BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1318|
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UNFINISHED BUSINESS
Bill No: SB 1318
Author: Wolk (D), et al.
Amended: 8/24/12
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
SENATE FLOOR : 23-9, 5/30/12
AYES: Alquist, Anderson, Berryhill, Blakeslee, Calderon,
Cannella, Correa, Dutton, Emmerson, Evans, Fuller,
Gaines, Hancock, Harman, Huff, Kehoe, La Malfa, Liu,
Simitian, Steinberg, Walters, Wolk, Wyland
NOES: Corbett, DeSaulnier, Leno, Lieu, Lowenthal, Pavley,
Vargas, Wright, Yee
NO VOTE RECORDED: De Le�n, Hernandez, Negrete McLeod,
Padilla, Price, Rubio, Runner, Strickland
ASSEMBLY FLOOR : Not available
SUBJECT : Health facilities: influenza vaccinations
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SOURCE : California Association for Nurse Practitioners
California Medical Association
Health Officers Association of California
DIGEST : This bill requires clinics and licensed health
care facilities (health facilities) to institute measures
designed to maximize influenza vaccination rates and to
prevent persons with privileges on the medical staff and
onsite health care workers affiliated with the clinics or
health care facilities from contracting, and transmitting
to patients, the influenza virus.
Assembly Amendments (1) delete a masking requirement, (2)
clarify the definition of clinics, (3) delete a requirement
that clinics make reports on employees and staff, (4)
require the Department of Public Health (DPH), by July 1,
2015, to develop specified vaccination policies, and (5)
make clarifying changes.
ANALYSIS :
Existing law:
1. Provides for the licensure and regulation of health
facilities, including acute care hospitals, by 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
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
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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.
This bill:
1. Requires clinics and health facilities to institute
measures designed to maximize influenza vaccination
rates and to prevent persons with privileges on the
medical staff and onsite health care workers affiliated
with the clinic and health care facilities from
contracting and transmitting to patients the influenza
virus. States that these measures shall include, but
not be limited to, aerosol transmissible diseases
training, as specified.
2. Requires clinics and health facilities to annually offer
employees onsite influenza vaccinations, if available,
at no cost to the employee.
3. Requires clinics and health facilities to require all
onsite health care workers affiliated with the clinic
and health care facility and persons with privileges on
the medical staff to either annually receive an
influenza vaccination or, as an alternative to the
annual influenza vaccination if an onsite health care
worker affiliated with the clinic and health facility or
person with privileges on the medical staff elects not
to be vaccinated, he/she shall agree, in writing, to
adhere to the most effective measures determined by the
clinic and health facility in preventing health care
workers from contracting and transmitting the influenza
virus.
4. Requires clinics and health facilities to annually
record their average vaccination rates, as specified,
and make those records available online or upon request
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of a government agency, organization, or individual.
Requires the records to be maintained and made available
during any inspection by DPH.
5. Requires a clinic and health facility, commencing on
January 1, 2015, to have a 90% or higher vaccination
rate. Provides that for each year that a clinic and
health facility does not achieve the 90% or higher
vaccination rate, the clinic and health facility shall
adopt for the following influenza season, as defined by
the State Public Health Officer the model mandatory
vaccination policy, as specified in #6 below, to achieve
the 90% or higher goal. Authorizes DPH or an
accrediting agency to waive the 90% vaccination rate
requirement for a clinic and health care facility that
is in substantial compliance.
6. Requires DPH, in consultation with the California
Conference of Local Health Officers, to develop a model
mandatory vaccination policy which has been determined
to achieve the 90% or higher goal through a stakeholder
process to be issued through an all facilities letter no
later than July 1, 2015.
7. Authorizes DPH or an accrediting agency to waive the 90%
vaccination rate requirement for a clinic during any
particular year if the clinic is able to show that it is
reasonably unable to access the appropriate influenza
vaccines necessary to achieve the 90% goal for that
year.
