BILL ANALYSIS Ó
Senate Committee on Labor and Industrial Relations
Ted W. Lieu, Chair
Date of Hearing: June 22, 2011 20011-2012 Regular
Session
Consultant: Alma Perez Fiscal:Yes
Urgency: No
Bill No: AB 1136
Author: Swanson
Version: June 20, 2011
SUBJECT
Employment safety: health facilities
KEY ISSUES
Should hospitals be required to have a "safe patient handling
policy" for all patient care units and be required to provide
trained lift teams or other support staff trained in safe
lifting techniques?
Should this policy require the replacement of manual lifting and
transferring of patients with powered lifting devices?
PURPOSE
To require acute care hospitals to establish a safe patient
handling policy that includes providing training and the
necessary equipment.
ANALYSIS
Existing law provides a framework for the protection of the
occupational safety and health of employees through the state's
Division of Occupational Safety and Health, better known as
Cal/OSHA, in the Department of Industrial Relations (DIR). The
California Occupational Safety and Health Act of 1973,
establishes certain safety and other responsibilities of
employers and employees necessary to render the employment safe.
Under existing law , California employers are required to have an
effective written, industry-specific Illness and Injury
Prevention Program (IIPP) that contains certain mandatory
provisions as part of an effort to reduce workplace injuries.
Existing law provides that no employer shall fail or neglect to
do any of the following (Labor Code §6403):
a) Provide and use safety devices and safeguards reasonably
adequate to render the employment and place of employment
safe;
b) Adopt and use methods and processes reasonably adequate
to render the employment and place of employment safe;
c) Do every other thing reasonably necessary to protect the
life, safety, and health of employees.
Existing law prohibits an employer from discharging or laying
off an employee for refusing to perform work in violation of
occupational safety and health standards which could create a
hazard to the employee or his or her fellow employees. An
employee who is laid off, discharged or otherwise not paid
because of his or her refusal to perform such work shall have a
right of action for wages for the time the employee is without
work as a result of the layoff or discharge. (Labor Code §6311)
This Bill would establish the Hospital Patient and Health Care
Worker Injury Protection Act to require an employer to maintain
a safe patient handling policy. Specifically, this bill:
1) Requires that all employers do the following:
a. Maintain a safe patient handling policy at all times
for all patient care units and provide trained lift teams
or other support staff trained in safe lifting techniques
in each general acute care hospital.
b. Provide training to health care workers on the
appropriate use of lifting devices and equipment to
handle patient safely and training on the five areas of
body exposure: vertical, lateral, bariatric,
repositioning and ambulation.
Hearing Date: June 22, 2011 AB 1136
Consultant: Alma Perez Page 2
Senate Committee on Labor and Industrial Relations
c. Adopt a patient protection and health care worker
back and musculoskeletal injury prevention plan, as part
of their IIPP, which shall include a safe patient
handling policy component.
1) Specifies that the safe patient handling policy would
require the replacement of manual lifting and transferring
of patients with powered patient transfer devices, lifting
devices, or lift teams, as specified.
2) 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 nurse's job
description.
3) Defines "lift team" but would specify that lift team
members may perform other duties as assigned during their
shift.
4) Prohibits a hospital from taking disciplinary action
against a health care worker who refuses to lift,
reposition, or transfer a patient due concerns for patient
or worker safety and lack of trained lift team personnel or
equipment.
5) Makes several findings and declarations regarding health
care worker injuries.
COMMENTS
1. Background and need for this bill?
According to 2009 data gathered by the federal Bureau of Labor
Statistics (BLS), 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 higher
incidence rate than all other private industry occupations. In
addition, BLS data shows that nurses have the second highest
rate of missed work days due to workplace injuries. The most
Hearing Date: June 22, 2011 AB 1136
Consultant: Alma Perez Page 3
Senate Committee on Labor and Industrial Relations
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.
A report by the Centers for Disease Control and Prevention
(CDC), titled "Safe Lifting and Movement of Nursing Home
Residents," 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 concluded that research has shown that incorporating
mechanical lifting devices into a safe resident lifting
program decreases caregiver injuries, lost workdays, workers'
compensation costs, and employee turn-over while improving
employee morale and the quality of care for residents.
Additionally, the CDC report notes that the initial investment
in the equipment and training is quickly recovered because of
the reduced injury costs to caregivers.
Clearly, back related injuries among health care workers is a
problem, and this bill would help to make sure every acute
care hospital has a safe patient handling policy at all times
in addition to requiring that lift teams be available and
trained in safe lifting techniques. Existing law requires all
employers to have an industry-specific Illness and Injury
Prevention Program (IIPP) that contains certain mandatory
provisions; this bill would provide additional requirements
regarding safe lifting techniques, necessary training and
equipment.
2. Kaiser Permanente (As an example) and Other States :
Kaiser Permanente developed the Workplace Safety Initiative
Labor Management Partnership to eliminate injuries within
their organization. A 2004 report on the partnership revealed
that the organization's California Division spent $75 million
for workers' compensation claims in 1998, and $81.1 million in
1999. In addition, the Kaiser report notes that the
organization's internal 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 an
additional $66.6 million in indirect costs consisting of
Hearing Date: June 22, 2011 AB 1136
Consultant: Alma Perez Page 4
Senate Committee on Labor and Industrial Relations
replacement workers, sick leave, accident investigation,
triage and record keeping. The Kaiser Report notes that of
these 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 time 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. 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
Adult Acute Care Nursing department.
Six other 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.
3. Proponent Arguments :
According to the author, registered nurses (RNs) manually lift
an estimated 1.8 tons, or 3,600 pounds, per shift and each
time an RN lifts a patient, the RN has a 75 percent chance of
injuring his or her back. Proponents 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. According to proponents, over 12
percent of the nursing workforce leaves the occupation because
of back injuries each year, resulting in a cost of between
$40,000 and $60,000 to train and orient each new nurse.
