Bill Text: NY A01548 | 2015-2016 | General Assembly | Introduced


Bill Title: Enacts the "safe staffing for quality care act" to require acute care facilities and nursing homes to implement certain direct-care nurse to patient ratios in all nursing units; sets minimum staffing requirements; requires every such facility to submit a documented staffing plan to the department on an annual basis and upon application for an operating certificate; requires acute care facilities to maintain staffing records during all shifts; authorizes nurses to refuse work assignments if the assignment exceeds the nurse's abilities or if minimum staffing is not present; requires public access to documented staffing plans; imposes civil penalties for violations of such provisions; establishes private right of action for nurses discriminated against for refusing any illegal work assignment.

Spectrum: Moderate Partisan Bill (Democrat 70-14)

Status: (Introduced - Dead) 2016-01-11 - enacting clause stricken [A01548 Detail]

Download: New_York-2015-A01548-Introduced.html
                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         1548
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                   January 12, 2015
                                      ___________
       Introduced by M. of A. GOTTFRIED, GUNTHER, CLARK, PEOPLES-STOKES, ROSEN-
         THAL,  BRINDISI, BRONSON, COLTON, BENEDETTO, CAMARA, JAFFEE, MAGNAREL-
         LI, MARKEY, MILLER, WEPRIN, RIVERA, ROBERTS, RYAN, SKARTADOS, SEPULVE-
         DA, AUBRY,  OTIS,  SKOUFIS,  STECK,  MAYER,  SANTABARBARA,  ZEBROWSKI,
         BROOK-KRASNY,  MOSLEY,  ORTIZ, TITUS -- Multi-Sponsored by -- M. of A.
         ABBATE, ABINANTI, ARROYO,  BRENNAN,  BUTLER,  CAHILL,  CERETTO,  COOK,
         CRESPO,  CUSICK,  CYMBROWITZ,  DAVILA,  DINOWITZ,  ENGLEBRIGHT,  FAHY,
         FARRELL, GLICK, GRAF, HEASTIE, HOOPER, JOHNS, KEARNS, LAVINE,  LIFTON,
         LUPARDO,  LUPINACCI,  MAGEE,  McDONOUGH,  McKEVITT, MONTESANO, PAULIN,
         PERRY, PRETLOW, RA, RAMOS, ROBINSON, RUSSELL,  SALADINO,  SCARBOROUGH,
         SCHIMEL,  SIMOTAS, SOLAGES, TEDISCO, THIELE, TITONE, WEINSTEIN, WRIGHT
         -- read once and referred to the Committee on Health
       AN ACT to amend the public health law, in relation to enacting the "safe
         staffing for quality care act"
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section  1.  Short  title. This act shall be known and may be cited as
    2  the "safe staffing for quality care act".
    3    S 2. Paragraphs (a) and (b) of subdivision 2 of section  2805  of  the
    4  public  health  law, paragraph (a) as amended by chapter 923 of the laws
    5  of 1973 and paragraph (b) as added by chapter 795 of the laws  of  1965,
    6  are amended to read as follows:
    7    (a)  Application  for an operating certificate for a hospital shall be
    8  made upon forms prescribed by  the  department.  The  application  shall
    9  [contain]  INCLUDE the name of the hospital, the kind or kinds of hospi-
   10  tal service to be provided, the location and physical description of the
   11  institution,  A  DOCUMENTED  STAFFING  PLAN,  AS  DEFINED   IN   SECTION
   12  TWENTY-EIGHT HUNDRED TWENTY-EIGHT OF THIS ARTICLE, and such other infor-
   13  mation as the department may require.
   14    (b)  An  operating  certificate  shall not be issued by the department
   15  unless it finds that  the  premises,  equipment,  personnel,  DOCUMENTED
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD02732-01-5
       A. 1548                             2
    1  STAFFING  PLAN, rules and by-laws, standards of medical care, and hospi-
    2  tal service are fit and adequate and that the hospital will be  operated
    3  in  the manner required by this article and rules and regulations there-
    4  under.
