|
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.1494
Session of 2002
INTRODUCED BY SCHWARTZ, MELLOW, O'PAKE, KUKOVICH, TARTAGLIONE,
HUGHES, COSTA, STACK, LOGAN, LAVALLE, A. WILLIAMS AND MUSTO,
JUNE 28, 2002
REFERRED TO PUBLIC HEALTH AND WELFARE, JUNE 28, 2002
AN ACT
1 Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
2 act relating to health care; prescribing the powers and
3 duties of the Department of Health; establishing and
4 providing the powers and duties of the State Health
5 Coordinating Council, health systems agencies and Health Care
6 Policy Board in the Department of Health, and State Health
7 Facility Hearing Board in the Department of Justice;
8 providing for certification of need of health care providers
9 and prescribing penalties," further providing for purpose of
10 certain provisions, for definitions, for powers of the
11 Department of Health, for administration and for licensure;
12 providing for compliance with staffing plan and
13 recordkeeping, for work assignment policy and for public
14 disclosure of staffing requirements; further providing for
15 issuance of license, for reliance on accrediting agencies and
16 Federal Government, for effect on departmental orders and for
17 actions against violations of law, rules and regulations; and
18 providing for nurse recruitment.
19 The General Assembly of the Commonwealth of Pennsylvania
20 hereby enacts as follows:
21 Section 1. Section 801.1 of the act of July 19, 1979
22 (P.L.130, No.48), known as the Health Care Facilities Act, added
23 July 12, 1980 (P.L.655, No.136), is amended to read:
24 Section 801.1. Purpose.
25 (a) Purpose of chapter.--It is the purpose of this chapter
page 2 . . . . 1 to protect and promote the public health and welfare through the
2 establishment and enforcement of regulations setting minimum
3 standards in the construction, maintenance and operation of
4 health care facilities. Such standards are intended by the
5 Legislature to assure safe, adequate and efficient facilities
6 and services, and to promote the health, safety and adequate
7 care of the patients or residents of such facilities. It is also
8 the purpose of this chapter to assure quality health care
9 through appropriate and nonduplicative review and inspection
10 with due regard to the protection of the health and rights of
11 privacy of patients and without unreasonably interfering with
12 the operation of the health care facility or home health agency.
13 (b) Need for safe staffing in health care facilities.--The
14 General Assembly has a substantial interest in assuring that
15 delivery of health care services to patients in health care
16 facilities located within this Commonwealth is adequate and safe
17 and that health care facilities retain sufficient nursing staff
18 so as to promote optimal health care outcomes. Recent changes in
19 health care delivery systems are resulting in a higher acuity
20 level among patients in health care facilities. Inadequate
21 hospital staffing results in dangerous medical errors and
22 patient infections. Registered nurses constitute the highest
23 percentage of direct health care staff in acute care facilities
24 and have a central role in health care delivery. To ensure the
25 adequate protection and care for patients in health care
26 facilities it is essential that qualified registered nurses be
27 accessible and available to meet the nursing needs of patients.
28 Inadequate and poorly monitored nurse staffing practices, which
29 result in having too few registered nurses providing care,
30 jeopardize delivery of quality health care services andpage 3 . . . . 1 adversely impact the health of patients who enter hospitals and
2 outpatient emergency and surgical centers. The basic principles
3 of staffing in health care facilities should be focused on
4 patient health care needs and based on consideration of patient
5 acuity levels and services that need to be provided to ensure
6 optimal outcomes. The setting of staffing standards for
7 registered nurses is not to be interpreted as justifying the
8 understaffing of other critical health care workers, including
9 licensed practical nurses and unlicensed assistive personnel.
10 Safe staffing practices recognize the importance of all health
11 care workers in providing quality patient care. Indeed, the
12 availability of these other health care workers enables
13 registered nurses to focus on the nursing care functions that
14 only registered nurses, by law, are permitted to perform and
15 thereby helps to ensure adequate staffing levels. To ensure
16 patient safety, hospital patient acuity measurements which are
17 adequate and followed must be in place. Establishing staffing
18 standards for registered nurses in acute care facilities will
19 ensure that health care facilities throughout this Commonwealth
20 operate in a manner that guarantees the public safety and the
21 delivery of quality health care services. In order to meet the
22 staffing standards set forth under this chapter, the General
23 Assembly recognizes the need to create incentives to increase
24 the number of registered nurses within this Commonwealth.
