BILL NUMBER: SB 1246 INTRODUCED
BILL TEXT
INTRODUCED BY Senator Hernandez
FEBRUARY 23, 2012
An act to amend Section 1279 of, and to add Section 1279.4 to, the
Health and Safety Code, relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
SB 1246, as introduced, Hernandez. Health facilities: staffing.
Existing law regulates general acute care hospitals, acute
psychiatric hospitals, and special hospitals, as defined. Existing
law required, by January 1, 2002, the State Department of Public
Health to adopt regulations establishing the minimum, specific, and
numerical licensed nurse-to-patient ratios by licensed nurse
classification and by hospital unit for general acute care hospitals,
acute psychiatric hospitals, and special hospitals. Existing law
requires these ratios to constitute the minimum number of registered
and licensed nurses that shall be allocated and additional staff to
be assigned in accordance with a documented patient classification
system for determining nursing requirements.
Existing law authorizes the department to assess a licensee of a
general acute care hospital, acute psychiatric hospital, or special
hospital an administrative penalty, as specified, for a violation of
existing law or for a deficiency constituting an immediate jeopardy
violation, except that no penalty shall be assessed if it is a minor
violation. Existing law requires that a person who willfully or
repeatedly violates a rule or regulation adopted pursuant to these
provisions is guilty of a misdemeanor.
This bill would require general acute care hospitals, acute
psychiatric hospitals, and special hospitals to maintain a patient
classification system, as defined, that is reviewed and updated
annually. This bill would provide that a failure to maintain and
annually update a patient classification system, or failure to comply
with a patient classification system, may be subject to an
administrative penalty. By expanding the definition of a crime, this
bill would impose a state-mandated local program.
Existing law requires that every health facility for which a
license or special permit has been issued shall be periodically
inspected by the State Department of Public Health, or by another
governmental entity under contract with the department. Existing law
requires the department to inspect for compliance with provisions of
state law and regulations during a state periodic inspection, or at
the same time as a federal periodic inspection.
This bill would require the inspections to include review of
compliance with state requirements for staffing, including the
regulations adopted by the department establishing nurse-to-patient
rations and regulations regarding patient classification systems.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1279 of the Health and Safety Code is amended
to read:
1279. (a) Every health facility for which a license or special
permit has been issued shall be periodically inspected by the
department, or by another governmental entity under contract with the
department. The frequency of inspections shall vary, depending upon
the type and complexity of the health facility or special service to
be inspected, unless otherwise specified by state or federal law or
regulation. The inspection shall include participation by the
California Medical Association consistent with the manner in which it
participated in inspections, as provided in Section 1282 prior to
September 15, 1992.
(b) Except as provided in subdivision (c), inspections shall be
conducted no less than once every two years and as often as necessary
to ensure the quality of care being provided.
(c) For a health facility specified in subdivision (a), (b), or
(f) of Section 1250, inspections shall be conducted no less than once
every three years, and as often as necessary to ensure the quality
of care being provided.
(d) During the inspection, the representative or representatives
shall offer such advice and assistance to the health facility as they
deem appropriate.
(e) For acute care hospitals of 100 beds or more, the inspection
team shall include at least a physician, registered nurse, and
persons experienced in hospital administration and sanitary
inspections. During the inspection, the team shall offer advice and
assistance to the hospital as it deems appropriate.
(f) The department shall ensure that a periodic inspection
conducted pursuant to this section is not announced in advance of the
date of inspection. An inspection may be conducted jointly with
inspections by entities specified in Section 1282. However, if the
department conducts an inspection jointly with an entity specified in
Section 1282 that provides notice in advance of the periodic
inspection, the department shall conduct an additional periodic
inspection that is not announced or noticed to the health facility.
(g) Notwithstanding any other provision of law, the department
shall inspect for compliance with provisions of state law and
regulations during a state periodic inspection or at the same time as
a federal periodic inspection, including, but not limited to, an
inspection required under this section. Insp ections
shall include review of compliance with state requirements
for staffing, including regulations adopted pursuant to Section
1276.4 and regulations regarding patient classification systems.
If the department inspects for compliance with state law and
regulations at the same time as a federal periodic inspection, the
inspection shall be done consistent with the guidance of the federal
Centers for Medicare and Medicaid Services for the federal portion of
the inspection.
(h) The department shall emphasize consistency across the state
and its district offices when conducting licensing and certification
surveys and complaint investigations, including the selection of
state or federal enforcement remedies in accordance with Section
1423. The department may issue federal deficiencies and recommend
federal enforcement actions in those circumstances where they provide
more rigorous enforcement action.
SEC. 2. Section 1279.4 is added to the Health and Safety Code, to
read:
1279.4. (a) A health facility licensed pursuant to subdivision
(a), (b), or (f) of Section 1250 shall maintain a patient
classification system that shall be reviewed and updated annually.
(b) Failure to maintain and annually update a patient
classification system shall constitute an immediate jeopardy of
patients for the purposes of Sections 1280.1 or 1280.3.
(c) Failure to comply with a patient classification system shall
constitute a violation subject to subdivision (b) of Section 1280.3.
(d) For purposes of this section, a "patient classification system"
means a method for establishing staffing requirements by unit,
patient, and shift that includes all of the following:
(1) A method to predict nursing care requirements of individual
patients.
(2) An established method by which the amount of nursing care
needed for each category of patient is validated for each unit and
for each shift.
(3) An established method to discern trends and patterns of
nursing care delivery by each unit, each shift, and each level of
licensed and unlicensed staff.
(4) A mechanism by which the accuracy of the nursing care
validation method described in paragraph (2) can be tested. This
method will address the amount of nursing care needed, by patient
category and pattern of care delivery, on an annual basis, or more
frequently, if warranted by the changes in patient populations, skill
level of the staff, or patient care delivery model.
(5) A method to determine staff resource allocations based on
nursing care requirements for each shift and each unit.
(6) A method by which the hospital validates the reliability of
the patient classification system for each unit and each shift.
SEC. 3. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.