Amended IN Assembly May 12, 2020 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2537Introduced by Assembly Member RodriguezFebruary 19, 2020 An act to add Section 6403.7 6403.3 to the Labor Code, relating to workplace safety. LEGISLATIVE COUNSEL'S DIGESTAB 2537, as amended, Rodriguez. Illness and injury prevention program: opioid exposure. Personal protective equipment: health care employees.Existing law requires an employer to furnish employment and a place of employment that is safe and healthful for the employees and to establish, implement, and maintain an effective injury prevention program, as prescribed. Regulations enacted by the Department of Industrial Relations regulate the nature and use personal protective equipment and regulate practices in health care facilities connected with aerosol transmissible diseases.This bill would require public and private employers of workers who provide direct patient care in a hospital setting to supply those employees with the personal protective equipment necessary to comply with the regulations described above, as specified. The bill would also require an employer to ensure that the employees use the personal protective equipment supplied to them. The bill would further require that an employer in this context maintain a supply of unexpired personal protective equipment in an amount equal to one year of normal consumption and to provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. The bill would authorize the assessment of a civil penalty of up to $25,000 for each violation to maintain the required stockpile. The bill would make a statement of legislative findings.This bill would require employers of workers who provide direct patient care to patients being treated for opioid overdose in specific settings to create, implement, and maintain an illness and injury prevention program (IIPP) to protect those employees. The bill would require the IIPP to meet specific requirements, including a screening protocol, the provision of personal protective equipment, decontamination and cleaning protocols, postexposure followup, training, and assessment.This bill would require the Division of Occupational Safety and Health to post a report on its website by January 1, 2022, and annually thereafter, with information regarding opioid exposure incidents at hospitals, as prescribed.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) As of May 4, 2020, local health departments in California have reported 6,167 confirmed positive COVID-19 cases in nurses and health care workers and 33 deaths statewide. This data is collected daily and the number of infected nurses and health care workers continues to climb exponentially. While these figures include on-the-job exposures, they do not include the significant number of asymptomatic nurses and health care workers who are currently working every day who lack personal protective equipment and who also lack the priority testing that should be conducted for health care workers, given they are essential employees. (b) Frontline nurses and health care workers treating patients with COVID-19 are likely exposed to the highest risk of infection because of their close, frequent contact with patients and working longer hours than usual. By the nature of their profession, health care workers in California are in daily danger of being directly exposed to all infectious diseases and novel pathogens, including COVID-19. (c) The California Occupational Safety and Health Act of 1973 stipulates that every employer has a legal obligation to provide and maintain a safe and healthful workplace for employees.(d) The United States Department of Labor and the United States Department of Health and Human Services have encouraged employers to stockpile face masks and respirators in advance of a pandemic. It is clear now that manufacturing capacity at the time of a pandemic outbreak does not meet expected demand. (e) Although over 41.5 million N95 respirators have been distributed in the State of California since March 2020, nurses and other health care workers have not seen the impact of this distribution in their units. In many cases, employers have locked up or rationed N95 respirators, leaving nurses and other health care workers unprotected. In some cases, nurses have been disciplined for bringing their own personal protective equipment or demanding that appropriate personal protective equipment be provided when treating COVID-19 positive patients. Nurses and health care workers who need protection should have access to these respirators. Nurses and health care workers deserve protection while doing their jobs and if they are not protected, the COVID-19 virus will spread even faster and impact our health care systems ability to respond. SEC. 2. Section 6403.3 is added to the Labor Code, to read:6403.3. (a) For purposes of this section: (1) Employer means a person or organization that employs workers in the public or private sector to provide direct patient care in the hospital setting.(2) Personal protective equipment means the equipment and devices necessary to comply with Sections 3380 and 5199 of Title 8 of the California Code of Regulations, as they read on May 4, 2020.(b) An employer shall supply personal protective equipment to employees who provide direct patient care in a hospital setting. An employer shall ensure that employees use the personal protective equipment supplied to them. (c) An employer shall maintain a stockpile of unexpired personal protective equipment in the amount equal to one year of normal consumption. An employer shall provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. An employer who violates the requirement to maintain a supply of unexpired personal protective equipment prescribed by this subdivision shall be assessed a civil penalty of up to twenty-five thousand dollars ($25,000) for each violation. SECTION 1.The Legislature finds and declares all of the following:(a)There has been an epidemic of opioid-related overdose deaths in the United States over the past few years. More than 53,000 people in the United States died from an opioid overdose in 2016. (b)In 2017 there were 2,199 overdose deaths involving opioids in California. The greatest increase in opioid deaths in California was seen in cases involving synthetic opioids, mainly fentanyl. Fentanyl was responsible for more than a twofold increase, from 229 to 536 deaths between 2017 and 2018. (c)Opioid-related emergency department visits in the United States increased by 99.4 percent between 2005 and 2014. The rate of inpatient adult hospital stays related to opioids increased 64.1 percent between 2005 and 2014. (d)Registered nurses and other health care workers who provide care to opioid overdose patients face exposure risk to the hazardous opioids through patient bodily fluids and contamination of patient clothing and belongings. Exposure to opioids is of significant concern given the small amounts of exposure that can cause severe reactions and death. SEC. 2.Section 6403.7 is added to the Labor Code, to read:6403.7.