BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 455|
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UNFINISHED BUSINESS
Bill No: SB 455
Author: Hernandez (D)
Amended: 8/6/14
Vote: 21
SENATE HEALTH COMMITTEE : 7-1, 4/10/13
AYES: Hernandez, Anderson, Beall, De Le�n, DeSaulnier, Monning,
Pavley
NOES: Nielsen
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE : 5-2, 4/29/13
AYES: De Le�n, Hill, Lara, Padilla, Steinberg
NOES: Walters, Gaines
SENATE FLOOR : 23-10, 5/13/13
AYES: Anderson, Beall, Block, Corbett, De Le�n, DeSaulnier,
Evans, Galgiani, Hancock, Hernandez, Hill, Hueso, Jackson,
Leno, Lieu, Liu, Monning, Padilla, Pavley, Roth, Steinberg,
Wolk, Yee
NOES: Berryhill, Cannella, Correa, Emmerson, Fuller, Huff,
Knight, Nielsen, Wright, Wyland
NO VOTE RECORDED: Calderon, Gaines, Lara, Price, Walters,
Vacancy, Vacancy
ASSEMBLY FLOOR : 49-22, 8/19/14 - See last page for vote
SUBJECT : General acute care hospitals: patient
classification system
SOURCE : AFSCME, AFL-CIO
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United Nurses Associations of California/Union of
Health Care Professionals
DIGEST : This bill requires a committee for each general acute
care hospital to review, at least annually, the reliability of
its patient classification system and requires at least 50% of
the committee members to be registered nurses (RNs) who provide
direct patient care, and that these RNs be appointed by their
bargaining agent, if any. This bill requires the Department of
Public Health (DPH), during every periodic state inspection of a
general acute care hospital, to inspect for compliance with the
nurse-to-patient ratios.
Assembly Amendments specify requirements for patient
classification review committees, require periodic inspection of
acute care hospitals for compliance with minimum
nurse-to-patient ratios, add legislative intent, and make other
changes.
ANALYSIS :
Existing law:
1. Licenses and regulates health facilities by DPH.
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
hospitals.
3. Requires the ratios adopted by regulation to constitute the
minimum number of registered and licensed nurses that must be
allocated. Requires additional staff to 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.
Existing regulations:
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1. Defines "patient classification system," in part, as a method
for establishing staffing requirements by unit, patient, and
shift.
2. Requires a hospital's administrator of nursing service to
develop a written staffing plan based on patient care needs
determined by the patient classification system.
3. Requires the reliability of the patient classification system
for validating staffing requirements to be reviewed at least
annually by a committee appointed by the nursing
administrator to determine whether or not the system
accurately measure patient care needs, and require at least
half of the members of the review committee to be RNs who
provide direct patient care.
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 RNs who
provide direct patient care, and requires such nurses to be
appointed by the bargaining agent of the RNs, if any, and in
the absence of a bargaining agent, by the nursing
administrator.
3.Requires 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.
Background
Existing law requires acute care hospitals to maintain specified
nurse-to-patient ratios. Regulations adopted by DPH to
implement nurse-to-patient ratios require hospitals to develop
and maintain patient classification systems, which are more
detailed protocols for establishing staffing levels based on the
care need of specific patients. Existing law requires DPH to
inspect hospitals no less than every three years to review
compliance with these and other regulatory requirements.
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Prior legislation . SB 1246 (Hernandez, 2012), which was vetoed,
contained similar provisions to this bill, among several other
provisions. In addition to the similar provisions to this bill,
SB 1246 also 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Assembly Appropriations Committee, minor costs
to DPH (Licensing and Certification Fund) to modify regulations
that conflict with this bill's provisions.
