BILL NUMBER: SB 1318	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 25, 2012
	AMENDED IN SENATE  APRIL 11, 2012

INTRODUCED BY   Senator Wolk
    (   Coauthor:   Senator   Anderson
  ) 

                        FEBRUARY 23, 2012

   An act to amend, repeal, and add Section 1288.7 of, and to add
 Section   Sections 1228.3,  1228.5  ,
and 1288.65  to, the Health and Safety Code, relating to
infectious diseases.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1318, as amended, Wolk. Health facilities: influenza
vaccinations.
   Existing law imposes on the State Department of Public Health
various duties and responsibilities regarding the regulation of
clinics and health facilities, including general acute care
hospitals, as defined.
   Existing law requires a general acute care hospital to annually
offer onsite influenza vaccinations, if available, to all hospital
employees. Existing law requires a general acute care hospital to
require its employees to be vaccinated, or if the employee elects not
to be vaccinated, to declare in writing that he or she declined the
vaccination. A violation of these provisions is punishable as a
misdemeanor. 
   This bill would require licensed clinics and health facilities to
institute measures, including aerosol transmissible diseases
training, designed to maximize influenza vaccination rates and to
prevent onsite health care workers affiliated with the clinic or
health facility and persons with privileges on the medical staff from
contracting, and transmitting to patients, the influenza virus.

   This bill would require, commencing  July 1, 2013
  January 1, 2015  , each clinic and health
facility to annually offer onsite influenza vaccinations to its
employees and to require its  employees, contractors,
students, volunteers, persons with privileges on the medical staff,
and other  onsite health care workers affiliated with the
clinic or health facility, as defined,  and persons with
privileges on the medical staff, as defined,  to be vaccinated.
This bill would require  each of the above-listed persons who
has received a vaccination from another health facility to present
verification to the clinic or health facility. This bill would
require each of the above-listed persons who elects not to be
vaccinated or does not provide proof of vaccination to wear a clinic-
or health facility-provided protective mask, as specified, while
serving his or her duties at the clinic or health facility during the
influenza season   licensed clinics and health
facilities to maintain vaccination records of their employees and
permit licensed clinics and health facilities to require
documentation of vaccination or vaccination refusal from an onsite
health care worker or person with privileges on the  
medical staff  . By expanding the definition of a crime, this
bill would impose a state-mandated local program.
   This bill would also require, on and after  July 1, 2013
  January 1, 2015  , each clinic and health
facility to develop policies to  implement these provisions and
to  ensure nonmedical staff, as defined  ,  compliance
with vaccination requirements. This bill would require, on and after
that date, the medical staff to develop separate policies to ensure
compliance with vaccination requirements  imposed by the clinic
or health facility. This bill would require clinics and health
facilities to report their percentage of employees and medical staff
and of medical staff who have been vaccinated for that year to the
State Department of Public Health. This bill would provide that a
clinic or health facility that reports a combined average of 90% or
higher   vaccination rate for its employees and medical
staff shall not be subject to specified implementation and compliance
requirements  .
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    The Legislature hereby declares that
mandatory mask-wearing policies for health care workers who have not
been immunized have proven effective to increase vaccination rates in
health care workers. While studies have not yet proven that masking
is effective to protect transmission of influenza in the asymptomatic
phase of the influenza illness, wearing a mask has proven effective
in preventing the transmission of other respiratory pathogens. 
   SEC. 2.    Section 1228.3 is added to the  
Health and Safety Code   , to read:  
   1228.3.  (a) A licensed clinic shall institute measures designed
to maximize influenza vaccination rates and to prevent persons with
privileges on the medical staff and onsite health care workers
affiliated with the clinic from contracting, and transmitting to
patients, the influenza virus to patients. These measures shall
include, but not be limited to, aerosol transmissible diseases
training as described in Section 5199(i) of Title 8 of the California
Code of Regulations, as in effect on January 1, 2013.
   (b) For purposes of this section, the following definitions shall
apply:
   (1) "Medical staff" shall have the same meaning provided in
Section 1228.5.
   (2) "Onsite health care worker affiliated with the clinic" shall
have the same meaning provided in Section 1228.5.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement this section by sending letters or similar
instruction to all applicable facilities without taking regulatory
action. 
   SECTION 1.   SEC. 3.   Section 1228.5 is
added to the Health and Safety Code, to read:
   1228.5.  (a) A  licensed  clinic shall annually offer its
employees onsite influenza vaccinations, if available, at no cost to
the employee.
   (b) A  licensed  clinic shall require all 
employees, contractors, students, volunteers, persons with privileges
on the medical staff, and all other  onsite health care
workers affiliated with the clinic  and persons with privileges
on the medical staff  to either annually receive an influenza
vaccination or, as an alternative to the annual influenza
vaccination, wear a clinic-provided surgical or procedural mask, or
other mask that covers the mouth and nose area of the face  ,
 while this person is performing his or her duties in any
patient care area of the clinic during the influenza season, as
defined by the State Health Officer or a local health officer, or
both.
   (c)  (1)    In meeting the requirements of
subdivision (b), the clinic shall maintain influenza vaccination
records of  employees, contractors, students, volunteers,
persons with privileges on the medical staff, and all other onsite
health care workers affiliated with the clinic who were vaccinated
onsite or offsite   employees and may maintain influenza
vaccination records of the other onsite health care workers
affiliated with, but not an employee of, the clinic and of persons
with privileges on the medical staff  . If the clinic does not
have records of  a   an onsite health care 
worker  or person with privileges on the medical staff 
being vaccinated onsite, the clinic  shall   may
 require the worker  or medical staff person  to
either provide documentation of  an offsite 
vaccination or documentation that he or she refused the vaccination.

