BILL ANALYSIS Ó
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 840
S
AUTHOR: Evans
B
AMENDED: April 28, 2011
HEARING DATE: May 4, 2011
8
CONSULTANT:
4
Trueworthy
0
SUBJECT
Health care facilities: carbon monoxide detectors
SUMMARY
Requires skilled nursing facilities with fossil fuel
burning appliances to install carbon monoxide (CO) devices.
CHANGES TO EXISTING LAW
Existing law:
Provides for the licensure and regulation of health
facilities, including skilled nursing facilities (SNFs), by
the Department of Public Health (DPH).
Defines a SNF to be a health facility providing skilled
nursing care and supportive care to patients whose primary
need is the availability of skilled nursing care on an
extended basis.
Requires the Department of Health Care Services (DHCS) to
develop and implement a facility-specific cost-based
Medi-Cal reimbursement rate methodology that reflects the
sum of the projected costs in specified cost categories and
defined pass-through costs for SNFs.
Continued---
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Establishes the Facilities Development Division (FDD),
under the Office of Statewide Planning and Development
(OSHPD), to review and inspect health facility construction
projects and enforce building standards, under the
California Building Code, as they relate to health
facilities construction.
Requires the building standards, as well as regulations
adopted by DPH, to prescribe standard of adequacy, safety,
and sanitation of staffing with duly qualified licensed
personnel.
Requires the State Fire Marshal to develop a certification
and decertification process to approve and list carbon
monoxide devices.
Requires dwellings intended for human occupancy that have a
fossil fuel burning appliance, a fireplace, or an attached
garage to install a carbon monoxide device. Defines a
"dwelling unit intended for human occupancy" to include a
single family dwelling, factory built home, duplex, lodging
house, dormitory apartment complex, hotel, motel,
condominium, stock cooperate, time-share project or
dwelling unit of a multi-family complex. Property owned or
leased by the state, the Regents of the University of
California or a local government agency are exempt from
this requirement.
This bill:
Requires a SNF to install carbon monoxide (CO) devices that
are approved by the State Fire Marshall by January 1, 2013.
Exempts SNFs that do not have fossil fuel burning
appliances within the interior of the facility from being
required to install a CO device.
Requires DPH to prescribe the criteria for the number and
placement of CO devices and to adopt and enforce
regulations prescribing building standards for adequacy and
safety.
Defines a fossil fuel to be coal, kerosene, oil, wood, fuel
gases, and other petroleum or hydrocarbon products that
emit CO.
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FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
According to the author, the goal of SB 840 is to protect
the lives of Californians residing and working in SNFs from
CO poisoning. The author states that, according to the
California Air Resources Board, 30 to 40 people die each
year from CO poisoning and it is the leading cause of
accidental poisoning deaths in the United States. The
Carbon Monoxide Poisoning Prevention Act of 2010 (Act)
requires dwellings in California intended for human
occupancy that have a fossil fuel burning appliance, a
fireplace, or an attached garage to install a carbon
monoxide device. However, SNFs are not included in this
requirement. The author contends this loophole poses a
major health risk to employees and vulnerable resident
populations in SNFs, and argues that CO monitors are an
effective, inexpensive way to combat CO poisoning.
Carbon monoxide
CO is a gas produced from the incomplete combustion of
fossil fuel such as natural gas, gasoline, fuel oil, coal
or wood. The most common carbon monoxide sources are gas,
wood, or coal burning furnaces; gas or wood stoves; gas or
charcoal barbeques; generators; and gasoline-powered tools.
In 2007, the American Association of Poison Control
Centers reported 15,769 cases of carbon monoxide poisoning
which resulted in 39 deaths.
A CO detector is a device that detects the presence of CO
gas in order to prevent CO poisoning. CO detectors are
designed to measure CO levels over time and sound an alarm
before dangerous levels of CO accumulate in an environment,
giving people adequate warning to safely ventilate the area
or evacuate. Because CO is a colorless, odorless, and
tasteless gas, it is virtually undetectable without using
detection technology.
Skilled nursing facilities
There are approximately 1,250 licensed SNFs in California,
including 120 hospital-based SNFs, which provide care to
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approximately 300,000 Californians each year. Most
California SNFs are certified to participate in Medicare
and Medi-Cal, and are required to meet federal and state
standards in order to be licensed and receive reimbursement
under these programs. Current standards do not require
SNFs or other health facilities to install CO devices, but
they do establish building requirements and staffing
standards that must be met to ensure the safety and
adequacy of the physical part of the facility.
