Bill Text: CA SB1246 | 2011-2012 | Regular Session | Enrolled
Bill Title: Health facilities: staffing.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Vetoed) 2012-09-30 - In Senate. Consideration of Governor's veto pending. [SB1246 Detail]
Download: California-2011-SB1246-Enrolled.html
BILL NUMBER: SB 1246 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 27, 2012
PASSED THE ASSEMBLY AUGUST 21, 2012
AMENDED IN ASSEMBLY JULY 5, 2012
AMENDED IN SENATE MAY 25, 2012
AMENDED IN SENATE APRIL 25, 2012
AMENDED IN SENATE APRIL 12, 2012
AMENDED IN SENATE MARCH 26, 2012
INTRODUCED BY Senator Hernandez
FEBRUARY 23, 2012
An act to amend Sections 1279 and 1280.3 of, to add Section 1279.4
to, and to repeal Section 1280.1 of, the Health and Safety Code,
relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
SB 1246, Hernandez. Health facilities: staffing.
Existing law regulates general acute care hospitals, acute
psychiatric hospitals, and special hospitals, as defined. Existing
law required, by January 1, 2002, the State Department of Public
Health to adopt regulations establishing the minimum, specific, and
numerical licensed nurse-to-patient ratios by licensed nurse
classification and by hospital unit for general acute care hospitals,
acute psychiatric hospitals, and special hospitals. Existing law
requires these ratios to constitute the minimum number of registered
and licensed nurses that shall be allocated and additional staff to
be assigned in accordance with a documented patient classification
system for determining nursing requirements.
Existing law requires the department to promulgate regulations
that include specified criteria for the purpose of assessing an
administrative penalty against general acute care hospitals, acute
psychiatric hospitals, and special hospitals. Existing law authorizes
the department to assess a licensee of these hospitals an
administrative penalty, as specified, for a violation of existing law
or for a deficiency constituting an immediate jeopardy violation,
except that no penalty shall be assessed if it is a minor violation.
Existing law provides that a person who willfully or repeatedly
violates a rule or regulation adopted pursuant to these provisions is
guilty of a misdemeanor.
This bill would eliminate the requirement that the department
promulgate regulations to assess an administrative penalty, as well
as associated provisions, and instead would require the department to
use the specified criteria to determine the amount of the
administrative penalty.
This bill would require general acute care hospitals to maintain a
patient classification system that is reviewed and updated annually.
By requiring general acute care hospitals to maintain a patient
classification system, this bill would expand the definition of a
crime and would impose a state-mandated local program.
Existing law requires that every health facility for which a
license or special permit has been issued shall be periodically
inspected by the State Department of Public Health, or by another
governmental entity under contract with the department. Existing law
requires the department to inspect the facility for compliance with
provisions of state law and regulations during a state periodic
inspection, or at the same time as a federal periodic inspection.
This bill would require the inspections to include review of
compliance with state requirements for staffing, including the
regulations adopted by the department establishing nurse-to-patient
ratios and regulations regarding patient classification systems.
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.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1279 of the Health and Safety Code is amended
to read:
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 such 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) Notwithstanding any other provision of law, the department
shall inspect the facility for compliance with provisions of 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. Inspections shall
include review of compliance with state requirements for staffing,
including regulations adopted pursuant to Section 1276.4 and
regulations regarding patient classification systems. If the
department inspects the facility 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.
(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.
SEC. 2. Section 1279.4 is added to the Health and Safety Code, to
read:
1279.4. (a) A health facility licensed pursuant to subdivision
(a) of Section 1250 shall maintain a patient classification system
that shall be reviewed and updated at least annually.
(b) The annual updating of the patient classification system shall
include a review of its reliability by a review committee. The
review committee shall be appointed by the nursing administration,
subject to subdivision (c). The review committee shall determine
whether the system accurately measures patient care needs.
(c) At least one-half of the committee shall be registered nurses
who provide direct patient care. If the registered nurses are
represented by a collective bargaining agent, the registered nurses
shall be selected by the agent.
SEC. 3. Section 1280.1 of the Health and Safety Code is repealed.
SEC. 4. Section 1280.3 of the Health and Safety Code is amended to
read:
1280.3. (a) The director may assess an administrative penalty
against a licensee of a health facility licensed under subdivision
(a), (b), or (f) of Section 1250 for a deficiency that occurs on or
after January 1, 2013, and constitutes an immediate jeopardy
violation, as determined by the department, up to a maximum of
seventy-five thousand dollars ($75,000) for the first administrative
penalty, up to one hundred thousand dollars ($100,000) for the second
subsequent administrative penalty, and up to one hundred twenty-five
thousand dollars ($125,000) for the third and every subsequent
violation. An administrative penalty issued after three years from
the date of the last issued immediate jeopardy violation shall be
considered a first administrative penalty so long as the facility has
not received additional immediate jeopardy violations and is found
by the department to be in substantial compliance with all state and
federal licensing laws and regulations. The department shall have
full discretion to consider all factors when determining the amount
of an administrative penalty pursuant to this section.
(b) Except as provided in subdivision (c), for a violation of this
chapter or the rules and regulations adopted thereunder that occurs
on or after January 1, 2013, but does not constitute a violation of
subdivision (a), the department may assess an administrative penalty
in an amount not less than two thousand five hundred dollars ($2,500)
and not exceeding twenty-five thousand dollars ($25,000) per
violation. This subdivision shall also apply to violation of
regulations set forth in Article 1 (commencing with Section 127400)
of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations
adopted thereunder.
The department shall use the following criteria to determine the
amount of an administrative penalty against a health facility
licensed pursuant to subdivision (a), (b), or (f) of Section 1250:
(1) The patient's physical and mental condition.
(2) The probability and severity of the risk that the violation
presents to the patient.
(3) The actual financial harm to patients, if any.
(4) The nature, scope, and severity of the violation.
(5) The facility's history of compliance with related state and
federal statutes and regulations.
(6) Factors beyond the facility's control that restrict the
facility's ability to comply with this chapter or the rules and
regulations adopted thereunder.
(7) The demonstrated willfulness of the violation.
(8) The extent to which the facility detected the violation and
took steps to immediately correct the violation and prevent the
violation from recurring.
(9) Compliance with staffing requirements of state and federal law
and regulation, including, but not limited to, the patient
classification system and nurse-to-patient ratios.
(c) The department shall not assess an administrative penalty for
minor violations.
(d) If the licensee disputes a determination by the department
regarding the alleged deficiency or alleged failure to correct a
deficiency, or regarding the reasonableness of the proposed deadline
for correction or the amount of the penalty, the licensee may, within
10 working days, request a hearing pursuant to Section 131071.
Penalties shall be paid when all appeals have been exhausted and the
department's position has been upheld.
(e) For purposes of this section, "immediate jeopardy" means a
situation in which the licensee's noncompliance with one or more
requirements of licensure has caused, or is likely to cause, serious
injury or death to the patient.
(f) In enforcing subdivision (a) the department shall take into
consideration the special circumstances of small and rural hospitals,
as defined in Section 124840, in order to protect access to quality
care in those hospitals.
SEC. 5. By amending Section 1280.3 of the Health and Safety Code
in Section 4 of this act, it is the intent of the Legislature to
authorize the State Department of Public Health to implement the
imposition of administrative penalties described in subdivisions (a)
and (b) of Section 1280.3 of the Health and Safety Code, without the
prior adoption of regulations to implement that section. The
amendments made to Section 1280.3 of the Health and Safety Code by
this act shall not be construed to prohibit the department from
adopting implementing regulations.
SEC. 6. 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.