(a)As used in this section:(1)Employer means a person or organization who employs workers in the public or private sector who provide direct patient care to patients being treated for opioid overdose in the prehospital, hospital, or hospital clinic setting.(2)IIPP means an illness and injury prevention program created pursuant to this section.(3)Opioids mean a class of drugs including fentanyl and carfentanyl and their analogues. This class of drugs also includes codeine, heroin, hydrocodone, and morphine.(4)PPE means personal protective equipment.(b)An employer shall create, implement, and maintain an IIPP, as part of the injury and illness prevention programs required by Section 3202 of Title 8 of the California Code of Regulations, to protect employees who provide direct patient care to patients being treated for opioid overdose. (c)The IIPP shall be created with the input of employees who provide direct patient care to patients being treated for opioid overdose. (d)The IIPP shall include, at a minimum, all of the following:(1)A screening protocol to identify and isolate patients who may be overdosing or likely to overdose on opioids.(A)It shall be assumed patients exhibiting signs and symptoms of opioid exposure or overdose, or both, including exposure to opioids adulterated with other controlled substances as defined in Section 11007 of the Health and Safety Code, are contaminated with the most toxic opioid.(B)Hospital and clinic employers shall create a designated area for patients exhibiting signs and symptoms of opioid overdose to minimize potential contamination of the health care facility.(2)PPE to circumvent employee exposure to opioids, as follows:(A)Employers shall supply and furnish all PPE described in this section to all employees.(B)The PPE shall include, at a minimum, all of the following:(i)Either a National Institute for Occupational Safety and Health (NIOSH)-approved elastomeric full facepiece air-purifying respirator with multipurpose N-, R-, or P-100 cartridges or a powered air-purifying respirator (PAPR) with high-efficiency particulate air (HEPA) filters, as respiratory protection. Where reusable respirators are implemented, a respirator maintenance program shall be developed by the employer.(ii)Full facepiece respirators or respirators with a hood due to the potential for bodily fluid splashes while providing patient care.(iii)Coverage of all skin surfaces by a fluid-resistant or impermeable PPE.(iv)Double gloves that shall be worn when providing patient care to an opioid overdose patient or handling any item that may have become contaminated with hazardous drugs.(v)Fluid-resistant or impermeable coveralls and shoe covers so all skin and other clothing is covered, including a hood or other head covering that fits snugly at the ankles and wrists.(C)Employers shall verify their respirator fit testing program is up to date and compliant with the Occupational Safety and Health Administration (OSHA) Respiratory Protection Standard.(D)Employers shall create and maintain PPE donning and doffing procedures to minimize the risk of exposure to the employee or contamination of the transport vehicle or health care facility environment.(E)Employers shall ensure all PPE is disposed of after use and kept separate for waste disposal, minimizing the risk for exposure to housekeeping and waste disposal workers and for contamination of other environments.(3)Decontamination and cleaning protocols to minimize potential for employee exposure to opioids and contamination of the transport vehicle or health care facility. PPE, as described in subparagraph (B) of paragraph (2), shall also be used when cleaning the patient care area.(4)A plan for postexposure followup, including the following requirements for an employer to:(A)Supply and maintain naloxone wherever opioid overdose patients may receive care or observation.(B)Develop protocols for administration of naloxone to employees who begin to exhibit symptoms of opioid exposure while or after providing care to an opioid overdose patient.(C)Record all exposure incidents and ensure the incidents are investigated as required under applicable OSHA and other standards.(D)Document and retain for a period of five years a written record of any employee opioid exposure, regardless of whether the employee sustains an injury, and regardless of whether the report is made by the employee who is the subject of the opioid exposure or any other employee.(E)Report opioid exposures to the division. If the incident results in injury or presents an urgent or emergent threat to the welfare, health, or safety of employees, the employer shall report the incident to the division within 24 hours.(5)An annual interactive training provided at no cost to the employee and during working hours, including at a minimum all of the following:(A)How to recognize signs and symptoms of opioid exposure.(B)How to appropriately administer naloxone.(C)A description of the employers IIPP for opioids, including the employers identification and isolation procedures for potential opioid overdose patients.(D)How employees can make concerns known about the IIPP or ask questions about the IIPP, including the appropriate person to contact.(E)A description and limitations of the PPE needed to provide care safely to opioid overdose patients.(F)How to properly don and doff, maintain, and dispose of PPE, including hands-on practice.(G)When and how to report and seek care when the employee is exposed to opioids.(6)A system to, at least annually, assess and improve upon factors that may contribute to, or help prevent, opioid exposure, including, but not limited to, staffing, including staffing patterns and patient classification systems that contribute to, or are insufficient to address, the risk of opioid exposure. (e)By January 1, 2022, and annually thereafter, the division, in a manner that protects patient and employee confidentiality, shall post a report on its internet website containing information regarding opioid exposure incidents at hospitals that includes, but is not limited to, the total number of reports pursuant to subparagraph (E) of paragraph (4) of subdivision (d), and which specific hospitals filed reports, the outcome of any related inspection or investigation, the citations levied against a hospital based on an opioid exposure, and recommendations of the division on the prevention of opioid exposure incidents at hospitals.