SNFs receiving Medi-Cal reimbursement receive a cost-based
reimbursement rate. This methodology reflects the sum of
the projected cost of specified cost categories and
pass-through costs for SNFs. Any costs associated with
installing a CO device would be included in this
methodology.
Prior legislation
SB 183 (Lowenthal), Chapter 19, Statutes of 2010, enacted
the Carbon Monoxide Poisoning Prevention Act of 2010 which
requires all existing dwellings intended for human
occupancy that have a fossil fuel burning appliance, a
fireplace, or an attached garage to install a CO device.
Arguments in support
Supporters state that homes, duplexes, hotels, and
residential care facilities are already required to have CO
monitors today, but skilled nursing facilities somehow were
not included in this requirement. Elders residing in SNFs
are at a higher risk of complications and death from CO
poisoning than other populations. Supporters contend that
30 to 40 Californian's die each year from CO poisoning and
that these are preventable deaths. CO monitors are an
effective, inexpensive way to combat CO poisoning, and SB
840 would protect elderly SNF residents. Supporters also
argue that the health staff and service staff working in
SNFs are serving their community, and the state must ensure
their health and safety by providing a secure, healthy work
environment.
Arguments in opposition
The California Association of Health Facilities (CAHF)
states that there is currently no problem in SNFs with
unintended exposure of residents to carbon monoxide gases.
CAHF also states there is a complication related to
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installation of a CO device with the interplay between the
facility Life Safety Code requirements and the oversight of
the OSHPD. The Life Safety Code requirements prohibit a CO
device from being plugged into the wall, and facilities
would instead have to receive a fire alarm/CO detection
combination device and purchase permits from OSHPD
resulting in a much higher cost. CAHF also questions the
required placement of these devices given that SNFs do not
have dwelling units like other facilities that are required
to have CO devices. To be effective, the device would need
to be placed in a setting that would alert staff as the
staff would be the appropriate responders, not the
patients. CAHF suggests SB 840 be amended to provide
guidance on where the CO device should be located.
Finally, CAHF points out that under current law, the state
would be required to reimburse providers for the increased
costs of purchasing and installing these devices for
facilities participating in the Medi-Cal program.
The California Hospital Association (CHA) does not believe
the requirements mandated by SB 840 are necessary. CHA
writes that harmful exposure of residents and patients to
CO gases is not a problem in SNFs. The installation of CO
devices will require significant expense to facilities for
new requirements that are neither necessary nor
appropriate.
COMMENTS
1. Criteria standards. SB 840 requires DPH to determine
the criteria standards for CO devices, including the
appropriate number and the appropriate location for the CO
to be placed. Under current law, OSHPD is responsible for
enforcing building standards, codes, and regulations
pertaining to most types of health care facilities in the
state. A recommended amendment would be to require OSHPD,
in consultation with the State Fire Marshall, to establish
the criteria standards. DPH would still enforce this
requirement as part of the facilities licensure
requirements.
2. CO device. SB 840 requires that only a CO device
approved by the State Fire Marshall be installed in
facilities. A recommended amendment would be to allow a
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battery operated CO device to be installed in order to meet
the requirements of this bill. Any hard wire change a
facility makes would require a permit by OSHPD, and payment
of a permit fee of $250 plus 1.5 percent of the cost of
construction. For Medi-Cal facilities, part of this cost
would be shifted to the state for reimbursement. Allowing
battery-operated CO devices would help reduce the cost to
the state and still ensure the safety of patients.
3. Facility exemption. SB 840 exempts SNFs that do not
have fossil fuel burning appliances inside from the
requirement to install a CO device. However, most
facilities have one or more fossil fuel burning appliances
inside their facility. Facilities may have dryers, hot
water heaters, stoves, or other appliances related to
dining and laundry services that are fossil fuel burning.
A recommended amendment would be to require a CO device to
be installed in or around areas that have a fossil fuel
burning appliance to ensure the safety of patients and
staff.
4. Other health care facilities. SB 840 only requires
SNFs to install CO devices and would not apply to other
health facilities, such as intermediate care facilities and
congregate living health facilities. A recommended
amendment would be to include other health facilities.
5. Timeline. SB 840 requires DPH to implement regulations
to prescribe the criteria for the number and placement of
CO devices. SB 840 also requires SNFs to install CO
devices by January 1, 2013. A recommended amendment would
be to require SNFs to install a CO device 180 days after
the regulations are in effect.
POSITIONS
Support: AARP California
California Advocates for Nursing Home Reform
California Building Officials
California Coalition for Children's Safety &
Health
California Employment Lawyers Association
California Industrial Hygiene Council
California Nurses Association
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California Senior Legislature
SEIU California
Oppose:California Association of Health Facilities
California Hospital Association
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