establish a patient protection and health care worker back
injury prevention plan. This bill was vetoed by the Governor.
In his veto message, the Governor stated that, the bill would
have imposed a one-size fits all mandate on hospitals to
establish a "zero lift" patient handling policy similar to
measures he vetoed in prior years.
SB 1204 (Perata) of 2006 would have required each general acute
care hospital to establish a health care worker back injury
prevention plan. This bill was vetoed by the Governor. In his
veto message, the Governor stated that hospitals of all sizes
from throughout the state had reported progress made on the
implementation of lift policies. The Governor wrote that he
believed that this was proof that allowing hospitals the
flexibility to implement lift policies that meet their
individual needs was far more effective than imposing a rigid
one-size-fits-all mandate on every hospital in California.
SB 363 (Perata) of 2005 would have required general acute care
hospitals, except rural those in rural areas, to provide "lift
teams" to assist health care workers in lifting patients. This
bill was vetoed by the Governor. In his veto message, the
Governor wrote that the bill would have imposed a
one-size-fits-all mandate on hospitals to establish a zero lift
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policy requiring teams and the use of equipment to lift
patients. The Governor also stated that if hospitals did not
initiate these measures on their own, he would consider
legislation that imposes the mandate in the next year.
REGISTERED SUPPORT / OPPOSITION :
Support
ALPHA Fund
Association of California Healthcare Districts
California Labor Federation, AFL-CIO
California Nurses Association (Sponsor)
Engineers and Scientists of California
United Nurses Association of California/Union of Health Care
Professionals
Opposition
California Hospital Association
California Children's Hospital Association
CSAC Excess Insurance Authority
Analysis Prepared by : Shannon McKinley / L. & E. / (916)
319-2091