Amended IN Assembly May 12, 2020 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2537Introduced by Assembly Member RodriguezFebruary 19, 2020 An act to add Section 6403.7 6403.3 to the Labor Code, relating to workplace safety. LEGISLATIVE COUNSEL'S DIGESTAB 2537, as amended, Rodriguez. Illness and injury prevention program: opioid exposure. Personal protective equipment: health care employees.Existing law requires an employer to furnish employment and a place of employment that is safe and healthful for the employees and to establish, implement, and maintain an effective injury prevention program, as prescribed. Regulations enacted by the Department of Industrial Relations regulate the nature and use personal protective equipment and regulate practices in health care facilities connected with aerosol transmissible diseases.This bill would require public and private employers of workers who provide direct patient care in a hospital setting to supply those employees with the personal protective equipment necessary to comply with the regulations described above, as specified. The bill would also require an employer to ensure that the employees use the personal protective equipment supplied to them. The bill would further require that an employer in this context maintain a supply of unexpired personal protective equipment in an amount equal to one year of normal consumption and to provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. The bill would authorize the assessment of a civil penalty of up to $25,000 for each violation to maintain the required stockpile. The bill would make a statement of legislative findings.This bill would require employers of workers who provide direct patient care to patients being treated for opioid overdose in specific settings to create, implement, and maintain an illness and injury prevention program (IIPP) to protect those employees. The bill would require the IIPP to meet specific requirements, including a screening protocol, the provision of personal protective equipment, decontamination and cleaning protocols, postexposure followup, training, and assessment.This bill would require the Division of Occupational Safety and Health to post a report on its website by January 1, 2022, and annually thereafter, with information regarding opioid exposure incidents at hospitals, as prescribed.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
Amended IN Assembly May 12, 2020
Amended IN Assembly May 12, 2020
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill
No. 2537
Introduced by Assembly Member RodriguezFebruary 19, 2020
Introduced by Assembly Member Rodriguez
February 19, 2020
An act to add Section 6403.7 6403.3 to the Labor Code, relating to workplace safety.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2537, as amended, Rodriguez. Illness and injury prevention program: opioid exposure. Personal protective equipment: health care employees.
Existing law requires an employer to furnish employment and a place of employment that is safe and healthful for the employees and to establish, implement, and maintain an effective injury prevention program, as prescribed. Regulations enacted by the Department of Industrial Relations regulate the nature and use personal protective equipment and regulate practices in health care facilities connected with aerosol transmissible diseases.This bill would require public and private employers of workers who provide direct patient care in a hospital setting to supply those employees with the personal protective equipment necessary to comply with the regulations described above, as specified. The bill would also require an employer to ensure that the employees use the personal protective equipment supplied to them. The bill would further require that an employer in this context maintain a supply of unexpired personal protective equipment in an amount equal to one year of normal consumption and to provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. The bill would authorize the assessment of a civil penalty of up to $25,000 for each violation to maintain the required stockpile. The bill would make a statement of legislative findings.This bill would require employers of workers who provide direct patient care to patients being treated for opioid overdose in specific settings to create, implement, and maintain an illness and injury prevention program (IIPP) to protect those employees. The bill would require the IIPP to meet specific requirements, including a screening protocol, the provision of personal protective equipment, decontamination and cleaning protocols, postexposure followup, training, and assessment.This bill would require the Division of Occupational Safety and Health to post a report on its website by January 1, 2022, and annually thereafter, with information regarding opioid exposure incidents at hospitals, as prescribed.
Existing law requires an employer to furnish employment and a place of employment that is safe and healthful for the employees and to establish, implement, and maintain an effective injury prevention program, as prescribed. Regulations enacted by the Department of Industrial Relations regulate the nature and use personal protective equipment and regulate practices in health care facilities connected with aerosol transmissible diseases.
This bill would require public and private employers of workers who provide direct patient care in a hospital setting to supply those employees with the personal protective equipment necessary to comply with the regulations described above, as specified. The bill would also require an employer to ensure that the employees use the personal protective equipment supplied to them. The bill would further require that an employer in this context maintain a supply of unexpired personal protective equipment in an amount equal to one year of normal consumption and to provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. The bill would authorize the assessment of a civil penalty of up to $25,000 for each violation to maintain the required stockpile. The bill would make a statement of legislative findings.
