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HOUSE DOCKET, NO. 2491 FILED ON: 1/19/2023
HOUSE . . . . . . . . . . . . . . . No. 2196
The Commonwealth of Massachusetts
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PRESENTED BY:
Natalie M. Higgins
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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act promoting patient safety and equitable access to care.
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PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:Natalie M. Higgins4th Worcester1/19/2023James C. Arena-DeRosa8th Middlesex1/24/2023Peter Capano11th Essex1/24/2023John H. Rogers12th Norfolk1/24/2023Angelo J. Puppolo, Jr.12th Hampden1/24/2023Daniel J. Ryan2nd Suffolk1/24/2023Patricia A. Duffy5th Hampden1/24/2023Josh S. Cutler6th Plymouth1/24/2023Joseph W. McGonagle, Jr.28th Middlesex1/24/2023David Henry Argosky LeBoeuf17th Worcester1/24/2023Frank A. Moran17th Essex1/24/2023Jeffrey N. Roy10th Norfolk1/24/2023Tram T. Nguyen18th Essex1/24/2023Daniel M. Donahue16th Worcester1/24/2023Christopher Hendricks11th Bristol1/24/2023Rodney M. Elliott16th Middlesex1/24/2023Steven Ultrino33rd Middlesex1/25/2023Gerard J. Cassidy9th Plymouth1/25/2023 2 of 3
Christopher J. Worrell5th Suffolk1/25/2023Lindsay N. Sabadosa1st Hampshire1/25/2023Erika Uyterhoeven27th Middlesex1/25/2023Jack Patrick Lewis7th Middlesex1/26/2023Carmine Lawrence Gentile13th Middlesex1/26/2023Michael D. BradySecond Plymouth and Norfolk1/26/2023Kevin G. Honan17th Suffolk1/26/2023Michael P. Kushmerek3rd Worcester1/26/2023Bruce J. Ayers1st Norfolk1/26/2023Adrianne Pusateri Ramos14th Essex1/26/2023Patrick Joseph Kearney4th Plymouth1/27/2023Marc R. PachecoThird Bristol and Plymouth1/27/2023Jessica Ann Giannino16th Suffolk1/27/2023Manny Cruz7th Essex1/27/2023Meghan Kilcoyne12th Worcester1/27/2023Sean Garballey23rd Middlesex1/27/2023Thomas M. Stanley9th Middlesex1/27/2023Rob Consalvo14th Suffolk1/27/2023Susannah M. Whipps2nd Franklin1/27/2023James K. Hawkins2nd Bristol1/29/2023Kate Donaghue19th Worcester1/29/2023Rita A. Mendes11th Plymouth1/30/2023Ryan M. Hamilton15th Essex1/31/2023Tackey Chan2nd Norfolk1/31/2023William C. Galvin6th Norfolk2/1/2023Samantha Montaño15th Suffolk2/1/2023Patrick M. O'ConnorFirst Plymouth and Norfolk2/1/2023Margaret R. Scarsdale1st Middlesex2/3/2023Jennifer Balinsky Armini8th Essex2/6/2023Mary S. Keefe15th Worcester2/8/2023Paul McMurtry11th Norfolk2/8/2023Joan Meschino3rd Plymouth2/9/2023Colleen M. Garry36th Middlesex2/9/2023James B. EldridgeMiddlesex and Worcester2/10/2023Adrian C. Madaro1st Suffolk2/14/2023Denise C. Garlick13th Norfolk2/15/2023Brian W. Murray10th Worcester2/17/2023Carol A. Doherty3rd Bristol2/21/2023Shirley B. Arriaga8th Hampden2/23/2023 3 of 3
Christopher Richard Flanagan1st Barnstable2/24/2023Vanna Howard17th Middlesex3/1/2023Michelle L. Ciccolo15th Middlesex3/6/2023 1 of 3
HOUSE DOCKET, NO. 2491 FILED ON: 1/19/2023
HOUSE . . . . . . . . . . . . . . . No. 2196
By Representative Higgins of Leominster, a petition (accompanied by bill, House, No. 2196) of
Natalie M. Higgins and others relative to registered nurse patient assignment. Public Health.
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act promoting patient safety and equitable access to care.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Section 1 of chapter 111 of the General Laws, as appearing in the 2020
2Official Edition, is hereby amended by inserting before the definition of “Board of health” the
3following 2 definitions:-
4 “Hospital”, any hospital or psychiatric hospital providing inpatient care 24 hours per day,
57 days a week and including the teaching Hospital of the University of Massachusetts Medical
6School.
7 “Maternal Child Care Patients”, including antepartum, intrapartum, postpartum, and
8neonatal care.
9 SECTION 2. Said chapter 111 is hereby further amended by inserting after section 231
10the following section:-
11 Section 231A. (a) There shall be a specific statewide limit on the number of patients a
12registered nurse shall be assigned to provide care for at 1 time, which shall be established under 2 of 3
13regulations promulgated by the department of public health, along with the department of mental
14health. The limit established by the department shall apply to hospitals.
15 This limit of patients shall be specific to each hospital unit and in effect at all times for
16each of the patient care areas, including, but not limited to, emergency services departments and
17units with step-down or intermediate care patients, post-anesthesia care patients, operating room
18patients, maternal child care patients, pediatric patients, psychiatric patients, medical, surgical
19and telemetry patients, observational and outpatient treatment patients, rehabilitation patients and
20any unit not otherwise listed.
21 (b) The limits established by the department shall not include a minimum number of
22patients assigned to a registered nurse at 1 time. Additional staff shall be assigned in accordance
23with nursing care requirements, including the severity of the illness, the need for specialized
24equipment and technology, the complexity of clinical judgment needed to design, implement and
25evaluate the patient care plan and the ability for self-care and the licensure of the personnel
26required for care.
27 (c) Prior to promulgating regulations, the department shall hold a series of public
28hearings throughout the commonwealth and invite comments from stakeholders.
29 (d) The regulations shall include mechanisms for enforcement of the limits by the
30attorney general, which shall include, but not be limited to, injunctive or declaratory relief and
31civil penalties in the amount of up to $25,000 per violation.
32 (e) Each day during which a violation continues following notice to the facility of such
33violation shall constitute a separate and distinct violation subject to any penalties established
34pursuant to subsection (d). 3 of 3
35 (f) Upon written notice by the department that a complaint has been made or a violation
36has occurred, a facility receiving such notice shall submit a written compliance plan to the
37department that demonstrates the manner in which the facility will ensure future compliance with
38all of the provisions of this act within the time frame required by the department.
39 (g) No employee shall be disciplined or retaliated against in any manner for complying
40with the patient limits set forth by the regulations established and any such employee so
41disciplined or retaliated against shall be entitled to the remedies under subsection (d) of section
42185 of chapter 149 of the General Laws regardless of whether the employee satisfies any other
43terms or conditions set forth in said section 185 of said chapter 149.
44 (h) The regulations promulgated pursuant to this act shall provide for suspension during a
45state or national public health emergency.
46 SECTION 3. The department of public health shall promulgate regulations pursuant to
47section 231A of chapter 111 of the General Laws not later than 24 months after passage of this
48act.