BILL NUMBER: SB 1246 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 25, 2012
AMENDED IN SENATE APRIL 12, 2012
AMENDED IN SENATE MARCH 26, 2012
INTRODUCED BY Senator Hernandez
FEBRUARY 23, 2012
An act to amend Sections 1279 and 1280.3 of, and to add Section
1279.4 to, the Health and Safety Code, relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
SB 1246, as amended, 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 requires the department to promulgate regulations
, that include specified criteria ,
for the purpose of assessing an administrative penalty
against general acute care hospitals, acute psychiatric hospitals,
and special hospitals. Existing law authorizes the department to
assess a licensee of these hospitals 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 eliminate the requirement that the department
promulgate regulations to assess an administrative penalty and
instead would require the department to use the specified criteria to
determine the amount of the administrative penalty.
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 to
comply with the requirements of 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 the facility 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
ratios 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 the facility 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. Inspections 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 the facility 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 at least
annually. annually.
(b) Failure to maintain a patient classification system shall
constitute an immediate jeopardy of patients for the
purposes purpose of Sections
Section 1280.1 or 1280.3.
(c) (1) Failure to comply with the requirements of a patient
classification system, including failure to annually update the
patient classification system, shall constitute a violation subject
to subdivision (b) of Section 1280.3.
(2) The annual updating of the patient classification system shall
include a review of its reliability by a review committee. The
review committee shall be appointed by the nursing administration,
subject to paragraph (3). The review committee shall determine
whether the system accurately measures patient care needs.
(3) At least one-half of the committee shall be registered nurses
who provide direct patient care. If the registered nurses are
represented by a collective bargaining agent, the registered nurses
shall be selected by the agent.
(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. Section 1280.3 of the Health and Safety Code is amended to
read:
1280.3. (a) The director may assess an administrative penalty
against a licensee of a health facility licensed under subdivision
(a), (b), or (f) of Section 1250 for a deficiency
constituting that occurs on or after January 1, 2013,
and constitutes an immediate jeopardy violation , as
determined by the department , up to a maximum of
seventy-five thousand dollars ($75,000) for the first administrative
penalty, up to one hundred thousand dollars ($100,000) for the second
subsequent administrative penalty, and up to one hundred twenty-five
thousand dollars ($125,000) for the third and every subsequent
violation. An administrative penalty issued after three years from
the date of the last issued immediate jeopardy violation shall be
considered a first administrative penalty so long as the facility has
not received additional immediate jeopardy violations and is found
by the department to be in substantial compliance with all state and
federal licensing laws and regulations. The department shall have
full discretion to consider all factors when determining the amount
of an administrative penalty pursuant to this section.
(b) Except as provided in subdivision (c), for a violation of this
chapter or the rules and regulations adopted thereunder that
occurs on or after January 1, 2013, but does not constitute a
violation of subdivision (a), the department may assess an
administrative penalty in an amount of up to twenty-five thousand
dollars ($25,000) per violation. This subdivision shall also apply to
violation of regulations set forth in Article 3 (commencing with
Section 127400) of Chapter 2 of Part 2 of Division 107 or the rules
and regulations adopted thereunder.
The department shall use the following criteria to determine the
amount of an administrative penalty against a health facility
licensed pursuant to subdivision (a), (b), or (f) of Section 1250:
(1) The patient's physical and mental condition.
(2) The probability and severity of the risk that the violation
presents to the patient.
(3) The actual financial harm to patients, if any.
(4) The nature, scope, and severity of the violation.
(5) The facility's history of compliance with related state and
federal statutes and regulations.
(6) Factors beyond the facility's control that restrict the
facility's ability to comply with this chapter or the rules and
regulations promulgated thereunder.
(7) The demonstrated willfulness of the violation.
(8) The extent to which the facility detected the violation and
took steps to immediately correct the violation and prevent the
violation from recurring.
(9) Compliance with staffing requirements of state and federal law
and regulation, including, but not limited to, the patient
classification system and nurse-to-patient ratios.
(c) The department shall not assess an administrative penalty for
minor violations.
(d) If the licensee disputes a determination by the department
regarding the alleged deficiency or alleged failure to correct a
deficiency, or regarding the reasonableness of the proposed deadline
for correction or the amount of the penalty, the licensee may, within
10 working days, request a hearing pursuant to Section 131071.
Penalties shall be paid when all appeals have been exhausted and the
department's position has been upheld.
(e) For purposes of this section, "immediate jeopardy" means a
situation in which the licensee's noncompliance with one or more
requirements of licensure has caused, or is likely to cause, serious
injury or death to the patient.
(f) In enforcing subdivision (a) the department shall take into
consideration the special circumstances of small and rural hospitals,
as defined in Section 124840, in order to protect access to quality
care in those hospitals.
SEC. 4. By amending Section 1280.3 of the Health
and Safety Code in Section 3 of this act, it is the intent of the
Legislature to authorize the State Department of Public Health to
implement the imposition of administrative penalties described in
subdivisions (a) and (b) of Section 1280.3 of the Health and Safety
Code, without the prior adoption of regulations to implement that
section. The amendments made to Section 1280.3 of the Health and
Safety Code by this act shall not be construed to prohibit the
department from adopting implementing regulations.
SEC. 4. SEC. 5. 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.