Bill Details 188th (2013 - 2014)
An Act patient safety act
Initiative petition of Karen A. Coughlin and others for the passage of An Act patient safety act (House, No. 3843).
|Status:||Referred to Joint Committee on Health Care Financing|
The Commonwealth of Massachusetts
INITIATIVE PETITION OF KAREN A. COUGHLIN AND OTHERS.
OFFICE OF THE SECRETARY.
BOSTON, JANUARY 1, 2014.
Steven T. James
Clerk of the House of Representatives
Boston, Massachusetts 02133
Sir: — I herewith transmit to you, in accordance with the requirements of Article XLVIII of the Amendments to the Constitution, an Initiative Petition for Law entitled “The Patient Safety Act” signed by ten qualified voters and filed with this department on or before December 4, 2013, together with additional signatures of qualified voters in the number of 90,826, being a sufficient number to comply with the Provisions of said Article
WILLIAM FRANCIS GALVIN,
Secretary of the Commonwealth.
AN INITIATIVE PETITION.
Pursuant to Article XLVIII of the Amendments to the Constitution of the Commonwealth, as amended, the undersigned qualified voters of the Commonwealth, ten in number at least, hereby petition for the enactment into law of the following measure:
The Commonwealth of Massachusetts
In the Year Two Thousand and Fourteen.
An Act patient safety act.
Be it enacted by the People, and by their authority, as follows:
Section 1. Chapter 111 of the General Laws is hereby amended by adding the following sections 229 to 235:
Section 229. Definitions
As used in sections 229 through 235 the following words shall have the following meanings:
A patient is said to be assigned to a registered nurse if the registered nurse accepts responsibility for the patient's nursing care.
”Facility”, a hospital licensed under Section 51, of Chapter 111 of the General Laws, the teaching hospital of the University of Massachusetts medical school, any licensed private or state-owned and state-operated general acute care hospital, an acute psychiatric hospital, an acute care specialty hospital, or any acute care unit within a state operated healthcare facility. This definition shall not include rehabilitation facilities or long-term care facilities.
“Health Care Workforce”, personnel employed by or contracted to work at a facility that have an effect upon the delivery of quality care to patients, including but not limited to registered nurses, licensed practical nurses, unlicensed assistive personnel, service, maintenance, clerical, professional and technical workers, or other health care workers.
"Nursing care", care which falls within the scope of practice as defined in Section 80B of chapter 112 of the General Laws or is otherwise encompassed within recognized standards of nursing practice, including assessment, nursing diagnosis, planning, intervention, evaluation and patient advocacy.
Section 230: The maximum number of patients assigned to a registered nurse in a facility shall not exceed the limits enumerated in this section. However, nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits enumerated in this section.
A. In all units with intensive care patients and in all units with critical care patients, the maximum patient assignment is one (1) patient. A registered nurse in such units may accept a second intensive care or critical care patient if that nurse assesses that each patient’s condition is stable.
B. In all units with step-down/intermediate care patients, the maximum patient assignment of step-down/intermediate patients is three (3).
C. In all units with post anesthesia care (PACU) patients the maximum patient assignment of PACU patients under anesthesia is one (1). The maximum patient assignment of PACU patients post anesthesia is two (2).
D. In all units with operating room (OR) patients the maximum patient assignment of OR patients under anesthesia is one (1). The maximum patient assignment of OR patients post anesthesia is two (2).
E. In the Emergency Department:
• The maximum patient assignment of critical care or intensive care patients is one (1). A registered nurse may accept a second critical care or intensive care patient if that nurse assesses that each patient’s condition is stable.
• The maximum patient assignment of urgent non-stable patients is two (2).
• The maximum patient assignment of urgent stable patients is three (3).
• The maximum patient assignment of non-urgent stable patients is four (4).
F. As used in this subsection, couplet shall mean one mother and one baby. In all units with maternal child care patients:
• The maximum patient assignment of active labor patients is one (1) patient.
• The maximum patient assignment during birth is one nurse responsible for the mother and, for each baby, one nurse whose sole responsibility is the baby.
• The maximum patient assignment of immediate postpartum patients is one couplet, and in the case of multiple births, one nurse for each additional baby.
• The maximum patient assignment of postpartum patients is six (6) patients or three (3) couplets.