   (2) The clinic may include language in its business contracts to
require a contract worker to maintain records of the verification of
offsite vaccination or documentation that he or she refused the
vaccination, which shall be available to the clinic upon request.
Nothing in this section shall be construed to require a clinic to
maintain separate vaccination records or to provide vaccinations at
no cost to a contract worker who is not an employee of the clinic.

   (d) Each  licensed  clinic shall develop policies to 
implement this section and to  ensure its  employees,
contractors, students, volunteers, and other  onsite health
care workers affiliated with the clinic  , not including
medical staff,  are in compliance with the vaccination
requirements imposed by this section. The medical staff shall 
also  develop policies  independent of the policies
established by the clinic  to ensure that persons who have
privileges on the medical staff are in compliance with the
vaccination requirements of this section  that have been
implemented by the clinic  . 
   (e) Nothing in this section shall be construed to prevent a clinic
from instituting additional measures to maximize influenza
vaccination rates and to prevent health care workers affiliated with
the clinic from contracting and transmitting the influenza virus.
 
   (f) 
    (e)  For purposes of this section, the following
definitions shall apply: 
   (1) "Health  
   (1) "Employee" means an individual who works for the clinic, is
listed on the clinic's payroll records, and is under the clinic's
direction and control. 
   (2) "Medical staff" means professional medical personnel who are
approved and given privileges to provide health care to patients
while onsite in a clinic and who are responsible for the adequacy and
quality of care rendered to patients. Medical staff includes, but is
not limited to, physicians and surgeons, and, if dental or podiatric
services are provided, dentists or podiatrists. 
    (3)     "Onsite health  care worker
affiliated with the clinic" means a person who is either a volunteer
or is employed by, paid by, or receives credit or any other form of
compensation from the  clinic.Health   clinic,
who performs some or all of his or her duties in a patient care area
of the facility. The patient care area of the facility shall be
determined by the clinic and is where onsite health care workers and
medical staff are within close proximity to patients receiving care.
An onsite health  care worker affiliated with the clinic
includes, but is not limited to,  employees,  physicians,
nurses, nursing assistants, therapists, technicians, emergency
medical service personnel, dental personnel, pharmacists, laboratory
personnel, autopsy personnel, students and trainees,  and
 contractual staff  , and registry staff who perform
direct patient care duties but are  not employed by the clinic.

   (2) "Medical staff" means professional medical personnel who are
approved and given privileges to provide health care to patients in a
clinic and who are responsible for the adequacy and quality of care
rendered to patients. Medical staff include physicians and surgeons,
and, where dental or podiatric services are provided, dentists or
podiatrists.  
   (f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement this section by sending letters or similar
instruction to all applicable facilities without taking regulatory
action.  
   (g) A clinic shall annually report its average vaccination
compliance rate for onsite health care workers who are employees and
of medical staff who have been vaccinated for that year to the State
Department of Public Health.  
   (h) This section, with the exception of the reporting requirement
of subdivision (g), shall not apply to a clinic that have a combined
average vaccination compliance rate of 90 percent or higher for its
onsite health care workers who are employees and medical staff. 

