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AB-2604 Public health: pandemic protocols.(2019-2020)

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Date Published: 05/06/2020 09:00 PM
AB2604:v98#DOCUMENT

Amended  IN  Assembly  May 06, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 2604


Introduced by Assembly Member Carrillo

February 20, 2020


An act to add Article 2.7 (commencing with Section 2820) to Chapter 2 of Division 3 of the Labor Code, relating to employment. 12 (commencing with Section 1339.60) to Chapter 2 of Division 2 of the Health and Safety Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


AB 2604, as amended, Carrillo. Employment: health information technology: worker rights. Public health: pandemic protocols.
Existing law provides for the licensure of health facilities by the State Department of Public Health. Existing law requires a health facility to comply with specified infection control protocols, including reporting specified infections to the department and having a health facility infection control officer or their designee available 24 hours per day. A violation of the licensing requirements for health facilities is a crime.
This bill would require a health facility to limit the possible introduction of the pathogen, infection, or illness that is the subject of a declared pandemic or health-related state of emergency or local emergency into the facility by indefinitely postponing routine medical appointments and prohibiting visitor access, as specified. The bill would also require a health facility to institute universal precautions based on scientific evidence and universal source control procedures to reduce potential for transmission of the pathogen, infection, or illness within the whole facility by implementing specified protocols, including establishing a contaminated zone, a potentially contaminated zone, and a clean zone, with separate passageways from each zone. Because a violation of the bill’s provisions would be a crime, 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 no reimbursement is required by this act for a specified reason.

Existing law authorizes the Labor Commissioner to investigate employee complaints and determine various matters arising under the labor commissioner’s jurisdiction.

This bill would provide that the use of technology shall not limit a worker who is providing direct patient care from exercising independent clinical judgment in the assessment, evaluation, planning and implementation of care, nor from acting as a patient advocate. The bill would define “technology” for these purposes to mean scientific hardware or software including algorithms derived from the use of health care related data, used to achieve a medical or nursing care objective at a health care facility. The bill would authorize each worker who provides direct patient care to be free to override health information technology and clinical practice guidelines if, in their professional judgment, and in accordance with their scope of practice, it is in the best interest of the patient to do so. The bill would prohibit an employer from retaliating or otherwise discriminating against a worker providing direct patient care who requests to override health information technology and clinical practice guidelines or discusses with other employees or supervisors overriding health information technology and clinical practice guidelines, or both. The bill would authorize a worker who is subject to retaliation to file a complaint with the Labor Commissioner against an employer who has retaliated or discriminated against the employee.

This bill would also require each employer to notify all workers who provide direct patient care, and if subject to a collective bargaining agreement, their representatives, before implementing new information technology that materially affects the jobs of the workers or their patients. The bill would also require each employer to ensure that appropriate education or training be provided to workers providing direct patient care for purposes of educating or training those workers on how to utilize the new technology and to understand its limitations. The bill would require health care facilities to provide opportunities for workers providing direct patient care in the affected clinical areas to participate in the design, building, and validation process for new technology impacting patient care delivery consistent with certain criteria, as provided.

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

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


SECTION 1.

 Article 12 (commencing with Section 1339.60) is added to Chapter 2 of Division 2 of the Health and Safety Code, to read:
Article  12. Pandemic and Health-Related Emergency Protocols for Health Facilities

1339.60.
 This article shall be known, and may be cited, as the Pandemic and Health-Related Emergency Protocols for Health Facilities Act.

1339.61.
 During a declared pandemic or health-related state of emergency or local emergency, as defined in Section 8558 of the Government Code, a health facility, as defined in subdivision (a) of Section 1250, shall limit possible introduction of the pathogen, infection, or illness that is the focus of the pandemic or emergency into the health facility by doing both of the following:
(a) Postpone indefinitely an appointment for routine medical care that may be delayed without undue risk to the current or future health of the patient, including an annual physical or elective surgery.
(b) Prohibit visitor access. An exception shall be made for all of the following:
(1) A pediatric patient, who shall be entitled to two identified support persons who shall not visit the patient at the same time.
(2) A labor and delivery patient, who shall be entitled to one identified support person.
(3) An end-of-life visit, as reasonable.
(4) Another extraordinary circumstance, as medically safe and appropriate to protect patient safety.

