AB 2144, as introduced, Yamada. Staff-to-patient ratios.
Existing law provides for the licensure and regulation of health facilities, including acute psychiatric hospitals, by the State Department of Public Health. A violation of those provisions is a crime.
This bill would require the department to adopt regulations by January 1, 2016, that establish minimum, specific, and numerical licensed nursing staff-to-patient ratios by licensing classification and minimum, specific, and numerical ancillary staff-to-patient ratios for acute psychiatric hospitals, as prescribed. By expanding the scope of a crime, the bill would impose a state-mandated local program.
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 1276.45 is added to the Health and Safety
2Code, immediately following Section 1276.4, to read:
(a) By January 1, 2016, the State Department of
4Public Health shall adopt regulations that establish minimum,
5specific, and numerical licensed nursing staff-to-patient ratios by
6licensed nursing classification and minimum, specific, and
7numerical ancillary staff-to-patient ratios for all health facilities
8licensed pursuant to subdivision (b) of Section 1250.
9(1) Administrative, supervisory, and non-unit-based staff shall
10not be included when calculating staff-to-patient ratios. Ratios
11shall be calculated on a unit-by-unit basis. Averaged figures across
12units shall not be used in determining staff-to-patient ratios.
13(2) Under no circumstances shall the minimum, specific, and
14
numerical licensed nursing staff-to-patient ratios by licensed
15nursing staff classification or ancillary staff-to-patient ratios be
16below the following standards for safe staffing and effective
17psychiatric care purposes:
18(A) For long-term units, the ratio for each of the four ancillary
19staff classifications described in paragraph (1) of subdivision (g)
20shall be not less than one ancillary staff person for each 25
21residents. Nursing staff-to-patient ratios for these units shall be
22not less than one licensed nurse or psychiatric technician for each
23six residents during day and evening shifts, and not less than one
24licensed nurse or psychiatric technician for each 12 residents during
25overnight shifts.
26(B) For admissions units, the ratio for each of the four ancillary
27staff classifications described in paragraph (1) of subdivision (g)
28shall be not less than one ancillary staff person
for each 15
29residents. Nursing staff ratios for these units shall be not less than
30one licensed nurse or psychiatric technician for each six residents
31during day and evening shifts and not less than one licensed nurse
32or psychiatric technician for each 12 residents during overnight
33shifts.
34(C) For units that have severely aggressive or severely
35self-injurious patients, including, but not limited to, enhanced
36treatment units and units that practice dialectical behavioral
37therapy, the ratio for each of the four ancillary staff classifications
38described in paragraph (1) of subdivision (g) shall not be less than
P3 11 ancillary staff person for each 12 residents. Nursing staff ratios
2for these units shall be not less than one licensed nurse or
3psychiatric technician for each six residents during day and evening
4shifts and not less than one licensed nurse or psychiatric technician
5for each 12 residents during overnight shifts.
6(b) The department shall review these regulations five years
7after adoption and shall report to the Legislature regarding any
8proposed changes.
9(c) These ratios shall constitute the minimum number of staff
10that shall be allocated. Additional staff shall be assigned in
11accordance with a documented patient classification system for
12determining nursing care requirements, including the severity of
13the illness, the need for specialized equipment and technology, the
14complexity of clinical judgment needed to design, implement, and
15evaluate the patient care plan and the ability for self-care, and the
16licensure of the personnel required for care.
17(d) The department may grant a waiver to this section if the
18waiver does not jeopardize the health, safety, and well-being of
19patients and staff affected and is needed for increased
operational
20efficiency.
21(e) In case of conflict between this section and any provision
22or regulation implementing that provision defining the scope of
23practice for nursing staff or ancillary staff, the scope of practice
24provisions shall control.
25(f) The regulations adopted by the department pursuant to this
26section shall augment and not replace existing nurse-to-patient
27ratios that exist in law and regulation.
28(g) For purposes of this section, the following definitions shall
29apply:
30(1) “Ancillary staff” means rehabilitation therapists, licensed
31social workers, psychologists, and psychiatrists.
32(2) “Nursing staff” means registered nurses and licensed
33psychiatric
technicians.
No reimbursement is required by this act pursuant to
35Section 6 of Article XIII B of the California Constitution because
36the only costs that may be incurred by a local agency or school
37district will be incurred because this act creates a new crime or
38infraction, eliminates a crime or infraction, or changes the penalty
39for a crime or infraction, within the meaning of Section 17556 of
40the Government Code, or changes the definition of a crime within
P4 1the meaning of Section 6 of Article XIII B of the California
2Constitution.
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