Proponents argue that preventing turn-over from injuries will
save hospitals money.
Hearing Date: June 22, 2011 AB 1136
Consultant: Alma Perez Page 5
Senate Committee on Labor and Industrial Relations
Proponents argue 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. Additionally,
sponsors of the measure note that the lift team policy is not
new; it has passed the legislature 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.
4. Opponent Arguments :
According to opponents, hospitals are very concerned about
patient and employee safety and already have safe patient
handling policies. However, opponents argue, hospitals across
the state are very diverse in terms of patient population,
staffing mix and resources. Opponents argue that it is
essential that hospitals retain flexibility to develop a safe
patient handling policy that takes into account these
differences and they believe that this bill lacks clarity in
allowing for this flexibility
The Children's Hospital Association is particularly concerned
and argues that children's hospitals differ greatly from all
other hospitals in terms of patient population, staffing and
resources. They recommend elimination of the provision in the
bill that prohibits disciplinary action when a health care
worker refuses to lift, reposition or transfer a patient
arguing that lifting a newborn does not pose any risk of
injury to a nurse or other staff member and such lifting is
essential to the care of infants and young children.
The California Hospital Association is also opposed to the
section of the bill that precludes a hospital from
disciplining a worker who refuses to lift, reposition or
transfer a patient. The Association argues that to the extent
this provision is intended to address patient safety, it is
outside the scope of Cal/OSHA and if it is intended to address
employee safety, they don't believe there is any justification
for creating this heightened level of protection. Opponents
Hearing Date: June 22, 2011 AB 1136
Consultant: Alma Perez Page 6
Senate Committee on Labor and Industrial Relations
argue that hospitals must retain the ability to discipline
employees who refuse to perform a legitimate aspect of their
job in accordance with hospital policies and argue that the
current Cal/OSHA standards strike the appropriate balance in
this regard.
Finally, according to opponents, although they understand that
patient transfer is a significant occupational safety issue,
it is their opinion that mandating this potential increase in
either staff or capital equipment expenditures is not
realistic in the current economic environment.
5. Prior Legislation :
This bill ƯAB 1136 (Swanson)], is the seventh attempt to
address the issue of requiring lift teams or safe patient
handling policies at acute care hospitals. This bill takes a
somewhat different approach than previous versions.
SB 1151 (Perata) of 2008: Vetoed by the Governor
SB 1151 would have required acute care hospital hospitals to
adopt, as part of their IIPP, a patient protection and health
care worker back injury prevention plan that would have
included a safe patient handling policy. In his veto message,
the Governor stated that "SB 1151 is similar to measures that
I have vetoed over the last four years. This bill is
unnecessary as current laws and regulations are in place to
address the workplace health and safety needs of health care
workers. Existing statutes are 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: Vetoed by the Governor
SB 171 sought to require acute care hospitals to establish a
patient protection and health care worker back injury
prevention plan. In his veto message, the Governor stated
that, "While I continue to support the goal of reducing
workplace injuries, I remain convinced that this inflexible
mandate is a poor alternative to giving hospitals the
flexibility needed to achieve this goal in the manner that
most efficiently addresses each hospital's needs and
Hearing Date: June 22, 2011 AB 1136
Consultant: Alma Perez Page 7
Senate Committee on Labor and Industrial Relations
resources."
AB 371 (Huffman) of 2007: Vetoed by the Governor
AB 371 sought to require 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 would
have included a "safe patient handling policy," as defined.
SB 1204 (Perata) of 2006: Vetoed by the Governor
SB 1204 sought to require each general acute care hospital to
establish a health care worker back injury prevention plan.
In his veto message, the Governor stated that, "Since my veto
message of last year, hospitals of all sizes from throughout
the state have reported on progress made in implementing lift
policies. I applaud their efforts and encourage the continued
development of these policies. I believe this is proof that
allowing hospitals the flexibility to implement lift policies
that meet their individual needs is far more effective than
imposing a rigid one-size-fits-all mandate on every hospital
in California."
SB 363 (Perata) of 2005: Vetoed by the Governor
SB 363 sought to require general acute care hospitals, except
rural ones, to provide "lift teams" to assist health care
workers in lifting patients. In his veto message, the
Governor stated that the bill, "imposes a one-size-fits-all
mandate on hospitals to establish a zero lift policy requiring
teams and the use of equipment to lift patients," he went
further to say, "If hospitals do not initiate these measures
on their own, I will consider legislation next year that
imposes the mandate."
AB 2532 (Hancock) of 2004: Vetoed by the Governor
AB 2532 sought to require general acute care hospitals, except
rural ones, to provide "lift teams" to assist health care
workers in lifting patients. Although vetoed, the Governor
encouraged hospitals to review their lift policies to
determine the extent to which they can develop lift teams and
purchase machinery to assist in lifting patients.
Hearing Date: June 22, 2011 AB 1136
Consultant: Alma Perez Page 8
Senate Committee on Labor and Industrial Relations
SUPPORT
California Nurses Association (Sponsor)
Alpha Fund
Association of California Healthcare Districts
California Labor Federation
Engineers and Scientists of California
Laborers' Locals 777 & 792
State Employees International Union
United Nurses Association of California/Union of Health Care
Professionals
OPPOSITION
California Children's Hospital Association (Unless amended)
California Hospital Association (Unless amended)
CSAC Excess Insurance Authority
Hearing Date: June 22, 2011 AB 1136
Consultant: Alma Perez Page 9
Senate Committee on Labor and Industrial Relations