25 Section 2. Section 802.1 of the act is amended by adding
26 definitions to read:
27 Section 802.1. Definitions.
28 The following words and phrases when used in this chapter
29 shall have, unless the context clearly indicates otherwise, the
30 meanings given them in this section: page 4 . . . . 1 "Acuity system." An established measurement instrument
2 which:
3 (1) predicts nursing care requirements for individual
4 patients based on severity of patient illness, need for
5 specialized equipment and technology, intensity of nursing
6 interventions required and the complexity of clinical nursing
7 judgment needed to design, implement and evaluate the
8 patient's nursing care plan;
9 (2) details the amount of nursing care needed, both in
10 number of direct care nurses and in skill mix of nursing
11 personnel required, on a daily basis, for each patient in a
12 nursing department or unit; and
13 (3) is stated in terms that readily can be used and
14 understood by direct care nurses.
15 The acuity system shall take into consideration the patient care
16 services provided not only by registered nurses but also by
17 licensed practical nurses and other health care personnel.
18 * * *
19 "Assessment tool." A measurement system which compares the
20 staffing level in each nursing department or unit against actual
21 patient nursing care requirements in order to review the
22 accuracy of an acuity system.
23 * * *
24 "Direct care nurse." A registered nurse who has direct
25 responsibility to oversee or carry out medical regimens, nursing
26 or other bedside care for one or more patients.
27 "Documented staffing plan." A detailed written plan setting
28 forth the minimum number and classification of direct care
29 nurses required in each nursing department or unit in the health
30 care facility for a given year, based on reasonable projections
page 5 . . . . 1 derived from the patient census and average acuity level within
2 each department or unit during the prior year, the department or
3 unit size and geography, the nature of services provided and any
4 forseeable changes in department or unit size or function during
5 the current year.
6 "Extended care facility." A home health care agency, a
7 hospice or a long-term care nursing facility.
8 * * *
9 "Nurse" or "registered nurse." An individual licensed to
10 practice professional nursing under the act of May 22, 1951
11 (P.L.317, No.69), known as "The Professional Nursing Law."
12 "Nursing care." Care which falls within the scope of
13 practice encompassed within recognized professional standards of
14 nursing practice, including assessment, nursing diagnosis,
15 planning, intervention, evaluation and patient advocacy.
16 "Staffing level." The actual numerical nurse-to-patient
17 ratio within a nursing department or unit.
18 "Unit." A patient care component within a health care
19 facility as defined by the Department of Health.
20 Section 3. Section 803 of the act, added July 12, 1980
21 (P.L.655, No.136), is amended to read:
22 Section 803. Powers of the Department of Health.
23 The Department of Health shall have the power and its duty
24 shall be:
25 (1) to promulgate, after consultation with the policy
26 board, the rules and regulations necessary to carry out the
27 purposes and provisions of this chapter[; and], including:
28 (i) regulations defining terms, setting forth direct
29 care nurse-to-patient ratios and prescribing the process
30 for approving acuity systems; andpage 6 . . . . 1 (ii) within six months of the effective date of this
2 subparagraph, regulations which at a minimum shall
3 provide for an accessible and confidential system to
4 report the failure to comply with requirements of this
5 chapter and public access to information regarding
6 reports of inspections, results, deficiencies and
7 corrections under this chapter; and
8 (2) to assure that the provisions of this chapter and
9 all rules and regulations promulgated under this chapter are
10 enforced.
11 Section 4. Sections 804 and 806 of the act are amended by
12 adding subsections to read:
13 Section 804. Administration.
14 * * *
15 (e) Approval of acuity system.--The department shall adopt
16 regulations prescribing the method by which it will approve a
17 health care facility's acuity system. The regulations may
18 include a system for class approval of acuity systems.
19 Section 806. Licensure.
20 * * *
21 (h) Staffing requirements.--Each health care facility, other
22 than an extended care facility, licensed pursuant to this act
23 shall ensure that it is staffed in a manner that provides
24 sufficient, appropriately qualified direct care nurses in each
25 department or unit within the facility in order to meet the
26 individualized care needs of the patients therein and to meet
27 the requirements set forth in subsections (i), (j) and (k).