This bill would require employers of workers who provide direct patient care to patients being treated for opioid overdose in specific settings to create, implement, and maintain an illness and injury prevention program (IIPP) to protect those employees. The bill would require the IIPP to meet specific requirements, including a screening protocol, the provision of personal protective equipment, decontamination and cleaning protocols, postexposure followup, training, and assessment.
This bill would require the Division of Occupational Safety and Health to post a report on its website by January 1, 2022, and annually thereafter, with information regarding opioid exposure incidents at hospitals, as prescribed.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) As of May 4, 2020, local health departments in California have reported 6,167 confirmed positive COVID-19 cases in nurses and health care workers and 33 deaths statewide. This data is collected daily and the number of infected nurses and health care workers continues to climb exponentially. While these figures include on-the-job exposures, they do not include the significant number of asymptomatic nurses and health care workers who are currently working every day who lack personal protective equipment and who also lack the priority testing that should be conducted for health care workers, given they are essential employees. (b) Frontline nurses and health care workers treating patients with COVID-19 are likely exposed to the highest risk of infection because of their close, frequent contact with patients and working longer hours than usual. By the nature of their profession, health care workers in California are in daily danger of being directly exposed to all infectious diseases and novel pathogens, including COVID-19. (c) The California Occupational Safety and Health Act of 1973 stipulates that every employer has a legal obligation to provide and maintain a safe and healthful workplace for employees.(d) The United States Department of Labor and the United States Department of Health and Human Services have encouraged employers to stockpile face masks and respirators in advance of a pandemic. It is clear now that manufacturing capacity at the time of a pandemic outbreak does not meet expected demand. (e) Although over 41.5 million N95 respirators have been distributed in the State of California since March 2020, nurses and other health care workers have not seen the impact of this distribution in their units. In many cases, employers have locked up or rationed N95 respirators, leaving nurses and other health care workers unprotected. In some cases, nurses have been disciplined for bringing their own personal protective equipment or demanding that appropriate personal protective equipment be provided when treating COVID-19 positive patients. Nurses and health care workers who need protection should have access to these respirators. Nurses and health care workers deserve protection while doing their jobs and if they are not protected, the COVID-19 virus will spread even faster and impact our health care systems ability to respond. SEC. 2. Section 6403.3 is added to the Labor Code, to read:6403.3. (a) For purposes of this section: (1) Employer means a person or organization that employs workers in the public or private sector to provide direct patient care in the hospital setting.(2) Personal protective equipment means the equipment and devices necessary to comply with Sections 3380 and 5199 of Title 8 of the California Code of Regulations, as they read on May 4, 2020.(b) An employer shall supply personal protective equipment to employees who provide direct patient care in a hospital setting. An employer shall ensure that employees use the personal protective equipment supplied to them. (c) An employer shall maintain a stockpile of unexpired personal protective equipment in the amount equal to one year of normal consumption. An employer shall provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. An employer who violates the requirement to maintain a supply of unexpired personal protective equipment prescribed by this subdivision shall be assessed a civil penalty of up to twenty-five thousand dollars ($25,000) for each violation. SECTION 1.The Legislature finds and declares all of the following:(a)There has been an epidemic of opioid-related overdose deaths in the United States over the past few years. More than 53,000 people in the United States died from an opioid overdose in 2016. (b)In 2017 there were 2,199 overdose deaths involving opioids in California. The greatest increase in opioid deaths in California was seen in cases involving synthetic opioids, mainly fentanyl. Fentanyl was responsible for more than a twofold increase, from 229 to 536 deaths between 2017 and 2018. (c)Opioid-related emergency department visits in the United States increased by 99.4 percent between 2005 and 2014. The rate of inpatient adult hospital stays related to opioids increased 64.1 percent between 2005 and 2014. (d)Registered nurses and other health care workers who provide care to opioid overdose patients face exposure risk to the hazardous opioids through patient bodily fluids and contamination of patient clothing and belongings. Exposure to opioids is of significant concern given the small amounts of exposure that can cause severe reactions and death. SEC. 2.Section 6403.7 is added to the Labor Code, to read:6403.7.(a)As used in this section:(1)Employer means a person or organization who employs workers in the public or private sector who provide direct patient care to patients being treated for opioid overdose in the prehospital, hospital, or hospital clinic setting.(2)IIPP means an illness and injury prevention program created pursuant to this section.(3)Opioids mean a class of drugs including fentanyl and carfentanyl and their analogues. This class of drugs also includes codeine, heroin, hydrocodone, and morphine.(4)PPE means personal protective equipment.(b)An employer shall create, implement, and maintain an IIPP, as part of the injury and illness prevention programs required by Section 3202 of Title 8 of the California Code of Regulations, to protect employees who provide direct patient care to patients being treated for opioid overdose. (c)The IIPP shall be created with the input of employees who provide direct patient care to patients being treated for opioid overdose. (d)The IIPP shall include, at a minimum, all of the following:(1)A screening protocol to identify and isolate patients who may be overdosing or likely to overdose on opioids.(A)It shall be assumed patients exhibiting signs and symptoms of opioid exposure or overdose, or both, including exposure to opioids adulterated with other controlled substances as defined in Section 11007 of the Health and Safety Code, are contaminated with the most toxic opioid.(B)Hospital and clinic employers shall create a designated area for patients exhibiting signs and symptoms of opioid overdose to minimize potential contamination of the health care facility.(2)PPE to circumvent employee exposure to opioids, as follows:(A)Employers shall supply and furnish all PPE described in this section to all employees.