    5    S  3.  The  public  health  law is amended by adding nine new sections
    6  2827, 2828, 2829, 2830, 2831, 2832, 2833,  2834  and  2835  to  read  as
    7  follows:
    8    S  2827. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL OF
    9  THE FOLLOWING:
   10    1. HEALTH CARE SERVICES ARE BECOMING COMPLEX AND  IT  IS  INCREASINGLY
   11  DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES;
   12    2.  THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE STAFF-
   13  ING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES;
   14    3. TO ENSURE THE  ADEQUATE  PROTECTION  OF  PATIENTS  IN  HEALTH  CARE
   15  SETTINGS,  IT  IS  ESSENTIAL  THAT QUALIFIED REGISTERED NURSES AND OTHER
   16  LICENSED NURSES BE  ACCESSIBLE  AND  AVAILABLE  TO  MEET  THE  NEEDS  OF
   17  PATIENTS; AND
   18    4.  THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING SHOULD
   19  BE BASED ON  THE  PATIENT'S  CARE  NEEDS,  THE  SEVERITY  OF  CONDITION,
   20  SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES.
   21    S  2828.  SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS AND PHRASES,
   22  AS USED IN THIS ARTICLE, SHALL HAVE THE FOLLOWING  MEANINGS  UNLESS  THE
   23  CONTEXT OTHERWISE PLAINLY REQUIRES:
   24    1.  "ACUTE  CARE FACILITY" SHALL MEAN A HOSPITAL OTHER THAN A RESIDEN-
   25  TIAL HEALTH CARE FACILITY AND  SHALL  ALSO  INCLUDE  ANY  FACILITY  THAT
   26  PROVIDES  HEALTH CARE SERVICES PURSUANT TO THE MENTAL HYGIENE LAW, ARTI-
   27  CLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION LAW IF SUCH FACIL-
   28  ITY IS OPERATED BY THE STATE OR A POLITICAL SUBDIVISION OF THE STATE  OR
   29  A PUBLIC AUTHORITY OR PUBLIC BENEFIT CORPORATION.
   30    2.  "ACUITY  SYSTEM"  SHALL MEAN AN ESTABLISHED MEASUREMENT INSTRUMENT
   31  WHICH (A) PREDICTS NURSING CARE  REQUIREMENTS  FOR  INDIVIDUAL  PATIENTS
   32  BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND
   33  TECHNOLOGY,   INTENSITY  OF  NURSING  INTERVENTIONS  REQUIRED,  AND  THE
   34  COMPLEXITY OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT  AND
   35  EVALUATE  THE  PATIENT'S  NURSING  CARE  PLAN; (B) DETAILS THE AMOUNT OF
   36  NURSING CARE NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND  IN  SKILL
   37  MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN
   38  A  NURSING  DEPARTMENT  OR UNIT; AND (C) IS STATED IN TERMS THAT READILY
   39  CAN BE USED AND UNDERSTOOD BY  DIRECT-CARE  NURSES.  THE  ACUITY  SYSTEM
   40  SHALL  TAKE  INTO  CONSIDERATION  THE PATIENT CARE SERVICES PROVIDED NOT
   41  ONLY BY REGISTERED PROFESSIONAL NURSES BUT ALSO  BY  LICENSED  PRACTICAL
   42  NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL.
   43    3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE
   44  STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT
   45  NURSING  CARE  REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF AN ACUITY
   46  SYSTEM.
   47    4. "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN  ANY
   48  NURSE  WHO  HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY OUT MEDICAL
   49  REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS.
   50    5. "DOCUMENTED STAFFING PLAN"  SHALL  MEAN  A  DETAILED  WRITTEN  PLAN
   51  SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURS-
   52  ES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN AN ACUTE CARE FACILITY
