BILL NUMBER: AB 2144 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Yamada
FEBRUARY 20, 2014
An act to add Section 1276.45 to the Health and Safety Code,
relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
AB 2144, as introduced, Yamada. Staff-to-patient ratios.
Existing law provides for the licensure and regulation of health
facilities, including acute psychiatric hospitals, by the State
Department of Public Health. A violation of those provisions is a
crime.
This bill would require the department to adopt regulations by
January 1, 2016, that establish minimum, specific, and numerical
licensed nursing staff-to-patient ratios by licensing classification
and minimum, specific, and numerical ancillary staff-to-patient
ratios for acute psychiatric hospitals, as prescribed. By expanding
the scope of a crime, the bill would impose a state-mandated local
program.
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. Section 1276.45 is added to the Health and Safety Code,
immediately following Section 1276.4, to read:
1276.45. (a) By January 1, 2016, the State Department of Public
Health shall adopt regulations that establish minimum, specific, and
numerical licensed nursing staff-to-patient ratios by licensed
nursing classification and minimum, specific, and numerical ancillary
staff-to-patient ratios for all health facilities licensed pursuant
to subdivision (b) of Section 1250.
(1) Administrative, supervisory, and non-unit-based staff shall
not be included when calculating staff-to-patient ratios. Ratios
shall be calculated on a unit-by-unit basis. Averaged figures across
units shall not be used in determining staff-to-patient ratios.
(2) Under no circumstances shall the minimum, specific, and
numerical licensed nursing staff-to-patient ratios by licensed
nursing staff classification or ancillary staff-to-patient ratios be
below the following standards for safe staffing and effective
psychiatric care purposes:
(A) For long-term units, the ratio for each of the four ancillary
staff classifications described in paragraph (1) of subdivision (g)
shall be not less than one ancillary staff person for each 25
residents. Nursing staff-to-patient ratios for these units shall be
not less than one licensed nurse or psychiatric technician for each
six residents during day and evening shifts, and not less than one
licensed nurse or psychiatric technician for each 12 residents during
overnight shifts.
(B) For admissions units, the ratio for each of the four ancillary
staff classifications described in paragraph (1) of subdivision (g)
shall be not less than one ancillary staff person for each 15
residents. Nursing staff ratios for these units shall be not less
than one licensed nurse or psychiatric technician for each six
residents during day and evening shifts and not less than one
licensed nurse or psychiatric technician for each 12 residents during
overnight shifts.
(C) For units that have severely aggressive or severely
self-injurious patients, including, but not limited to, enhanced
treatment units and units that practice dialectical behavioral
therapy, the ratio for each of the four ancillary staff
classifications described in paragraph (1) of subdivision (g) shall
not be less than 1 ancillary staff person for each 12 residents.
Nursing staff ratios for these units shall be not less than one
licensed nurse or psychiatric technician for each six residents
during day and evening shifts and not less than one licensed nurse or
psychiatric technician for each 12 residents during overnight
shifts.
(b) The department shall review these regulations five years after
adoption and shall report to the Legislature regarding any proposed
changes.
(c) These ratios shall constitute the minimum number of staff that
shall be allocated. Additional staff shall be assigned in accordance
with a documented patient classification system for determining
nursing care requirements, including the severity of the illness, the
need for specialized equipment and technology, the complexity of
clinical judgment needed to design, implement, and evaluate the
patient care plan and the ability for self-care, and the licensure of
the personnel required for care.
(d) The department may grant a waiver to this section if the
waiver does not jeopardize the health, safety, and well-being of
patients and staff affected and is needed for increased operational
efficiency.
(e) In case of conflict between this section and any provision or
regulation implementing that provision defining the scope of practice
for nursing staff or ancillary staff, the scope of practice
provisions shall control.
(f) The regulations adopted by the department pursuant to this
section shall augment and not replace existing nurse-to-patient
ratios that exist in law and regulation.
(g) For purposes of this section, the following definitions shall
apply:
(1) "Ancillary staff" means rehabilitation therapists, licensed
social workers, psychologists, and psychiatrists.
(2) "Nursing staff" means registered nurses and licensed
psychiatric technicians.
SEC. 2. 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.