(B)The PPE shall include, at a minimum, all of the following:(i)Either a National Institute for Occupational Safety and Health (NIOSH)-approved elastomeric full facepiece air-purifying respirator with multipurpose N-, R-, or P-100 cartridges or a powered air-purifying respirator (PAPR) with high-efficiency particulate air (HEPA) filters, as respiratory protection. Where reusable respirators are implemented, a respirator maintenance program shall be developed by the employer.(ii)Full facepiece respirators or respirators with a hood due to the potential for bodily fluid splashes while providing patient care.(iii)Coverage of all skin surfaces by a fluid-resistant or impermeable PPE.(iv)Double gloves that shall be worn when providing patient care to an opioid overdose patient or handling any item that may have become contaminated with hazardous drugs.(v)Fluid-resistant or impermeable coveralls and shoe covers so all skin and other clothing is covered, including a hood or other head covering that fits snugly at the ankles and wrists.(C)Employers shall verify their respirator fit testing program is up to date and compliant with the Occupational Safety and Health Administration (OSHA) Respiratory Protection Standard.(D)Employers shall create and maintain PPE donning and doffing procedures to minimize the risk of exposure to the employee or contamination of the transport vehicle or health care facility environment.(E)Employers shall ensure all PPE is disposed of after use and kept separate for waste disposal, minimizing the risk for exposure to housekeeping and waste disposal workers and for contamination of other environments.(3)Decontamination and cleaning protocols to minimize potential for employee exposure to opioids and contamination of the transport vehicle or health care facility. PPE, as described in subparagraph (B) of paragraph (2), shall also be used when cleaning the patient care area.(4)A plan for postexposure followup, including the following requirements for an employer to:(A)Supply and maintain naloxone wherever opioid overdose patients may receive care or observation.(B)Develop protocols for administration of naloxone to employees who begin to exhibit symptoms of opioid exposure while or after providing care to an opioid overdose patient.(C)Record all exposure incidents and ensure the incidents are investigated as required under applicable OSHA and other standards.(D)Document and retain for a period of five years a written record of any employee opioid exposure, regardless of whether the employee sustains an injury, and regardless of whether the report is made by the employee who is the subject of the opioid exposure or any other employee.(E)Report opioid exposures to the division. If the incident results in injury or presents an urgent or emergent threat to the welfare, health, or safety of employees, the employer shall report the incident to the division within 24 hours.(5)An annual interactive training provided at no cost to the employee and during working hours, including at a minimum all of the following:(A)How to recognize signs and symptoms of opioid exposure.(B)How to appropriately administer naloxone.(C)A description of the employers IIPP for opioids, including the employers identification and isolation procedures for potential opioid overdose patients.(D)How employees can make concerns known about the IIPP or ask questions about the IIPP, including the appropriate person to contact.(E)A description and limitations of the PPE needed to provide care safely to opioid overdose patients.(F)How to properly don and doff, maintain, and dispose of PPE, including hands-on practice.(G)When and how to report and seek care when the employee is exposed to opioids.(6)A system to, at least annually, assess and improve upon factors that may contribute to, or help prevent, opioid exposure, including, but not limited to, staffing, including staffing patterns and patient classification systems that contribute to, or are insufficient to address, the risk of opioid exposure. (e)By January 1, 2022, and annually thereafter, the division, in a manner that protects patient and employee confidentiality, shall post a report on its internet website containing information regarding opioid exposure incidents at hospitals that includes, but is not limited to, the total number of reports pursuant to subparagraph (E) of paragraph (4) of subdivision (d), and which specific hospitals filed reports, the outcome of any related inspection or investigation, the citations levied against a hospital based on an opioid exposure, and recommendations of the division on the prevention of opioid exposure incidents at hospitals.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. The Legislature finds and declares all of the following:(a) As of May 4, 2020, local health departments in California have reported 6,167 confirmed positive COVID-19 cases in nurses and health care workers and 33 deaths statewide. This data is collected daily and the number of infected nurses and health care workers continues to climb exponentially. While these figures include on-the-job exposures, they do not include the significant number of asymptomatic nurses and health care workers who are currently working every day who lack personal protective equipment and who also lack the priority testing that should be conducted for health care workers, given they are essential employees. (b) Frontline nurses and health care workers treating patients with COVID-19 are likely exposed to the highest risk of infection because of their close, frequent contact with patients and working longer hours than usual. By the nature of their profession, health care workers in California are in daily danger of being directly exposed to all infectious diseases and novel pathogens, including COVID-19. (c) The California Occupational Safety and Health Act of 1973 stipulates that every employer has a legal obligation to provide and maintain a safe and healthful workplace for employees.(d) The United States Department of Labor and the United States Department of Health and Human Services have encouraged employers to stockpile face masks and respirators in advance of a pandemic. It is clear now that manufacturing capacity at the time of a pandemic outbreak does not meet expected demand. (e) Although over 41.5 million N95 respirators have been distributed in the State of California since March 2020, nurses and other health care workers have not seen the impact of this distribution in their units. In many cases, employers have locked up or rationed N95 respirators, leaving nurses and other health care workers unprotected. In some cases, nurses have been disciplined for bringing their own personal protective equipment or demanding that appropriate personal protective equipment be provided when treating COVID-19 positive patients. Nurses and health care workers who need protection should have access to these respirators. Nurses and health care workers deserve protection while doing their jobs and if they are not protected, the COVID-19 virus will spread even faster and impact our health care systems ability to respond.
