Amended in Assembly April 10, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 2144

Introduced by Assembly Member Yamada

February 20, 2014

An act to add Section 1276.45 to the Health and Safety Code, relating to health facilities.

LEGISLATIVE COUNSEL’S DIGEST

AB 2144, as amended, Yamada. Staff-to-patient ratios.

Existing law provides for the licensure and regulation of health facilities begin delete , including acute psychiatric hospitals, end delete by the State Department of Public Health. A violation of those provisions is a crime. begin insert Existing law establishes the State Department of State Hospitals and sets forth its powers and duties relating to the administration of state hospitals. end insert

This bill would require the begin delete department end delete begin insert State Department of Public Health end insert 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 begin delete acute psychiatric hospitals, end delete begin insert health facilities that are operated by the State Department of State Hospitals, end insert as prescribed. begin delete By expanding the scope of a crime, the bill would impose a state-mandated local program. end delete

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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.

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This bill would provide that no reimbursement is required by this act for a specified reason.

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Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program:  begin delete yes end delete begin insert no end insert .

The people of the State of California do enact as follows:

SECTION 1.  

Section 1276.45 is added to the Health and Safety
Code, immediately following Section 1276.4, to read:

1276.45.  

(a) By January 1, 2016, the State Department of
Public Health shall adopt regulations that establish minimum,
specific, and numerical licensed nursing staff-to-patient ratios by
licensed nursing classification and minimum, specific, and
numerical ancillary staff-to-patient ratios for all health facilities
licensed pursuant to begin delete subdivision (b) of Section 1250. end delete begin insert Section 1250
that are operated by the State Department of State Hospitals. end insert

(1) Administrative, supervisory, and non-unit-based staff shall
not be included when calculating staff-to-patient ratios. Ratios
shall be calculated on a unit-by-unit basis. Averaged figures across
units shall not be used in determining staff-to-patient ratios.

(2) Under no circumstances shall the minimum, specific, and
numerical licensed nursing staff-to-patient ratios by licensed
nursing staff classification or ancillary staff-to-patient ratios be
below the following standards for safe staffing and effective
psychiatric care purposes:

(A) For long-term units, the ratio for each of the four ancillary
staff classifications described in paragraph (1) of subdivision (g)
shall be not less than one ancillary staff person for each 25
residents. Nursing staff-to-patient ratios for these units shall be
not less than one licensed nurse or psychiatric technician for each
six residents during day and evening shifts, and not less than one
licensed nurse or psychiatric technician for each 12 residents during
overnight shifts.

(B) For admissions units, the ratio for each of the four ancillary
staff classifications described in paragraph (1) of subdivision (g)
shall be not less than one ancillary staff person for each 15
residents. Nursing staff ratios for these units shall be not less than
one licensed nurse or psychiatric technician for each six residents
during day and evening shifts and not less than one licensed nurse
or psychiatric technician for each 12 residents during overnight
shifts.

(C) For units that have severely aggressive or severely
self-injurious patients, including, but not limited to, enhanced
treatment units and units that practice dialectical behavioral
therapy, the ratio for each of the four ancillary staff classifications
described in paragraph (1) of subdivision (g) shall not be less than
begin delete 1 end delete begin insert one end insert ancillary staff person for each 12 residents. Nursing staff
ratios for these units shall be not less than one licensed nurse or
psychiatric technician for each six residents during day and evening
shifts and not less than one licensed nurse or psychiatric technician
for each 12 residents during overnight shifts.

(b) The department shall review these regulations five years
after adoption and shall report to the Legislature regarding any
proposed changes.

(c) These ratios shall constitute the minimum number of staff
that shall be allocated. Additional staff shall be assigned in
accordance with a documented patient classification system for
determining nursing care requirements, including the severity of
the illness, the need for specialized equipment and technology, the
complexity of clinical judgment needed to design, implement, and
evaluate the patient care plan and the ability for self-care, and the
licensure of the personnel required for care.

(d) The department may grant a waiver to this section if the
waiver does not jeopardize the health, safety, and well-being of
patients and staff affected and is needed for increased operational
efficiency.

(e) In case of begin insert a end insert conflict between this section and any provision
or regulation implementing that provision defining the scope of
practice for nursing staff or ancillary staff, the scope of practice
provisions shall control.

(f) The regulations adopted by the department pursuant to this
section shall augment and not replace existing nurse-to-patient
ratios that exist in law and regulation.

(g) For purposes of this section, the following definitions shall
apply:

(1) “Ancillary staff” means rehabilitation therapists, licensed
social workers, psychologists, and psychiatrists.

(2) “Nursing staff” means registered nurses and licensed
psychiatric technicians.

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SEC. 2.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

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