BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1136|
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THIRD READING
Bill No: AB 1136
Author: Swanson (D)
Amended: 8/15/11 in Senate
Vote: 21
SENATE LABOR & INDUSTRIAL RELATIONS COMM. : 5-1, 6/22/11
AYES: Lieu, DeSaulnier, Leno, Padilla, Yee
NOES: Wyland
NO VOTE RECORDED: Runner
SENATE APPROPRIATIONS COMMITTEE : 6-3, 8/25/11
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Emmerson, Runner
ASSEMBLY FLOOR : 50-27, 6/2/11 - See last page for vote
SUBJECT : Employment safety: health facilities
SOURCE : California Nurses Association
DIGEST : This bill requires 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 requires 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.
ANALYSIS : Existing law regulates the operation of health
CONTINUED
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facilities.
Existing law, the California Occupational Safety and Health
Act of 1973, establishes certain safety and other
responsibilities of employers and employees, including the
requirement that employers provide safety devices and
safeguards reasonably necessary to render the employment
safe. Willful or repeated violations are a crime.
This bill requires 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 requires 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.
Comments
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 common injuries suffered by
nurses include musculoskeletal disorders 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
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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.
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 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 three 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.
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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.
Prior Legislation
This bill 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, 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. Subsequently, Governor Schwarzenegger
vetoed this bill. In his veto message he states 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, sought to require acute care
hospitals to establish a patient protection and health care
worker back injury prevention plan. Subsequently Governor
Schwarzenegger vetoed this bill. In his veto message he
states 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 resources."
AB 371 (Huffman) of 2007, sought to require acute care
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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. This bill was vetoed
by Governor Schwarzenegger.
SB 1204 (Perata) of 2006, sought to require each general
acute care hospital to establish a health care worker back
injury prevention plan. Subsequently this bill was vetoed
by Governor Schwarzenegger. In his veto message he states
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, sought to require general acute
care hospitals, except rural ones, to provide "lift teams"
to assist health care workers in lifting patients.
Subsequently this bill was vetoed by Governor
Schwarzenegger. In his veto message he states 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, sought to require general acute
care hospitals, except rural ones, to provide "lift teams"
to assist health care workers in lifting patients.
Although this bill was vetoed by Governor Schwarzenegger,
he 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
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 Special**
FY 2012-2013
**Occupational Safety and Health Fund
SUPPORT : (Verified 8/30/11)
California Nurses Association (source)
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 : (Verified 8/30/11)
California Children's Hospital Association (Unless amended)
California Hospital Association (Unless amended)
CSAC Excess Insurance Authority
ARGUMENTS IN SUPPORT : According to the author's office,
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/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
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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.
Proponents further 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, the California Nurses
Association, the sponsors of this bill 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.
ARGUMENTS IN OPPOSITION : 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 this 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
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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 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.
ASSEMBLY FLOOR : 50-27, 6/2/11
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bonilla, Bradford, Brownley, Buchanan,
Butler, Charles Calderon, Campos, Carter, Cedillo,
Chesbro, Davis, Dickinson, Eng, Feuer, Fong, Fuentes,
Furutani, Galgiani, Gatto, Gordon, Hayashi, Roger
Hernández, Hill, Hueso, Huffman, Lara, Bonnie Lowenthal,
Ma, Mendoza, Mitchell, Monning, Pan, Perea, V. Manuel
Pérez, Portantino, Skinner, Solorio, Swanson, Torres,
Wieckowski, Williams, Yamada, John A. Pérez
NOES: Achadjian, Bill Berryhill, Conway, Cook, Donnelly,
Fletcher, Beth Gaines, Garrick, Grove, Hagman, Halderman,
Harkey, Jeffries, Jones, Knight, Logue, Mansoor, Miller,
Morrell, Nestande, Nielsen, Norby, Olsen, Silva, Smyth,
Valadao, Wagner
NO VOTE RECORDED: Gorell, Hall, Huber
PQ:do 8/30/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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