BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1318|
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THIRD READING
Bill No: SB 1318
Author: Wolk (D)
Amended: 5/25/12
Vote: 21
SENATE HEALTH COMMITTEE : 6-0, 4/18/12
AYES: Harman, Alquist, Anderson, Blakeslee, Rubio, Wolk
NO VOTE RECORDED: Hernandez, De Le�n, DeSaulnier
SENATE LABOR & INDUSTRIAL RELATIONS COMM. : 4-1, 4/25/12
AYES: Lieu, Wyland, DeSaulnier, Yee
NOES: Leno
NO VOTE RECORDED: Padilla, Runner
SENATE APPROPRIATIONS COMMITTEE : 5-0, 5/7/12
AYES: Kehoe, Walters, Alquist, Dutton, Steinberg
NO VOTE RECORDED: Lieu, Price
SUBJECT : Health facilities: influenza vaccinations
SOURCE : California Association for Nurse Practitioners
California Medical Association
Health Officers Association of California
DIGEST : This bill requires licensed clinics and health
facilities to institute measures, including aerosol
transmissible diseases training, designed to maximize
influenza vaccination rates and to prevent onsite health
care workers affiliated with the clinic or health facility
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and persons with privileges on the medical staff from
contracting, and transmitting to patients, the influenza
virus. This bill requires, commencing January 1, 2015,
each clinic and health facility to annually offer onsite
influenza vaccinations to its employees and to require
onsite health care workers affiliated with the clinic or
health faculty, as defined and person with privileges on
the medical staff as defined, to be vaccinated. This bill
requires licensed clinics and health facilities to maintain
vaccination records of their employees and permit licensed
clinics and health facilities to require documentation of
vaccination or vaccination refusal from an onsite health
care worker or person with privileges on the medical staff.
Lastly, this bill requires require, on and after January
1, 2015, each clinic and health facility to develop
policies to implement these provisions and to ensure
nonmedical staff, as defined, compliance with vaccination
requirements. This on and after that date, the medical
staff to develop separate policies to ensure bill would
require, compliance with vaccination requirements imposed
by the clinic or health facility. This bill requires
clinics and health facilities to report their percentage of
employees and medical staff and of medical staff who have
been vaccinated for that year to the DPH. This bill
provides that a clinic or health facility that reports a
combined average of 90% or higher vaccination rate for its
employees and medical staff shall not be subject to
specified implementation and compliance requirements.
Senate Floor Amendments of 5/25/12, while making
substantive amendments, clarify what was in the previous
version and the author's intent.
ANALYSIS :
Existing law:
1. Provides for the licensure and regulation of health
facilities, including acute care hospitals, by the
Department of Public Health (DPH).
2. Requires DPH to require that each general acute care
hospital, in accordance with the Centers for Disease
Control and Prevention (CDC) guidelines, take all of the
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following actions.
A. Annually offer onsite influenza vaccinations, if
available, to all hospital employees at no cost to
the employee.
B. Requires hospitals to require its employees to be
vaccinated, or if the employee elects not to be
vaccinated, to declare in writing that he or she has
declined the vaccination.
C. Institute respiratory hygiene and cough etiquette
protocols, develop and implement procedures for the
isolation of patients with influenza, and adopt a
seasonal influenza plan.
D. Revise an existing or develop a new disaster plan
that includes a pandemic influenza component. The
plan is required to document any actual or
recommended collaboration with local, regional, and
state public health agencies or officials in the
event of an influenza pandemic.
Background
According to the CDC, the flu is a contagious respiratory
illness caused by viruses that infect the nose, throat, and
lungs. It can cause mild to severe illness, and at times
can lead to death. Most experts believe that flu viruses
spread mainly by droplets made when people with flu cough,
sneeze or talk, which can land in the mouths or noses of
people who are nearby. Less often, a person might also get
flu by touching a surface or object that has flu virus on
it and then touching their own mouth, eyes or possibly
their nose. The flu can be passed to someone else before
symptoms appear, as well as while a person is symptomatic.
Most healthy adults may be able to infect others beginning
one day before symptoms develop and up to five to seven
days after becoming sick. Some people, especially young
children and people with weakened immune systems, might be
able to infect others for an even longer time. There are a
number of groups of people considered at high risk to
develop flu-related complications, including: children
younger than 5, but especially children younger than 2
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years old; adults over 65 years of age; pregnant women; and
people with certain medical conditions (including asthma,
neurological and neurodevelopmental conditions, chronic
lung disease, heart disease, blood disorders, diabetes,
kidney disorders, liver disorders, and weakened immune
systems).
Flu vaccine . According to the CDC, the single best way to
prevent the flu is to get a flu vaccine each season. There
are two types of flu vaccines: flu shots, which are
inactivated vaccines that are given with a needle and the
nasal-spray flu vaccine (a vaccine made with live, weakened
flu viruses that is given as a nasal spray. About two
weeks after vaccination, antibodies develop that protect
against influenza virus infection. Driven by the H1N1
pandemic, in February 2010, the Advisory Committee on
Immunization Practices (ACIP) voted to recommend that all
people six months and older should obtain a flu vaccine
(universal recommendation for vaccination). ACIP and the
Healthcare Infection Control Practices Advisory Committee
also recommend that all health care workers get vaccinated
annually against influenza. According to the CDC, health
care workers include, but are not limited to, physicians,
nurses, nursing assistants, therapists, technicians,
emergency medical service personnel, dental personnel,
pharmacists, laboratory personnel, autopsy personnel,
students and trainees, contractual staff not employed by
the health care facility, and persons (e.g., clerical,
dietary, housekeeping, laundry, security, maintenance,
administrative, billing, and volunteers) not directly
involved in patient care but potentially exposed to
infectious agents that can be transmitted to and from
health care workers and patients. According to DPH, the
mean hospital-specific employee vaccination percentage in
California was 55 percent in 2008-09 and has grown since:
63 percent in 2009-10 and 64.3 percent in 2010-11. The
U.S. Department of Health and Human Services' goal is a 90
percent vaccination rate by 2020.
