On November 9, 2011 we published an article under the title "Safe Patient Handling Law Signed by California Governor". We've since learned the article contained at least one error, and it has sparked a debate over some points of confusion with regard to the interpretation of certain key sections of the law. (Special thanks to Kathy Espinoza, Director of Ergonomic Services, Keenan & Associates, for her assistance in recognizing, researching and correcting this error).
One thing is certain … at least at the time of this writing … AB 1136, Hospital Patient and Health Care Worker Injury Protection Act, will take effect, including enforcement, on January 1, 2012 — just weeks from now.
The original article, submitted by guest contributor Charissa Shaw, incorrectly indicated that the enforcement of the law would not take effect until January 2013. Earlier versions of the regulation contained the January 2013 enforcement date, but that provision was removed from the final version signed by the Governor. We apologize for any confusion or inconvenience this may have caused. There is, however, a political debate brewing over whether it is realistic to expect affected parties to establish compliance within such a short time frame (the law wasn't approved by the Governor until October 7, 2011, giving employers just a few months to research, plan and implement its requirements). Thus, it is possible that the State of California may revisit the enforcement deadlines for this new law.
Regardless, as the law stands today, AB 1136 enforcement will begin January 1, 2012.
Another point of confusion relates to the availability and use of patient handling equipment. Earlier versions of the law contained language mandating "enough safe handling equipment to eliminate the need to conduct manual patient handling and transfers," but that language was also stricken from the final version of the law. Charissa's article erroneously described patient handling equipment as a requirement of AB 1136. Instead, the final version of the law uses language such as "patient transfer, repositioning, or lifting devices as appropriate …" Therefore, it does not mandate such equipment be available, but instead requires patient handling policies to supply, use and train personnel in their use "as appropriate."
It also remains unclear whether lift teams are or are not required by AB 1136. According to Gail Blanchard-Saiger, VP Labor & Employment, California Hospital Association, "With regard to the actual requirements of the bill, our position is that the legislation is internally inconsistent. While in one section it may appear that lift teams are required, other sections dictate the opposite conclusion. Until Cal/OSHA issues enforcement guidance, the law remains unclear."
To help you better understand the key requirements of AB 1136, I've prepared the following point-by-point summary of the law (See the end of this article for a copy of the entire law. We will continue to monitor the progress of AB 1136 and will let you know of any significant changes or updates that may occur.):
SECTION 1
The act shall be known as: Hospital Patient and Health Care Worker Injury Protection Act
SECTION 2
This section contains various statistics and data to support the need for this act.
SECTION 3
(a)
Employers shall:
- … adopt a patient protection and health care worker back and musculoskeletal injury prevention plan.
- … include a safe patient handling policy component reflected in professional occupational safety guidelines for the protection of patients and health care workers in health care facilities.
(b)
Employer shall:
- … maintain a safe patient handling policy at all times for all patient care units.
- … provide trained lift teams or other support staff trained in safe lifting techniques in each general acute care hospital.
-
… provide training to health care workers that includes at least the following:
- … use of lifting devices and equipment.
- The five areas of body exposure: vertical, lateral, bariatric, repositioning, and ambulation.
- The use of lifting devices to handle patients safely.
(c)
-
… registered nurse shall be responsible for the observation and direction of patient lifts and mobilization …
(d)
-
… "lift team" means hospital employees specifically trained to handle patient lifts, repositionings, and transfers using patient transfer, repositioning, or lifting devices as appropriate …
-
… A general acute care hospital shall not be required by this section to hire new staff to comprise the lift team so long as direct patient care assignments are not compromised.
(e)
- … "health care worker" means a lift team member or other staff responsible for assisting in lifting patients who is a hospital employee specifically trained to handle patient lifts, repositioning, and transfers using patient transfer, repositioning, and lifting devices as appropriate …
(f)
-
… "safe patient handling policy" means a policy that requires replacement of manual lifting and transferring of patients with powered patient transfer devices, lifting devices, and lift teams, as appropriate …
-
… consistent with the employer's safety policies and the professional judgment and clinical assessment of the registered nurse.
(g)
-
A health care worker who refuses to lift, reposition, or transfer a patient due to concerns about patient or worker safety or the lack of trained lift team personnel or equipment shall not, based upon the refusal, be the subject of disciplinary action by the hospital or any of its managers or employees.
(h)
-
… shall not apply to general acute care hospitals within the Department of Corrections and Rehabilitation or the State Department of Developmental Services.