   (g) 
    (i)  This section shall become operative on 
July 1, 2013   January 1, 2015  .
   SEC. 4.    Section 1288.65 is added to the  
Health and Safety Code   , to read:  
   1288.65.  A licensed health facility shall institute measures
designed to maximize influenza vaccination rates and to prevent
persons with privileges on the medical staff and onsite health care
workers affiliated with the health facility from contracting, and
transmitting to patients, the influenza virus. These measures shall
include, but not be limited to, aerosol transmissible diseases
training, as described in Section 5199(i) of Title 8 of the
California Code of Regulations, as in effect January 1, 2013.
   (b) For purposes of this section, the following definitions shall
apply:
   (1) "Medical staff" means professional medical personnel who are
approved and given privileges to provide health care to patients in a
health facility and who are responsible for the adequacy and quality
of care rendered to patients. Medical staff includes, but is not
limited to, physicians and surgeons, and, if dental or podiatric
services are provided, dentists or podiatrists.
   (2) "Onsite health care worker affiliated with the health facility"
means a person who is either a volunteer or is employed by, paid by,
or receives credit or any other form of compensation from the health
facility, who performs some or all of his or her duties in a patient
care area of the facility. The patient care area of the facility
shall be determined by the health facility and is where onsite health
care workers and medical staff are within close proximity to
patients receiving care. An onsite health care worker affiliated with
the health facility includes, but is not limited to, employees,
physicians, nurses, nursing assistants, therapists, technicians,
emergency medical service personnel, dental personnel, pharmacists,
laboratory personnel, autopsy personnel, students and trainees,
contractual staff, and registry staff who perform direct patient care
duties but are not employed by the health facility.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement this section by sending letters or similar
instruction to all applicable facilities without taking regulatory
action. 
   SEC. 2.   SEC. 5.   Section 1288.7 of
the Health and Safety Code is amended to read:
   1288.7.  By July 1, 2007, the department shall require that each
general acute care hospital, in accordance with the Centers for
Disease Control and Prevention guidelines, take all of the following
actions:
   (a)  Annually offer onsite influenza vaccinations, if available,
to all hospital employees at no cost to the employee. Each general
acute care hospital shall require its employees to be vaccinated, or
if the employee elects not to be vaccinated, to declare in writing
that he or she has declined the vaccination.
   (b) Institute respiratory hygiene and cough etiquette protocols,
develop and implement procedures for the isolation of patients with
influenza, and adopt a seasonal influenza plan.
   (c) Revise an existing or develop a new disaster plan that
includes a pandemic influenza component. The plan shall also document
any actual or recommended collaboration with local, regional, and
state public health agencies or officials in the event of an
influenza pandemic. 
   (d) This section shall become inoperative on July 1, 2013, and, as
of January 1, 2013, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2013, deletes or
extends the dates on which it becomes inoperative and is repealed.
 
