BILL ANALYSIS �
SB 1246
Page 1
SENATE THIRD READING
SB 1246 (Ed Hernandez)
As Amended July 5, 2012
Majority vote
SENATE VOTE :22-15
HEALTH 13-5 APPROPRIATIONS 12-5
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|Ayes:|Monning, Atkins, Bonilla, |Ayes:|Gatto, Blumenfield, |
| |Eng, Gordon, Hayashi, | |Bradford, |
| |Roger Hern�ndez, Bonnie | |Charles Calderon, Campos, |
| |Lowenthal, Mitchell, | |Davis, Fuentes, Hall, |
| |Nestande, Pan, V. Manuel | |Hill, Cedillo, Mitchell, |
| |P�rez, Williams | |Solorio |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Harkey, Donnelly, |
| |Silva, Smyth | |Nielsen, Norby, Wagner |
| | | | |
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SUMMARY : Requires the Department of Public Health (DPH), during
its periodic inspections of hospitals, to review compliance with
existing nurse staffing ratios and patient classifications
systems. Eliminates the requirement that DPH promulgate
regulations further defining criteria for assessing
administrative penalties for non-immediate jeopardy violations.
Specifically, this bill :
1)Requires that periodic DPH inspections of hospitals include a
review of compliance with nurse staffing ratios and patient
classification systems.
2)Codifies existing regulations requiring hospitals to develop,
maintain, and annually update patient classification systems.
3)Codifies existing regulations requiring an annual review of
the reliability of the patient classification system by a
committee appointed by a hospital nursing administrator to
determine whether or not the patient classification system
accurately measures patient care needs.
4)Requires registered nurses appointed to the hospital's patient
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classification review committee referenced in 3) above, to be
selected by the collective bargaining agent, if the registered
nurses are represented.
5)Eliminates the requirement that DPH promulgate regulations
further defining criteria for assessing administrative
penalties not less than $2,500 and not to exceed $25,000 for
non-immediate jeopardy violations.
6)Eliminates the requirement that DPH promulgate regulations
which allow higher immediate jeopardy violation penalty levels
to go into effect.
7)Adds compliance with staffing requirements, including, but not
limited to, nurse-to-patient ratios, to the existing criteria
by which DPH is required to consider to determine the amount
of an administrative penalty.
EXISTING LAW :
1)Establishes that DPH license and regulate health facilities.
2)Requires DPH to inspect for compliance with state laws and
regulations during a state periodic inspection or at the same
time as a federal periodic inspection. Requires, for general
acute care hospitals, acute psychiatric hospitals, and special
hospitals, the inspection to be conducted no less than once
every three years.
3)Requires DPH to adopt regulations that establish minimum,
specific, and numerical licensed nurse-to-patient ratios, by
licensed nurse classification and by hospital unit, for
hospitals, and requires these ratios to constitute the minimum
number of registered and licensed nurses that must be
allocated.
4)Establishes a structure under which DPH is permitted to assess
administrative fines to general acute care hospitals, acute
psychiatric hospitals, and special hospitals for violation of
any of their licensing laws and regulations. Requires DPH to
promulgate regulations establishing the criteria to assess
these administrative penalties, and requires these criteria to
include, but not be limited to, the following:
a) The patient's physical and mental condition;
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b) The probability and severity of the risk that the
violation presents to the patient;
c) The actual financial harm to patients, if any;
d) The nature, scope, and severity of the violation;
e) The facility's history of compliance with related state
and federal statutes and regulations;
f) Factors beyond the facility's control that restrict
their ability to comply with state law;
g) The demonstrated willfulness of the violation; and,
h) The extent to which the facility detected the violation
and took steps to immediately correct the violation and
prevent the violation from recurring.
5)Defines "immediate jeopardy" as a situation in which a DPH
licensee's noncompliance with one or more requirements of
licensure has caused, or is likely to cause, serious injury or
death to the patient.
6)Permits DPH, on the effective date of the regulations required
above, to assess an administrative penalty against a general
acute care hospital, acute psychiatric hospital, and special
hospital, for a deficiency constituting an immediate jeopardy
violation, as defined, up to a maximum of $75,000 for the
first administrative penalty, up to $100,000 for the second
administrative penalty, and up to $125,000 for the third and
every subsequent administrative penalty.
7)Permits DPH, on the effective date of the regulations, to
assess an administrative penalty of up to $25,000 per
violation for those not deemed to constitute immediate
jeopardy.
8)Prohibits DPH from assessing an administrative penalty for
minor violations.
9)Permits DPH, prior to the effective date of the regulations
required above, to assess immediate jeopardy administrative
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penalties of up $50,000 for the first administrative penalty,
up to $75,000 for the second administrative penalty, and up to
$100,000 for the third and every subsequent administrative
penalty.
10)Requires DPH to have full discretion to consider all factors
when determining the amount of an administrative penalty.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Increased staff costs for DPH's Licensing and Certification
division to check compliance with staffing standards would
likely cost $50,000 to $100,000 annually. Costs could be
higher if more complicated methods are necessary to check
compliance with staffing standards. These costs would be
fully offset by increased licensure fees, which are updated
annually to reflect actual workload.
2)Unknown, potentially significant fee-supported special fund
costs associated with appeals for non-immediate jeopardy
penalties. If 100 non-immediate jeopardy deficiencies
resulted in fines that resulted in appeals, increased costs to
the Licensing and Certification Fund of $1.8 million annually.
3)Potential increased penalty revenue in the millions, or
potentially tens of millions of dollars. Penalty revenue may
be increased for two reasons: a) immediate jeopardy
violations will have higher maximum penalty levels under this
bill as compared to the status quo; and, b) DPH may begin
assessing penalties for other (non-immediate jeopardy)
violations under the bill sooner than they would otherwise.
COMMENTS : According to the author, under existing law, there is
no specific mechanism to ensure that hospitals are complying
with nurse staffing ratios or patient classification systems,
nor do hospitals face any penalties for failure to comply with
these laws and regulations. The author maintains that this bill
will strengthen the existing nurse-to-patient staffing ratio
requirements in California hospitals by requiring DPH to check
for compliance during regular periodic inspections, and by
putting into effect existing statutory penalty authority for DPH
by removing the requirement that DPH issue regulations.
Additionally, the author asserts that this bill codifies
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existing regulations relating to patient classification systems,
which has been a requirement for hospitals for more than 15
years.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0005054