According to the State of California's official legal web site, legalinfo.ca.gov, as of the date of this writing, below is final version of AB 1136:
SECTION 1. This act shall be known and cited as the Hospital
Patient and Health Care Worker Injury Protection Act.
SEC. 2. The Legislature finds and declares the following:
(a) In 2008, there were 36,130 occupational musculoskeletal
disorder (MSD) cases in private industry where the source of injury
or illness was a health care patient or resident of a health care
facility. This accounted for 11 percent of the 317,440 total cases of
MSDs that resulted in at least one lost day from work in 2008.
Almost all (98 percent) of the cases involving patient handling
occurred within the health care and social assistance industry,
composing 55 percent of the 64,300 total MSD cases in that industry.
(b) For MSD cases involving patient handling, almost all (99
percent) were the result of overexertion. A sprain, strain, or tear
was the type of injury that was incurred in 84 percent of the MSD
cases involving patient handling.
(c) Nursing aides, orderlies, and attendants incurred occupational
injuries or illnesses in 52 percent of the MSD cases involving
health care patients. Registered nurses accounted for 16 percent and
home health aides for another 6 percent. Other occupations with MSD
cases involving health care patients included licensed practical and
licensed vocational nurses, emergency medical technicians and
paramedics, personal and home care aides, health care support
workers, radiologic technologists and technicians, and medical and
health services managers.
(d) Over 12 percent of the nursing workforce leaves the bedside
due to back injuries each year. California's nursing workforce is
aging at the same time patient acuity and obesity are rising. It is
imperative that we protect our registered nurses and other health
care workers from injury, and provide patients with safe and
appropriate care. At a cost of between sixty thousand dollars
($60,000) and one hundred forty thousand dollars ($140,000) to train
and orient each new nurse, preventing turnover from injuries will
save hospitals money.
SEC. 3. Section 6403.5 is added to the Labor Code, to read:
6403.5. (a) As part of the injury and illness prevention programs
required by Section 3203 of Title 8 of the California Code of
Regulations, or any successor law or regulation, employers shall
adopt a patient protection and health care worker back and
musculoskeletal injury prevention plan. The plan shall include a safe
patient handling policy component reflected in professional
occupational safety guidelines for the protection of patients and
health care workers in health care facilities.
(b) An employer shall maintain a safe patient handling policy at
all times for all patient care units, and shall provide trained lift
teams or other support staff trained in safe lifting techniques in
each general acute care hospital. The employer shall provide training
to health care workers that includes, but is not limited to, the
following:
(1) The appropriate use of lifting devices and equipment.
(2) The five areas of body exposure: vertical, lateral, bariatric,
repositioning, and ambulation.
(3) The use of lifting devices to handle patients safely.
(c) As the coordinator of care, the registered nurse shall be
responsible for the observation and direction of patient lifts and
mobilization, and shall participate as needed in patient handling in
accordance with the nurse's job description and professional
judgment.
(d) For purposes of this section, "lift team" means hospital
employees specifically trained to handle patient lifts,
repositionings, and transfers using patient transfer, repositioning,
or lifting devices as appropriate for the specific patient. Lift team
members may perform other duties as assigned during their shifts. A
general acute care hospital shall not be required by this section to
hire new staff to comprise the lift team so long as direct patient
care assignments are not compromised.
(e) For purposes of this section, "health care worker" means a
lift team member or other staff responsible for assisting in lifting
patients who is a hospital employee specifically trained to handle
patient lifts, repositioning, and transfers using patient transfer,
repositioning, and lifting devices as appropriate for the specific
patient.
(f) For the purposes of this section, "safe patient handling
policy" means a policy that requires replacement of manual lifting
and transferring of patients with powered patient transfer devices,
lifting devices, and lift teams, as appropriate for the specific
patient and consistent with the employer's safety policies and the
professional judgment and clinical assessment of the registered
nurse.
(g) A health care worker who refuses to lift, reposition, or
transfer a patient due to concerns about patient or worker safety or
the lack of trained lift team personnel or equipment shall not, based
upon the refusal, be the subject of disciplinary action by the
hospital or any of its managers or employees.
(h) This section shall not apply to general acute care hospitals
within the Department of Corrections and Rehabilitation or the State
Department of Developmental Services.
SEC. 4.
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.
Source: http://leginfo.ca.gov/pub/11-12/bill/asm/ab_1101-1150/ab_1136_bill_20111007_chaptered.html, last accessed on December 14, 2011.