• The maximum patient assignment of intermediate care babies is three (3) babies. The nurse may accept a fourth intermediate care baby if the nurse assesses that each baby’s condition is stable.
• The maximum patient assignment of well-baby patients is six (6) babies.
G. In all units with pediatric patients the maximum patient assignment of pediatric patients is four (4).
H. In all units with psychiatric patients the maximum patient assignment of psychiatric patients is five (5).
I. In all units with medical, surgical and telemetry patients the maximum patient assignment of medical, surgical and telemetry patients is four (4).
J. In all units with observational/outpatient treatment patients the maximum patient assignment of observational/outpatient treatment patients is four (4).
K. In all units with transitional care patients the maximum patient assignment of transitional care patients is five (5).
L. In all units with rehabilitation patients the maximum patient assignment of rehabilitation patients is five (5).
M. In any unit not otherwise listed the maximum patient assignment is four (4).
Section 231: Each facility shall implement the patient limits established by Section 230 without
diminishing the staffing levels of its health care workforce.
Section 232: The Massachusetts Health Policy Commission shall promulgate regulations governing the implementation and operation of this act.
Section 233: Patient Acuity System. Each facility shall develop a patient acuity system, to determine if the maximum number of patients that may be assigned to a unit’s registered nurses on a particular shift should be lower than the limits specified in Section 230, in which case that lower number will govern for the duration of that shift. The patient acuity system shall be written so as to be readily used and understood by registered nurses, and it shall consider criteria including but not limited to: (1) the need for specialized equipment and technology; (2) the intensity of nursing interventions required and the complexity of clinical nursing judgment needed to design, implement and evaluate patients’ nursing care plans consistent with professional standards of care; (3) the skill mix of members of the health care workforce necessary to the delivery of quality care for each patient; and (4) the proximity of patients, the proximity and availability of other healthcare resources, and facility design. A facility’s patient acuity system shall, prior to implementation, be certified by the Health Policy Commission as meeting the above criteria, and the Commission may issue regulations governing such systems, including their content and implementation.
Section 234: This act shall not be construed to impair any collective bargaining agreement or any other contract in effect as of July 1, 2015 that permits limits that are greater than the limits established by this act but shall have full force and effect upon the earliest expiration date of any such collective bargaining agreement or other contract. Nothing in this act shall prevent the enforcement of terms in a collective bargaining agreement or other contract that provides for lower limits than those established by this act.
Section 235: Enforcement. A facility's failure to adhere to the limits set by Section 230 and adjusted pursuant to Section 233, shall be reported by the Health Policy Commission to the Attorney General for enforcement, for which the Attorney General may bring a Superior Court action seeking injunctive relief and civil penalties. A separate and distinct violation, for which the facility shall be subject to a civil penalty of up to twenty-five thousand dollars, shall be deemed to have been committed on each day during which any violation continues after written notice thereof by the Health Policy Commission to the authority in charge of the facility is received. The requirements of this act, and its enforcement, shall be suspended during a state or nationally declared public health emergency.
Section 2: Severability. The provisions of this law are severable, and if any clause, sentence, paragraph or section of this law or an application thereof shall be adjudged by any court of competent jurisdiction to be invalid, such judgment shall not affect, impair, or invalidate the remainder thereof but shall be confined in its operation to the clause, sentence, paragraph, section or application adjudged invalid and such clause, sentence, paragraph, section or application shall be reformed and construed so that it would be valid to the maximum extent permitted.
Section 3: The provisions of Sections 229 to 235 shall be effective commencing on July 1, 2015, except that regulations required by Section 232 and 233 shall be promulgated to be effective no later than January 1, 2016.
FIRST TEN SIGNERS
NAME RESIDENCE CITY OR TOWN
Karen A. Coughlin 30 Smith Road Mansfield
Karen Ann Higgins 85 Keith Street Weymouth
Donna Kelly-Williams 110 Mary Street Arlington
Katherine Murphy 16 Powder Mill Road Framingham
Karen Powers 235 Pleasant Street Reading
Marie E. Ritacco 13 Sharry Lane Auburn
Donna L. Stern 42 Adams Road, #13 Greenfield
Nora A. Watts 62 Warren Street Westborough
Colleen E. Wolfe 181 Oxford Road Charlton
Susan J. Wright Thomas 2 Christine Road Hull
Summary of 13-06.
