BILL ANALYSIS �
Senate Committee on Labor and Industrial Relations
Ted W. Lieu, Chair
Date of Hearing: June 27, 2012 2011-2012 Regular
Session
Consultant: Gideon L. Baum Fiscal:Yes
Urgency: No
Bill No: AB 808
Author: Skinner
As Introduced/Amended: May 29, 2012
SUBJECT
Workers' compensation: hospital employers: presumption.
KEY ISSUE
Should the Legislature create a disputable presumption of an
occupational if a hospital employee contracts
Methicillin-Resistant Staphylococcus aureus (MRSA) skin
infection in an acute care hospital?
PURPOSE
To create a presumption, which may be disputed by evidence, that
a hospital employee who contracts a MRSA skin 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 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 must include full hospital,
surgical, medical treatment, disability indemnity, and death
benefits, as provided by workers compensation law.
This bill would provide that the MRSA presumption be extended
for a period of 60 days , commencing with the last date actually
worked.
Hearing Date: June 27, 2013 AB 808
Consultant: Gideon L. Baum Page 2
Senate Committee on Labor and Industrial Relations
This bill would also provide that a MRSA skin infection
developing or manifesting itself in these cases must not be
attributed to any disease or skin infection existing prior to
that development or manifestation.
This bill would also make finding and declarations on the danger
of MRSA in the healthcare setting for healthcare workers.
COMMENTS
1. What is Methicillin-Resistant Staphylococcus aureus (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.
Hearing Date: June 27, 2013 AB 808
Consultant: Gideon L. Baum Page 3
Senate Committee on Labor and Industrial Relations
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.
2. 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 Methicillin-Resistant
Staphylococcus aureus (MRSA) skin infection, but nurses who
are exposed to MRSA 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 MRSA infection.
3. 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
Hearing Date: June 27, 2013 AB 808
Consultant: Gideon L. Baum Page 4
Senate Committee on Labor and Industrial Relations
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.
4. Prior Legislation :
AB 375 (Skinner) of 2011 contained nearly identical provisions
to this bill on Methicillin-Resistant Staphylococcus aureus
(MRSA) skin infections, but also included bloodborne
pathogens. That bill was refused passage on the Senate Floor.
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 (Sponsor)
California Applicants' Attorneys Association
California Labor Federation
California Professional Firefighters
Laborers' Locals 777 & 792
Union of Healthcare Professionals
United Nurses Association of California
Hearing Date: June 27, 2013 AB 808
Consultant: Gideon L. Baum Page 5
Senate Committee on Labor and Industrial Relations
OPPOSITION
ALPHA Fund
Association of California Healthcare Districts
Association of California Insurance Companies
California Association for Health Services at Home
California Association of Joint Powers Authorities
California Chamber of Commerce
California Coalition of Workers' Compensation
California Hospital Association
California Special Districts Association
California State Association of Counties
CSAC Excess Insurance Authority
Los Angeles Area Chamber of Commerce
Regional Council of Rural Counties
Hearing Date: June 27, 2013 AB 808
Consultant: Gideon L. Baum Page 6
Senate Committee on Labor and Industrial Relations