California Senate Bill SB1318 Amended / Bill

 BILL NUMBER: SB 1318AMENDED BILL TEXT AMENDED IN SENATE MAY 25, 2012 AMENDED IN SENATE APRIL 11, 2012 INTRODUCED BY Senator Wolk  (   Coauthor:   Senator   Anderson   )  FEBRUARY 23, 2012 An act to amend, repeal, and add Section 1288.7 of, and to add  Section   Sections 1228.3,  1228.5  , and 1288.65  to, the Health and Safety Code, relating to infectious diseases. LEGISLATIVE COUNSEL'S DIGEST SB 1318, as amended, Wolk. Health facilities: influenza vaccinations. Existing law imposes on the State Department of Public Health various duties and responsibilities regarding the regulation of clinics and health facilities, including general acute care hospitals, as defined. Existing law requires a general acute care hospital to annually offer onsite influenza vaccinations, if available, to all hospital employees. Existing law requires a general acute care hospital to require its employees to be vaccinated, or if the employee elects not to be vaccinated, to declare in writing that he or she declined the vaccination. A violation of these provisions is punishable as a misdemeanor.  This bill would require licensed clinics and health facilities to institute measures, including aerosol transmissible diseases training, designed to maximize influenza vaccination rates and to prevent onsite health care workers affiliated with the clinic or health facility and persons with privileges on the medical staff from contracting, and transmitting to patients, the influenza virus.  This bill would require, commencing  July 1, 2013   January 1, 2015  , each clinic and health facility to annually offer onsite influenza vaccinations to its employees and to require its  employees, contractors, students, volunteers, persons with privileges on the medical staff, and other  onsite health care workers affiliated with the clinic or health facility, as defined,  and persons with privileges on the medical staff, as defined,  to be vaccinated. This bill would require  each of the above-listed persons who has received a vaccination from another health facility to present verification to the clinic or health facility. This bill would require each of the above-listed persons who elects not to be vaccinated or does not provide proof of vaccination to wear a clinic- or health facility-provided protective mask, as specified, while serving his or her duties at the clinic or health facility during the influenza season   licensed clinics and health facilities to maintain vaccination records of their employees and permit licensed clinics and health facilities to require documentation of vaccination or vaccination refusal from an onsite health care worker or person with privileges on the   medical staff  . By expanding the definition of a crime, this bill would impose a state-mandated local program. This bill would also require, on and after  July 1, 2013   January 1, 2015  , each clinic and health facility to develop policies to  implement these provisions and to  ensure nonmedical staff, as defined  ,  compliance with vaccination requirements. This bill would require, on and after that date, the medical staff to develop separate policies to ensure compliance with vaccination requirements  imposed by the clinic or health facility. This bill would require clinics and health facilities to report their percentage of employees and medical staff and of medical staff who have been vaccinated for that year to the State Department of Public Health. This bill would provide that a clinic or health facility that reports a combined average of 90% or higher   vaccination rate for its employees and medical staff shall not be subject to specified implementation and compliance requirements  . 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. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:  SECTION 1.   The Legislature hereby declares that mandatory mask-wearing policies for health care workers who have not been immunized have proven effective to increase vaccination rates in health care workers. While studies have not yet proven that masking is effective to protect transmission of influenza in the asymptomatic phase of the influenza illness, wearing a mask has proven effective in preventing the transmission of other respiratory pathogens.   SEC. 2.   Section 1228.3 is added to the   Health and Safety Code   , to read:   1228.3. (a) A licensed clinic shall institute measures designed to maximize influenza vaccination rates and to prevent persons with privileges on the medical staff and onsite health care workers affiliated with the clinic from contracting, and transmitting to patients, the influenza virus to patients. These measures shall include, but not be limited to, aerosol transmissible diseases training as described in Section 5199(i) of Title 8 of the California Code of Regulations, as in effect on January 1, 2013. (b) For purposes of this section, the following definitions shall apply: (1) "Medical staff" shall have the same meaning provided in Section 1228.5. (2) "Onsite health care worker affiliated with the clinic" shall have the same meaning provided in Section 1228.5. (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement this section by sending letters or similar instruction to all applicable facilities without taking regulatory action.   