BILL ANALYSIS �
SB 455
Page 1
Date of Hearing: August 13, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 455 (Hernandez) - As Amended: August 6, 2014
Policy Committee: HealthVote:14-3
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill specifies enforcement and validation of current-law
staffing requirements for hospitals. Specifically, this bill:
1)Requires each hospital to have a committee annually review
patient classification systems for reliability, in order to
validate staffing requirements.
2)Requires at least 50% of the committee members to be
registered nurses who provide direct patient care, and
requires such nurses to be appointed by the bargaining agent
of the registered nurses, if any, and in the absence of a
bargaining agent, by the nursing administrator.
3)Requires the Department of Public Health (DPH) to inspect for
compliance with nurse-to-patient ratios during every periodic
state inspection of a general acute care hospital.
4)Specifies intent to supersede existing, related regulations.
FISCAL EFFECT
Minor costs to the Department of Public Health (DPH) (Licensing
and Certification Fund) to modify regulations that conflict with
this bill's provisions.
COMMENTS
1)Purpose . According to the author, by placing the patient
classification committee requirement in statute, this bill
will help ensure hospitals are complying with the law.
Additionally, the author believes selecting representatives
SB 455
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for workplace committees is an appropriate function of a
collective bargaining agent. This bill is sponsored by the
United Nurses Associations of California/Union of Health Care
professionals (UNAC/UHP), which states many laws incorporate
protections that could be subject to collective bargaining.
2)Background . Current regulations operationalize provisions of
AB 394 (Kuehl), Chapter 945, Statutes of 1999, which requires
nurse-to-patient ratios for hospitals. Specifically, Title
22, Section 70217 of the California Code of Regulations
requires a committee, composed of 50% direct care nursing
staff, to annually review the reliability of a patient
classification system for validating staffing requirements, to
determine whether or not the system accurately measures
patient care needs. Section 70217 further stipulates the
committee is to be appointed by the nursing administrator. If
the review reveals adjustments are necessary in the patient
classification system in order to assure accuracy in measuring
patient care needs, regulations require such adjustments to be
implemented within 30 days of that determination.
This bill essentially mirrors existing regulations, but adds a
new requirement that the registered nurses who provide direct
patient care must be appointed by a collective bargaining
agent, if any. It also specifies that the department must
inspect for compliance with the nurse-to-patient ratios
established in current law during periodic inspections. DPH
currently enforces existing law and regulations, including
those related to staffing, through periodic inspections and in
response to complaints.
3)Previous Legislation. SB 1246 (Hernandez), 2012, would have
required periodic inspections by DPH to include a review of
compliance with nurse staffing ratios and patient
classification systems, and eliminated a requirement that DPH
promulgate regulations further defining the criteria for
assessing administrative penalties, thereby allowing existing
fine authority to go into effect. SB 1246 would have also
codified patient classification regulations, as does this
bill.
SB 1246 was vetoed by Governor Brown. In his veto message he
stated, "This bill seeks to grant [DPH] greater authority to
enforce hospital nurse staffing ratios and patient
classification system requirements. Everything is already on
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track to get this job done. The department will soon release
proposed regulations on administrative penalties that will
apply to a broad range of violations. The rulemaking process
should be completed next year."
DPH issued regulations this March, effective April 1, 2014,
that describe how the department will impose penalties for
violations of licensure requirements that do not constitute
"immediate jeopardy" to patient health and safety, potentially
including, presumably, violations of nurse staffing ratios and
patient classification systems. To date, no penalties have
been imposed for such violations.
4)Opposition . The California Hospital Association (CHA) writes
in opposition to this bill that the hospital has the ultimate
responsibility for ensuring quality patient care, including
ensuring appropriate staffing levels. Given this
responsibility, CHA believes it is inappropriate to require
the hospital to delegate a major component of its assessment
tool to a third party. The Association of California
Healthcare Districts, representing district hospitals, echoes
CHA's concerns, stating delegation of the patient
classification authority is particularly problematic given the
hospital's interests and the union's interests may not always
be aligned. In addition, CHA indicates the requirement for
compliance checks is redundant, given the department already
routinely inspects all aspects of patient care delivery during
their periodic inspections.
The California Nurses Association also opposes this bill,
contending it is already addressed through regulations, and
echoing CHA's position that provisions related to collective
bargaining should stay within the collecting bargaining
process.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081