May 28, 2004
California Assembly Passes Bill to Limit Hospital Closures
Law Would Require More Notice, Aid Efforts to Keep Hospitals Open Assembly also Passes Bill to Reduce Hospital Workplace Injuries
The Assembly late Thursday approved legislation that would help mitigate hospital closures in California, requiring more advanced public notice and providing assistance to elected officials who work to maintain emergency and acute care services.
AB 2874, authored by Assembly member Manny Diaz (D-San Jose) and sponsored by the California Nurses Association, was passed 44-34 despite an intensive lobbying campaign by California's multi-billion hospital industry. The bill next heads to the State Senate.
CNA President Deborah Burger, RN congratulated the Assembly for "a vote for patients and communities that are harmed by the unwarranted loss of vital hospital and emergency services. This common sense bill allows local officials and the public more time to plan in the event of a pending closure - and to develop proposals to keep the hospitals open."
1) Requires a hospital to provide 12 months notice of an emergency room or acute care hospital closure. Current law is 90 days.
2) Starts the community impact analysis process a full year before closure instead of the current 90 days.
3) Provides that if the Board of Supervisors or public petition puts a Healthcare District on the ballot and if it passes with a parcel tax to raise funds, the private hospital will sell the hospital to the District at fair market value with no liability for prior debt (or below market value if both parties agree).
'Step forward for availability and accessibility of care'
"This bill is a critical step forward in the efforts many caregivers and communities are taking to assure the availability, accessibility, and quality of hospital care," said Burger.
Over the past decade as many as 42 hospitals have closed in California. Burger cited a variety of reasons for closures, including inadequate Medicare and insurance industry reimbursement rates and poor management. But some closures, she added, are also "a result of anti-competitive business practices by corporate hospital chains that seek to increase market share by buying up hospitals in one area, shifting resources and revenue from one hospital to another, and then strategically closing the hospital deemed to be 'losing money'."
Bill to Reduce Injuries, Cut Hospital Costs Approved
Two other CNA-sponsored bills also moved forward this week.
AB 2532, authored by Assembly member Loni Hancock (D-Berkeley), requires hospitals to have a plan to prevent back injuries and to provide specially trained lift team staff and equipment. The bill would help reduce debilitating back injuries for RNs and other healthcare workers.
Hospital industry lobbyists opposed AB 2532 even though the bill will reduce hospital costs.
Work-related back injuries and other musculoskeletan disorders occur more frequently to healthcare employees than to any other American workers. In 2000, for example, the Bureau of Labor Statistics reported 62,332 such injuries to RNs, licensed vocational nurses and nurses aides. Recent studies found that 52% of all nurses report chronic back pain and 12% of nurses who leave the profession cite back injuries as the main, or a significant contributing factor.
Many of the injuries are associated with lifting patients, at a time when national obesity has been rising and the nursing workforce ages. Hospitals that use lift teams report a sharp drop in such injuries. Kaiser Permanente, for example, saw a 46% reduction in nursing staff injuries following the introduction of lift teams trained to handle the increase of heavy patients. Tampa General Hospital in Tampa Bay, Fl. cut patient handling injuries by 62% in the first year after implementing the use of lift teams.
AB 2532, said Burger, will reduce hospital costs in both workers compensation claims and the expenditures needed to train replacements when a nurse or other employee is injured. In a Spring 2003 article, the Journal of Healthcare Safety found significant across the board savings for hospitals employing lift teams.
One 500-bed hospital using lift teams reported a 69% reduction in injury claims and 95% cut in employee lost days. The hospital saw average costs per injury dropped from nearly $10,000 to just over $1,000 - and a total medical cost savings of $690,504. Another 400-bed hospital reported reduced workers compensation costs and medical costs from a three year average of $242,000 to $14,000.
Hospitals also save in retraining costs. Turnover costs hospitals at least $40,000 to $60,000 per RN in training and orienting expenditures.
RN education bill advances
SB 1245, by Sen. Sheila Kuehl (D-Los Angeles), which expands educational opportunities for nursing students, was approved by the State Senate without opposition. The bill now heads to the Assembly.
The bill would create entry level Masters Degree programs to be established within all California State Universities that have a Board of Registered Nursing-approved professional nursing program.
Among the positive effects, says CNA, is that initiative will open up undergraduate nursing program slots for students who do not already have a B.A. and help encourage RNs to become educators, an important aspect of addressing the need for California to increase the RN work force.
SB 1245 is the latest in a series of bills, workplace initiatives, grant programs and other steps CNA has taken in recent years to increase opportunities for RNs and to boost the number of licensed RNs in the state.