BILL ANALYSIS �
Senate Committee on Labor and Industrial Relations
Ted W. Lieu, Chair
Date of Hearing: June 22, 2011 2011-2012 Regular
Session
Consultant: Gideon L. Baum Fiscal:Yes
Urgency: No
Bill No: AB 375
Author: Skinner
Version: As Amended May 27, 2011
SUBJECT
Hospital employees: presumption.
KEY ISSUE
Should the Legislature create a disputable presumption of an
occupational if a hospital employee contracts MRSA or a
bloodborne infectious disease in an acute care hospital?
PURPOSE
To create a presumption, which may be disputed by evidence, that
a hospital employee who contracts a bloodborne illness or MRSA
infection did so in the course of his or her employment.
ANALYSIS
Existing law establishes a workers' compensation system that
provides benefits to an employee who suffers from an injury or
illness that arises out of and in the course of employment,
irrespective of fault. This system requires all employers to
secure payment of benefits by either securing the consent of the
Department of Industrial Relations to self-insure or by securing
insurance against liability from an insurance company duly
authorized by the state.
Existing law creates a series of disputable presumptions of an
occupational injury for peace and safety officers for the
purposes of the workers' compensation system. These
presumptions include:
Heart disease;
Hernias;
Pneumonia;
Cancer;
Meningitis;
Tuberculosis;
Methicillin-Resistant Staphylococcus aureus (MRSA) skin
infections; and
Bloodborne infectious disease.
The compensation awarded for these injuries must include full
hospital, surgical, medical treatment, disability indemnity, and
death benefits, as provided by workers compensation law. These
presumptions tend to run for 5 to 10 years commencing on their
last day of employment, depending on the injury and the peace
officer classification involved. (Labor Code ��3212 to 3213.2)
Existing law provides that the presumptions listed above are
disputable and may be controverted by evidence. However, unless
controverted, the Workers' Compensation Appeals Board must find
is accordance with the presumption. (Labor Code ��3212 to
3213.2)
This bill would create a disputable presumption of an
occupational injury if a hospital employee who provides direct
care in an acute care hospital contracts a Methicillin-Resistant
Staphylococcus aureus (MRSA) skin infection or a bloodborne
infectious disease that develops or manifests itself during a
period of the person's employment with the hospital.
This bill would provide that the compensation awarded for a
hospital employee who contracts MRSA or a bloodborne infectious
disease must include full hospital, surgical, medical treatment,
disability indemnity, and death benefits, as provided by workers
compensation law.
This bill would provide that the bloodborne infectious disease
presumption must be extended to a hospital employee following
termination of service for a period of 180 days and that the
MRSA presumption be extended for a period of 90 days , commencing
Hearing Date: June 22, 2011 AB 375
Consultant: Gideon L. Baum Page 2
Senate Committee on Labor and Industrial Relations
with the last date actually worked.
This bill would also provide that a bloodborne infectious
disease developing or manifesting itself in these cases must not
be attributed to any disease existing prior to that development
or manifestation.
COMMENTS
1. What is MRSA?
Staphylococcus aureus, often referred to simply as "staph,"
are bacteria commonly carried on the skin or in the nose of
healthy people. Approximately 25% to 30% of the population is
colonized (when bacteria are present, but not causing an
infection) in the nose with staph bacteria. Staph bacteria
are one of the most common causes of skin infections in the
United States. Most of these skin infections are minor and
occur through direct physical contact of the staphylococci
with a break in the skin (cut or scrape). The staph can be
spread by the infected person to someone else or to an object.
Susceptibility to infection depends on factors such as
immunity and general state of health.
In the past, these staph infections typically have been easy
to treat with an inexpensive, short course, usually
well-tolerated antibiotics. Now, in most communities in the
U.S., over half of the staph causing skin infections are
resistant to commonly used antibiotics, and the infections
often return in spite of apparently successful initial
treatment.
Methicillin-Resistant Staphylococcus aureus (MRSA) is
Staphylococcus aureus that is resistant to the penicillin.
Originally, MRSA was confined to hospitals and long-term care
facilities. Many of these hospital-associated MRSA infections
caused very serious complications and were resistant to all
oral antibiotics.
More recently, a newer, more virulent strain of MRSA has
emerged in the community that causes boils, abscesses, and
Hearing Date: June 22, 2011 AB 375
Consultant: Gideon L. Baum Page 3
Senate Committee on Labor and Industrial Relations
other soft tissue infections that are not linked to previous
antibiotic use. It is called community-associated MRSA. It is
generally believed that the community-associated MRSA strains
did not originate from the strains of MRSA that cause
infections in hospitals and other healthcare facilities.
However, individuals seeking treatment for
community-associated MRSA would likely seek treatment in a
hospital due to the risks involved.
