BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
AB 1136 (Swanson)
Hearing Date: 7/11/2011 Amended: 7/5/2011
Consultant: Katie Johnson Policy Vote: Labor 5-1
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BILL SUMMARY: AB 1136 would require all general acute care
hospitals to maintain a safe patient handling policy and provide
trained lift teams or other support staff trained in safe
lifting techniques. The bill would also require employers to
adopt a patient protection and health care worker back and
musculoskeletal injury prevention plan as part of the injury and
illness prevention programs required by existing state
regulations.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
CDCR hospitals' potentially significant in the
General
officer training hundreds of thousands of dollars
DDS hospital staff potentially significant in the
highGeneral/*
and training costs hundreds of thousands to low
millionsFederal
of dollars ongoing
Hospital staff, training, potentially significant, would
vary General/**
and purchase of by hospital Federal/
equipment cost pressure Local
on all payers
DIR regulations up to $100 one-time through FY
2012-2013Special***
*50 percent federal funds, 50 percent General Funds
**See Staff Comments
***Occupational Safety and Health Fund
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AB 1136 (Swanson)
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
This bill would require all general acute care hospitals to
maintain a safe patient handling policy and to provide trained
lift teams or other support staff trained in safe lifting
techniques. This bill would require employers to provide
training to health care workers that would be required to
include the appropriate use of lifting devices and equipment,
the five areas of body exposure, and the use of lifting devices
to handle patients safely. A registered nurse would be required
to be responsible for the observation and direction of patient
lifts and mobilization.
This bill would also require employers to adopt a patient
protection and health care worker back and musculoskeletal
injury prevention plan as part of the injury and illness
prevention programs (IIPPs) required by existing state
regulations, Section 3203, Title 8 of the California Code of
Regulations. Every employer in California is required to have an
IIPP; in hospitals, a safe patient handling or lift policy may
be part of the IIPP.
There are approximately 420 hospitals in California. This bill
would apply to all general acute care hospitals, including the
three run by the California Department of Corrections and
Rehabilitation (CDCR) and the four run by the Department of
Developmental Services (DDS).
State Facilities
Costs to train CDCR peace officers and health care staff
pursuant to this bill would likely be in the hundreds of
thousands of dollars General Fund one-time. Additionally, there
would be overtime pay expenses because CDCR would need to
backfill the positions of the officers receiving training. Also,
there could be one-time equipment purchase costs to the extent
that CDCR facilities do not have adequate lift equipment.
While DDS currently has adequate lifting equipment and IIPPs,
they do not have dedicated lift teams, nor a nurse dedicated to
the observation and direction of patient lifts. There would be a
cost to increase staffing and to train those new staff, which
would be shared 50 percent General Fund and 50 percent federal
AB 1136 (Swanson)
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funds. Assuming a lift team of two people plus a dedicated nurse
to oversee the team at an estimated cost of $200,000 - $300,000
per team, expenses could be approximately $1 million ongoing.
Other Hospitals
To the extent that a hospital does not have a patient handling
policy that meets this bill's provisions, there would be similar
increased costs in the low hundreds of thousands of dollars per
lift team. Additionally, if a hospital does not have the
necessary lifting equipment, it could incur one-time equipment
purchase costs as well. In California, hospitals are paid by a
variety of public and private "payers," such as insurers, health
care service plans, the state, counties, or individuals. There
would be cost pressure on all payers, including state payers
such as the Medi-Cal program, the Healthy Families Program
(Healthy Families), and California Public Employees Retirement
System (CalPERS), to cover any increased costs to hospitals that
would result from this bill in the rates that they pay to the
hospital; state programs do not pay hospitals directly for
administrative costs. Medi-Cal costs are shared 50 percent
General Fund/other non-federal funds and 50 percent federal
funds depending on the private or publicly-owned status of the
hospital; Healthy Families costs are shared 35 percent General
Fund and 65 percent federal funds; and CalPERS costs are shared
approximately 55 percent General Fund and 45 percent other
funds.
This bill would require that all "health care workers" would
need to receive training. It is unclear if these workers are
part of the lift team or if all health care workers in a
hospital would need to be trained. Staff notes that in order to
avoid higher costs, the author may want to consider amending
this bill to further define the scope of individuals who would
require training.
There would be costs of up to $100,000 special funds one-time to
the Department of Industrial Relations (DIR) for regulations.
Occupational Safety and Health Fund monies are capped and
annually adjusted by a deflator. This bill would put pressure on
those limited funds.
Previous Legislation
This bill is similar to several previous bills that were all
vetoed by Governor Schwarzenegger: SB 1151 (Perata, 2008), SB
AB 1136 (Swanson)
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171 (Perata, 2007), AB 371 (Huffman, 2007), SB 1204 (Perata,
2006), SB 363 (Perata, 2005), and AB 2532 (Hancock, 2004). In
his SB 1151 veto message, the Governor said, "?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?."