BILL ANALYSIS �
AB 2144
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Date of Hearing: April 22, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 2144 (Yamada) - As Amended: April 10, 2014
SUBJECT : Staff-to-patient ratios.
SUMMARY : Requires the Department of Public Health (DPH) to
adopt regulations by January 1, 2016, that establish minimum,
specific, and numerical licensed nursing and ancillary
staff-to-patient ratios for all hospitals operated by the State
Department of State Hospitals (DSH). Specifically, this bill :
1)Prohibits administrative, supervisory, and non-unit-based
staff from being included when calculating staff-to-patient
ratios.
2)Prohibits, under any circumstances, the minimum
staff-to-patient ratios by licensed nursing staff
classification or ancillary staff-to-patient ratios to be
below the following standards:
a) For ancillary staff classifications in long term units,
25:1;
b) For nursing staff classifications in long term units,
6:1 during day and evening shifts and 12:1 during overnight
shifts;
c) For ancillary staff classifications in admissions units
15:1;
d) For nursing staff classifications in admissions units,
6:1 during day and evening shifts and 12:1 during overnight
shifts; and,
e) For units with severely aggressive or severely
self-injurious patients, including, but not limited to
enhanced treatment units and units that practice
dialectical behavioral therapy, ancillary staff
classifications shall not be less than 12:1, and nursing
staff classifications shall not be less than 6:1during day
and evening shifts and 12:1 during overnight shifts.
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3)Specifies that these ratios constitute the minimum number of
staff to be allocated, and that additional staff be assigned
in accordance with a documented patient classification system.
4)Requires DPH to review the regulations five years after
adoption and to report to the Legislature regarding any
proposed changes.
5)Allows DPH to grant a waiver to these requirements if the
waiver does not jeopardize the health, safety, and well-being
of patients and staff affected and is needed for increased
operational efficiency.
6)Provides that in case of conflicts between this bill and any
provision or regulation defining the scope of practice for
nursing or ancillary staff, the scope of practice provisions
will control.
7)Specifies that the regulations adopted pursuant to these
provisions augment and not replace existing nurse-to-patient
ratios.
8)Defines the following terms:
a) Ancillary staff are rehabilitation therapists, licensed
social workers, psychologists, and psychiatrists,
b) Nursing staff are registered nurses and licensed
psychiatric technicians.
EXISTING LAW :
1)Establishes the DSH to manage the California state hospital
system, which provides mental health services to patients
admitted into DSH facilities.
2)Requires DPH to adopt regulations that establish minimum,
specific, and numerical licensed nurse-to-patient ratios, by
licensed nurse classification and by hospital unit, for
general acute care hospitals, and requires these ratios to
constitute the minimum number of registered and licensed
nurses that must be allocated.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
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COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, due to the
changing nature of the state hospital population, which
reflects many of the characteristics of the correctional
system population, safe nursing and safe staffing ratios are
overdue. The author further states that to ensure the welfare
of resident patients and workers, and to ensure the best use
of public resources to support effective therapy in state
hospitals, minimum levels of ancillary staff must be increased
to appropriately manage the needs of the modern state hospital
population. According to the author, this bill does this by
establishing an updated safe-staffing standard, thus assuring
a therapeutic environment for the patient, as well as safety
for the workers who treat them.
2)BACKGROUND . DSH manages the California state hospital system,
which provides mental health services to patients admitted
into DSH facilities. DSH oversees five state hospitals,
Atascadero, Coalinga, Metropolitan (in Los Angeles County),
Napa, and Patton. Through an interagency agreement with the
California Department of Corrections and Rehabilitation, they
also treat inmates at prisons in Vacaville, Salinas Valley,
and Stockton. DSH was created by Governor Jerry Brown's
2012-13 Budget, which eliminated the Department of Mental
Health by transferring its various functions to other
departments.
3)STAFFING RATIOS . Nurse-to-patient ratios were established in
acute hospital settings with the adoption of AB 394 (Kuehl),
Chapter 945, Statutes of 1999, and regulations implementing
the bill went into effect on January 1, 2004. State hospitals
were specifically exempted from the legislation.
4)ENHANCEMENT PLAN/CONSENT DECREE . In May 2006, an
investigation found that four out of five California state
hospitals failed to provide a safe environment for patients,
failed to provide complete psychiatric assessments, and in
some cases neglected to regularly review a patient's needs
before prescribing medication. The United States Department
of Justice filed a lawsuit against the state which resulted in
a settlement, through a consent judgment, or consent decree,
which required the four hospitals to implement an "Enhancement
Plan" (EP) to improve conditions. The extensive reforms
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required by the EP were intended to ensure that individuals in
the hospitals are adequately protected from harm and provided
adequate services to support their recovery and mental health.
A court monitor and a team of clinical experts were appointed
to review the compliance of each hospital. Within the last
year, all of the hospitals have been released from the EP and
are no longer under federal supervision.
5)LEGISLATIVE ANALYST'S REPORT . According to a March 2012
Legislative Analyst's Office report entitled "2012-13 Budget:
Oversight and Accountability at State Hospitals" (LAO Report),
over the last 10 years, changes in policies and patient
demographics forced state hospitals to adjust their staffing,
mental health care delivery model, and other aspects of state
hospital operations. The major changes include: a) a rise in
the number of sexually violent predator commitments; b) the
implementation of the Civil Rights of Institutionalized
Persons Act consent decree or EP, requiring state hospitals to
reform their practices; and, c) an increase in "forensic"
commitments (those with mental illness who are involved in the
court system).
6)SUPPORT . The American Federation of State, County and
Municipal Employees, AFL-CIO supports this bill writing, by
requiring the specific minimum staff-to-patient ratios at
state hospitals, this bill will provide that no facility is
understaffed and no patient is underserved. The California
Association of Psychiatric Technicians also supports this bill
stating that such changes to state hospitals' staffing ratios
are long overdue and that their ratios have not changed in
more than 30 years, even though their clientele has. In 1994,
state hospitals' forensic population was 20%; now, it is 92%,
but the ratios have remained the same throughout the years.
7)PREVIOUS LEGISLATION .
a) AB 2397 (Allen) of 2012 would have required state
hospitals under the jurisdiction of the Department of
Mental Health (now DSH) to have, at a minimum, an ancillary
clinical staff-to-patient ratio of 1-to-25 (1:25) for each
applicable staff classification, based on the facility's
licensed bed capacity with a specified shift relief factor.
AB 2397 was held on the Senate Appropriations Committee
suspense file.
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b) AB 394 (Kuehl), Chapter 945, Statutes of 1999, required
the Department of Health Services (now DPH) to adopt
regulations that establish licensed nurse-to-patient ratios
for all health facilities, as specified, and limited the
nursing-related duties performed by unlicensed assistive
personnel.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees,
AFL-CIO
California Association of Psychiatric Technicians
National Association of Social Workers, California Chapter
Service Employees International Union Local 1000
Union of American Physicians and Dentists/AFSCME-Local 206
Opposition
None on file.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097