BILL ANALYSIS �
AB 2144
Page 1
Date of Hearing: April 30, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 2144 (Yamada) - As Amended: April 10, 2014
Policy Committee: HealthVote:13-6
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires the Department of Public Health (DPH) to
adopt regulations that establish minimum, specific, and
numerical staff-to-patient ratios for licensed nursing and
ancillary staff in facilities operated by the Department of
State Hospitals (DSH). It defines "ancillary staff" as
rehabilitation therapists, licensed social workers,
psychologists, and psychiatrists, and "nursing staff" as
registered nurses and licensed psychiatric technicians.
It allows DPH to 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.
FISCAL EFFECT
1)GF costs of at least $120 million annually for additional
nursing and ancillary staff to comply with minimum ratios. To
the extent regulations issued pursuant to this bill specified
higher ratios than the minimum ratios included in the bill,
costs would be higher.
2)The bill's specification of personnel required to meet the
ratios precludes using pre-licensed personnel, such as
trainees, and licensed vocational nurses instead of RNs, to
meet minimum ratios. Currently, nearly 500 such personnel are
employed system-wide. The salary differential between these
personnel and personnel classifications specified by this bill
would impose an additional $10 million in GF costs.
3)Unknown, significant additional one-time administrative costs
AB 2144
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for recruitment and training of nearly 1,000 additional
personnel, and the replacement of an additional 500 current
pre-licensed or lower-level classifications with personnel
meeting the bill's requirements.
COMMENTS
1)Purpose . The author and sponsor of this bill contend, given
the forensic nature of the state hospital population, safe
nursing and safe staffing ratios are overdue. The author
further argues minimum staff levels must be increased to
appropriately manage the needs of the modern state hospital
population and adequately provide for treatment of patients
and safe working condition of DSH employees.
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)Federal Oversight Recently Lifted . On May 2, 2006, the United
States Department of Justice (USDOJ) and the state reached a
settlement concerning civil rights violations at four DSH
hospitals. The settlement required the four hospitals to
implement an Enhancement Plan (EP) to improve conditions. The
extensive reforms required by the EP were intended to ensure
individuals in the hospitals were 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.
As part of this EP, minimum staff ratios similar to those
included in this bill were imposed. DSH indicates, for
example, a 1:25 ratio for ancillary staff was used under the
EP to improve treatment and bring California into compliance.
However, DMH indicates this ratio was put in place to
stabilize patients, improve conditions, and handle increased
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documentation requirements on a temporary basis. Within the
last year, all of the hospitals have been released from the EP
and are no longer under federal supervision. The department
now operates higher staff ratios than those imposed under the
EP, without federal objection.
4)Staff Comment . There do not appear to be widely accepted
numbers on what constitutes acceptable minimum staffing ratios
for DSH facilities. Whether the minimum staffing level in this
bill would in fact improve safety, given current fiscal
constraints, is not clear. For example, some of the safety
concerns are a product of DSH facilities that were built in an
era where most commitments were civil in nature; currently,
over 96% of patients are referred to DSH from the criminal
justice system. Implementing this ratio commits the state to
certain levels of expenditure for clinical staffing and would
limit the state's options with respect to the ability to fund
other measures that could improve safety, such as facility
redesign or replacement, hiring additional security staff, or
implementing technological solutions.
5)Prior Legislation.
a) AB 2397 (Allen) in 2012 required an independent review
of appropriate staffing levels at DSH facilities, and was
held on the Suspense File of the Senate Appropriations
Committee. The introduced version of AB 2397 required
minimum 1:25 staff-to-patient ratios ancillary staff.
b) AB 394 (Kuehl), Chapter 945, Statutes of 1999
established nurse-to-patient ratios for acute hospital
settings and regulations implementing the bill went into
effect on January 1, 2004. State hospitals were
specifically exempted from the legislation.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081