28 (i) Staffing plan.--As a condition of licensing, each health
29 care facility annually shall submit to the department a
30 documented staffing plan together with a written certification page 7 . . . . 1 that the staffing plan is sufficient to provide adequate and
2 appropriate delivery of health care services to patients for the
3 ensuing year. The staffing plan must:
4 (1) Meet the minimum requirements set forth in
5 subsection (j).
6 (2) Be adequate to meet any additional requirements
7 provided by other law or regulation.
8 (3) Employ and identify an approved acuity system for
9 addressing fluctuations in actual patient acuity levels and
10 nursing care requirements necessitating increased staffing
11 levels above the minimums set forth in the plan.
12 (4) Factor in other unit or department activity, such as
13 discharges, transfers and admissions and administrative and
14 support tasks, that is expected to be done by direct care
15 nurses in addition to direct nursing care.
16 (5) Factor in the staffing level of and services
17 provided by other health care personnel in meeting patient
18 care needs.
19 (6) Identify the assessment tool used to validate the
20 acuity system relied on in the plan.
21 (7) Identify the system which will be used to document
22 actual staffing on a daily basis within each department or
23 unit.
24 (8) Include a written assessment of the accuracy of the
25 prior year's staffing plan in light of actual staffing needs.
26 (9) Identify each nurse staff classification referenced
27 therein together with a statement setting forth minimum
28 qualifications for each classification.
29 (10) Be developed in consultation with a majority of the
30 direct care nurses within each department or unit or, where page 8 . . . . 1 nurses are represented, with the applicable recognized or
2 certified collective bargaining representative of the direct
3 care nurses.
4 (j) Nurse-to-patient ratios.--The staffing plan must
5 incorporate, at a minimum, the following direct care nurse-to-
6 patient ratios:
7 (1) One nurse to one patient in operating room and
8 trauma emergency units.
9 (2) One nurse to two patients in all critical care
10 areas, including emergency critical care and all intensive
11 care units, labor and delivery units and postanesthesia
12 units.
13 (3) One nurse to three patients in antepartum, emergency
14 room, pediatrics, step-down and telemetry units.
15 (4) One nurse to four patients in intermediate care
16 nursery, medical/surgical and acute care psychiatric units.
17 (5) One nurse to five patients in rehabilitation units.
18 (6) One nurse to six patients in postpartum (three
19 couplets) and well-baby nursery units.
20 (7) For any units not listed above, including
21 psychiatric units in facilities other than acute care
22 hospitals, direct care nurse-to-patient ratio as established
23 by the department.
24 (k) Additional standards.--
25 (1) The ratios set forth in subsection (j) shall
26 constitute the minimum number of direct care nurses to be
27 allocated within a department or unit. Additional direct care
28 nurses must be added and the ratio adjusted to ensure
29 adequate staffing of each nursing department or unit, in
30 accordance with an approved acuity system.
page 9 . . . . 1 (2) Nothing shall preclude the department from
2 establishing and requiring a staffing plan to have higher
3 nurse-to-patient ratios than those set forth in subsection
4 (j).
5 (3) The staffing plan may not incorporate or assume that
6 nursing care functions required by licensing law or
7 regulations or accepted standards of practice to be performed
8 by a registered nurse are to be performed by other personnel.
9 Section 5. The act is amended by adding sections to read:
10 Section 806.2. Compliance with staffing plan and recordkeeping.
11 (a) General rule.--As a condition of licensing, a health
12 care facility required to have a staffing plan under section 806
13 shall at all times staff in accordance with its staffing plan
14 and the staffing standards set forth under section 806. However,
15 nothing in this section shall be deemed to preclude any health
16 care facility from implementing higher direct care nurse-to-
17 patient staffing levels, nor shall the requirements set forth be
18 deemed to supersede or replace any higher requirements otherwise
19 mandated by law, regulation or contract.
20 (b) Assigned nursing staff.--For purposes of compliance with
21 the minimum staffing requirements standards set forth under
22 section 806, no nurse shall be assigned or included in the count
23 of assigned nursing staff in a nursing department or unit or a
24 clinical area within the health care facility unless that nurse
25 has an appropriate license under the act of May 22, 1951
26 (P.L.317, No.69), known as "The Professional Nursing Law,"
27 received prior orientation in that clinical area sufficient to
28 provide competent nursing care to the patients in that area, and
29 demonstrated current competence in providing care in that area.
