BILL ANALYSIS
Senate Committee on Labor and Industrial Relations
Carole Migden, Chair
Date of Hearing: March 26, 2008 2007-2008 Regular
Session
Consultant: Alma Perez Fiscal:Yes
Urgency: No
Bill No: SB 1151
Author: Perata
Version: As Introduced February 6, 2008
SUBJECT
Hospitals: lift teams.
KEY ISSUE
Should hospitals be required to have a "zero lift/safe patient
handling policy"?
PURPOSE
To require acute care hospitals to establish a patient
protection and health care worker back injury prevention plan
that shall include a zero lift/safe patient handling policy.
ANALYSIS
Existing law provides a framework for the occupational safety
and health of employees through the state's Division of
Occupational Safety and Health, better known as Cal/OSHA, 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.
A key element of the Cal-OSHA program is the Occupational Safety
and Health Standards Board (OSHSB). The board, a seven-member
body appointed by the Governor, is the standards-setting agency
within the Cal/OSHA program. The Standards Board is responsible
for the adoption of reasonable and enforceable standards, at
least as effective as federal OSHA standards that will ensure a
safe and healthful workplace for California workers.
California employers are required to have a written,
industry-specific illness and injury prevention program (IIPP)
that contains certain mandatory provisions as part of an effort
to reduce workplace injuries.
Labor Code Section 6403 provides that no employer shall fail or
neglect to do any of the following:
a) Provide and use safety devices and safeguards reasonably
adequate to render the employment and place of employment
safe;
b) Adopt and use methods and processes reasonably adequate
to render the employment and place of employment safe;
c) Do every other thing reasonably necessary to protect the
life, safety, and health of employees.
This Bill would require each general acute care hospital, as
defined, to establish a patient protection and health care
worker back and musculoskeletal injury prevention plan which
shall include a zero lift/safe patient handling policy.
Specifically, this bill would require acute care hospitals to do
the following:
Develop its own needs assessment to determine patients
needing lift teams, or specialized equipment for patient
lifts, repositioning, and transfers.
Use a lift team or specialized equipment for patients
identified as being at risk of injury or placing health
care workers at risk of injury while conducting the move.
Provide training to health care workers on the
appropriate use of lift, repositioning, and transfer
devices.
Provide lift team members with specialized training to
assist health care workers, however, lift team members may
Hearing Date: March 26, 2008 SB 1151
Consultant: Alma Perez Page 2
Senate Committee on Labor and Industrial Relations
perform other duties as assigned during their shifts.
Only discipline a health care worker who refuses to lift
a patient, if the worker has been trained on appropriate
patient and equipment lifting procedures and has
appropriate, functional lifting devices and equipment
available to perform the requested lift.
This bill makes several findings and declarations regarding
health care worker injuries. Additionally, this bill provides
definitions to "lift, reposition, and transfer needs
assessment," "lift team," and "zero lift/safe patient handling
policy."
If passed and signed by the Governor, this bill would become
operative on July 1, 2009.
COMMENTS
1. Need for this bill?
According to information gathered by the Bureau of Labor
Statistics (BLS) regarding musculoskeletal disorders (MSDs),
in the year 2000, health care workers suffered 62,332 MSDs.
And in BLS data from 2006, California is leading the nation in
the number of MSDs suffered by its workers. Clearly, back
injuries among health care workers is a problem, and this bill
would help to make sure every acute care hospital has an
injury and illness prevention plan that aims at reducing such
injuries in the workplace. Existing law requires all
employers to have an industry-specific illness and injury
prevention program (IIPP) that contains certain mandatory
provisions, this bill would provide more specific requirements
for hospitals regarding their IIPP.
2. Staff Question:
An emergency lift can be unpredictable and often require
immediate attention. Section 3(f) of the bill references an
exception to the required use of a lift team under an
Hearing Date: March 26, 2008 SB 1151
Consultant: Alma Perez Page 3
Senate Committee on Labor and Industrial Relations
"emergency situation or where specifically contraindicated by
a patient's condition or medical status." Given the
opposition's concern regarding an emergency lift, does the
author feel the language in section 3(f) is clear enough to
allow for a lift under an emergency situation without being in
violation of the law?
3. Staff Comment:
There is no significant difference between this bill and SB
171 (Perata) of last year, which the governor vetoed [see #6
below]. The Legislature's Joint Rule 54c allows
reintroduction and consideration of an identical or
substantially similar bill in the same session if the first
bill has been vetoed, but the reintroduced bill may still
again face a potential veto. The author's office and sponsors
believe the Governor might consider signing the bill this
year.
4. Proponent Arguments :
According to the author, current law requires employers to
have injury and illness prevention programs, however,
healthcare workers, 95% of whom are women, lead the nation in
work-related musculoskeletal disorders (MSDs). The author
argues that California's nursing workforce is aging at the
same time patient acuity and obesity is rising.
