BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  AB 375
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          ASSEMBLY THIRD READING
          AB 375 (Skinner)
          As Amended  May 27, 2011
          Majority vote 

           INSURANCE           8-4         APPROPRIATIONS      12-5        
           
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          |Ayes:|Solorio, Charles          |Ayes:|Fuentes, Blumenfield,     |
          |     |Calderon, Carter, Feuer,  |     |Bradford, Charles         |
          |     |Hayashi, Skinner, Torres, |     |Calderon, Campos, Davis,  |
          |     |Wieckowski                |     |Gatto, Hall, Hill, Lara,  |
          |     |                          |     |Mitchell, Solorio         |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Hagman, Grove, Miller,    |Nays:|Harkey, Donnelly,         |
          |     |Olsen                     |     |Nielsen, Norby, Wagner    |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY  :  Provides that methicillin-resistant Staphylococcus 
          aureus (MRSA) and blood-borne infectious diseases are presumed 
          to be job related if suffered or contracted by a hospital 
          employee.  Specifically,  this bill  :  

          1)Specifies that the term "injury" as used in the workers' 
            compensation law with respect to specified hospital employees 
            shall include blood-borne infectious disease and MRSA that 
            develops or manifests itself during a person's employment at a 
            hospital.

          2)Provides that these diseases shall be presumed to arise out of 
            and in the course of employment.

          3)Allows the employer to dispute the presumption, requiring the 
            employer to prove by evidence that the disease is NOT related 
            to employment.

          4)Specifies that the presumptions apply only to hospital 
            employees who provide direct patient care at an acute care 
            hospital.

          5)Extends to 180 days the period beyond separation from hospital 
            employment during which a hospital employee may rely on the 
            presumption relating to blood-borne infectious disease.








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          6)Extends to 90 days the period beyond separation from hospital 
            employment during which a hospital employee may rely on the 
            presumption relating to MRSA or back and neck injuries.

          7)Contains legislative findings and declarations in support of 
            the bill's proposals.

           EXISTING LAW  :

          1)Establishes a comprehensive system of workers' compensation 
            benefits for injuries, including diseases, that arise out of 
            and in the course of employment.  The benefits include full 
            medical benefits to treat the injury or condition, 
            indemnification for temporary and permanent disability, and 
            death benefits, among other benefits.

          2)Requires in most cases that the employee establish that the 
            injury or condition underlying the claim arose out of and in 
            the course of employment.

          3)Provides safety officers (i.e., specified police, sheriff, and 
            firefighter employees) with a presumption that certain 
            injuries or conditions are related to employment.  These 
            conditions or injuries are more extensive than, but include, 
            the conditions included in this bill.

           FISCAL EFFECT  :  According to the Assembly Appropriations 
          Committee, potential workers compensation cost increase in the 
          range of $75,000 to $100,000 (various public funds), partially 
          offset by minor administrative savings from fewer dispute 
          resolution proceedings.

           COMMENTS  :   

          1)The author states that this bill is needed for the following 
            reasons:

               According to U.S. Department of Labor, health care is the 
               second fastest growing sector of the United States 
               economy, employing over 12 million workers. Women 
               represent nearly 80 percent of the health care work 
               force.









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               Registered nurses and hospital workers by the nature of 
               their work, which involves ill patients and medical 
               equipment, are in constant danger of being exposed to a 
               variety of illnesses and becoming injured by lifting and 
               mobilizing patients and by medical equipment.  Because of 
               the physical nature of patient care, California's aging 
               nursing workforce, combined with rising patient acuity 
               and obesity, more work related injuries to the neck and 
               back and higher levels of exposure to infectious diseases 
               are occurring.  Each year thousands of nurses, nursing 
               aides, and health care workers sustain musculoskeletal 
               disorders (MSDs) from manual lifting of patients and 
               residents. 

               According to the 2009 Bureau of Labor Statistics, 
               direct-care registered nurses ranked 7th among all 
               occupations for the number of cases of MSDs resulting in 
               days away from work exceeding that of workers in 
               construction, mining, and manufacturing.
               Additionally, blood-borne diseases and 
               methicillin-resistant Staphylococcus aureus (MRSA) are 
               contact work related hazards for hospital employees.  In 
               California health care acquired infections in hospitals 
               account for an estimated 200,000 infections and 12,000 
               deaths annually, according to the State Department of 
               Public Health. MRSA is increasingly infecting hospital 
               workers and their patients.  MRSA is one of the most 
               virulent types of antibiotic-resistant staph infections.  
               Although infection control measures help to stop the 
               spread of MRSA and other blood-borne diseases they do not 
               eliminate the job related threat of contracting MRSA or 
               other blood- borne diseases completely."

          2)Under current law, the only employees (subject to two 
            exceptions discussed below) who receive the benefit of 
            presumptions that injuries or conditions are job-related are 
            police and firefighters - public safety employees.  This bill 
            would extend this special benefit to private sector employees, 
            and to non-safety employees.  The bill is therefore extending 
            the concept of presumptions in two novel respects.

          The two exceptions to the "only public employees" and "only 
            safety officers" rules for presumptions involve somewhat 
            unique circumstances.  In 2008, a small group of firefighters 








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            who happen to be employed by a private contractor due to a 
            quirk in federal law were granted the same status with respect 
            to presumptions afforded public employee firefighters  �(SB 
            1271 (Cedillo), Statutes 2008, Chapter 747].  The other 
            exception is for public employee lifeguards, and that 
            presumption is limited to skin cancer.  Cancer was the initial 
            condition where the notion of presumptions was applied.  The 
            policy is that it is a condition that intuitively is job 
            related, but due to the long latency period and uncertain 
            medical causation issues, difficult for the employee to prove.

          3)Supporters point to the statistics surrounding injuries to 
            nurses and other hospital workers, including the consequences 
            of disease due to needle pricks, and argue that these 
            employees are providing critical services to their communities 
            and deserve the protection that a presumption of 
            compensability would afford them.

          4)A presumption has historically been adopted when employees 
            have had difficulty proving that the injury or condition at 
            issue is job-related, while at the same time it is intuitively 
            logical that it is, in fact, job-related.  The Insurance 
            Committee has not received information indicating that 
            hospital workers suffering from the conditions or injuries 
            that the bill would presume to be job-related have had 
            difficulty in the workers' compensation system establishing 
            that the injuries or conditions were in fact job-related.

          5)The opponents argue that there is no rationale to extend the 
            concept of presumptions to employees who are not in the 
            traditional group - public safety officers - who have received 
            this special benefit due to the special dangers of the work 
            they do.  Because of the unique role that public safety 
            officers play in our society, they have historically received 
            several different and unique benefits, including enhanced 
            retirement rules, special disability retirement rules, 
            enhanced temporary disability rules, and presumptions of 
            compensability.  While these enhanced benefits may be 
            appropriate for public safety employees, it does not follow 
            that these rules should be expanded to other classes of 
            employee.  

          Opponents argue that there is no evidence that the normal rules 
            governing how injuries or conditions are proven to be 








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            job-related are not working properly with respect to the 
            employees and the conditions being addressed by the bill.  

          6)AB 664 (Skinner) of 2009 and AB 1994 (Skinner) of 2010 
            proposed similar provisions to AB 375 (Skinner), but also 
            included additional conditions to which the presumption would 
            apply, and, in some circumstances, longer post-employment 
            periods of time when the presumption would apply.  AB 664 and 
            AB 1994 were held on the Assembly Appropriations Committee 
            suspense file.

           
          Analysis Prepared by  :    Mark Rakich / INS. / (916) 319-2086


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