SUPPORT : (Verified 8/19/13)
AFSCME, AFL-CIO (co-source)
United Nurses Associations of California/Union of Health Care
Professionals (co-source)
American Nurses Association\California
SEIU
OPPOSITION : (Verified 8/19/13)
Association of California Healthcare Districts
California Hospital Association
California Nurses Association
Department of Finance
ARGUMENTS IN SUPPORT : A sponsor of this bill, the United
Nurses Associations of California/Union of Health Care
Professionals (UNAC/UHCP), points out that many laws incorporate
protections that could be subject to collective bargaining,
including the minimum wage, the eight-hour day, and the nurse
ratios themselves. California law provides minimum standards
for these areas of law, and that appointment of nurses to the
patient classification review committee by a collective
bargaining agent, if any, should be another such instance.
The other sponsor of this bill, AFSCME, also states that
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hospitals need to respect the right of the collective bargaining
agent to appoint direct care nurses to the patient
classification review committees.
ARGUMENTS IN OPPOSITION : The California Hospital Association
(CHA) is opposed to this bill unless amended to remove the
provision giving a third-party labor union the right to appoint
specific members to the patient classification review committee,
arguing that this is an inappropriate infringement on the
hospital's ultimate responsibility for patient care. Under
current regulations, CHA states that the members of the patient
classification committee are appointed by the hospital nursing
administrator, and this bill changes that process. CHA states
that the hospital has ultimate responsibility for ensuring
quality patient care, and given this responsibility, it is
inappropriate to delegate a major component of its assessment
tool to a third party. For example, CHA states that the
hospital may want to have particular units represented on the
committee, while the union may appoint individuals based on
their own priorities such as leadership development or other
factors. Further, CHA states that the hospital must maintain
the prerogative to appoint staff in good standing who are
eligible and qualified to perform the duties vested in the
review committee. The bargaining agent is not a hospital
representative and cannot determine performance eligibility
requirements.
The California Nurses Association (CNA) states that it is
strongly concerned about the potential for this bill to weaken
existing hospital regulations governing patient classification
systems by requiring DPH to adopt and review patient
classification system regulations that already exist. CNA
states that regulations that have been vetted through the
Administrative Procedures Act for clarity, authority, reference
and necessity, and that have been refined though public comments
during rulemaking, as well as tested through the court of law,
should not be replaced by vague legislative language. CNA
states that opening up existing language could result in the
dilution of many important mandates established through prior
rulemaking. CNA states that while the language of this bill is
redundant of some current regulations, it leaves out critical
elements set forth in current regulations, and is concerned
about preservation of these provisions should this bill be
enacted and require DPH to adopt new regulations on the subject.
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Finally, CNA states that this bill is unnecessary as union
participation in patient classification review committees can be
achieved through collective bargaining. CNA states that it has
successfully achieved similar provisions in countless collective
bargaining contracts with hospitals, and for that reason, does
not find the need for such a provision in statute compelling
enough to put out current staffing regulations at risk.
ASSEMBLY FLOOR : 49-22, 8/19/14
AYES: Alejo, Bocanegra, Bonilla, Bonta, Bradford, Brown,
Buchanan, Ian Calderon, Campos, Chau, Chesbro, Cooley,
Dababneh, Daly, Eggman, Fong, Fox, Frazier, Garcia, Gatto,
Gonzalez, Gordon, Gray, Hall, Roger Hern�ndez, Holden,
Jones-Sawyer, Levine, Linder, Lowenthal, Maienschein, Medina,
Mullin, Muratsuchi, Nazarian, Pan, Perea, John A. P�rez, V.
Manuel P�rez, Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez,
Salas, Stone, Ting, Weber, Williams, Atkins
NOES: Achadjian, Allen, Bigelow, Ch�vez, Conway, Dahle,
Donnelly, Beth Gaines, Gorell, Grove, Hagman, Harkey, Jones,
Logue, Mansoor, Melendez,
Nestande, Olsen, Patterson, Wagner, Waldron, Wilk
NO VOTE RECORDED: Ammiano, Bloom, Dickinson, Gomez, Quirk,
Skinner, Wieckowski, Yamada, Vacancy
JL:k 8/19/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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