   53  FOR  A  GIVEN  YEAR,  BASED  ON  REASONABLE PROJECTIONS DERIVED FROM THE
   54  PATIENT CENSUS AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT  OR  UNIT
   55  DURING  THE  PRIOR  YEAR, THE DEPARTMENT OR UNIT SIZE AND GEOGRAPHY, THE
       A. 1548                             3
    1  NATURE OF SERVICES PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR
    2  UNIT SIZE OR FUNCTION DURING THE CURRENT YEAR.
    3    6.  "NURSE"  SHALL  MEAN  A  REGISTERED PROFESSIONAL NURSE OR LICENSED
    4  PRACTICAL NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE  OF
    5  THE EDUCATION LAW.
    6    7.  "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE DEFINITION
    7  OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF
    8  THE EDUCATION LAW, OR OTHERWISE ENCOMPASSED WITH THE  RECOGNIZED  STAND-
    9  ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN-
   10  NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY.
   11    8.  "SAFE STAFFING REQUIREMENTS" SHALL MEAN THE PROVISIONS OF SECTIONS
   12  TWENTY-EIGHT   HUNDRED   TWENTY-SEVEN   THROUGH   TWENTY-EIGHT   HUNDRED
   13  THIRTY-FIVE OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSU-
   14  ANT THERETO.
   15    9.  "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY AND
   16  EXPERIENCE AMONG DIRECT-CARE NURSES.
   17    10. "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO  PATIENT
   18  RATIO WITHIN A NURSING DEPARTMENT OR UNIT.
   19    11.  "UNIT"  SHALL  MEAN  A  PATIENT CARE COMPONENT, AS DEFINED BY THE
   20  DEPARTMENT, WITHIN AN ACUTE CARE FACILITY.
   21    12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT
   22  A NURSE OR OTHER PERSON LICENSED, CERTIFIED OR  REGISTERED  UNDER  TITLE
   23  EIGHT  OF  THE  EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY IS TO CARRY
   24  OUT PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT  ASSISTANCE
   25  IN THE DELIVERY OF PATIENT CARE.
   26    S  2829. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE COMMISSIONER
   27  SHALL:
   28    1. APPOINT AN ACUTE  CARE  FACILITY  COUNCIL  CONSISTING  OF  THIRTEEN
   29  MEMBERS.  NO  LESS  THAN  SEVEN MEMBERS SHALL BE REGISTERED PROFESSIONAL
   30  NURSES, THREE OF WHOM SHALL BE DIRECT CARE REGISTERED NURSES,  THREE  OF
   31  WHOM  SHALL  BE NURSE MANAGERS AND ONE OF WHOM SHALL BE A NURSE ADMINIS-
   32  TRATOR. NO LESS THAN TWO MEMBERS OF  THE  ACUTE  CARE  FACILITY  COUNCIL
   33  SHALL  BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE BARGAIN-
   34  ING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO
   35  REPRESENTATIVES OF ACUTE CARE FACILITIES, ONE REPRESENTATIVE OF A  NURS-
   36  ING  PROFESSIONAL ASSOCIATION, AND ONE REPRESENTATIVE OF A RECOGNIZED OR
   37  CERTIFIED BARGAINING AGENT OF NURSES. THE ACUTE  CARE  FACILITY  COUNCIL
   38  SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS, INCLUD-
   39  ING  REGISTERED  PROFESSIONAL NURSE TO PATIENT STAFFING REQUIREMENTS AND
   40  NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS THAT ARE  NOT  SPECIFIED
   41  IN  THIS  ARTICLE; THE EFFICACY OF ACUITY SYSTEMS SUBMITTED FOR APPROVAL
   42  BY THE COMMISSIONER; THE DEVELOPMENT OF AN ASSESSMENT TOOL USED TO EVAL-
   43  UATE THE EFFICACY OF ACUITY SYSTEMS; AND REVIEW AND MAKE RECOMMENDATIONS
   44  ON APPROVAL OF STAFFING PLANS PRIOR TO  THE  GRANTING  OF  AN  OPERATING
