BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 57|
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THIRD READING
Bill No: AB 57
Author: Price (D)
Amended: As introduced
Vote: 21
SENATE HEALTH COMMITTEE : 7-4, 6/25/09
AYES: Alquist, Cedillo, DeSaulnier, Leno, Negrete McLeod,
Pavley, Wolk
NOES: Strickland, Aanestad, Cox, Maldonado
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 48-31, 5/21/09 - See last page for vote
SUBJECT : University of California hospitals: staffing
SOURCE : American Federation of State, County and
Municipal
Employees
DIGEST : This bill requires the Department of Public
Health (DPH) to establish a procedure for collecting and
reviewing written staffing plans developed by the
University of California hospitals, and requires DPH to
review documentation from each hospital concerning several
aspects of its patient classification plan, as specified.
ANALYSIS :
Existing law:
CONTINUED
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1. Provides for the inspection and licensure of health
facilities, including hospitals, by DPH.
2. Requires DPH to adopt regulations that establish
minimum, specific, and numerical nurse-to-patient
ratios, by licensed nurse classification and by hospital
unit, for general acute care, acute psychiatric, and
specialty hospitals. Existing law requires the ratios
to constitute the minimum number of registered and
licensed nurses that must be allocated, and 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, the ability for self-care, and the licensure of
the personnel required for care.
3. Authorizes the Director of DPH to assess administrative
penalties against general acute care, acute psychiatric,
and specialty hospitals for licensing deficiencies and
violations, including violations of staffing
requirements, as specified. In particular, the director
is authorized to assess the licensee of specified health
facilities an administrative penalty in an amount not to
exceed $25,000 per violation, if a licensee receives a
notice of deficiency constituting an immediate jeopardy
to the health or safety of a patient, as defined, and is
required to submit a plan of correction.
Existing regulations:
1. Requires the administrator of nursing services for each
hospital, or their designee, to develop a written
staffing plan for each patient care unit, based on
patient care needs as determined by the hospital's
patient classification system.
2. Requires a staffing plan to be developed and implemented
for each patient care unit, which must specify patient
care requirements, and the staffing levels for
registered nurses and other licensed and unlicensed
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personnel.
3. Requires hospitals to develop and document a process by
which all interested staff may provide input on the
patient classification system.
This bill:
1. Requires DPH to establish a procedure for collecting and
reviewing the written staffing plans developed by
University of California (UC) general acute care
hospitals, acute psychiatric hospitals, and special
hospitals.
2. Requires DPH, as part of its procedure, to collect and
review documentation from each hospital relating to all
of the following:
A. The hospital's annual review of the reliability of
its patient classification system.
B. The hospital's adjustments to its patient
classification system, based on the annual review of
the patient classification system.
C. The hospital's process for accepting staff input
about the patient classification system, the system's
required revisions, and the overall staffing plan.
3. Requires DPH to exclude from its review issues related
to registered nurse staffing.
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 to 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,
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and that this 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 a state entity.
7. Sunsets its provisions on July 1, 2013.
Prior Legislation
AB 2244 (Price), 2007-08 Session, contained provisions
substantially similar to this bill. The bill was vetoed by
Governor Schwarzenegger, who stated in his veto message
that current law already requires hospitals to have written
staffing plans for nursing staff and that hospitals must
determine the staffing needs for "non-licensed"
classifications using the hospital's individual patient
care requirements and their system of delivering care.
AB 13 (Brownley), 2007-08 Session, would have required
specified hospitals to adopt a plan or procedure for
determining staffing of non-nurse professionals and
technical classifications, as specified, and would have
directed DPH to review hospitals' compliance with their
plans, and allowed the director to levy administrative
penalties for failure to comply with the bill's provisions.
The bill was vetoed by the Governor.
AB 520 (Brownley), 2007-08 Session, was substantially
similar to AB 13. The bill was held in the Assembly
Appropriations Committee.
AB 2754 (Chan), 2005-06 Session, was substantially similar
to AB 13. The bill failed passage on the Senate Floor.
AB 761 (Jones), 2005-06 Session, would have required
hospitals to consider staffing guidelines developed by
relevant professional associations and worker and patient
injury rates in determining non-nurse staffing levels in
hospitals. The bill failed passage on the Senate Floor.
AB 2300 (Dymally), 2003-04 Session, would have required
hospitals to develop a staffing plan for professional,
technical, and support staffing. The bill failed passage
in the Assembly Health Committee.
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AB 1927 (Dymally), 2003-04 Session, would have required
general acute care hospitals, acute psychiatric hospitals,
and special hospitals to at least annually, review the use
of, and consult with, professional, technical, and support
staff, as specified. The bill failed passage on the
Assembly Floor.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/19/09)
American Federation of State, County and Municipal
Employees (source)
American Federation of State, County and Municipal
Employees, Local 3299
United Nurses of California/Union of Health Care
Professionals
OPPOSITION : (Verified 8/19/09)
Department of Public Health
ARGUMENTS IN SUPPORT : According to the author, the
intent of this bill is to better ensure safe hospital
staffing at UC medical centers by requiring DPH to collect
and review the medical centers' written staffing plans and
related documentation. The author states that recruitment
and retention of key employees is a challenge at UC medical
centers, and that UC has acknowledged that it faces a
shortage of key personnel in its 2007-08 budget request.
The author cites a 2007 analysis that found that one in
four patient care workers at the UC medical centers has two
years or less experience and states that for many critical
patient care positions, turnover is high. The author
states that this bill will also provide a factual basis
upon which the Legislature and DPH can evaluate the need
for minimum staffing requirements in professional and
technical classifications other than nursing. The author
states that closer oversight of staffing in the medical
centers is appropriate, given that the medical centers
constitute the only general purpose health care system
owned and operated by a state entity.
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ARGUMENTS IN OPPOSITION : DPH states that this bill will
result in the redirection of DPH staff from other mandated
activities. Since non-nurse staff, such as respiratory
therapists, phlebotomists, and radiology technicians, are
not required to be included in each hospital's patient
classification system and written staffing plan, DPH does
not believe a review of the staffing plans will yield the
information related to adequacy of staffing of non-nurse
personnel. DPH also estimates the bill will require
surveyors to spend an additional 150 hours per annual
hospital inspection to review UC hospital staffing plans,
and divert them from other state-mandated activities.
ASSEMBLY FLOOR :
AYES: Ammiano, Beall, Block, Blumenfield, Brownley,
Buchanan, Caballero, Charles Calderon, Carter, Chesbro,
Coto, Davis, De La Torre, De Leon, Eng, Evans, Feuer,
Fong, Fuentes, Furutani, Galgiani, Hall, Hayashi,
Hernandez, Hill, Huffman, Jones, Krekorian, Lieu, Bonnie
Lowenthal, Ma, Mendoza, Monning, Nava, John A. Perez, V.
Manuel Perez, Portantino, Price, Ruskin, Salas, Skinner,
Solorio, Swanson, Torlakson, Torres, Torrico, Yamada,
Bass
NOES: Adams, Anderson, Arambula, Bill Berryhill, Tom
Berryhill, Blakeslee, Conway, Cook, DeVore, Duvall,
Emmerson, Fletcher, Fuller, Gaines, Garrick, Gilmore,
Hagman, Harkey, Huber, Jeffries, Knight, Logue, Miller,
Nestande, Niello, Nielsen, Silva, Smyth, Audra
Strickland, Tran, Villines
NO VOTE RECORDED: Saldana
JJA:mw 8/19/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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