   (d) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date. 
   SEC. 3.  SEC. 6.   Section 1288.7 is
added to the Health and Safety Code, to read:
   1288.7.  (a) A  licensed  health facility shall annually
offer its employees onsite influenza vaccinations, if available, at
no cost to the employee.
   (b) A licensed  health facility shall require all
 employees, contractors, students, volunteers, persons with
privileges on the medical staff, and all other  onsite
health care workers affiliated with the health facility  and
persons with privileges on the medical staff  to either annually
receive an influenza vaccination or, as an alternative to the annual
influenza vaccination, wear a health facility-provided surgical or
procedural mask, or other mask that covers the mouth and nose area of
the face while this person is performing his or her duties in any
patient care area of the health facility during the influenza season,
as defined by the State Health Officer or a local health officer, or
both.
   (c)  (1)    In meeting the requirements of
subdivision (b), the health facility shall maintain influenza
vaccination records of  employees, contractors, students,
volunteers, persons with privileges on the medical staff, and all
other onsite health care workers affiliated with the health
facilities who were vaccinated onsite or offsite  
employees and may maintain influenza vaccination records of the other
onsite health care workers who are affiliated with, but are not
employees of, the health facilities and of persons with privileges on
the medical staff  . If the health facility does not have
records of  a   an onsite health care 
worker  or person with privileges on the medical staff 
being vaccinated onsite  , the health facility
 shall   may  require the worker  or
medical staff person  to either provide documentation of
 an offsite  vaccination or documentation that he or
she refused the vaccination. 
   (2) The health facility may include language in its business
contracts to require a contract worker to maintain records of the
verification of offsite vaccination or documentation that he or she
refused the vaccination, which shall be available to the health
facility upon request. Nothing in this section shall be construed to
require a health facility to maintain separate vaccination records or
to provide vaccinations at no cost to a contract worker who is not
an employee of the health facility. 
   (d) Each  licensed  health facility shall develop
policies to  implement this section and to  ensure its
 employees, contractors, students, volunteers, and other
 onsite health care workers affiliated with the health
facility  , not including medical staff,  are in
compliance with the vaccination requirements imposed by this section.
The medical staff shall develop policies  independent of the
policies established by the health facility  to ensure that
persons who have privileges on the medical staff are in compliance
with the vaccination requirements of this section  that have been
implemented by the health facility  . 
   (e) Nothing in this section shall be construed to prevent a health
facility from instituting additional measures to maximize influenza
vaccination rates and to prevent health care workers affiliated with
the health facility from contracting and transmitting the influenza
virus.  
   (f) 
    (e)  In addition to other requirements of this section,
general acute care hospitals shall take all of the following actions:

   (1) Institute respiratory hygiene and cough etiquette protocols,
develop and implement procedures for the isolation of patients with
influenza, and adopt a seasonal influenza plan.
   (2) Revise an existing or develop a new disaster plan that
includes a pandemic influenza component. The plan shall also document
any actual or recommended collaboration with local, regional, and
state public health agencies or officials in the event of an
influenza pandemic. 
   (g) 
    (f)  For purposes of this section, the following
definitions shall apply: 
   (1) "Health  
   (1) "Employee" means an individual who works for the health
facility, is listed on the health facility's payroll records, and is
under the health facility's direction and control.  
   (2) "Medical staff" means professional medical personnel who are
approved and given privileges to provide health care to patients in a
health facility and who are responsible for the adequacy and quality
of care rendered to patients. Medical staff include physicians and
if dental or podiatric services are provided, dentists or
podiatrists. 
    (3)     "Onsite health  care worker
affiliated with the health facility" means a person who is either a
volunteer or is employed by, paid by, or receives credit or any other
form of compensation from the health  facility. Health
 facility, who performs some or all of his or her duties
in a patient care area of the facility. The patient care area of the
facility shall be determined by the health facility and is where
onsite health care   workers and medical staff are within
close proximity to patients receiving care. An onsite health 
care worker affiliated with the health facility includes, but is not
limited to, physicians, nurses, nursing assistants, therapists,
technicians, emergency medical service personnel, dental personnel,
pharmacists, laboratory personnel, autopsy personnel, students and
trainees,  and  contractual staff  and registry
staff performing direct patient care duties but are  not
employed by the health facility. 
   (2) "Medical staff" means professional medical personnel who are
approved and given privileges to provide health care to patients in a
health facility and who are responsible for the adequacy and quality
of care rendered to patients. Medical staff include physicians, and,
where dental or podiatric services are provided, dentists or
podiatrists.  
   (g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement this section by sending letters or similar
instruction to all applicable facilities without taking regulatory
action.  
   (h) A health facility shall annually report its average
vaccination compliance rate of onsite health care workers that are
employees and of medical staff who have been vaccinated for that year
to the State Department of Public Health.  
   (i) This section, with the exception of the reporting requirement
of subdivision (h), shall not apply to health facilities that have a
combined average vaccination compliance rate of 90 percent or higher
for its onsite health care workers that are employees and medical
staff.  
   (h) 
    (j)  This section shall become operative on 
July 1, 2013   January 1, 2015  .
   SEC. 4.   SEC. 7.   No reimbursement is
required by this act pursuant to Section 6 of Article XIII B of the
California Constitution because the only costs that may be incurred
by a local agency or school district will be incurred because this
act creates a new crime or infraction, eliminates a crime or
infraction, or changes the penalty for a crime or infraction, within
the meaning of Section 17556 of the Government Code, or changes the
definition of a crime within the meaning of Section 6 of Article XIII
B of the California Constitution.