   45  CERTIFICATE BY THE DEPARTMENT.
   46    2.  PROMULGATE,  AFTER CONSULTATION WITH THE ACUTE CARE FACILITY COUN-
   47  CIL, THE RULES AND REGULATIONS NECESSARY TO CARRY OUT THE  PURPOSES  AND
   48  PROVISIONS  OF  THE  SAFE  STAFFING  REQUIREMENTS, INCLUDING REGULATIONS
   49  DEFINING TERMS, SETTING  FORTH  DIRECT-CARE  NURSE  TO  PATIENT  RATIOS,
   50  SETTING  FORTH  NON-NURSING  DIRECT-CARE  STAFF  TO  PATIENT  RATIOS AND
   51  PRESCRIBING THE PROCESS FOR APPROVING FACILITY SPECIFIC ACUITY  SYSTEMS;
   52  AND
   53    3.  ASSURE  THAT  THE  PROVISIONS  OF  SAFE  STAFFING REQUIREMENTS ARE
   54  ENFORCED, INCLUDING THE ISSUANCE  OF  REGULATIONS  WHICH  AT  A  MINIMUM
   55  PROVIDE  FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE FAILURE
   56  TO COMPLY WITH  SUCH  REQUIREMENTS  AND  PUBLIC  ACCESS  TO  INFORMATION
       A. 1548                             4
    1  REGARDING  REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS
    2  PURSUANT TO SUCH REQUIREMENTS.
    3    S  2830.  STAFFING  REQUIREMENTS. 1. STAFFING REQUIREMENTS. EACH ACUTE
    4  CARE FACILITY SHALL ENSURE THAT IT IS STAFFED IN A MANNER THAT  PROVIDES
    5  SUFFICIENT,  APPROPRIATELY  QUALIFIED DIRECT-CARE NURSES IN EACH DEPART-
    6  MENT OR UNIT WITHIN SUCH FACILITY IN ORDER TO  MEET  THE  INDIVIDUALIZED
    7  CARE  NEEDS  OF  THE  PATIENTS THEREIN. AT A MINIMUM, EACH SUCH FACILITY
    8  SHALL MEET THE REQUIREMENTS  OF  SUBDIVISIONS  TWO  AND  THREE  OF  THIS
    9  SECTION.
   10    2.  STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING CERTIF-
   11  ICATE TO ANY ACUTE CARE FACILITY UNLESS SUCH FACILITY  ANNUALLY  SUBMITS
   12  TO THE DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN CERTIFICATION
   13  THAT  THE  SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE ADEQUATE AND
   14  APPROPRIATE DELIVERY OF HEALTH CARE SERVICES TO PATIENTS FOR THE ENSUING
   15  YEAR. THE DOCUMENTED STAFFING PLAN SHALL:
   16    (A) MEET THE MINIMUM REQUIREMENTS SET FORTH IN  SUBDIVISION  THREE  OF
   17  THIS SECTION;
   18    (B)  BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY OTHER
   19  LAWS, RULES OR REGULATIONS;
   20    (C) EMPLOY AND IDENTIFY AN ACUITY SYSTEM FOR  ADDRESSING  FLUCTUATIONS
   21  IN  ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS REQUIRING
   22  INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE PLAN;
   23    (D) FACTOR IN OTHER UNIT OR DEPARTMENT ACTIVITY  SUCH  AS  DISCHARGES,
   24  TRANSFERS  AND  ADMISSIONS,  STAFF  BREAKS,  MEALS, ROUTINE AND EXPECTED
   25  ABSENCES FROM THE UNIT AND ADMINISTRATIVE AND  SUPPORT  TASKS  THAT  ARE
   26  EXPECTED  TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT NURSING
   27  CARE;
   28    (E) INCLUDE A PLAN TO MEET  NECESSARY  STAFFING  LEVELS  AND  SERVICES
   29  PROVIDED  BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE NEEDS
   30  PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE
   31  STAFFING PLAN SHALL NOT INCORPORATE OR ASSUME THAT  NURSING  CARE  FUNC-
   32  TIONS  REQUIRED  BY LAWS, RULES OR REGULATIONS, OR ACCEPTED STANDARDS OF
   33  PRACTICE TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE  ARE  TO  BE
   34  PERFORMED BY OTHER PERSONNEL;
   35    (F)  IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL STAFFING
   36  ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT;