SECTION 1. The Legislature finds and declares all of the following:(a) As of May 4, 2020, local health departments in California have reported 6,167 confirmed positive COVID-19 cases in nurses and health care workers and 33 deaths statewide. This data is collected daily and the number of infected nurses and health care workers continues to climb exponentially. While these figures include on-the-job exposures, they do not include the significant number of asymptomatic nurses and health care workers who are currently working every day who lack personal protective equipment and who also lack the priority testing that should be conducted for health care workers, given they are essential employees. (b) Frontline nurses and health care workers treating patients with COVID-19 are likely exposed to the highest risk of infection because of their close, frequent contact with patients and working longer hours than usual. By the nature of their profession, health care workers in California are in daily danger of being directly exposed to all infectious diseases and novel pathogens, including COVID-19. (c) The California Occupational Safety and Health Act of 1973 stipulates that every employer has a legal obligation to provide and maintain a safe and healthful workplace for employees.(d) The United States Department of Labor and the United States Department of Health and Human Services have encouraged employers to stockpile face masks and respirators in advance of a pandemic. It is clear now that manufacturing capacity at the time of a pandemic outbreak does not meet expected demand. (e) Although over 41.5 million N95 respirators have been distributed in the State of California since March 2020, nurses and other health care workers have not seen the impact of this distribution in their units. In many cases, employers have locked up or rationed N95 respirators, leaving nurses and other health care workers unprotected. In some cases, nurses have been disciplined for bringing their own personal protective equipment or demanding that appropriate personal protective equipment be provided when treating COVID-19 positive patients. Nurses and health care workers who need protection should have access to these respirators. Nurses and health care workers deserve protection while doing their jobs and if they are not protected, the COVID-19 virus will spread even faster and impact our health care systems ability to respond.
SECTION 1. The Legislature finds and declares all of the following:
### SECTION 1.
(a) As of May 4, 2020, local health departments in California have reported 6,167 confirmed positive COVID-19 cases in nurses and health care workers and 33 deaths statewide. This data is collected daily and the number of infected nurses and health care workers continues to climb exponentially. While these figures include on-the-job exposures, they do not include the significant number of asymptomatic nurses and health care workers who are currently working every day who lack personal protective equipment and who also lack the priority testing that should be conducted for health care workers, given they are essential employees.
(b) Frontline nurses and health care workers treating patients with COVID-19 are likely exposed to the highest risk of infection because of their close, frequent contact with patients and working longer hours than usual. By the nature of their profession, health care workers in California are in daily danger of being directly exposed to all infectious diseases and novel pathogens, including COVID-19.
(c) The California Occupational Safety and Health Act of 1973 stipulates that every employer has a legal obligation to provide and maintain a safe and healthful workplace for employees.
(d) The United States Department of Labor and the United States Department of Health and Human Services have encouraged employers to stockpile face masks and respirators in advance of a pandemic. It is clear now that manufacturing capacity at the time of a pandemic outbreak does not meet expected demand.
(e) Although over 41.5 million N95 respirators have been distributed in the State of California since March 2020, nurses and other health care workers have not seen the impact of this distribution in their units. In many cases, employers have locked up or rationed N95 respirators, leaving nurses and other health care workers unprotected. In some cases, nurses have been disciplined for bringing their own personal protective equipment or demanding that appropriate personal protective equipment be provided when treating COVID-19 positive patients. Nurses and health care workers who need protection should have access to these respirators. Nurses and health care workers deserve protection while doing their jobs and if they are not protected, the COVID-19 virus will spread even faster and impact our health care systems ability to respond.
SEC. 2. Section 6403.3 is added to the Labor Code, to read:6403.3. (a) For purposes of this section: (1) Employer means a person or organization that employs workers in the public or private sector to provide direct patient care in the hospital setting.(2) Personal protective equipment means the equipment and devices necessary to comply with Sections 3380 and 5199 of Title 8 of the California Code of Regulations, as they read on May 4, 2020.(b) An employer shall supply personal protective equipment to employees who provide direct patient care in a hospital setting. An employer shall ensure that employees use the personal protective equipment supplied to them. (c) An employer shall maintain a stockpile of unexpired personal protective equipment in the amount equal to one year of normal consumption. An employer shall provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. An employer who violates the requirement to maintain a supply of unexpired personal protective equipment prescribed by this subdivision shall be assessed a civil penalty of up to twenty-five thousand dollars ($25,000) for each violation.