This proposed law would limit how many patients could be assigned to a registered nurse in Massachusetts hospitals and certain other health-care facilities, but not rehabilitation or long-term care facilities. The maximum number of patients per registered nurse would be:
• In units with intensive care and critical care patients: 1, or 2 if the nurse assessed each patient’s condition as stable.
• In units with step-down/intermediate care patients: 3.
• In units with post anesthesia care patients: 1 patient under anesthesia; 2 patients post anesthesia.
• In units with operating room patients: 1 patient under anesthesia; 2 patients post anesthesia.
• In the emergency department: 1 critical or intensive care patient, or 2 if the nurse assessed each patient’s condition as stable; 2 urgent non-stable patients; 3 urgent stable patients; or 4 non-urgent stable patients.
• In units with pediatric, medical, surgical, telemetry, or observational/outpatient treatment patients: 4.
• In units with psychiatric, transitional care, or rehabilitation patients: 5.
• In units with maternity patients: (a) active labor patients: 1 per nurse; (b) during birth: 1 mother per nurse, and 1 baby per nurse; (c) immediate postpartum: 1 mother and 1 baby per nurse, and in the case of multiple births, 1 additional baby per nurse; (d) postpartum: 6 patients per nurse; (e) intermediate care: 3 babies per nurse, plus a 4th if the nurse assessed each baby’s condition as stable; (f) well babies: 6 per nurse.
• In any other unit: 4 patients per nurse.
The hospital or other covered facility would have to follow these limits without reducing the staffing levels of other personnel who affect the quality of patient care. The proposed law would not override any collective bargaining agreement or other contract in effect on July 1, 2015 that set higher patient limits, but the proposed law’s limits would take effect after any such agreement or contract expired.
The proposed law would also require a hospital or other covered facility to develop a patient acuity system to decide if the maximum number of patients assigned to a nurse on a particular shift should be lower than the above limits. The patient acuity system would have to be written to be easily used by nurses, and would consider factors such as the need for specialized equipment, the intensity of interventions and complexity of nursing judgments required, the skills of other personnel necessary to deliver quality care to each patient, and the physical proximity of patients and other health care resources. The Health Policy Commission would have to certify the patient acuity system as meeting the above criteria.
The Health Policy Commission would have to report a violation of patient assignment limits to the Attorney General, who could file suit to enforce the proposed law and obtain a civil penalty of $25,000 for each day a violation continued after the Commission notified the hospital or other covered facility. The proposed law’s requirements would be suspended during a state or nationally declared public health emergency. The Commission would issue regulations to implement the proposed law.
The proposed law would take effect on July 1, 2015. The proposed law states that if any of its parts were declared invalid, the other parts would stay in effect.
CERTIFICATE OF THE ATTORNEY GENERAL.
September 4, 2013.
Honorable William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Room 1705
Boston, Massachusetts 02108
RE: Initiative Petition No. 13-06: Patient Safety Act.
Dear Secretary Galvin:
In accordance with the provisions of Article 48 of the Amendments to the Massachusetts Constitution, I have reviewed the above-referenced initiative petition, which was submitted to me on or before the first Wednesday of August of this year.
I hereby certify that this measure is in proper form for submission to the people; that the measure is not, either affirmatively or negatively, substantially the same as any measure which has been qualified for submission or submitted to the people at either of the two preceding biennial state elections; and that it contains only subjects that are related or are mutually dependent and which are not excluded from the initiative process pursuant to Article 48, the Initiative, Part 2, Section 2.
In accordance with Article 48, I enclose a fair, concise summary of the measure.
|1/13/2014||House||Referred to the committee on Health Care Financing|
|3/10/2014||Joint||Hearing scheduled for 03/24/2014 from 11:00 AM-02:00 PM in Gardner Auditorium|
|1/6/2015||House||No further action taken|
Petitioners: Karen A. Coughlin, Karen Ann Higgins, Donna Kelly-Williams, Katherine Murphy, Karen Powers, Marie E. Ritacco, Donna L. Stern, Nora A. Watts, Colleen E. Wolfe, Susan J. Wright Thomas