1339.62.
 During a declared pandemic or health-related state of emergency or local emergency, as defined in Section 8558 of the Government Code, a health facility, as defined in subdivision (a) of Section 1250, shall institute universal precautions based on scientific evidence and universal source control procedures to reduce potential for transmission of the pathogen, infection, or illness that is the focus of the pandemic or emergency based on within the whole facility by doing all of the following:
(a) Ensure all patients and staff are always wearing surgical masks, except when a higher level of personal protective equipment (PPE) is indicated per the aerosol transmissible disease standards in Section 5199 of Title 8 of the California Code of Regulations, as that section read on April 28, 2020.
(b) Ensure thorough education and enforcement regarding hand hygiene and cough etiquette for patients and staff.
(c) Ensure consistent and regular environmental cleaning and disinfection, including disinfection of floors, walls, furniture, surfaces, and objects at least three times per day with cleaning chemicals that contain a disinfectant known to be effective against the pathogen, infection, or illness that is the subject of the pandemic or emergency.
(d) Add air cleaning equipment to ventilation systems, including ultraviolet cleaners and High Efficiency Particulate Air filter units.
(e) Establish three zones within the health facility using the “three zones, two passages” model to prevent transmission.
(1) The three zones, a contaminated zone, a potentially contaminated zone, and a clean zone, shall be clearly demarcated, with two buffer zones between the contaminated zone and potentially contaminated zone.
(2) A health facility shall have dedicated teams who only work in one particular zone.
(3) A separate passageway shall be established for each zone strictly for the one-way transport of items directly from that zone.
(4) A health facility shall implement strict procedures for donning and doffing PPE between zones, which shall include hands on training, full-length mirrors, and observation by trained personnel. Dedicated walkways shall be used to prevent transmission and contamination between zones.
(5) A health facility shall tightly control transport of patients and health workers through the facility to prevent transmission and contamination.
(f) Implement outdoor triage where patients are promptly triaged and sent to the appropriate zone to prevent transmission within crowded waiting rooms.
(g) Monitor all entrances to the facility and consider limiting public access by reducing the number of entrances.
(h) Consider all patients to have “suspected cases” of the pathogen, infection, or illness until confidently ruled out or confirmed.

SEC. 2.

 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 are the result of a program for which legislative authority was requested by that local agency or school district, within the meaning of Section 17556 of the Government Code and Section 6 of Article XIII B of the California Constitution.
SECTION 1.

(a)It is the intent of the Legislature that health information technology, clinical practice guidelines, or algorithms shall not limit the effective exercise of, or be a substitute for, the professional judgment of workers providing direct patient care. This is crucial to protect millions of patients’ safety in interacting with a deeply flawed medical technological system, that among many issues, has shown their commercial algorithms exhibit significant racial bias.

(b)It is also the intent of the Legislature that new technology will continue to permit the exercise of professional clinical judgment in providing patient care and patient advocacy by workers providing direct patient care. Clinical technology is intended to complement, not diminish, skills, judgment, and decisionmaking. Professional judgment, not algorithms, shall determine the care needed by patient populations or individuals.

SEC. 2.Article 2.7 (commencing with Section 2820) is added to Chapter 2 of Division 3 of the Labor Code, to read:
2.7.Health Information Technology: Worker Rights
2820.

(a)For purposes of this article, “technology” means scientific hardware or software including algorithms derived from the use of health care-related data, used to achieve a medical or nursing care objective at a health care facility.

(b)Use of technology shall not limit a worker who is providing direct patient care from exercising independent clinical judgment in assessment, evaluation, planning and implementation of care, nor from acting as a patient advocate. New technology shall not be used to replace the worker’s role in delivery of care to patients.

(c)Each worker who provides direct patient care shall be free to override health information technology and clinical practice guidelines if, in their professional judgment, and in accordance with their scope of practice, it is in the best interest of the patient to do so.

(d)An employer shall not retaliate or otherwise discriminate against a worker providing direct patient care who requests to override, or who discusses with other employees or supervisors about overriding, health information technology and clinical practice guidelines. A worker who is subject to retaliation or discrimination has the right under this article to file a complaint with the Labor Commissioner against an employer who retaliates or discriminates against the employee.

(e)Each employer shall notify all workers who provide direct patient care and, if subject to a collective bargaining agreement, their representatives prior to implementing new information technology that materially affects the job of the workers or their patients.

(f)(1)Each employer shall ensure that appropriate education or training is provided to its workers that provide direct patient care for purposes of educating or training those workers on how to utilize the new technology and to understand its limitations.

(2)The worker’s patient care assignment shall be taken into consideration when determining the appropriate method for training on new technology.

(g)Health care facilities shall provide opportunities for workers providing direct patient care in the affected clinical areas to participate in the design, building, and validation process for new technology impacting patient care delivery, consistent with the following:

(1)Representatives of a health care facilities professional practice committee shall be entitled to recommend measures to improve the delivery of safe, therapeutic, equitable, and effective care in conjunction with the use of new technology. Representatives of a health care facilities professional practice committee shall also be entitled to participate in the selection, design, building, and validation processes whenever new technology affecting the delivery of medical or nursing care is being considered.

(2)When sharing technology, employers shall protect patient’s private medical information in accordance with the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191), known as HIPAA, and all other relevant privacy laws.