SEC. 2. Section 6403.3 is added to the Labor Code, to read:
### SEC. 2.
6403.3. (a) For purposes of this section: (1) Employer means a person or organization that employs workers in the public or private sector to provide direct patient care in the hospital setting.(2) Personal protective equipment means the equipment and devices necessary to comply with Sections 3380 and 5199 of Title 8 of the California Code of Regulations, as they read on May 4, 2020.(b) An employer shall supply personal protective equipment to employees who provide direct patient care in a hospital setting. An employer shall ensure that employees use the personal protective equipment supplied to them. (c) An employer shall maintain a stockpile of unexpired personal protective equipment in the amount equal to one year of normal consumption. An employer shall provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. An employer who violates the requirement to maintain a supply of unexpired personal protective equipment prescribed by this subdivision shall be assessed a civil penalty of up to twenty-five thousand dollars ($25,000) for each violation.
6403.3. (a) For purposes of this section: (1) Employer means a person or organization that employs workers in the public or private sector to provide direct patient care in the hospital setting.(2) Personal protective equipment means the equipment and devices necessary to comply with Sections 3380 and 5199 of Title 8 of the California Code of Regulations, as they read on May 4, 2020.(b) An employer shall supply personal protective equipment to employees who provide direct patient care in a hospital setting. An employer shall ensure that employees use the personal protective equipment supplied to them. (c) An employer shall maintain a stockpile of unexpired personal protective equipment in the amount equal to one year of normal consumption. An employer shall provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. An employer who violates the requirement to maintain a supply of unexpired personal protective equipment prescribed by this subdivision shall be assessed a civil penalty of up to twenty-five thousand dollars ($25,000) for each violation.
6403.3. (a) For purposes of this section: (1) Employer means a person or organization that employs workers in the public or private sector to provide direct patient care in the hospital setting.(2) Personal protective equipment means the equipment and devices necessary to comply with Sections 3380 and 5199 of Title 8 of the California Code of Regulations, as they read on May 4, 2020.(b) An employer shall supply personal protective equipment to employees who provide direct patient care in a hospital setting. An employer shall ensure that employees use the personal protective equipment supplied to them. (c) An employer shall maintain a stockpile of unexpired personal protective equipment in the amount equal to one year of normal consumption. An employer shall provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. An employer who violates the requirement to maintain a supply of unexpired personal protective equipment prescribed by this subdivision shall be assessed a civil penalty of up to twenty-five thousand dollars ($25,000) for each violation.
6403.3. (a) For purposes of this section:
(1) Employer means a person or organization that employs workers in the public or private sector to provide direct patient care in the hospital setting.
(2) Personal protective equipment means the equipment and devices necessary to comply with Sections 3380 and 5199 of Title 8 of the California Code of Regulations, as they read on May 4, 2020.
(b) An employer shall supply personal protective equipment to employees who provide direct patient care in a hospital setting. An employer shall ensure that employees use the personal protective equipment supplied to them.
(c) An employer shall maintain a stockpile of unexpired personal protective equipment in the amount equal to one year of normal consumption. An employer shall provide an inventory of its stockpile to the Division of Occupational Safety and Health upon request. An employer who violates the requirement to maintain a supply of unexpired personal protective equipment prescribed by this subdivision shall be assessed a civil penalty of up to twenty-five thousand dollars ($25,000) for each violation.
The Legislature finds and declares all of the following:
(a)There has been an epidemic of opioid-related overdose deaths in the United States over the past few years. More than 53,000 people in the United States died from an opioid overdose in 2016.
(b)In 2017 there were 2,199 overdose deaths involving opioids in California. The greatest increase in opioid deaths in California was seen in cases involving synthetic opioids, mainly fentanyl. Fentanyl was responsible for more than a twofold increase, from 229 to 536 deaths between 2017 and 2018.
(c)Opioid-related emergency department visits in the United States increased by 99.4 percent between 2005 and 2014. The rate of inpatient adult hospital stays related to opioids increased 64.1 percent between 2005 and 2014.
(d)Registered nurses and other health care workers who provide care to opioid overdose patients face exposure risk to the hazardous opioids through patient bodily fluids and contamination of patient clothing and belongings. Exposure to opioids is of significant concern given the small amounts of exposure that can cause severe reactions and death.
(a)As used in this section:
(1)Employer means a person or organization who employs workers in the public or private sector who provide direct patient care to patients being treated for opioid overdose in the prehospital, hospital, or hospital clinic setting.
(2)IIPP means an illness and injury prevention program created pursuant to this section.
