Bill Text: CA SB1318 | 2011-2012 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Health facilities: influenza vaccinations.

Spectrum: Bipartisan Bill

Status: (Vetoed) 2012-09-30 - In Senate. Consideration of Governor's veto pending. [SB1318 Detail]

Download: California-2011-SB1318-Amended.html

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BILL NUMBER: SB 1318	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  AUGUST 8, 2012
	AMENDED IN ASSEMBLY  AUGUST 7, 2012
	AMENDED IN ASSEMBLY  JUNE 14, 2012
	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 add  Sections 1228.3, 1228.5, and 1288.65
  Section 1228.5  to, and to repeal and add Section
1288.7 of, 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 each clinic and health facility to
annually offer onsite influenza vaccinations to its employees and to
require its 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 clinic and health facility to annually record its
vaccination rate, as defined, for each year and to make those records
available online or upon request.  This bill would require
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 increasing the responsibilities of clinics
and health facilities,  and adding instances where a clinic or
health facility could be subject to a misdemeanor,  this bill
would expand the definition of a crime and would impose a
state-mandated local program.
   This bill would also require 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 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, by
January 1, 2015, 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. This bill would
require the department, by January 1, 2016, to develop a model
mandatory vaccination policy, as specified, and would require clinics
and health facilities which fail to reach the 90% compliance rate
requirement to be subject to the model mandatory vaccination policy
  require, commencing January 1, 2015, each clinic and
health facility to have a 90% or higher vaccination rate. The bill
would require the department, by July 1, 2015, to develop a model
mandatory vaccination policy, as specified, and for each year a
clinic or health facility does not achieve the 90% or higher
vaccination rate, would require the clinic or health facility to
adopt the model mandatory vaccination policy for the following flu
season  .
   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 declares that influenza can be a
serious disease that can lead to hospitalization and even death, and
that increased access to vaccinations is a critical component in the
promotion of health and wellness. Because of their contact with
patients, many health care workers are at risk for exposure to, and
possible transmission of, vaccine-preventable diseases. By getting
vaccinated, health care workers can protect themselves, their
families, and patients from contracting the flu. It is the intent of
the Legislature in enacting this statute to protect the health,
safety, and welfare of health care workers and patients who enter a
clinic or health care facility. It is also the intent of the
Legislature that health care facilities and clinics institute
measures designed to maximize influenza vaccination rates and
increase vaccination among health care workers. It is also the intent
of the Legislature that the State Department of Public Health
develop a model mandatory vaccination policy through a stakeholder
process to achieve a 90-percent influenza vaccination compliance rate
requirement for health care workers. 
  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. 
   SEC. 3.   SEC. 2.   Section 1228.5 is
added to the Health and Safety Code, to read:
   1228.5.  (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. These measures shall include, but
not be limited to, aerosol transmissible diseases training as
described in subdivision (i) of Section 5199 of Title 8 of the
California Code of Regulations, as in effect on January 1, 2013.

    (b)  A licensed clinic shall annually offer its
employees onsite influenza vaccinations, if available, at no cost to
the employee. 
   (b) 
    (c)  A licensed clinic shall require all 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
if an onsite health care worker affiliated with the clinic or person
with privileges on the medical staff elects not to be vaccinated, he
or she shall agree, in writing, to adhere to the most effective
measures determined by the clinic in preventing health care workers
from contracting and transmitting the influenza virus. 
   (d) (1) A clinic shall annually record its average vaccination
compliance rate, as defined in paragraph (4) of subdivision (i), for
that year, and make those records available online or upon request of
a government agency, organization, or individual.  
   (2) The records described in paragraph (1) shall be maintained and
made available during any inspection made by the department. 

   (e) (1) Commencing January 1, 2015, a clinic shall have a
90-percent or higher vaccination rate. For each year that a clinic
does not achieve the 90-percent or higher vaccination rate, the
clinic shall adopt for the following flu season, as defined by the
State Health Officer, local health officer, or both, the model
mandatory vaccination policy described in paragraph (2), to achieve
the 90-percent or higher goal. The department may waive the
90-percent vaccination rate requirement for a clinic that is in
substantial compliance.  
   (2) The department shall develop a model mandatory vaccination
policy through a stakeholder process to be issued through an all
facilities letter no later than July 1, 2015.  
   (c) 
    (f)  (1) In meeting the requirements of 
subdivision (b)   subdivisions (c), (d), and (e)  ,
the clinic shall maintain influenza vaccination records of employees
and may maintain influenza vaccination records of the other onsite
health care workers  who are  affiliated with, but  are
 not  an employee   employees  of, the
clinic and of persons with privileges on the medical staff. If the
clinic does not have records of an onsite health care worker or
person with privileges on the medical staff being vaccinated onsite,
the clinic may require the worker or medical staff person to either
provide documentation of 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) 
    (g)  Each licensed clinic shall develop policies to
implement this section and to ensure its onsite health care workers
affiliated with the clinic are in compliance with the vaccination
requirements imposed by this section. The medical staff shall also
develop policies 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. 
   (h) Subdivisions (f) and (g) shall not be applicable to a dialysis
clinic which maintains an influenza immunization log for its
patients, health care workers, and medical staff pursuant to an
infection control program in compliance with the Medicare "Conditions
for Coverage for End-State Renal Disease Facilities," conditions
that are promulgated by the Centers for Medicare and Medicaid
Services, if the immunization log is available for review during
routine department inspections or during an inspection in response to
a complaint.  
   (e) 
    (i)  For purposes of this section, the following
definitions shall apply:
   (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,
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, contractual staff, and
registry staff who perform direct patient care duties but are not
employed by the clinic. 
   (4) "Vaccination rate" means the percentage of a clinic's onsite
health care workers who are employees and persons with privileges on
the medical staff who receive influenza vaccination during a specific
year or influenza season.  
   (f) 
    (j)  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 subdivision (a) and the
reporting requirement of subdivision (g), shall not apply to a clinic
that has a combined average vaccination compliance rate of 90
percent or higher, by January 1, 2015, for its onsite health care
workers who are employees and medical staff. For clinics that fail to
reach the 90-percent compliance rate requirement, the clinic shall
adopt the model mandatory vaccination policy as determined by the
State Department of Public Health to achieve the 90-percent or higher
goal. The department shall develop a model mandatory vaccination
policy through a stakeholder process to be issued through an all
facilities letter no later than January 1, 2016. The department may
waive the 90-percent compliance rate requirement for a clinic that is
in substantial compliance. Implementation of this section shall be
exempt from the Administrative Procedure Act.  
   (k) This section does not to prevent a clinic or local
jurisdiction from instituting additional measures or policies to
maximize influenza vaccination rates and to prevent health care
workers affiliated with the clinic from contracting and transmitting
the influenza virus.  
   (l) This section does not require the department to perform any
additional duties to ensure compliance that are separate from its
existing licensing survey activity or other statutory requirements.
 