Individuals at risk for MRSA include workers in a healthcare
setting, individuals visiting patients in a healthcare
setting, athletic facilities, dormitories, military barracks,
correctional facilities, and daycare centers. However, MRSA
is now found throughout the general community.
2. Bloodborne Infectious Diseases in the Workforce:
Currently, the Department of Industrial Relations (DIR)
defines bloodborne pathogens and describes the best practices
for mitigating them in the workplace. The regulations (Title
8, Section 5193) define bloodborne pathogens as "pathogenic
microorganisms that are present in human blood and can cause
disease in humans. These pathogens include, but are not
limited to, hepatitis B virus (HBV), hepatitis C virus (HCV)
and human immunodeficiency virus (HIV)."
In a healthcare setting, contact with these pathogens can
occur though contact with human tissue and biological fluids,
including blood, semen, saliva, organ and muscle tissue, and
skin. Such contact can occur in a variety of different
situations in a hospital setting, such as emergency care,
assault by a patient (eg biting a treating nurse), and routine
medical care involving intravenous needles.
3. Possible Amendments:
For peace and safety officers, the definition of bloodborne
infectious diseases are defined by statute and tied to
Department of Industrial Relations regulations. Currently,
this bill is silent on a definition for bloodborne infectious
diseases.
Hearing Date: June 22, 2011 AB 375
Consultant: Gideon L. Baum Page 4
Senate Committee on Labor and Industrial Relations
Therefore, the Committee may wish to amend AB 375 to create a
definition for bloodborne pathogens using the same language as
found in existing law for peace and safety officers:
For the purposes of this section, "blood-borne infectious
disease" means a disease caused by exposure to pathogenic
microorganisms that are present in human blood that can cause
disease in humans, including those pathogenic microorganisms
defined as blood-borne pathogens by the Department of
Industrial Relations.
4. Proponent Arguments :
Proponents of this bill believe that this bill will ensure
that nurses are appropriately protected from the pathogenic
hazards found in hospitals. Proponents note that current law
provides a presumption of occupational injury to public safety
officers if they contract a bloodborne illness or
Methicillin-Resistant Staphylococcus aureus (MRSA), but nurses
who are exposed to both on a routine basis are not provided a
similar presumption. Proponents note that while existing
procedures have done much to reduce MRSA exposures, it remains
a daily threat to the health of nurses throughout California.
Finally, proponents note that nurses perform a highly
specialized and key role in ensuring the health and welfare of
the people of California, and they should be able to provide
that service without fighting with an insurance company in the
event of a serious bloodborne illness or MRSA infection.
5. Opponent Arguments :
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
Hearing Date: June 22, 2011 AB 375
Consultant: Gideon L. Baum Page 5
Senate Committee on Labor and Industrial Relations
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
job-related are not working properly with respect to the
employees and the conditions being addressed by the bill.
6. Prior Legislation :
AB 1994 (Skinner) of 2010 proposed similar provisions to AB
375, but also included additional conditions to which the
presumption would apply, such as back and neck injuries. AB
1994 was held on the Assembly Appropriations Committee
suspense file.
AB 664 (Skinner) of 2009 was similar to AB 1994. AB 664 was
held on the Assembly Appropriations Committee suspense file.
SUPPORT
California Nurses Association/National Nurses Organizing
Committee (Sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
CA Conference Board of the Amalgamated Transit Union
CA Conference of Machinists
CA Official Court Reporters Association
California Labor Federation
California National Organization for Women
California Professional Firefighters
California Teamsters Public Affairs Council
Consumer Attorneys of California
Engineers and Scientists of California
International Longshore and Warehouse Union
Professional and Technical Engineers, Local 21
San Bernardino Public Employees Association
Union of Health Care Professionals
UNITE HERE!
United Food and Commercial Workers-Western States Conference
United Nurses Association of California
Hearing Date: June 22, 2011 AB 375
Consultant: Gideon L. Baum Page 6
Senate Committee on Labor and Industrial Relations
Utility Workers Union of America, Local 132
OPPOSITION
Acclimation Insurance Management Services
Allied Managed Care
Apha Fund
Association of California Healthcare Districts
Association of California Insurance Companies
California Association of Joint Powers Authorities
California Chamber of Commerce
California Coalition on Workers' Compensation
California Hospital Association
California Manufacturers & Technology Association
California Special Districts Association
California State Association of Counties
County of San Bernardino
CSAC Excess Insurance Authority
Greater Corona Valley Chamber of Commerce
Irvine Chamber of Commerce
LA County Board of Supervisors
Long Beach Area Chamber of Commerce
Regional Council of Rural Counties
Hearing Date: June 22, 2011 AB 375
Consultant: Gideon L. Baum Page 7
Senate Committee on Labor and Industrial Relations