8. Provides that in meeting the requirements of #3, #4 and
#5 above, clinics and health facilities:
A. Must maintain flu vaccination records of employees
and may maintain flu vaccination records of the other
onsite health care workers who are affiliated with,
but are not employees of, the clinic and of persons
with privileges on the medical staff. If the clinic
and health facility do not have records of an onsite
health care worker or person with privileges on the
medical staff being vaccinated onsite, they may
require the worker or medical staff person to either
provide documentation of vaccination or documentation
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that he/she refused the vaccination; and
B. Allow language to be included in its business
contracts to require a contract worker to maintain
records of the verification of offsite vaccination or
documentation that he or she refused the vaccination
and require this documentation be made available to
the clinic and health care facility upon request.
The clinic and health facility are not required to
maintain separate vaccination records or to provide
vaccinations at no cost to a contract worker who is
not an employee of the clinic and health facility.
9. Requires each clinic and health facility to develop
policies to implement this bill and to ensure its onsite
health care workers are in compliance with the
vaccination requirements. Requires the medical staff to
develop policies to ensure that persons who have
privileges on the medical staff are in compliance with
the vaccination requirements of this bill that have been
implemented by the clinic and health facility.
10.Provides that #8 and #9 above shall not apply to a
dialysis clinic which maintains an influenza vaccination
log for its patients, health care workers, and medical
staff pursuant to an infection control program in
compliance with the Medicare "Conditions for Coverage
for End-Stage Renal Disease Facilities," conditions that
are promulgated by the Centers for Medicare and Medicaid
Services, if the immunization log is available for
review during routine department inspections or during
an inspection in response to a complaint.
11.Defines the following terms: employee, medical staff,
onsite health care worker affiliated with the clinic,
health care facility, and vaccination rate.
12.Allows DPH to implement this bill by sending letters or
similar instruction to all applicable facilities without
taking regulatory action.
13.Provides that this bill does not prevent a clinic or
local jurisdiction from instituting additional measures
or policies to maximize influenza vaccination rates and
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to prevent health care workers affiliated with the
clinic from contracting and transmitting the influenza
virus.
14.Provides that this bill does not require DPH to perform
any additional surveillance for the purpose of ensuring
compliance with this bill that is above and beyond its
routine licensing survey schedule or other statutory
requirements.
15.Indicates that implementation of this bill is exempt
from the rulemaking provisions of the Administrative
Procedure Act.
16.Defines clinic to include a clinic licensed by DPH, a
clinic that is conducted, operated, or maintained as an
outpatient setting department of a hospital, and an
outpatient setting that is accredited by an accrediting
agency approved by the Medical Board of California
(MBC).
17.Provides that accrediting agencies approved by the MBC
to be solely responsible for ensuring that outpatient
settings, are in compliance with specified provisions of
this bill.
18.Requires, in addition to the other requirements of this
bill, general acute care hospitals to also do the
following:
A. Institute respiratory hygiene and cough etiquette
protocols, develop and implement procedures for the
isolation of patients with influenza, and adopt a
seasonal influenza plan; and
B. Revise an existing or develop a new disaster plan
that includes a pandemic influenza component.
Requires the plan to also document any actual or
recommended collaboration with local, regional, and
state public health agencies or officials in the
event of an influenza pandemic.
19.Deletes existing law that requires DPH to require each
general acute care hospital to offer onsite flu
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vaccinations, if available to all hospital employees at
no cost to the employee, as specified.
20.Exempts a correctional treatment center, as specified,
from the provisions of this bill.
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
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
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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
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.
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FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Assembly Appropriations Committee:
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
the California Public Employees' Retirement System and
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.
SUPPORT : (Verified 8/28/12)
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 Academy of Physicians Assistants
California Hospital Association
California Pharmacists Association
California Primary Care Association
California Psychiatric Association
California Society of Health-System Pharmacists
Californians for Patient Care
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Santa Clara County Board of Supervisors
OPPOSITION : (Verified 8/28/12)
California Hospital Association
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
entrenched as a practice.
ARGUMENTS IN OPPOSITION : The California Hospital
Association (CHA) writes, "CHA is now opposing SB 1318
because the bill no longer requires a mandatory masking
policy and, as recently amended, does not go far enough to
assist hospitals in increasing their vaccination rates.
The goal of all hospitals is to achieve a 90 percent
vaccination rate every year as quickly as possible in order
to reduce healthcare-acquired influenza."
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CTW:m 8/28/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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