30 (c) Records.--As a condition of licensure, each health carepage 10 . . . . 1 facility required to have a staffing plan under section 806
2 shall maintain accurate daily records showing:
3 (1) The number of patients admitted, released and
4 present in each nursing department or unit within the
5 facility.
6 (2) The individual acuity level of each patient present
7 in each nursing department or unit within the facility.
8 (3) The identity and duty hours of each direct care
9 nurse in each nursing department or unit within the facility.
10 (d) Daily statistics.--As a condition of licensure, each
11 health care facility required to have a staffing plan under
12 section 806 shall maintain daily statistics, by nursing
13 department and unit, of mortality, morbidity, infection,
14 accident, injury and medical errors.
15 (e) Time period for retaining records.--All records required
16 to be kept under this section shall be retained for a period of
17 seven years.
18 (f) Release to department and public.--All records required
19 to be kept under this section shall be made available upon
20 request to the department and to the public. However,
21 information released to the public shall comply with applicable
22 patient privacy laws and regulations.
23 Section 806.3. Work assignment policy.
24 (a) Work assignment refusal.--As a condition of licensure,
25 each health care facility other than an extended care facility
26 shall adopt, disseminate to direct care nurses and comply with a
27 written policy that meets the requirements set forth in this
28 section, detailing the circumstances under which a direct care
29 nurse may refuse a work assignment.
30 (b) Minimum conditions.--At a minimum, the work assignment page 11 . . . . 1 policy shall permit a direct care nurse to refuse an assignment
2 if:
3 (1) The nurse is not prepared by education, training or
4 experience to safely fulfill the assignment without
5 compromising or jeopardizing patient safety, the nurse's
6 ability to meet foreseeable patient needs or the nurse's
7 license.
8 (2) The assignment otherwise would violate requirements
9 set forth in this act.
10 (c) Minimum procedures.--At a minimum, the work assignment
11 policy shall contain procedures for the following:
12 (1) Reasonable requirements for prior notice to the
13 nurse's supervisor regarding the nurse's request and
14 supporting reasons for being relieved of the assignment or
15 continued duty.
16 (2) Where feasible, an opportunity for the supervisor to
17 review the specific conditions supporting the nurse's request
18 and to decide whether to remedy the conditions, to relieve
19 the nurse of the assignment or to deny the nurse's request to
20 be relieved of the assignment or continued duty.
21 (3) A process which permits the nurse to exercise the
22 right to refuse the assignment or continued on-duty status
23 when the supervisor denies the request to be relieved if:
24 (i) the supervisor rejects the request without
25 proposing a remedy or the proposed remedy would be
26 inadequate or untimely;
27 (ii) the complaint and investigation process with a
28 regulatory agency would be untimely to address the
29 concern; and
30 (iii) the employee in good faith believes that the
page 12 . . . . 1 assignment meets conditions justifying refusal.
2 (4) A nurse who refuses an assignment pursuant to a work
3 assignment policy as set forth in this section shall not be
4 deemed, by reason thereof, to have engaged in negligent or
5 incompetent action, patient abandonment or otherwise to have
6 violated applicable nursing law.
7 Section 806.4. Public disclosure of staffing requirements.
8 As a condition of licensing, a health care facility required
9 to have a staffing plan under section 806 shall:
10 (1) Post in a conspicuous place readily accessible to
11 the general public a notice prepared by the department
12 setting forth the mandatory provisions for safe staffing
13 under this chapter together with a statement of the mandatory
14 and actual daily nurse staffing levels in each nursing
15 department or unit.
16 (2) Upon request, make copies of the staffing plan filed
17 with the department available to the public.
18 (3) Make readily available to the nursing staff with a
19 department or unit, during each work shift, the following
20 information:
21 (i) A copy of the current staffing plan for that
22 department or unit.
23 (ii) Documentation of the number of direct care
24 nurses required to be present during the shift based on
25 the approved adopted acuity system.
26 (iii) Documentation of the actual number of direct
27 care nurses present during the shift.
