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SB-768 Hepatitis A pilot project: County of San Diego.(2019-2020)

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Date Published: 03/27/2019 09:00 PM
SB768:v98#DOCUMENT

Amended  IN  Senate  March 27, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 768


Introduced by Senator Hueso

February 22, 2019


An act to amend Section 1276.4 add and repeal Part 8 (commencing with Section 122480) of Division 105 of the Health and Safety Code, relating to health facilities. public health.


LEGISLATIVE COUNSEL'S DIGEST


SB 768, as amended, Hueso. Health facilities: nurse-to-patient ratio. Hepatitis A pilot project: County of San Diego.
Existing law contains various programs relating to communicable disease prevention, including certain programs related to hepatitis B and hepatitis C, as specified.
This bill would require the County of San Diego to operate a 3-year pilot program for the purpose of providing general health care outreach and triage care for the homeless population in the County of San Diego, including providing specific outreach and vaccinations against hepatitis A. The bill would require the County of San Diego’s local health department to be the lead agency for the pilot project and would require the local health department to provide public health nurses at homeless shelters in the County of San Diego and to establish a mobile health unit to be dispatched for purposes of assisting public health nurses in providing health-related services to homeless individuals outside of the shelter setting. The bill would require the local public health department to establish a written public health care outreach, triage care, and vaccination policy for the pilot project and would require the local public health department to work in conjunction with the County of San Diego’s local social services department and local mental health department for purposes of achieving the goals of the pilot project. The bill would repeal those provisions on January 1, 2023.
By imposing new duties on the County of San Diego, the 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. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
This bill would make legislative findings and declarations as to the necessity of a special statute for the County of San Diego.

Existing law provides for the licensure and regulation of health facilities, including hospitals, by the State Department of Public Health. Existing law requires the department to adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for all health facilities.

This bill would make technical, nonsubstantive changes to those provisions.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NOYES  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) The County of San Diego is the second most populous county in the state, with an estimated population of 3,300,000 residents as of January 2018.
(b) In 2017, the County of San Diego suffered an outbreak of hepatitis A, that, according to the County of San Diego’s Health and Human Services, resulted in at least 590 cases of hepatitis A 405 hospitalizations, and 20 deaths as of July 12, 2018.
(c) Hepatitis A is a highly contagious liver infection that is spread person to person via feces-contaminated material.
(d) According to the County of San Diego’s May 2018 Hepatitis A Outbreak After Action Report, the county detected the hepatitis A virus outbreak in early March 2017. The county determined that the outbreak primarily affected people who were homeless or using illicit drugs. On September 1, 2017, the County of San Diego’s Health and Human Services declared a local health emergency, and in October of 2017, the Governor declared a state of emergency for all of California and ordered that all measures necessary should be taken to obtain hepatitis A vaccines.

SEC. 2.

 Part 8 (commencing with Section 122480) is added to Division 105 of the Health and Safety Code, to read:

PART 8. Hepatitis A Pilot Project

122480.
 (a) The County of San Diego shall operate a three-year pilot program for the purpose of providing general health care outreach and triage care for the homeless population in the County of San Diego, including providing specific outreach and vaccinations against hepatitis A.
(b) The County of San Diego’s local health department shall be the lead agency for the pilot project and shall do both of the following:
(1) Provide public health nurses at homeless shelters in the County of San Diego.
(2) Establish a mobile health unit to be dispatched for purposes of assisting public health nurses in providing health-related services to homeless individuals outside of the shelter setting.

122481.
 The County of San Diego’s local health department shall establish a written public health care outreach, triage care, and vaccination policy for the pilot project, which shall, at a minimum, require procedures and protocols for follow-up care, including the linkage to any appropriate supports and services to improve health and behavioral health outcomes for homeless individuals. The written policy shall also include protocols for specific triage and treatment services for individuals who are likely experiencing, or who are at risk for experiencing, mental health illness or cooccurring mental health and substance use disorders.

122482.
 (a) The County of San Diego’s local health department shall work in conjunction with the county’s local social services department and local mental health department for purposes of achieving the goals of the pilot project, particularly as it relates to the establishment and staffing of the mobile health unit.
(b) The pilot project shall be implemented in conjunction with other existing outreach, triage, or vaccination programs already undertaken by the County of San Diego.

122483.
 This part shall remain in effect only until January 1, 2023, and as of that date is repealed.

SEC. 3.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.

SEC. 4.

 The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique public health concerns within the County of San Diego as a result of its large homeless population and the recent outbreak of hepatitis A in 2017, which resulted in at least 590 cases of hepatitis A, 405 hospitalizations, and 20 deaths in the County of San Diego as of July 12, 2018.
SECTION 1.Section 1276.4 of the Health and Safety Code is amended to read:
1276.4.

(a)By January 1, 2002, the State Department of Public Health shall adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for all health facilities licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The department shall adopt these regulations in accordance with the department’s licensing and certification regulations as stated in Sections 70053.2, 70215, and 70217 of Title 22 of the California Code of Regulations, and the professional and vocational regulations in Section 1443.5 of Title 16 of the California Code of Regulations. The department shall review these regulations five years after adoption and shall report to the Legislature regarding any proposed changes. Flexibility shall be considered by the department for rural general acute care hospitals in response to their special needs. As used in this subdivision, “hospital unit” means a critical care unit, burn unit, labor and delivery room, postanesthesia service area, emergency department, operating room, pediatric unit, step-down/intermediate care unit, specialty care unit, telemetry unit, general medical care unit, subacute care unit, and transitional inpatient care unit. The regulation addressing the emergency department shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to care for critical care patients in the emergency department.

(b)These ratios shall constitute the minimum number of registered and licensed nurses that shall be allocated. Additional staff shall 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.

(c)“Critical care unit” as used in this section means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring and complex intervention by licensed nurses.

(d)A health facility licensed under subdivision (a), (b), or (f) of Section 1250 shall adopt written policies and procedures for training and orientation of nursing staff.

(e)A registered nurse shall not be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area, and has demonstrated current competence in providing care in that area.

(f)The written policies and procedures for orientation of nursing staff shall require that all temporary personnel receive orientation and be subject to competency validation consistent with Sections 70016.1 and 70214 of Title 22 of the California Code of Regulations.

(g)Requests for waivers to this section that do not jeopardize the health, safety, and well-being of patients affected and that are needed for increased operational efficiency may be granted by the department to rural general acute care hospitals meeting the criteria set forth in Section 70059.1 of Title 22 of the California Code of Regulations.

(h)In case of conflict between this section and any provision or regulation defining the scope of nursing practice, the scope of practice provisions shall control.

(i)The regulations adopted by the department shall augment and not replace existing nurse-to-patient ratios that exist in regulation or law for the intensive care units, the neonatal intensive care units, or the operating room.

(j)The regulations adopted by the department shall not replace existing licensed staff-to-patient ratios for hospitals operated by the State Department of State Hospitals.

(k)The regulations adopted by the department for health facilities licensed under subdivision (b) of Section 1250 that are not operated by the State Department of State Hospitals shall take into account the special needs of the patients served in the psychiatric units.

(l)The department may take into consideration the unique nature of the University of California teaching hospitals as educational institutions when establishing licensed nurse-to-patient ratios. The department shall coordinate with the Board of Registered Nursing to ensure that staffing ratios are consistent with the Board of Registered Nursing approved nursing education requirements. This includes nursing clinical experience incidental to a work-study program rendered in a University of California clinical facility approved by the Board of Registered Nursing provided there will be sufficient direct care registered nurse preceptors available to ensure safe patient care.