SECTION 1.   SEC. 3.  Section 1228.5 is added to the Health and Safety Code, to read: 1228.5. (a) A  licensed  clinic shall annually offer its employees onsite influenza vaccinations, if available, at no cost to the employee. (b) A  licensed  clinic shall require all  employees, contractors, students, volunteers, persons with privileges on the medical staff, and all other  onsite health care workers affiliated with the clinic  and persons with privileges on the medical staff  to either annually receive an influenza vaccination or, as an alternative to the annual influenza vaccination, wear a clinic-provided surgical or procedural mask, or other mask that covers the mouth and nose area of the face  ,  while this person is performing his or her duties in any patient care area of the clinic during the influenza season, as defined by the State Health Officer or a local health officer, or both. (c)  (1)    In meeting the requirements of subdivision (b), the clinic shall maintain influenza vaccination records of  employees, contractors, students, volunteers, persons with privileges on the medical staff, and all other onsite health care workers affiliated with the clinic who were vaccinated onsite or offsite   employees and may maintain influenza vaccination records of the other onsite health care workers affiliated with, but not an employee of, the clinic and of persons with privileges on the medical staff  . If the clinic does not have records of  a   an onsite health care  worker  or person with privileges on the medical staff  being vaccinated onsite, the clinic  shall   may  require the worker  or medical staff person  to either provide documentation of  an offsite  vaccination or documentation that he or she refused the vaccination.  (2) The clinic may include language in its business contracts to require a contract worker to maintain records of the verification of offsite vaccination or documentation that he or she refused the vaccination, which shall be available to the clinic upon request. Nothing in this section shall be construed to require a clinic to maintain separate vaccination records or to provide vaccinations at no cost to a contract worker who is not an employee of the clinic.  (d) Each  licensed  clinic shall develop policies to  implement this section and to  ensure its  employees, contractors, students, volunteers, and other  onsite health care workers affiliated with the clinic  , not including medical staff,  are in compliance with the vaccination requirements imposed by this section. The medical staff shall  also  develop policies  independent of the policies established by the clinic  to ensure that persons who have privileges on the medical staff are in compliance with the vaccination requirements of this section  that have been implemented by the clinic  .  (e) Nothing in this section shall be construed to prevent a clinic from instituting additional measures to maximize influenza vaccination rates and to prevent health care workers affiliated with the clinic from contracting and transmitting the influenza virus.   (f)   (e)  For purposes of this section, the following definitions shall apply:  (1) "Health   (1) "Employee" means an individual who works for the clinic, is listed on the clinic's payroll records, and is under the clinic's direction and control.  (2) "Medical staff" means professional medical personnel who are approved and given privileges to provide health care to patients while onsite in a clinic and who are responsible for the adequacy and quality of care rendered to patients. Medical staff includes, but is not limited to, physicians and surgeons, and, if dental or podiatric services are provided, dentists or podiatrists.   (3)     "Onsite health  care worker affiliated with the clinic" means a person who is either a volunteer or is employed by, paid by, or receives credit or any other form of compensation from the  clinic.Health   clinic, who performs some or all of his or her duties in a patient care area of the facility. The patient care area of the facility shall be determined by the clinic and is where onsite health care workers and medical staff are within close proximity to patients receiving care. An onsite health  care worker affiliated with the clinic includes, but is not limited to,  employees,  physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees,  and  contractual staff  , and registry staff who perform direct patient care duties but are  not employed by the clinic.  (2) "Medical staff" means professional medical personnel who are approved and given privileges to provide health care to patients in a clinic and who are responsible for the adequacy and quality of care rendered to patients. Medical staff include physicians and surgeons, and, where dental or podiatric services are provided, dentists or podiatrists.   (f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement this section by sending letters or similar instruction to all applicable facilities without taking regulatory action.   (g) A clinic shall annually report its average vaccination compliance rate for onsite health care workers who are employees and of medical staff who have been vaccinated for that year to the State Department of Public Health.   (h) This section, with the exception of the reporting requirement of subdivision (g), shall not apply to a clinic that have a combined average vaccination compliance rate of 90 percent or higher for its onsite health care workers who are employees and medical staff.   (g)   (i)  This section shall become operative on  July 1, 2013   January 1, 2015  .  SEC. 4.   Section 1288.65 is added to the   Health and Safety Code   , to read:   1288.65. A licensed health facility shall institute measures designed to maximize influenza vaccination rates and to prevent persons with privileges on the medical staff and onsite health care workers affiliated with the health facility from contracting, and transmitting to patients, the influenza virus. These measures shall include, but not be limited to, aerosol transmissible diseases training, as described in Section 5199(i) of Title 8 of the California Code of Regulations, as in effect January 1, 2013. (b) For purposes of this section, the following definitions shall apply: (1) "Medical staff" means professional medical personnel who are approved and given privileges to provide health care to patients in a health facility and who are responsible for the adequacy and quality of care rendered to patients. Medical staff includes, but is not limited to, physicians and surgeons, and, if dental or podiatric services are provided, dentists or podiatrists. (2) "Onsite health care worker affiliated with the health facility" means a person who is either a volunteer or is employed by, paid by, or receives credit or any other form of compensation from the health facility, who performs some or all of his or her duties in a patient care area of the facility. The patient care area of the facility shall be determined by the health facility and is where onsite health care workers and medical staff are within close proximity to patients receiving care. An onsite health care worker affiliated with the health facility includes, but is not limited to, employees, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff, and registry staff who perform direct patient care duties but are not employed by the health facility. (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement this section by sending letters or similar instruction to all applicable facilities without taking regulatory action.   SEC. 2.   SEC. 5.  Section 1288.7 of the Health and Safety Code is amended to read: 1288.7. By July 1, 2007, the department shall require that each general acute care hospital, in accordance with the Centers for Disease Control and Prevention guidelines, take all of the following actions: (a) Annually offer onsite influenza vaccinations, if available, to all hospital employees at no cost to the employee. Each general acute care hospital shall require its employees to be vaccinated, or if the employee elects not to be vaccinated, to declare in writing that he or she has declined the vaccination. (b) Institute respiratory hygiene and cough etiquette protocols, develop and implement procedures for the isolation of patients with influenza, and adopt a seasonal influenza plan. (c) Revise an existing or develop a new disaster plan that includes a pandemic influenza component. The plan shall also document any actual or recommended collaboration with local, regional, and state public health agencies or officials in the event of an influenza pandemic.  (d) This section shall become inoperative on July 1, 2013, and, as of January 1, 2013, is repealed, unless a later enacted statute, that becomes operative on or before January 1, 2013, deletes or extends the dates on which it becomes inoperative and is repealed.   (d) This section shall remain in effect only until January 1, 2015, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2015, deletes or extends that date.   SEC. 3.  SEC. 6.  Section 1288.7 is added to the Health and Safety Code, to read: 1288.7. (a) A  licensed  health facility shall annually offer its employees onsite influenza vaccinations, if available, at no cost to the employee. (b) A licensed  health facility shall require all  employees, contractors, students, volunteers, persons with privileges on the medical staff, and all other  onsite health care workers affiliated with the health facility  and persons with privileges on the medical staff  to either annually receive an influenza vaccination or, as an alternative to the annual influenza vaccination, wear a health facility-provided surgical or procedural mask, or other mask that covers the mouth and nose area of the face while this person is performing his or her duties in any patient care area of the health facility during the influenza season, as defined by the State Health Officer or a local health officer, or both. (c)  (1)    In meeting the requirements of subdivision (b), the health facility shall maintain influenza vaccination records of  employees, contractors, students, volunteers, persons with privileges on the medical staff, and all other onsite health care workers affiliated with the health facilities who were vaccinated onsite or offsite   employees and may maintain influenza vaccination records of the other onsite health care workers who are affiliated with, but are not employees of, the health facilities and of persons with privileges on the medical staff  . If the health facility does not have records of  a   an onsite health care  worker  or person with privileges on the medical staff  being vaccinated onsite  , the health facility  shall   may  require the worker  or medical staff person  to either provide documentation of  an offsite  vaccination or documentation that he or she refused the vaccination.  (2) The health facility may include language in its business contracts to require a contract worker to maintain records of the verification of offsite vaccination or documentation that he or she refused the vaccination, which shall be available to the health facility upon request. Nothing in this section shall be construed to require a health facility to maintain separate vaccination records or to provide vaccinations at no cost to a contract worker who is not an employee of the health facility.  (d) Each  licensed  health facility shall develop policies to  implement this section and to  ensure its  employees, contractors, students, volunteers, and other  onsite health care workers affiliated with the health facility  , not including medical staff,  are in compliance with the vaccination requirements imposed by this section. The medical staff shall develop policies  independent of the policies established by the health facility  to ensure that persons who have privileges on the medical staff are in compliance with the vaccination requirements of this section  that have been implemented by the health facility  .  (e) Nothing in this section shall be construed to prevent a health facility from instituting additional measures to maximize influenza vaccination rates and to prevent health care workers affiliated with the health facility from contracting and transmitting the influenza virus.   (f)   (e)  In addition to other requirements of this section, general acute care hospitals shall take all of the following actions: (1) Institute respiratory hygiene and cough etiquette protocols, develop and implement procedures for the isolation of patients with influenza, and adopt a seasonal influenza plan. (2) Revise an existing or develop a new disaster plan that includes a pandemic influenza component. The plan shall also document any actual or recommended collaboration with local, regional, and state public health agencies or officials in the event of an influenza pandemic.  (g)   (f)  For purposes of this section, the following definitions shall apply:  (1) "Health   (1) "Employee" means an individual who works for the health facility, is listed on the health facility's payroll records, and is under the health facility's direction and control.   (2) "Medical staff" means professional medical personnel who are approved and given privileges to provide health care to patients in a health facility and who are responsible for the adequacy and quality of care rendered to patients. Medical staff include physicians and if dental or podiatric services are provided, dentists or podiatrists.   (3)     "Onsite health  care worker affiliated with the health facility" means a person who is either a volunteer or is employed by, paid by, or receives credit or any other form of compensation from the health  facility. Health  facility, who performs some or all of his or her duties in a patient care area of the facility. The patient care area of the facility shall be determined by the health facility and is where onsite health care   workers and medical staff are within close proximity to patients receiving care. An onsite health  care worker affiliated with the health facility includes, but is not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees,  and  contractual staff  and registry staff performing direct patient care duties but are  not employed by the health facility.  (2) "Medical staff" means professional medical personnel who are approved and given privileges to provide health care to patients in a health facility and who are responsible for the adequacy and quality of care rendered to patients. Medical staff include physicians, and, where dental or podiatric services are provided, dentists or podiatrists.   (g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement this section by sending letters or similar instruction to all applicable facilities without taking regulatory action.   (h) A health facility shall annually report its average vaccination compliance rate of onsite health care workers that are employees and of medical staff who have been vaccinated for that year to the State Department of Public Health.   (i) This section, with the exception of the reporting requirement of subdivision (h), shall not apply to health facilities that have a combined average vaccination compliance rate of 90 percent or higher for its onsite health care workers that are employees and medical staff.   (h)   (j)  This section shall become operative on  July 1, 2013   January 1, 2015  .  SEC. 4.   SEC. 7.  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 will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.