BILL ANALYSIS
AB 57
Page 1
Date of Hearing: April 21, 2009
ASSEMBLY COMMITTEE ON HIGHER EDUCATION
Anthony Portantino, Chair
AB 57 (Price) - As Introduced: December 5, 2008
SUBJECT : University of California hospitals: staffing.
SUMMARY : Requires specified University of California (UC)
health facilities to report to the Department of Public Health
(DPH) regarding specified staffing levels and for DPH to
establish a procedure for the collection and review of the
staffing data provided. Specifically, this bill :
1)Makes findings and declarations regarding:
a) The public health interest in requiring hospitals to
meet safe staffing levels;
b) The California laws and regulations that require
hospitals to develop and implement written staffing plans
and to meet nurse-to-patient ratios in specific hospital
units;
c) The need to ensure adequate care of patients through
adequate technical and professional staffing levels;
d) The unique role the UC health facilities can play in
providing DPH with information regarding staffing levels
and written plans; and,
e) The intent of this bill to lead to the collection and
review of information necessary for the Legislature and DPH
to evaluate the need for minimum staffing requirements in
hospital professional and technical classifications, other
than nursing.
2)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.
3)Provides that the data review shall include an examination of
the reliability of the patient classification system,
potential adjustments in the patient classification system,
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and staff input about the patient classification system and
the overall staffing plan.
4)Provides that DPH may, if deemed necessary to reduce the
volume of data collected, specify time periods for the
information to be collected and review that data as a
representative sample.
5)Requires licensed UC acute care hospitals, acute psychiatric
hospitals, and special hospitals to cooperate with DPH in
providing this information.
6)Provides that all of the aforementioned provisions shall
become inoperative on July 1, 2013, and repealed on January 1,
2014, unless a later statute is enacted that extends those
sunset dates.
EXISTING LAW
1)Establishes UC as a public trust and confers upon the Regents
of UC the full powers of its organization and government,
subject only to legislative controls that may be necessary to
ensure the security of its funds and compliance with the terms
of its endowments.
2)Establishes minimum nurse-to-patient staffing ratios by nurse
classification and hospital unit, requires the ratios to
constitute the minimum number of nurses that must be
allocated, and requires additional staff to be assigned in
accordance with a documented patient classification system.
3)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, and requires the staffing plan
to be developed and implemented for each patient care unit and
to specify patient care requirements and staffing levels for
nurses and other licensed and unlicensed personnel.
FISCAL EFFECT : Unknown, however, according to an Assembly
Appropriations Committee analysis of AB 2244 (Price), a
substantially similar bill from 2008:
1)Annual General Fund (GF) costs and cost pressures of $300,000
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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.
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.
COMMENTS : Purpose of This Bill : According to the author,
there is a well established link between safe nurse staffing
levels and quality patient care. DPH, through regulation, has
determined what constitutes safe staffing levels for registered
nurses. Hospitals, including UC hospitals, are required to meet
those nurse-to-patient staffing ratios. While current law
requires hospitals, including UC hospitals, to establish general
staffing procedures for non-nursing patient services, hospitals
are not required to meet specified staffing levels in these
professional and technical staffing areas. The author notes
that many professional and technical staff positions require
direct patient care, and inadequate staffing of these positions
can cause delays in patient test results, lead to inaccurate
films and tests, and increase employee injuries that affect
their ability to continue to provide quality care. The author
indicates that the information that will be provided by UC
hospitals to DPH under the provisions of this bill will
establish a foundation upon which the Legislature and/or DPH can
evaluate the need for hospital staffing requirements in
professional and technical classifications.
Hospital Staffing Practices and Data Reviews by DPH : Hospitals
currently use a number of different types of non-nurse
professional and technical staff to care for patients, including
respiratory therapists, phlebotomists, radiology technicians,
emergency room and surgical technicians, lab technicians,
physical therapy assistants, and pharmacy technicians. While
not subject to specific staffing ratio requirements, hospitals
are required to establish general staffing policies and
procedures for certain services that are not provided by nursing
staff, such as radiological services, intensive care newborn
nursery services, and basic emergency medical services.
According to DPH, it does not review the methods or procedures
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used by hospitals for determining non-nurse professional and
technical staffing, but if surveyors find adverse patient
outcomes that indicate that staffing might be the root of the
problem, they would investigate further. If a patient suffered
harm and shortage of staff was determined to be a causative
factor, a deficiency would be issued for staffing.
Second Committee of Reference : This bill was heard and approved
by the Assembly Health Committee on April 14, 2009.
UC Hospitals as a Representative Sample: 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. This bill requires UC
hospitals to provide staffing policies and procedures to DPH
with a primary goal that, from this data, DPH and the
Legislature will be able to evaluate the need for statewide
hospital staffing requirements in professional and technical
classifications. The Committee may wish to consider whether UC
hospitals, operating with a focus towards teaching and research,
will provide the best representative sample of statewide
hospital staffing needs.
Constitutionally Allowable Legislative Controls Over UC : The
California Constitution (Section 9 of Article IX) establishes UC
as a public trust and confers the full powers of the UC upon the
UC Regents. The Constitution establishes that the UC is subject
to legislative control only to the degree necessary to ensure
the security of its funds and compliance with the terms of its
endowments. Judicial decisions have held that there are three
additional areas in which there may be limited legislative
intrusion into university operations: authority over the
appropriation of state moneys; exercise of the general police
power to provide for the public health, safety and welfare; and,
legislation on matters of general statewide concern not
involving internal university affairs. By requiring only UC
health facilities to provide information to DPH, this bill may
not fall within the areas where the Constitution and the courts
have found there may be legislative regulation.
Governor's Veto Message: AB 2244 (Price) of 2008, which was
vetoed by the Governor, was identical to this bill. In vetoing
AB 2244, the Governor wrote:
"Current law already requires hospitals to have written
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staffing plans for nursing staff. In addition, hospitals
must determine the staffing needs for "non-licensed"
classifications using the hospital's individual patient
care requirements and their system of delivering care. To
target a requirement specifically at the five University of
California hospitals is both unnecessary and ineffective.
All hospitals are currently licensed and held accountable
using the same criteria - this makes good policy sense and
creates an environment that protects all patients equally,
regardless of the type of hospital."
Related legislation : In addition to AB 2244 (Price) of 2008,
mentioned above, AB 13 (Brownley), which died on the Senate
Inactive File, would require hospitals to adopt and review
non-nurse staffing plans. The provisions of AB 520 (Brownley)
of 2007, which was held in the Assembly Appropriations
Committee, and of AB 2754 (Chan) of 2006, which failed passage
on the Senate Floor, were substantially similar to AB 13. AB
761 (Jones) of 2005, which failed passage on the Senate Floor,
would have required hospitals to consider staffing guidelines
developed by relevant professional associations and to review
and report on worker and patient injury rates. AB 2300
(Dymally) and AB 1927 (Dymally) of 2004, both of which failed
passage in the Assembly, would have established hospital
staffing plan requirements for professional, technical, and
support staff.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file
Opposition
None on file
Analysis Prepared by : Laura Metune / HIGHER ED. / (916)
319-3960