BILL ANALYSIS
AB 57
Page 1
Date of Hearing: April 14, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 57 (Price) - As Introduced: December 5, 2008
SUBJECT : University of California hospitals: staffing.
SUMMARY : Requires the Department of Public Health (DPH) to
establish a procedure for collecting and reviewing the written
staffing plans developed by specified University of California
(UC)-operated health facilities. Specifically, this bill :
1)Requires DPH to establish a procedure for collecting and
reviewing the written staffing plans developed by UC general
acute care hospitals, acute psychiatric hospitals, and special
hospitals.
2)Requires the collection and review procedure developed by DPH
to include all of the following:
a) Review of the reliability of the patient classification
system for validating staffing requirements;
b) Potential adjustments in the patient classification
system, as specified; and,
c) Staff input about the patient classification system, the
system's required revisions, and the overall staffing plan.
3)Excludes a review of documentation relating only to registered
nurses from the collection and review procedure developed by
DPH.
4)Allows DPH, if it deems it necessary to reduce the volume of
information collected and reviewed, to identify specific time
frames for which the information is to be collected and review
that information as a representative sample.
5)Requires a UC general acute care hospital, acute psychiatric
hospital, and special hospital to cooperate with DPH in
providing the required information.
6)Makes various findings and declarations including that
inadequate staffing is a matter of statewide concern and this
AB 57
Page 2
bill is intended to provide DPH and the public with access to
the written staffing plans and actual staffing levels of the
only general purpose health care system owned and operated by
the state.
7)Sunsets the provisions of this bill on July 1, 2013.
EXISTING LAW :
1)Provides for the inspection and licensure of health
facilities, including hospitals, by DPH.
2)Establishes, pursuant to regulations, minimum, specific, and
numerical nurse-to-patient ratios by licensed nurse
classification and by hospital unit for hospitals.
3)Requires the ratios 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.
4)Requires, pursuant to regulations, a written staffing plan to
be developed by the administrator of nursing services or a
designee, based on patient care needs determined by the
patient classification system. Requires the staffing plan to
be developed and implemented for each patient care unit and to
specify patient care requirements and the staffing levels for
registered nurses and other licensed and unlicensed personnel.
5)Authorizes DPH to assess the licensee of specified health
facilities an administrative penalty in an amount not to
exceed $50,000 for a first violation, $75,000 for a second
violation within three years of the first violation, and
$100,000 for a third and subsequent violation penalty within
three years of the first violation, if a licensee receives a
notice of deficiency constituting an immediate jeopardy to the
health or safety of a patient and the health facility is
required to submit a plan of correction. Defines immediate
jeopardy as a situation in which the licensee's noncompliance
AB 57
Page 3
with one or more requirements of licensure has caused, or is
likely to cause, serious injury or death to the patient.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee. According to an Assembly Appropriations Committee
analysis of a substantially similar bill last year, AB 2244
(Price), the provisions of this bill could result in:
1)Annual General Fund (GF) costs and cost pressures of $300,000
to $600,000 from 2009 through 2013 for UC to hire additional
analysts to establish, review, and monitor staffing plans for
each of the five UC hospitals.
2)Major GF staffing costs and cost pressures of $10 million per
100 hospital employees hired pursuant to staffing ratios
established after 2014 pursuant to the intent of this bill.
The legislative intent of this bill is to provide a "factual
foundation" upon which the Legislature and DPH may evaluate
the need for minimum staffing requirements to improve patient
safety. Staffing ratios established for nurses pursuant to AB
394 (Kuehl), Chapter 945, Statutes of 2000, are expected to
create almost $1 billion in new annual staffing costs in 2008,
according to ramp-up estimates by the former Department of
Health Services (now DPH).
3)Annual GF costs to DPH of $50,000 from 2009 through 2013 to
provide review and analysis of UC staffing plans and patient
classification system requirements.
4)Unknown DPH and UC workload and penalty revenue to the extent
DPH levies penalties on UC hospitals pursuant to this bill.
COMMENTS :
1)PURPOSE OF THIS BILL. The author maintains that understanding
safe staffing levels for key hospital personnel is critical
for quality patient care. The author asserts that
understaffing of professional and technical hospital employees
may endanger patient care by forcing staff to simultaneously
cover multiple patients in different units of the hospital,
delaying timely receipt of patient test results, causing
inaccurate or misleading films and tests, and increasing
employee back or other injuries that affect their ability to
provide quality care. The author points out that UC academic
AB 57
Page 4
medical centers are the only general purpose health care
system owned and operated by a state of California and, as
such, UC should be required to make data available to DPH and
the public to ensure quality health care is provided in these
facilities.
2)UC MEDICAL CENTERS . According to UC, the five medical centers
operated by UC (Davis, Irvine, Los Angeles, San Diego, and San
Francisco) support the clinical teaching programs of UC's
medical and health sciences schools and receive more than
138,000 inpatient discharges, 261,000 emergency room visits
and more than 3.6 million outpatient visits each year. The UC
medical centers provide a full range of health care services
in their communities and are sites for the development and
testing of new diagnostic and therapeutic techniques.