28 Section 6. Section 808(a) of the act, amended December 18,
29 1992 (P.L.1602, No.179), is amended to read:
30 Section 808. Issuance of license.page 13 . . . . 1 (a) Standards.--The department shall issue a license to a
2 health care provider when it is satisfied that the following
3 standards have been met:
4 (1) that the health care provider is a responsible
5 person;
6 (2) that the place to be used as a health care facility
7 is adequately constructed, equipped, maintained and operated
8 to safely and efficiently render the services offered;
9 (3) that the health care facility provides safe and
10 efficient services which are adequate for the care, treatment
11 and comfort of the patients or residents of such facility;
12 (4) that there is substantial compliance with the rules
13 and regulations adopted by the department pursuant to this
14 act; [and]
15 (5) that a certificate of need has been issued if one is
16 necessary[.]; and
17 (6) in the case of a health care facility required to
18 have a staffing plan under section 806, that the facility has
19 submitted a documented staffing plan and is operating in
20 compliance with the requirements pertaining thereto set forth
21 in this chapter and in applicable regulations.
22 * * *
23 Section 7. Section 810 of the act is amended by adding a
24 subsection to read:
25 Section 810. Reliance on accrediting agencies and Federal
26 Government.
27 * * *
28 (d) Construction.--This section shall not be construed to
29 permit the department to delegate any of its functions with
30 respect to the staffing requirements set forth under thispage 14 . . . . 1 chapter.
2 Section 8. Section 815(c) of the act, added July 12, 1980
3 (P.L.655, No.136), is amended to read:
4 Section 815. Effect of departmental orders.
5 * * *
6 (c) Medical assistance payments.--Orders of the department,
7 to the extent that they are sustained by the board, which fail
8 to renew a license or which suspend or revoke a license, shall
9 likewise revoke or suspend certification of the facility as a
10 medical assistance provider, and no medical assistance payment
11 for services rendered subsequent to the final order shall be
12 made during the pendency of an appeal for the period of
13 revocation or suspension without an order of supersedeas by the
14 appellate court. Any health care facility that falsifies or
15 causes to be falsified documentation required by this chapter
16 shall be prohibited from receiving any medical assistance
17 payment for a period of six months subsequent to the final order
18 of violation.
19 Section 9. Section 817 of the act, amended December 18, 1992
20 (P.L.1602, No.179), is amended to read:
21 Section 817. Actions against violations of law, rules and
22 regulations.
23 (a) Actions brought by department.--Whenever any person,
24 regardless of whether such person is a licensee, has violated
25 any of the provisions of this chapter or the regulations issued
26 pursuant thereto, the department may maintain an action in the
27 name of the Commonwealth for an injunction or other process
28 restraining or prohibiting such person from engaging in such
29 activity.
30 (b) Civil penalty.-- page 15 . . . .
1 (1) Any person, regardless of whether such person is a
2 licensee, who has committed a violation of any of the
3 provisions of this chapter or of any rule or regulation
4 issued pursuant thereto, including failure to correct a
5 serious licensure violation (as defined by regulation) within
6 the time specified in a deficiency citation, may be assessed
7 a civil penalty by an order of the department of up to $500
8 for each deficiency for each day that each deficiency
9 continues.
10 (2) A health care facility required to have a staffing
11 plan under section 806 that fails to comply with the
12 requirements of section 806.2(c) may be assessed a civil
13 penalty by an order of the department of up to $10,000 for
14 each day of noncompliance.
15 (3) Civil penalties shall be collected from the date the
16 facility receives notice of the violation until the
17 department confirms correction of such violation.
18 (b.1) Civil penalty for interference with reporting
19 obligations.--Any person or health care facility that fails to
20 report or falsifies information, or coerces, threatens,
21 intimidates or otherwise influences another person to fail to
22 report or to falsify information required to be reported under
23 this chapter, may be assessed a penalty of up to $10,000 for
24 each incident.
25 (c) Funds collected as a result of the assessment of a civil
26 penalty.--When all other sources of funding have been exhausted,
27 the department shall apply funds collected as a result of the
28 assessment of a civil penalty to the protection of the health or
29 property of patients or residents of the health care facility.
30 Funds may be utilized to: page 16 . . . . 1 (1) Provide payment to temporary management.
2 (2) Maintain the operation of the health care facility
3 pending correction of deficiencies or closure.
