BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 455|
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THIRD READING
Bill No: SB 455
Author: Hernandez (D)
Amended: 4/16/13
Vote: 21
SENATE HEALTH COMMITTEE : 7-1, 4/10/13
AYES: Hernandez, Anderson, Beall, De Le�n, DeSaulnier, Monning,
Pavley
NOES: Nielsen
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE : 5-2, 4/29/13
AYES: De Le�n, Hill, Lara, Padilla, Steinberg
NOES: Walters, Gaines
SUBJECT : General acute care hospitals: patient
classification system
SOURCE : AFSCME, AFL-CIO
United Nurses Associations of California/Union of
Health Care Professionals
DIGEST : This bill requires, under the Department of Public
Health (DPH), licensed health facilities to establish and
maintain a patient classification system for establishing
staffing requirements by unit, patient, and shift. Establishes
a patient classification system review committee to review the
reliability of the patient classification system, as specified.
Requires the patient classification system to be reviewed at
least annually.
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ANALYSIS : Existing law:
1. Licenses and regulates health facilities by DPH.
2. Requires DPH to adopt regulations that establish minimum,
specific, and numerical licensed nurse-to-patient ratios, by
licensed nurse classification and by hospital unit, for
hospitals.
3. Requires the ratios adopted by regulation to constitute the
minimum number of registered and licensed nurses that must be
allocated. Requires additional staff to 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.
Existing regulations:
1. Define "patient classification system," in part, as a method
for establishing staffing requirements by unit, patient, and
shift.
2. Require a hospital's administrator of nursing service to
develop a written staffing plan based on patient care needs
determined by the patient classification system.
3. Require the reliability of the patient classification system
for validating staffing requirements to be reviewed at least
annually by a committee appointed by the nursing
administrator to determine whether or not the system
accurately measure patient care needs, and require at least
half of the members of the review committee to be registered
nurses who provide direct patient care.
This bill:
1. Requires, under DPH, licensed facilities to establish and
maintain a patient classification system for establishing
staffing requirements by unit, patient, and shift.
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2. Establishes a patient classification system review committee
to review the reliability of the patient classification
system.
3. Requires the review committee to be appointed by the
facility's nursing administration unless the registered
nurses are represented by collective bargaining unit, in
which case, they are required to be appointed by the
bargaining unit.
4. Requires at least one-half of the membership of the review
committee to be composed of registered nurses who provide
direct patient care.
5. Requires the patient classification system to be reviewed at
least annually.
Background
Existing law requires acute care hospitals to maintain specified
nurse-to-patient ratios. Regulations adopted by DPH to
implement nurse-to-patient ratios require hospitals to develop
and maintain patient classification systems, which are more
detailed protocols for establishing staffing levels based on the
care need of specific patients. Existing law requires DPH to
inspect hospitals no less than every three years to review
compliance with these and other regulatory requirements.
Prior legislation . SB 1246 (Hernandez, 2012), which was vetoed,
contained similar provisions to this bill, among several other
provisions. In addition to the similar provisions to this bill,
SB 1246 also would have required periodic inspections by DPH to
include a review of compliance with nurse staffing ratios and
patient classification systems, and eliminated a requirement
that DPH promulgate regulations further defining the criteria
for assessing administrative penalties, thereby allowing
existing fine authority to go into effect.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee, there are
likely one-time costs of about $70,000 for the revision of
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existing regulations (Licensing and Certification Program Fund).
Implementation of this bill will require the revision of an
existing regulation.
SUPPORT : (Verified 4/30/13)
AFSCME, AFL-CIO (co-source)
United Nurses Associations of California/Union of Health Care
Professionals (co-source)
OPPOSITION : (Verified 4/30/13)
California Hospital Association
California Nurses Association
Hospital Corporation of America
ARGUMENTS IN SUPPORT : A sponsor of this bill, the United
Nurses Associations of California/Union of Health Care
Professionals (UNAC/UHCP), points out that many laws incorporate
protections that could be subject to collective bargaining,
including the minimum wage, the eight-hour day, and the nurse
ratios themselves. California law provides minimum standards
for these areas of law, and that appointment of nurses to the
patient classification review committee by a collective
bargaining agent, if any, should be another such instance.
The other sponsor of this bill, AFSCME, also states that
hospitals need to respect the right of the collective bargaining
agent to appoint direct care nurses to the patient
classification review committees.
ARGUMENTS IN OPPOSITION : The California Hospital Association
(CHA) is opposed to this bill unless amended to remove the
provision giving a third-party labor union the right to appoint
specific members to the patient classification review committee,
arguing that this is an inappropriate infringement on the
hospital's ultimate responsibility for patient care. Under
current regulations, CHA states that the members of the patient
classification committee are appointed by the hospital nursing
administrator, and this bill changes that process. CHA states
that the hospital has ultimate responsibility for ensuring
quality patient care, and given this responsibility, it is
inappropriate to delegate a major component of its assessment
tool to a third party. For example, CHA states that the
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hospital may want to have particular units represented on the
committee, while the union may appoint individuals based on
their own priorities such as leadership development or other
factors. Further, CHA states that the hospital must maintain
the prerogative to appoint staff in good standing who are
eligible and qualified to perform the duties vested in the
review committee. The bargaining agent is not a hospital
representative and cannot determine performance eligibility
requirements.
JL:k 4/30/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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