BILL ANALYSIS �
SB 1318
Page 1
Date of Hearing: August 16, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 1318 (Wolk) - As Amended: August 8, 2012
Policy Committee: HealthVote:15-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill, beginning January 1, 2015, requires licensed clinics
and other health facilities that do not achieve a 90% influenza
(flu) vaccination rate among onsite health care workers who are
employees and medical staff (health care personnel) to adopt a
model mandatory vaccination policy as determined by the
Department of Public Health (DPH). Specifically, this bill:
1)Requires licensed clinics and other health facilities to:
a) Institute measures designed to maximize flu immunization
rates, including but not limited to aerosol transmissible
disease training.
b) Offer all employees free onsite influenza vaccinations,
if available.
c) Require health care personnel to either receive a flu
vaccination or adhere to the most effective measures to
prevent flu transmission, as determined by the facility.
d) Keep records of vaccination compliance among health care
personnel, and make records available upon request of any
government agency, organization, or individual.
e) Beginning January 1, 2015, either achieve a 90% flu
vaccination rate among health care personnel, or adopt a
model mandatory vaccination policy, as determined by the
State Health Officer, the local health officer, or both,
during the following flu season.
2)Authorizes clinics and health facilities to request and
maintain vaccination records of contract employees, and
require contract employees to verify compliance with flu
immunization.
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3)Requires facilities and medical staff to develop policies to
ensure compliance with this bill among employees and medical
staff, respectively.
4)Requires DPH to develop the model mandatory vaccination policy
through a stakeholder process no later than July 1, 2015.
Exempts this policy development from the Administrative
Procedures Act and allows the policy to be communicated via
all-facility letters.
5)States that it does not require DPH to perform additional
duties that are separate from its existing licensing survey or
other statutory requirements.
6)Allows facilities and local jurisdictions to institute
additional measures to prevent flu transmission.
7)Exempts correctional treatment centers, as well as dialysis
clinics that meet certain infection control protocols required
for reimbursement through the Medicare program, as specified.
8)Repeals provisions of law that require hospitals to offer free
onsite flu vaccines, institute influenza plans and protocols,
and revises disaster plans to include a pandemic influenza
component.
FISCAL EFFECT
1)One-time fee-supported special fund costs of $50,000 to
$100,000 (Licensing and Certification Program Fund) to DPH to
conduct a stakeholder process.
2)DPH will incur costs of $350,000 annually to verify compliance
with new requirements in approximately 4,500 health
facilities. DPH enforcement processes include inspection for
deficient practices during periodic licensing surveys, and
during complaint investigations.
In future years, as facilities and DPH inspectors gain greater
experience and vaccination rates increase, particularly if
most facilities achieve 90% compliance rates, enforcement
costs may be reduced.
3)Unknown, indirect cost savings may be experienced by health
care facilities and health care payers, including CalPERS and
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state programs such as Medi-Cal, if improved vaccination rates
at health facilities reduce transmission of health
care-acquired flu. Literature suggests high vaccination rates
will have this effect.
COMMENTS
1)Rationale . The California Medical Association, the Health
Officers Association of California, and the California
Association for Nurse Practitioners are the sponsors of this
bill. According to the author, this bill ensures that all
health care workers in health facilities, including
physicians, either receive the flu vaccination or comply with
an effective means to prevent the spread of the flu virus.
The author cites a 64% vaccination rate among health care
workers in California hospitals as evidence that comprehensive
voluntary programs are inadequate to improve vaccination
rates. She indicates mandatory vaccination policies are
proven to prevent flu transmission, and that this bill will
protect vulnerable patients by reducing spread of the flu.
2)Background. According to the Centers for Disease Control and
Prevention (CDC), high vaccination rates among health care
workers reduce flu transmission, staff illness, and
absenteeism, and flu-related illness and death, especially
among people in health care facilities who are at increased
risk for severe flu illnesses. Additionally, reports have
shown that higher vaccination levels among staff have been
associated with a lower risk of hospital-acquired flu cases.
Lower flu vaccination rates have led to greater number of flu
outbreaks in hospitals and long term care facilities. Major
professional societies have all endorsed and published
recommendations requiring health care workers with direct
patient care to be immunized. Even so, mandatory vaccination
remains a controversial strategy that pits health care worker
autonomy against patient safety.
DPH reports that among hospitals that reported vaccination
rates for the 2009-10 flu season, vaccination rates were 62%
on average, despite requirements to offer free vaccines and
for signed declinations for those who refuse vaccines. The
CDC's Healthy People 2020 initiative includes a target
vaccination rate among health care workers of 90%. The CDC
indicates vaccination rates are 98.1% among health care
workers who had an employer requirement for vaccination,
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suggesting that this bill will lead to dramatic increases in
vaccination rates among health care workers.
3)Previous Legislation . SB 739 (Speier), Chapter 526, Statutes
of 2006 required hospitals to, among other things, offer
onsite flu vaccinations, if available, to all hospital
employees at no cost to the employee. It also required
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.
4)Opposition . The California Hospital Association supported a
previous version of this bill that included a masking
requirement for workers who declined a flu vaccination, but
oppose the current language requiring hospitals that fail to
achieve a 90% vaccination rate to adopt a policy, as
determined by DPH. They cite uncertainty with respect to the
policy that will be developed by DPH, and whether that policy
will be effective at increasing vaccination rates as intended.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081