According to the sponsor, the California Nurses Association, 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. At a cost of between
$40,000 and $60,000 to train and orient each new nurse,
preventing turn-over from injuries will save hospitals money.
CNA cites the proven effectiveness of lift teams from two
years of data collection on a 500 bed unit referenced in the
book, "Back Injury among Health Care Workers" by William
Hearing Date: March 26, 2008 SB 1151
Consultant: Alma Perez Page 4
Senate Committee on Labor and Industrial Relations
Charney. The studies found that lift teams reduced injury
claims by 69 percent, reduced lost work days by 95 percent,
and reduced average cost per injury due to patient handling
from $9,894 to $1,099. This is a realized cost savings
(direct and indirect) of $690,504. According to the sponsor,
preventing costly, debilitating injuries to patients and
healthcare workers saves millions of dollars in needless costs
to hospitals, taxpayers and injured workers.
5. Opponent Arguments :
The California Hospital Association (CHA) opposes SB 1151
(Perata). CHA states that hospitals are very concerned about
patient and employee safety; however, CHA believes the policy
required by this bill is not reasonable and may be detrimental
to patient care.
CHA argues that under current law, hospitals are required to
"establish, implement and maintain an effective injury
prevention program" and must "correct unsafe and unhealthy
conditions and work practices in a timely manner." According
to CHA, in a hospital setting this obligation requires
hospitals to have a patient lift policy as part of their
injury prevention programs.
CHA is concerned that SB 1151 requires that a lift team or
specialized equipment be used at all times when caring for a
patient identified as having the potential for placing health
care workers at risk of being injured while lifting,
repositioning or transferring the patient. This puts the
hospital in the position of violating law on some occasions
because patient care needs may preclude the use of a lift team
or specialized equipment in emergency and/or unexpected
circumstances. A zero lift/safe patient handling policy would
never allow a patient to be lifted or transferred even in
emergency or unusual circumstances unless it was done by a
lift team or the use of equipment.
According to CHA, minimizing patient lifts and transfers
without the use of a lift team or equipment is desirable.
Eliminating them totally without harm to patients may not be
possible.
Hearing Date: March 26, 2008 SB 1151
Consultant: Alma Perez Page 5
Senate Committee on Labor and Industrial Relations
6. Prior Legislation :
SB 171 (Perata): To the Governor on September 12, 2007
VETOED on October 13, 2007
SB 171 sought to require acute care hospitals to establish a
patient protection and health care worker back injury
prevention plan. In his veto message, the Governor stated
that, "This bill, which imposes a one-size fits all mandate on
hospitals to establish a "zero lift" patient handling policy,
is similar to measures I have vetoed the last three years.
While I continue to support the goal of reducing workplace
injuries, I remain convinced that this inflexible mandate is a
poor alternative to giving hospitals the flexibility needed to
achieve this goal in the manner that most efficiently
addresses each hospital's needs and resources."
SB 1204 (Perata): To the Governor on September 12, 2006
VETOED on September 29, 2006
SB 1204 sought to require each general acute care hospital to
establish a health care worker back injury prevention plan.
In his veto message, the Governor stated that, "Since my veto
message of last year, hospitals of all sizes from throughout
the state have reported on progress made in implementing lift
policies. I applaud their efforts and encourage the continued
development of these policies. I believe this is proof that
allowing hospitals the flexibility to implement lift policies
that meet their individual needs is far more effective than
imposing a rigid one-size-fits-all mandate on every hospital
in California."
SB 363 (Perata): To the Governor on September 17, 2005
VETOED on September 29, 2005
SB 363 sought to require general acute care hospitals, except
rural ones, to provide "lift teams" to assist health care
workers in lifting patients. In his veto message, the
Governor stated that the bill, "imposes a one-size-fits-all
mandate on hospitals to establish a zero lift policy requiring
teams and the use of equipment to lift patients," he went
further to say, "If hospitals do not initiate these measures
on their own, I will consider legislation next year that
imposes the mandate."
Hearing Date: March 26, 2008 SB 1151
Consultant: Alma Perez Page 6
Senate Committee on Labor and Industrial Relations
AB 2532 (Hancock): To the Governor on September 17, 2004
VETOED on September 22, 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 his veto message, the
Governor 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."
SB 1151 (Perata) in this session, is the fifth attempt to
address the issue of requiring lift teams at acute care
hospitals. This bill does not differ (for the exception of one
word) from SB 171 (Perata) of last year.
SUPPORT
California Nurses Association (CNA) - Sponsor
American Federation of State, County and Municipal Employees,
AFL-CIO
California Applicants' Attorneys Association (CAAA)
California Labor Federation, AFL-CIO
United Nurses Association of California/Union of Health Care
Professionals (UNAC/UHCP)
OPPOSITION
California Hospital Association (CHA)
* * *
Hearing Date: March 26, 2008 SB 1151
Consultant: Alma Perez Page 7
Senate Committee on Labor and Industrial Relations