   37    (G) INCLUDE A WRITTEN ASSESSMENT OF THE ACCURACY OF THE  PRIOR  YEAR'S
   38  STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS;
   39    (H)  IDENTIFY  EACH NURSE STAFF CLASSIFICATION REFERENCED IN SUCH PLAN
   40  TOGETHER WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR  EACH
   41  SUCH CLASSIFICATION; AND
   42    (I)  BE  DEVELOPED  IN CONSULTATION WITH A MAJORITY OF THE DIRECT-CARE
   43  NURSES WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE  REPRES-
   44  ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING
   45  REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER
   46  SUPPORTIVE AND ASSISTIVE STAFF.
   47    3.  MINIMUM  STAFFING  REQUIREMENTS.  (A) THE DOCUMENTED STAFFING PLAN
   48  SHALL INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE  NURSE-TO-PA-
   49  TIENT RATIOS:
   50    (I)  ONE  NURSE  TO  ONE  PATIENT: OPERATING ROOM AND TRAUMA EMERGENCY
   51  UNITS AND MATERNAL/CHILD CARE UNITS FOR THE SECOND  OR  THIRD  STAGE  OF
   52  LABOR;
   53    (II)  ONE  NURSE  TO TWO PATIENTS:   MATERNAL/CHILD CARE UNITS FOR THE
   54  FIRST STAGE OF LABOR, AND ALL CRITICAL CARE  AREAS  INCLUDING  EMERGENCY
   55  CRITICAL CARE AND ALL INTENSIVE CARE UNITS AND POSTANESTHESIA UNITS;
       A. 1548                             5
    1    (III)  ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA-
    2  TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME-
    3  DIATE CARE NURSERY UNITS;
    4    (IV)  ONE  NURSE  TO THREE PATIENTS:   POSTPARTUM MOTHER/BABY COUPLETS
    5  (MAXIMUM SIX PATIENTS PER NURSE);
    6    (V) ONE NURSE TO  FOUR  PATIENTS:  NON-CRITICAL  ANTEPARTUM  PATIENTS,
    7  POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHI-
    8  ATRIC UNITS;
    9    (VI)  ONE  NURSE  TO  FIVE PATIENTS: REHABILITATION UNITS AND SUBACUTE
   10  PATIENTS; AND
   11    (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS.
   12    FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED
   13  TO, PSYCHIATRIC UNITS, AND ACUTE CARE FACILITIES  OPERATED  PURSUANT  TO
   14  THE  MENTAL  HYGIENE  LAW  OR  THE  CORRECTION LAW, THE DEPARTMENT SHALL
   15  ESTABLISH BY REGULATION  THE  APPROPRIATE  DIRECT-CARE  NURSE-TO-PATIENT
   16  RATIO.
   17    (B)  THE  NURSE-TO-PATIENT  RATIOS  SET FORTH IN PARAGRAPH (A) OF THIS
   18  SUBDIVISION SHALL REFLECT THE MAXIMUM NUMBER OF  PATIENTS  THAT  MAY  BE
   19  ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT AT ANY ONE TIME.