(3)Opioids mean a class of drugs including fentanyl and carfentanyl and their analogues. This class of drugs also includes codeine, heroin, hydrocodone, and morphine.
(4)PPE means personal protective equipment.
(b)An employer shall create, implement, and maintain an IIPP, as part of the injury and illness prevention programs required by Section 3202 of Title 8 of the California Code of Regulations, to protect employees who provide direct patient care to patients being treated for opioid overdose.
(c)The IIPP shall be created with the input of employees who provide direct patient care to patients being treated for opioid overdose.
(d)The IIPP shall include, at a minimum, all of the following:
(1)A screening protocol to identify and isolate patients who may be overdosing or likely to overdose on opioids.
(A)It shall be assumed patients exhibiting signs and symptoms of opioid exposure or overdose, or both, including exposure to opioids adulterated with other controlled substances as defined in Section 11007 of the Health and Safety Code, are contaminated with the most toxic opioid.
(B)Hospital and clinic employers shall create a designated area for patients exhibiting signs and symptoms of opioid overdose to minimize potential contamination of the health care facility.
(2)PPE to circumvent employee exposure to opioids, as follows:
(A)Employers shall supply and furnish all PPE described in this section to all employees.
(B)The PPE shall include, at a minimum, all of the following:
(i)Either a National Institute for Occupational Safety and Health (NIOSH)-approved elastomeric full facepiece air-purifying respirator with multipurpose N-, R-, or P-100 cartridges or a powered air-purifying respirator (PAPR) with high-efficiency particulate air (HEPA) filters, as respiratory protection. Where reusable respirators are implemented, a respirator maintenance program shall be developed by the employer.
(ii)Full facepiece respirators or respirators with a hood due to the potential for bodily fluid splashes while providing patient care.
(iii)Coverage of all skin surfaces by a fluid-resistant or impermeable PPE.
(iv)Double gloves that shall be worn when providing patient care to an opioid overdose patient or handling any item that may have become contaminated with hazardous drugs.
(v)Fluid-resistant or impermeable coveralls and shoe covers so all skin and other clothing is covered, including a hood or other head covering that fits snugly at the ankles and wrists.
(C)Employers shall verify their respirator fit testing program is up to date and compliant with the Occupational Safety and Health Administration (OSHA) Respiratory Protection Standard.
(D)Employers shall create and maintain PPE donning and doffing procedures to minimize the risk of exposure to the employee or contamination of the transport vehicle or health care facility environment.
(E)Employers shall ensure all PPE is disposed of after use and kept separate for waste disposal, minimizing the risk for exposure to housekeeping and waste disposal workers and for contamination of other environments.
(3)Decontamination and cleaning protocols to minimize potential for employee exposure to opioids and contamination of the transport vehicle or health care facility. PPE, as described in subparagraph (B) of paragraph (2), shall also be used when cleaning the patient care area.
(4)A plan for postexposure followup, including the following requirements for an employer to:
(A)Supply and maintain naloxone wherever opioid overdose patients may receive care or observation.
(B)Develop protocols for administration of naloxone to employees who begin to exhibit symptoms of opioid exposure while or after providing care to an opioid overdose patient.
(C)Record all exposure incidents and ensure the incidents are investigated as required under applicable OSHA and other standards.
(D)Document and retain for a period of five years a written record of any employee opioid exposure, regardless of whether the employee sustains an injury, and regardless of whether the report is made by the employee who is the subject of the opioid exposure or any other employee.
(E)Report opioid exposures to the division. If the incident results in injury or presents an urgent or emergent threat to the welfare, health, or safety of employees, the employer shall report the incident to the division within 24 hours.
(5)An annual interactive training provided at no cost to the employee and during working hours, including at a minimum all of the following:
(A)How to recognize signs and symptoms of opioid exposure.
(B)How to appropriately administer naloxone.
(C)A description of the employers IIPP for opioids, including the employers identification and isolation procedures for potential opioid overdose patients.
(D)How employees can make concerns known about the IIPP or ask questions about the IIPP, including the appropriate person to contact.
(E)A description and limitations of the PPE needed to provide care safely to opioid overdose patients.
(F)How to properly don and doff, maintain, and dispose of PPE, including hands-on practice.
(G)When and how to report and seek care when the employee is exposed to opioids.
(6)A system to, at least annually, assess and improve upon factors that may contribute to, or help prevent, opioid exposure, including, but not limited to, staffing, including staffing patterns and patient classification systems that contribute to, or are insufficient to address, the risk of opioid exposure.
(e)By January 1, 2022, and annually thereafter, the division, in a manner that protects patient and employee confidentiality, shall post a report on its internet website containing information regarding opioid exposure incidents at hospitals that includes, but is not limited to, the total number of reports pursuant to subparagraph (E) of paragraph (4) of subdivision (d), and which specific hospitals filed reports, the outcome of any related inspection or investigation, the citations levied against a hospital based on an opioid exposure, and recommendations of the division on the prevention of opioid exposure incidents at hospitals.