BILL ANALYSIS
Senate Committee on Labor and Industrial Relations
Richard Alarcon, Chair
Date of Hearing: April 13, 2005 2005-2006 Regular
Session
Consultant: Alma Perez Fiscal:Yes
Urgency: No
Bill No: SB 363
Author: Perata
Version: February 17, 2005
Subject: Hospitals: lift teams.
Purpose:
This bill would require each general acute care hospital,
except rural general acute hospitals, to establish a health
care worker back injury prevention plan which will include
identifying the need of lift teams and devices for all
shifts.
Analysis:
Existing Law provides a framework for the occupational
safety and health of employees through the state's Cal-OSHA
program in the Department of Industrial Relations. The
California Occupational Safety and Health Act of 1973,
establishes certain safety and other responsibilities of
employers and employees, including, but not limited to, the
requirement that no employer shall fail or neglect to
provide safety devices or safeguards reasonably necessary
to render the employment safe.
Employers must have an industry-specific illness and injury
prevention program (IIPP) that contains certain mandatory
provisions as part of an effort to reduce workplace
injuries.
A key element of the Cal-OSHA program is the Occupational
Safety and Health Standards Board. Under the enforcement
of the Division of Occupational Safety and Health (DOSH),
the board is responsible for the adoption of reasonable and
enforceable standards at least as effective as federal OSHA
standards.
Willful or repeated violations are a crime, and are subject
to criminal and civil penalties.
This Bill would require each general acute care hospital,
except rural general acute hospitals, to establish a health
care worker back injury prevention plan which will include
identifying the need of lift teams and devices for all
shifts. Specifically, this bill would:
1) Require each hospital to conduct a needs assessment
that utilizes a lifting and transferring process
identifying patients needing lift teams, lifting
devices, and lifting equipment.
2) Require hospitals to implement a "zero lift policy"
for all shifts for patients identified pursuant to
subdivision (a), thus requiring the use of lift teams,
lifting devices and lifting equipment.
3) Require lift team members be given specialized
training to assist health care workers throughout the
hospital; however, nothing precludes lift team members
from performing other duties.
4) Require each general acute care hospital to provide
training to health care workers on the appropriate use
of lifting devices and equipment.
5) Provide that a health care worker who refuses to
lift a patient would not be disciplined, unless the
worker had been trained on appropriate patient and
equipment lifting procedures and has appropriate,
functional lifting devices and equipment available to
perform the requested lift.
By changing the definition of a crime, this bill would
impose a state-mandated local program. The California
Constitution requires the state to reimburse local agencies
and school districts for certain costs mandated by the
state. However, this bill would provide that no
reimbursement is required by this act for a specified
reason.
Hearing Date: April 13, 2005 SB
363
Consultant: Alma Perez
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Senate Committee on Labor and Industrial Relations
Comments:
1. Proponents :
According to sponsor, the California Nurses Association
(CNA), healthcare workers, 95% of whom are women, lead
the nation in work-related musculoskeletal disorders
(MSDs). In 1999, the Bureau of Labor Statistics (BLS)
identified "health care patient" as the source of 59,002
MSDs. In 2000, BLS data showed that CNAs, RNs, and LPNs
together suffered 62,332 MSDs; 17,005 more than truck
drivers listed as number one with 45,327 MSDs.
Healthcare workers equaled 138%, above "first place" for
work-related MSDs.
California's nursing workforce is aging at the same time
patient acuity and obesity is rising. CNA estimates a
cost of between $40,000 and $60,000 to train and orient
each new nurse, thus, preventing turn-over from injuries
to save hospitals money. The Nurses Association also
notes that, "Back Injury Prevention Plans will also
create an incentive for new nurses to work in the
hospital setting."