   20    (C)  THERE  SHALL  BE  NO  AVERAGING OF THE NUMBER OF PATIENTS AND THE
   21  TOTAL NUMBER OF NURSES ON THE UNIT DURING ANY ONE  SHIFT  NOR  OVER  ANY
   22  PERIOD OF TIME.
   23    (D)  THE  COMMISSIONER,  IN  CONSULTATION WITH THE ACUTE CARE FACILITY
   24  COUNCIL, SHALL ESTABLISH REGULATIONS PROVIDING FOR  THE  MAINTENANCE  OF
   25  MINIMUM NURSE-TO-PATIENT RATIOS, AS SET FORTH IN THIS SECTION, INCLUDING
   26  DURING  ROUTINE  OR  EXPECTED  ABSENCES  FROM THE UNIT, SUCH AS MEALS OR
   27  BREAKS.
   28    4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC-
   29  TICAL NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY  PATIENTS
   30  ASSIGNED  TO  THE  LICENSED  PRACTICAL  NURSE  SHALL ALSO BE INCLUDED IN
   31  CALCULATING THE NUMBER OF PATIENTS ASSIGNED TO  ANY  REGISTERED  PROFES-
   32  SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC-
   33  TICE  TO  SUPERVISE  OR  OVERSEE THE DIRECT-NURSING CARE PROVIDED BY THE
   34  LICENSED PRACTICAL NURSE.
   35    5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURS-
   36  ING CARE FUNCTIONS REQUIRED BY SECTION SIXTY-NINE  HUNDRED  TWO  OF  THE
   37  EDUCATION  LAW  OR  ACCEPTED  STANDARDS OF PRACTICE TO BE PERFORMED BY A
   38  REGISTERED PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED  PRACTI-
   39  CAL  NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE FUNC-
   40  TIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR
   41  ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A  LICENSED  PRACTICAL
   42  NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL.
   43    6.  ADJUSTMENTS  BY  FACILITY.    THE MINIMUM STAFFING REQUIREMENT AND
   44  NURSE-TO-PATIENT RATIO SET FORTH IN THIS SECTION SHALL  BE  ADJUSTED  BY
   45  THE  ACUTE CARE FACILITY AS NECESSARY TO REFLECT THE NEED FOR ADDITIONAL
   46  DIRECT-CARE NURSES.  ADDITIONAL STAFF SHALL BE  ASSIGNED  IN  ACCORDANCE
   47  WITH THE APPROVED, FACILITY-SPECIFIC PATIENT ACUITY SYSTEM FOR DETERMIN-
   48  ING  NURSING  CARE  REQUIREMENTS, INCLUDING THE SEVERITY OF THE ILLNESS,
   49  THE NEED FOR SPECIALIZED EQUIPMENT AND  TECHNOLOGY,  THE  COMPLEXITY  OF
   50  CLINICAL  JUDGMENT  NEEDED TO DESIGN, IMPLEMENT AND EVALUATE THE PATIENT
   51  CARE PLAN AND THE ABILITY  FOR  SELF-CARE,  AND  THE  LICENSURE  OF  THE
   52  PERSONNEL REQUIRED FOR CARE.
   53    7.  COMMISSIONER  REGULATIONS.    THE  COMMISSIONER  MAY BY REGULATION
   54  REQUIRE A DOCUMENTED  STAFFING  PLAN  TO  HAVE  HIGHER  NURSE-TO-PATIENT
   55  RATIOS THAN THOSE SET FORTH IN THIS SECTION.
       A. 1548                             6
    1    8.   NOTHING CONTAINED IN THIS SECTION SHALL SUPERSEDE OR DIMINISH THE
    2  TERMS OF A COLLECTIVE BARGAINING AGREEMENT THAT  PROVIDES  FOR  STAFFING
    3  RATIOS THAT EXCEED THE RATIOS ESTABLISHED UNDER THIS SECTION.
    4    S  2831.  COMPLIANCE  WITH  STAFFING PLAN AND RECORDKEEPING. 1.   EACH
    5  ACUTE CARE FACILITY SHALL AT ALL TIMES  STAFF  IN  ACCORDANCE  WITH  ITS
    6  DOCUMENTED STAFFING PLAN AND THE STAFFING STANDARDS SET FORTH IN SECTION
    7  TWENTY-EIGHT  HUNDRED  THIRTY  OF  THIS ARTICLE; PROVIDED, HOWEVER, THAT
    8  NOTHING IN THIS SECTION SHALL BE DEEMED TO PRECLUDE  ANY  SUCH  FACILITY
    9  FROM  IMPLEMENTING  HIGHER DIRECT-CARE NURSE-TO-PATIENT STAFFING LEVELS,
   10  NOR SHALL THE  REQUIREMENTS  SET  FORTH  IN  SUCH  SECTION  TWENTY-EIGHT
   11  HUNDRED  THIRTY  OF  THIS  ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY
   12  HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, REGULATION OR CONTRACT.
   13    2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM  STAFFING  REQUIREMENTS
