Amended in Assembly August 6, 2014

Amended in Assembly June 25, 2013

Amended in Assembly June 10, 2013

Amended in Senate April 16, 2013

Senate Bill No. 455

Introduced by Senator Hernandez

February 21, 2013

An act to begin insert amend Section 1279 of, and to end insert add Section 1276.45 begin delete to end delete begin insert to, end insert the Health and Safety Code, relating to health facilities.

LEGISLATIVE COUNSEL’S DIGEST

SB 455, as amended, Hernandez. General acute care hospitals: begin delete patient classification system. end delete begin insert nurse-to-patient ratios. end insert

Existing law establishes the State Department of Public Health and sets forth its powers and duties, including, but not limited to, the licensing and regulation of health facilities, as defined.

Existing law requires the department to adopt regulations governing the operation of a health facility, including, but not limited to, regulations that require prescribed health facilities to meet minimum nurse-to-patient ratios, and to assign additional staff according to a documented patient classification system for determining nursing care requirements. Violation of these provisions, or willful or repeated violation of the rules or regulations, is a crime.

This bill would, with respect to this patient classification system, require that a committee for each general acute care hospital review the reliability of this system for validating staffing requirements at least annually to determine whether the system accurately measures patient care needs. The bill would require that at least 50% of the committee members be registered nurses who provide direct patient care. The bill would require that these nurses be appointed by the bargaining agent of the registered nurses, if any, and in the absence of a bargaining agent, by the nursing administrator. The bill would require the remaining members of the committee to be appointed by the nursing administrator. By changing the definition of an existing crime, this bill would impose a state-mandated local program.

This bill would state that it is the Legislature’s intent in enacting begin delete this bill end delete begin insert these provisions end insert to supersede specified provisions of a certain regulation, and not to affect any other begin delete provision of end delete law.

begin insert

Existing law requires the department to periodically inspect every licensed health facility for compliance with state law and regulations.

end insert begin insert

This bill would require the department, during its periodic inspection of a general acute care hospital, to inspect for compliance with the minimum nurse-to-patient ratios established pursuant to existing law.

end insert

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 1.  

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

1276.45.  

(a) With respect to the patient classification system
referenced in subdivision (b) of Section 1276.4, a committee for
each general acute care hospital shall review the reliability of this
system for validating staffing requirements at least annually to
determine whether or not the system accurately measures patient
care needs.

(b) (1) At least 50 percent of the committee members shall be
registered nurses who provide direct patient care. These registered
nurses shall be appointed by the bargaining agent of the registered
nurses, if any, and in the absence of a bargaining agent, shall be
appointed by the nursing administrator.

(2) The remaining members of the committee shall be appointed
by the nursing administrator.

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 1279 of the end insert begin insert Health and Safety Code end insert begin insert is amended
to read: end insert

1279.  

(a) Every health facility for which a license or special
permit has been issued shall be periodically inspected by the
department, or by another governmental entity under contract with
the department. The frequency of inspections shall vary, depending
upon the type and complexity of the health facility or special
service to be inspected, unless otherwise specified by state or
federal law or regulation. The inspection shall include participation
by the California Medical Association consistent with the manner
in which it participated in inspections, as provided in Section 1282
prior to September 15, 1992.

(b) Except as provided in subdivision (c), inspections shall be
conducted no less than once every two years and as often as
necessary to ensure the quality of care being provided.

(c) For a health facility specified in subdivision (a), (b), or (f)
of Section 1250, inspections shall be conducted no less than once
every three years, and as often as necessary to ensure the quality
of care being provided.

(d) During the inspection, the representative or representatives
shall offer begin delete such end delete advice and assistance to the health facility as they
deem appropriate.

(e) For acute care hospitals of 100 beds or more, the inspection
team shall include at least a physician, registered nurse, and persons
experienced in hospital administration and sanitary inspections.
During the inspection, the team shall offer advice and assistance
to the hospital as it deems appropriate.

(f) The department shall ensure that a periodic inspection
conducted pursuant to this section is not announced in advance of
the date of inspection. An inspection may be conducted jointly
with inspections by entities specified in Section 1282. However,
if the department conducts an inspection jointly with an entity
specified in Section 1282 that provides notice in advance of the
periodic inspection, the department shall conduct an additional
periodic inspection that is not announced or noticed to the health
facility.

(g)  begin insert (1) end insert begin insert   end insert Notwithstanding any other begin delete provision of end delete law, the
department shall inspect for compliance with begin delete provisions of end delete state
law and regulations during a state periodic inspection or at the
same time as a federal periodic inspection, including, but not
limited to, an inspection required under this section. If the
department inspects for compliance with state law and regulations
at the same time as a federal periodic inspection, the inspection
shall be done consistent with the guidance of the federal Centers
for Medicare and Medicaid Services for the federal portion of the
inspection.

begin insert

(2) During every periodic state inspection of a general acute
care hospital, the department shall inspect for compliance with
the nurse-to-patient ratios established pursuant to Section 1276.4.

end insert

(h) The department shall emphasize consistency across the state
and its district offices when conducting licensing and certification
surveys and complaint investigations, including the selection of
state or federal enforcement remedies in accordance with Section
1423. The department may issue federal deficiencies and
recommend federal enforcement actions in those circumstances
where they provide more rigorous enforcement action.

begin delete SEC. 2. end delete
begin insert SEC. 3. end insert   

It is the intent of the Legislature in enacting Section
1276.45 of the Health and Safety Code to supersede subdivisions
(e) and (f) of Section 70217 of Title 22 of the California Code of
Regulations, and not to affect any other begin delete provision of end delete law.

begin delete SEC. 3. end delete
begin insert SEC. 4. end insert   

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.