At Kaiser Permanente, since the implementation of special
two-person lift teams specifically trained to handle the
increase of heavy patients, they have seen a 46 percent
reduction in nursing staff injuries in the second quarter
of this year. At the University of California, in 2003
there were 723 such injuries. A conservative calculation
shows that these injuries cost the University between $8
and $11 million dollars in workers compensation costs and
lost time and replacement costs, making a zero lift
policy smart business.
According to proponents, a recent study found that 52
percent of all nurses complain of chronic back pain, and
another study found that 12 percent of nurses who are
leaving the profession cite back injuries as the main, or
a contributing factor.
Hearing Date: April 13, 2005 SB
363
Consultant: Alma Perez
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Senate Committee on Labor and Industrial Relations
2. Opponents :
The California Hospital Association (CHA) opposes this
measure, arguing that the financial situation of
hospitals confronted with every un-funded mandate,
either puts hospitals closer to performing with a
negative margin or increases the already negative
margin.
CHA must function under the current guidelines of the
Cal-OSHA program and fear that developing another,
separate plan, may only serve to cause confusion. CHA
also argues that every hospital's patient needs and
resources are different; therefore, each hospital
should be allowed to develop whatever approach works
best.
Both CHA and the University of California (UC) argue
that waiting for a special lift team to move a patient
is not always practical since in many situations time
does not allow for a planned lift. Demanding that a
lift team be used whenever a patient is moved could
place the patient in unsafe circumstances and would be
detrimental to safe patient care.
Hospitals do not wish to have injured employees and
recognize the challenge in finding a replacement for
the duration of the health workers injury. Registered
nurses, licensed vocational nurses and other
professionals are difficult and expensive to recruit,
however, hospitals must already abide by the Cal-OSHA
requirements and have multiple safety programs in
place to assure injuries do not occur.
The California Hospital Association views this
legislation as unnecessary and one that will only
serve to increase the cost of health care.
For the University of California (UC) academic medical
centers, this new mandate would divert existing
Hearing Date: April 13, 2005 SB
363
Consultant: Alma Perez
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Senate Committee on Labor and Industrial Relations
personnel away from direct patient care duties and
redirect resources away from progressive interventions
that better meet the objective of decreasing injuries
associated with patient lifting. To avoid placing
employees at risk, UC's academic medical centers have
adopted several state-of-the-art alternatives to the
traditional lift team concept.
3. Prior Legislation : AB 2532 (Hancock) was passed by
the legislature to the governor on September 17, 2004.
AB 2532 sought to require general acute care
hospitals, except rural ones, to provide "lift teams"
to assist health care workers in lifting patients, in
addition to legislative findings and declarations.
Specifically this bill would (1) required each
hospital to adopt a back injury prevention plan, (2)
require hospitals to provide at least one designated
lift team for each shift, (3) require hospitals to
provide lifting devices and equipment, and (4) provide
that a health care worker who refuses to lift a
patient due to safety concerns and the lack of trained
lift team personnel and equipment, may not be the
subject of disciplinary action.
AB 2532 was vetoed by Governor Arnold Schwarzenegger
on September 22, 2004. In his veto message Governor
Schwarzenegger stated that, "Because I am concerned
about the financial burden hospitals are already
under, I cannot support the costly mandate imposed on
them by AB 2532," however, he believes that "the goal
of having all hospitals implement a standardized lift
policy that includes lift teams and modern equipment
is laudable."
Support:
California Nurses Association (Sponsor)
American Nurses Association of California
California Applicants' Attorneys Association
Hearing Date: April 13, 2005 SB
363
Consultant: Alma Perez
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Senate Committee on Labor and Industrial Relations
California Labor Federation, AFL-CIO
Consumer Attorneys of California
United Nurses Associations of California/Union of Health
Care Professionals, AFSCME
Opposition:
California Chamber of Commerce
California Hospital Association
MemorialCare Medical Centers
University of California
* * *
Hearing Date: April 13, 2005 SB
363
Consultant: Alma Perez
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Senate Committee on Labor and Industrial Relations