BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 375|
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THIRD READING
Bill No: AB 375
Author: Skinner (D), et al.
Amended: 8/31/11 in Senate
Vote: 21
SENATE LABOR & INDUSTRIAL RELATIONS COMM. : 5-1, 6/22/11
AYES: Lieu, DeSaulnier, Leno, Padilla, Yee
NOES: Wyland
NO VOTE RECORDED: Runner
SENATE APPROPRIATIONS COMMITTEE : 6-3, 8/25/11
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Emmerson, Runner
ASSEMBLY FLOOR : 49-25, 6/1/11 - See last page for vote
SUBJECT : Workers compensation: hospital employees:
presumption
SOURCE : California Nurses Association/National Nurses
Organization
Committee
DIGEST : This bill provides, with respect to hospital
employees, who provide direct patient care in an acute care
hospital, that the term "injury" include a blood borne
infectious disease or methicillin-resistant Staphylococcus
aureus that develops or manifests itself during the period
of the person's employment with the hospital. This bill
further creates a disputable presumption that the above
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injury arises out of and in the course of the person's
employment if it develops or manifests, as specified.
Senate Floor Amendments of 8/31/11 add a provision to
define an "acute care hospital" for the purposes of the
bill.
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.
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.
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.
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This bill:
1.Creates a disputable presumption of an occupational
injury if a hospital employee who provides direct care in
an acute care hospital contracts a MRSA skin infection or
a bloodborne infectious disease that develops or
manifests itself during a period of the person's
employment with the hospital.
2.Provides 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.
3.Provides 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 with the last date actually worked.
4.Provides 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
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
percent to 30 percent 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
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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.
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
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.
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
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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 (e.g. biting a
treating nurse), and routine medical care involving
intravenous needles.
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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
New workers' Minimum $33 to
$65 for industrial General
compensation disability benefit (up to one year),
injury presumptionup to $53 for additional temporary
disability benefit (up to one
additional
year); unknown, potentially major
permanent disability benefits and
medical costs per claim
SUPPORT : (Verified 9/1/11)
California Nurses Association/National Nurses Organizing
Committee (source)
American Federation of State, County and Municipal
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Employees, AFL-CIO
California Conference Board of the Amalgamated Transit
Union
California Conference of Machinists
California 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
Utility Workers Union of America, Local 132
OPPOSITION : (Verified 9/1/11)
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
Los Angeles County Board of Supervisors
Long Beach Area Chamber of Commerce
Regional Council of Rural Counties
ARGUMENTS IN SUPPORT : Proponents of this bill believe
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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 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.
ARGUMENTS IN OPPOSITION : 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
job-related are not working properly with respect to the
employees and the conditions being addressed by the bill.
ASSEMBLY FLOOR : 49-25, 6/1/11
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bonilla, Bradford, Brownley, Buchanan,
Butler, Charles Calderon, Campos, Carter, Cedillo,
Chesbro, Dickinson, Eng, Feuer, Fong, Fuentes, Furutani,
Galgiani, Gatto, Hall, Hayashi, Roger Hern�ndez, Hill,
Huber, Hueso, Huffman, Lara, Bonnie Lowenthal, Ma,
Mendoza, Mitchell, Monning, Pan, Perea, Portantino,
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Skinner, Solorio, Swanson, Torres, Wieckowski, Williams,
Yamada, John A. P�rez
NOES: Achadjian, Bill Berryhill, Conway, Cook, Donnelly,
Fletcher, Beth Gaines, Grove, Hagman, Halderman, Harkey,
Jones, Knight, Logue, Mansoor, Miller, Morrell, Nestande,
Nielsen, Norby, Olsen, Silva, Smyth, Valadao, Wagner
NO VOTE RECORDED: Davis, Garrick, Gordon, Gorell, Jeffries,
V. Manuel P�rez
PQ:do 9/1/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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