BILL NUMBER: SB 1318 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 7, 2012
AMENDED IN ASSEMBLY JUNE 14, 2012
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 Sections 1228.3, 1228.5, and 1288.65 to, and to
repeal and add Section 1288.7 of, 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 January 1, 2015,
each clinic and health facility to annually offer onsite
influenza vaccinations to its employees and to require its 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 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 increasing the
responsibilities of clinics and health facilities, this bill would
expand the definition of a crime , this bill
and would impose a state-mandated local program.
This bill would also require , on and after 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 , by January 1, 2015, 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. This bill would require the department, by January
1, 2016, to develop a model mandatory vaccination policy, as
specified, and would require clinics and health facilities which fail
to reach the 90% compliance rate requirement to be subject to the
model mandatory vaccination policy.
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
declares that influenza can be a serious disease that
can lead to hospitalization and even death, and
that increased access to vaccinations is a critical component in the
promotion of health and wellness. Because of their contact with
patients, many health care workers are at risk for exposure to, and
possible transmission of, vaccine-preventable diseases. By getting
vaccinated, health care workers can protect themselves, their
families, and patients from contracting the flu. It is the intent of
the Legislature in enacting this statute to protect the health,
safety, and welfare of health care workers and patients who enter a
clinic or health care facility. It is also the intent of the
Legislature that health care facilities and clinics institute
measures designed to maximize influenza vaccination rates and
increase vaccination among health care workers. It is also the intent
of the Legislature that the State Department of Public Health
develop a model mandatory vaccination policy through a stakeholder
process to achieve a 90-percent influenza vaccination compliance rate
requirement for health care workers .
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.
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 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 if an onsite health
care worker affiliated with the clinic or person with privileges on
the medical staff elects not to be vaccinated, he or she shall agree,
in writing, to adhere to the most effective measures determined by
the clinic in preventing health care workers from contracting and
transmitting the influenza virus .
(c) (1) In meeting the requirements of subdivision (b), the clinic
shall maintain influenza vaccination records of 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 an onsite health care worker or person with
privileges on the medical staff being vaccinated onsite, the clinic
may require the worker or medical staff person to either provide
documentation of 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 onsite health care workers affiliated with
the clinic are in compliance with the vaccination requirements
imposed by this section. The medical staff shall also develop
policies 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) For purposes of this section, the following definitions shall
apply:
(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,
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, contractual staff, and
registry staff who perform direct patient care duties but are not
employed by the clinic.
(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 subdivision (a) and the
reporting requirement of subdivision (g), shall not apply to a clinic
that have has a combined average
vaccination compliance rate of 90 percent or higher , by January
1, 2015, for its onsite health care workers who are employees
and medical staff. For clinics that fail to reach the 90-percent
compliance rate requirement, the clinic shall adopt the model
mandatory vaccination policy as determined by the State Department of
Public Health to achieve the 90-percent or higher goal. The
department shall develop a model mandatory vaccination policy through
a stakeholder process to be issued through an all facilities letter
no later than January 1, 2016. The department may waive
the 90-percent compliance rate requirement for a clinic that is in
substantial compliance. Implementation of this section shall be
exempt from the Administrative Procedure Act.
(i) This section shall become operative on January 1, 2015.
SEC. 4. Section 1288.65 is added to the Health and Safety Code, to
read:
1288.65. (a) 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. 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 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. 5. Section 1288.7 of the Health
and Safety Code is repealed.
1288.7. By July 1, 2007, the department shall require that each
general acute care hospital, in accordance with the Centers for
Disease Control 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.
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 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 if the onsite health care worker affiliated with
the health facility or person with privileges on the medical staff
elects not to be vaccinated, he or she shall agree, in writing, to
adhere to the most effective measures determined by the health
facility in preventing health care workers from contracting and
transmitting the influenza virus .
(c) (1) In meeting the requirements of subdivision (b), the health
facility shall maintain influenza vaccination records of 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 an
onsite health care worker or person with privileges on the medical
staff being vaccinated, the health facility may require the worker or
medical staff person to either provide documentation of 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 onsite health care workers
affiliated with the health facility are in compliance with the
vaccination requirements imposed by this section. The medical staff
shall develop policies 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) 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.
(f) For purposes of this section, the following definitions shall
apply:
(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, 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, contractual
staff and registry staff performing direct patient care duties but
are not employed by the health facility.
(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 subdivisions (a) and (e),
and 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 by January 1, 2015, for its
onsite health care workers that are employees and medical staff.
For health facilities that fail to reach the 90-percent compliance
rate requirement, the health facility shall adopt the model mandatory
vaccination policy as determined by the State Department of Public
Health to achieve the 90-percent or higher goal. The department shall
develop a model mandatory vaccination policy through a stakeholder
process to be issued through an all facilities letter later no later
than January 1, 2016. The department may waive the 90-percent
compliance rate requirement for a health facility that is
in substantial compliance. Implementation of this section shall be
exempt from the Administrative Procedure Act.
(j) This section shall become operative on January 1, 2015.
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.