   (m) Implementation of this section is exempt from the rulemaking
provisions of the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code).  
  SEC. 4.    Section 1288.65 is added to the Health
and Safety Code, to read:
   1288.65.  (a) 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. 5.   SEC. 3.   Section 1288.7 of
the Health and Safety Code is repealed.
   SEC. 6.   SEC. 4.   Section 1288.7 is
added to the Health and Safety Code, to read:
   1288.7.  (a)  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 subdivision (i) of Section 5199 of
Title 8 of the California Code of Regulations, as in effect on
January 1, 2013. 
    (b)  A licensed health facility shall annually offer its
employees onsite influenza vaccinations, if available, at no cost to
the employee. 
   (b) 
    (c)  A licensed health facility shall require all 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 if the onsite health care worker affiliated with the
health facility or person with privileges on the medical staff elects
not to be vaccinated, he or she shall agree, in writing, to adhere
to the most effective measures determined by the health facility in
preventing health care workers from contracting and transmitting the
influenza virus. 
   (d) (1) A health facility shall annually record its vaccination
rate, as defined in paragraph (4) of subdivision (i), for that year,
and make those records available online or upon request of a
government agency, organization, or individual.  
   (2) The records described in paragraph (1) shall be maintained and
made available during any inspection made by the department. 

   (e) (1) Commencing January 1, 2015, a health facility shall have a
90-percent or higher vaccination rate. For each year that a health
facility does not achieve the 90-percent or higher vaccination rate,
the health facility shall adopt for the following flu season, as
defined by the State Health Officer, local health officer, or both,
the model mandatory vaccination policy described in paragraph (2), to
achieve the 90-percent or higher goal. The department may waive the
90-percent vaccination rate requirement for a health facility that is
in substantial compliance.  
   (2) The department shall develop a model mandatory vaccination
policy through a stakeholder process to be issued through an all
facilities letter no later than July 1, 2015.  
   (c) 
    (f)  (1) In meeting the requirements of 
subdivision (b)   subdivisions (c), (d), and (e)  ,
the health facility shall maintain influenza vaccination records of
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
an onsite health care worker or person with privileges on the medical
staff being vaccinated, the health facility may require the worker
or medical staff person to either provide documentation of
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) 
    (g)  Each licensed health facility shall develop
policies to implement this section and to ensure its onsite health
care workers affiliated with the health facility are in compliance
with the vaccination requirements imposed by this section. The
medical staff shall develop policies 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) 
    (h)  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. 
   (f) 
    (i)  For purposes of this section, the following
definitions shall apply:
   (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
  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 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, 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 performing direct patient care
duties but are not employed by the health facility. 
   (4) "Vaccination rate" means the percentage of a health facility's
onsite health care workers who are employees and persons with
privileges on the medical staff who receive an influenza vaccination
during a specific year or influenza season. 
   (g) 
    (j)  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 subdivisions (a) and (e),
and 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 by January 1, 2015, for its onsite
health care workers that are employees and medical staff. For health
facilities that fail to reach the 90-percent compliance rate
requirement, the health facility shall adopt the model mandatory
vaccination policy as determined by the State Department of Public
Health to achieve the 90-percent or higher goal. The department shall
develop a model mandatory vaccination policy through a stakeholder
process to be issued through an all facilities letter later no later
than January 1, 2016. The department may waive the 90-percent
compliance rate requirement for a health facility that is in
substantial compliance. Implementation of this section shall be
exempt from the Administrative Procedure Act.  
   (k) This section does not apply to correctional treatment centers
as defined in subdivision (j) of Section 1250.  
   (l) This section does not prevent a health facility or local
jurisdiction from instituting additional measures or policies to
maximize influenza vaccination rates and to prevent health care
workers affiliated with the health facility from contracting and
transmitting the influenza virus.  
   (m) This section does not require the department to perform any
additional duties to ensure compliance that are separate from its
existing licensing survey activity or other statutory requirements.
 
   (n) Implementation of this section is exempt from the rulemaking
provisions of the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code). 
   SEC. 7.   SEC. 5.   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.