4 (3) In the case of a long-term care nursing facility,
5 relocate residents to other licensed health care facilities.
6 (4) In the case of a long-term care nursing facility,
7 reimburse residents for misappropriated personal needs
8 allowance.
9 (d) Facility closure for threat to health or safety.--
10 Whenever the department determines that deficiencies pose an
11 immediate and serious threat to the health or safety of the
12 patients or residents of the health care facility, the
13 department may direct the closure of the facility and the
14 transfer of patients or residents to other licensed health care
15 facilities.
16 (e) Discharge or discrimination.--No person shall discharge,
17 discriminate or in any manner retaliate against any employee
18 because such employee has filed any complaint or instituted or
19 caused to be instituted any proceeding under or related to this
20 act or has testified or is about to testify in any such
21 proceeding or because of the exercise by such employee on behalf
22 of himself or others of any right afforded by this act.
23 (f) Private right of action for certain violations.--Any
24 health care facility other than an extended care facility which
25 violates the rights of an employee set forth in subsection (e)
26 or under an adopted work assignment policy under section 806.3
27 may be held liable to the employee in an action brought in a
28 court of competent jurisdiction for the legal or equitable
29 relief appropriate to effectuate the purposes of this chapter,
30 including, but not limited to, reinstatement, promotion, lostpage 17 . . . . 1 wages and benefits and compensatory and consequential damages
2 resulting from the violation together with an equal amount in
3 liquidated damages. The court in the action shall, in addition
4 to any judgment awarded to the plaintiff, award reasonable
5 attorney fees and costs of action to be paid by the defendant.
6 The employee's right to institute a private action under this
7 subsection is not limited by any other rights granted under this
8 chapter.
9 Section 10. The act is amended by adding a section to read:
10 Section 901.1. Nurse recruitment.
11 (a) Nurse recruitment grant program.--
12 (1) The department shall award grants as set forth under
13 this section to increase nursing education opportunities.
14 (2) Eligible entities to whom grants may be provided
15 include the following:
16 (i) A health care facility.
17 (ii) A labor organization representing registered
18 nurses in this Commonwealth.
19 (iii) An approved nursing education program for the
20 preparation of professional registered nurses in
21 accordance with the requirements of the act of May 22,
22 1951 (P.L.317, No.69), known as "The Professional Nursing
23 Law."
24 (3) Grants shall be available to:
25 (i) Support outreach programs at elementary and
26 secondary schools that inform guidance counselors and
27 students of education opportunities regarding nursing.
28 (ii) Create demonstration programs to provide
29 mentors for high school students designed to encourage
30 them to enter a career in professional nursing. page 18 . . . . 1 (iii) Provide scholarships or tuition reimbursement,
2 or both, to Pennsylvania residents from diverse racial
3 and ethnic backgrounds who want to become registered
4 nurses. To be eligible for a scholarship or tuition
5 reimbursement, a student must meet designated academic
6 criteria and be accepted into an approved nursing
7 program. Scholarships and tuition reimbursement may be
8 conditioned on a commitment of paid service up to three
9 years in duration. Preference for scholarships shall be
10 given to a student who is from an underrepresented ethnic
11 and minority background or who is otherwise
12 underrepresented in the profession of nursing. A student
13 who is awarded a scholarship is obligated to perform
14 three years of service at full pay at a health care
15 facility or face a penalty of treble the scholarship
16 amount plus interest.
17 (b) Career ladder grant program.--
18 (1) The department shall award grants to health care
19 facilities to assist in creating career ladder programs that
20 will encourage employees to obtain the education required to
21 become registered nurses. In making awards, preference shall
22 be given to health care facilities that have active labor
23 management cooperative programs.
24 (2) Grants provided under this subsection shall be used
25 to cover costs incurred by employees of the health care
26 facility who enroll in an approved program to become
27 registered nurses, including tuition costs, work release time
28 and dependent care costs.
29 (c) Nursing faculty loan program.--The department shall
30 establish and implement a grant program designed to encourage page 19 . . . .
1 health care facilities to loan professional nursing staff to
2 serve as faculty at approved nursing schools or nursing
3 education programs.
4 Section 11. This act shall take effect in one year. |
|