Previous statewide efforts . Upon passage of SB 739
(Speier), Chapter 526, Statutes of 2006, DPH's Healthcare
Associated Infections Program was tasked with increasing
patient protection from influenza in hospitals through
vaccination of healthcare personnel. The Department of
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Industrial Relation's Division of Occupational Safety and
Health also promulgated (aerosol transmissible diseases)
ATD regulations (effective August 5, 2009), establishing
procedures for ATD in health care facilities. Among other
things, the ATD regulations require health facilities to
establish, implement, and maintain an effective, written
ATD Exposure Control Plan which is specific to the
workplace or operations. While the ATD regulations are
meant to address more than just the transmission of the
flu, there are some provisions that could be related to the
provisions of this bill. For example, with regard to
"medical services," which the regulation states includes
vaccinations, tests, examinations, evaluations,
determinations, procedures, and medical management and
follow-up, the law requires them to be, among other things,
provided in a manner that ensures the confidentiality of
employees and patients.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
As of the previous version, according to the Senate
Appropriations Committee, "Potential increased costs to
review compliance by clinics, up to $150,000 (Licensing and
Certification Fund). The Department may need additional
resources to review hospital and clinic records of
vaccinations by employees and others. Because the
Department already performs periodic inspections of health
facilities as part of its licensing program, total
additional costs to gather this information are not likely
to be significant."
SUPPORT : (Verified 5/30/12)
California Association for Nurse Practitioners (co-source)
California Medical Association (co-source)
Health Officers Association of California (co-source)
American Academy of Pediatrics
American Congress of Obstetricians and Gynecologists,
District IX CA
California Hospital Association
California Pharmacists Association
California Psychiatric Association
California Society of Health-System Pharmacists
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Californians for Patient Care
Santa Clara County Board of Supervisors
California Primary Care Association
American Academy of Physicians Assistants
OPPOSITION : (Verified 5/30/12)
American Federation of State, County and Municipal
Employees, AFL-CIO
California Labor Federation
California Nurses Association
Laborers' Locals 777 and 792
Service Employees International Union
United Nurses Associations of California/Union of Health
Care Professionals
ARGUMENTS IN SUPPORT : The California Medical Association
(CMA), co-sponsor of this bill, argues that masking
policies have proven to be the most effective policy to
increase vaccination compliance rates and protect its
patients. CMA states that California hospitals with the
highest vaccine compliance rate are those that have such
policies in place. CMA asserts that the sole purpose of
this bill is to protect patients from contracting the flu
virus in health care settings and do it in the most proven
effective and efficient way possible. The Health Officers
Association of California (HOAC), co-sponsor of this bill,
states that this bill will increase influenza vaccination
rates at hospitals in California, resulting in a healthier
workforce and a healthier population. According to The
American Congress of Obstetricians and Gynecologists,
District IX (California), SB 739 required California's
acute care hospitals to offer the vaccine free of charge,
but unfortunately the success of that legislation has
fallen short of achieving desired compliance rates, and we
need to look at other options to protect our most
vulnerable populations. The California Association for
Nurse Practitioners (CANP), co-sponsor of this bill, writes
that several counties and numerous hospitals have gone
beyond state law and have established mandatory vaccination
policies. CANP states that according to their members,
receiving an annual flu vaccine has become a standard
practice for health care providers, and this bill will
ensure that this practice becomes even more firmly
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entrenched as a practice.
ARGUMENTS IN OPPOSITION : The California Nurses
Association (CNA) writes that this bill provides for the
medical staff at health facilities and clinics to develop
an independent influenza policy, and that having two
separate influenza policies for employees who work in the
same clinics and health facilities is confusing for those
attempting to implement the new policy, and in particular
for the employees who are navigating through two separate
policies. CNA also asserts that transmission of the
influenza virus does not delineate between classifications
of health care workers and that having two policies
jeopardizes patients, workers and the public who enter the
health facilities and clinics. CNA states that there is no
sound public policy that supports two standards, and they
strongly object, stating it is divisive and could lead to
future discrimination issues in the workplace. CNA further
states that requiring health care workers who decline
vaccination to wear a mask will not properly stem the
transmission of influenza. CNA points to a 2008 CDC study
that concludes that although personal protection equipment
is usually worn only a short time, viruses such as
influenza can survive for hours on surfaces, and viral
infection can be spread by surface-to-hand and hand-to-hand
contact by adjusting or removing the mask, and that masking
creates a false sense of protection for employees and
patients. Laborers' Locals 777 and 792 writes that current
data do not dictate that everyone who works in a health
facility should get a flu shot, there are reasons an
employee may be disinclined to get a flu shot, and they
should not be forced to wear the "Scarlett Letter" of a
mask just because they've chosen not to get a flu shot.
NOTE: The author's office is having further discussions
with the opposition relative to their concerns.
CTW:do 5/30/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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