Collectively, these UC medical centers comprise one of the
largest health care systems in California and one of the two
largest Medi-Cal providers in the state. The UC health system
operates Level I trauma centers in four of its five regions
and staffs San Francisco General Hospital's Level I trauma
center. A major provider to uninsured and underinsured
patients in Sacramento, San Diego, and Orange Counties, the UC
system also has relationships with more than 100 affiliated
Veterans Affairs, county, and community-based health
facilities throughout California.
3)CURRENT HEALTH WORKFORCE SHORTAGES AT UC . UC indicates that
all UC medical centers currently have systems in place to
determine staffing needs, measure turnover rates, and assess
staffing effectiveness based on each individual hospital's
facility details, patient acuity levels, and employee needs.
For example, a 2007 Human Resources Annual Report of the UC
Davis Health System, which includes the UC Davis Medical
Center (UCDMC), indicated that some of the most difficult to
recruit positions in 2006-07 included clinical laboratory
scientists, physical/occupational therapists, respiratory
therapists, magnetic resonance imaging technologists, and
radiological technologists. The report noted that to attract
applicants to positions that are difficult to fill, UCDMC
offered sign on bonuses, participated in employee referral
programs, partnered with other hospitals to offer training
programs, and recruited at employment and career fairs.
4)HOSPITAL STAFFING PRACTICES . Current regulations require
hospitals to meet established nurse-to-patient ratios and to
AB 57
Page 5
develop a written staffing plan for registered nurses and
other licensed and unlicensed personnel that reflects patient
care needs based on a patient classification system.
Hospitals use various types of non-nursing professional and
technical staff to provide direct patient care, including
respiratory therapists, phlebotomists, radiology technicians,
lab technicians, pharmacy technicians, emergency room and
surgical technicians, and nursing assistants. However,
according to DPH, hospitals may use non-nursing staff to meet
patient care needs, if they are otherwise allowed to provide
those services. For instance, respiratory care services could
be provided by a nurse or respiratory therapist or blood draws
could be done by a nurse or phlebotomist. DPH also indicates
that while it does not review the methods or procedures that
hospitals use to determine non-nursing professional and
technical staffing levels, it would investigate a complaint
that it received related to staffing, including non-nurse
personnel, in a hospital and the investigation would involve
examining the hospital's written staffing plan. If a patient
suffered harm and understaffing was determined to be a
contributing causative factor, DPH states that it would issue
a deficiency notice for staffing.
5)SUPPORT . The sponsor of this bill, the American Federation of
State, County and Municipal Employees (AFSCME), writes that UC
hospitals comprise a crucial component of the state's health
care system and, as such, it is necessary to ensure that these
facilities are maintaining adequate staffing levels. AFSCME
believes the expanded oversight and review provided by this
bill will allow for appropriate monitoring of staffing levels
and patient care requirements at UC hospitals while
safeguarding public health.
6)PREVIOUS AND RELATED LEGISLATION .
a) AB 2244 (Price) of 2008 was substantially similar to
this bill and was vetoed by Governor Arnold Schwarzenegger.
In his veto message, the Governor stated that current law
already requires hospitals to have written staffing plans
for nursing staff and that to target a requirement
specifically at the five UC hospitals is both unnecessary
and ineffective.
b) AB 13 (Fuentes) of 2007 would have required specified
hospitals to adopt a plan or procedure for determining
AB 57
Page 6
staffing of professional and technical classifications, as
specified, and would have directed DPH to review compliance
and deem failure to maintain, review annually, or comply
with the plan or procedure to constitute staffing that has
the potential for harm to patients. AB 13 was vetoed by
Governor Arnold Schwarzenegger with his message stating
that current law already requires hospitals to have written
staffing plans for nursing staff and that DPH already has
the authority to issue deficiencies and administrative
penalties to hospitals when an investigation concludes that
staffing deficiencies lead to harm or poor patient
outcomes.
c) AB 520 (Brownley) of 2007 was substantially similar to
AB 13 and was held in the Assembly Appropriations
Committee.
d) AB 2754 (Chan) of 2006 was substantially similar to AB
13. AB 2754 failed passage on the Senate Floor.
e) AB 761 (Jones) of 2005 would have required hospitals to
consider any staffing guidelines developed by relevant
professional associations and to annually review and report
worker and patient injury rates. AB 761 failed passage on
the Senate Floor.
f) AB 2300 (Dymally) of 2004 would have required hospitals
to develop a staffing plan for professional, technical, and
support staffing. AB 2300 failed passage in the Assembly
Health Committee.
g) AB 1927 (Dymally) of 2004 would have addressed staffing
in hospitals for professional, technical and support staff.
AB 1927 failed passage on the Assembly Floor.
7)DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to
the Assembly Higher Education Committee.
8)QUESTIONS AND COMMENTS .
a) The scope of this bill does not identify the occupations
for which data is to be collected and reviewed . The author
may wish to clarify the classifications that are the
subject of this bill.
AB 57
Page 7
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees,
Local 3299 (co-sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO (co-sponsor)
United Nurses Associations of California/Union of Health Care
Professionals
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097