   14  STANDARDS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED THIRTY OF THIS ARTI-
   15  CLE,  NO  NURSE  SHALL  BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT
   16  RATIO COUNT IN A NURSING UNIT OR A CLINICAL AREA WITHIN  AN  ACUTE  CARE
   17  FACILITY  UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTI-
   18  CLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION  LAW,  HAS  RECEIVED  PRIOR
   19  ORIENTATION  IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURS-
   20  ING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND  HAS  DEMON-
   21  STRATED  CURRENT  COMPETENCE  IN PROVIDING CARE IN THAT UNIT OR CLINICAL
   22  AREA. ACUTE CARE FACILITIES  THAT  UTILIZE  TEMPORARY  NURSING  AGENCIES
   23  SHALL  HAVE  AND  ADHERE  TO  A WRITTEN PROCEDURE TO ORIENT AND EVALUATE
   24  PERSONNEL FROM SUCH SOURCES TO ENSURE ADEQUATE ORIENTATION AND COMPETEN-
   25  CY PRIOR TO INCLUSION IN THE NURSE-TO-PATIENT RATIO.  IN THE EVENT OF AN
   26  EMERGENCY STAFFING SITUATION IN WHICH INSUFFICIENT STAFFING MAY LEAD  TO
   27  UNSAFE  PATIENT  CARE, NURSES MAY BE TEMPORARILY ASSIGNED TO A DIFFERENT
   28  UNIT OR CLINICAL AREA, PROVIDED  THAT  SUCH  NURSES  SHALL  BE  ASSIGNED
   29  PATIENTS  APPROPRIATE  TO THEIR SKILL AND COMPETENCY LEVEL. THE FACILITY
   30  SHALL ESTABLISH A CONSISTENT  PLAN  FOR  ADDRESSING  EMERGENCY  STAFFING
   31  SITUATIONS  AND  MONITOR  OUTCOMES.   EMERGENCIES ARE DEFINED AS NATURAL
   32  DISASTERS, DECLARED EMERGENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS
   33  NOT REASONABLY ANTICIPATED AND PLANNED FOR AND NOT  REGULARLY  OCCURRING
   34  WITHIN THE FACILITY.
   35    3.  EACH  ACUTE  CARE  FACILITY  SHALL MAINTAIN ACCURATE DAILY RECORDS
   36  SHOWING:
   37    (A) THE NUMBER OF PATIENTS ADMITTED,  RELEASED  AND  PRESENT  IN  EACH
   38  NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY;
   39    (B)  THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH NURS-
   40  ING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; AND
   41    (C) THE IDENTITY AND DUTY HOURS OF  EACH  DIRECT-CARE  NURSE  IN  EACH
   42  NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY.
   43    4.  EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURS-
   44  ING DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY,  INFECTION,  ACCIDENT,
   45  INJURY AND MEDICAL ERRORS.
   46    5.  ALL  RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE
   47  MAINTAINED FOR A PERIOD OF SEVEN YEARS.
   48    6. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION  SHALL  BE
   49  MADE  AVAILABLE  UPON  REQUEST  TO  THE  DEPARTMENT  AND  TO THE PUBLIC;
   50  PROVIDED, HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL  COMPLY
   51  WITH  THE  APPLICABLE  PATIENT  PRIVACY LAWS, RULES AND REGULATIONS, AND
   52  THAT IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE  IDENTITY
   53  AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC.
   54    S  2832. WORK ASSIGNMENT POLICY. 1. GENERAL.  EACH ACUTE CARE FACILITY
   55  SHALL ADOPT, DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN
   56  WORK ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS  TWO
       A. 1548                             7
    1  AND  THREE  OF  THIS  SECTION, DETAILING THE CIRCUMSTANCES UNDER WHICH A
    2  DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT.
    3    2.  MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
    4  PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT:
    5    (A) FOR WHICH THE NURSE IS NOT  PREPARED  BY  EDUCATION,  TRAINING  OR
    6  EXPERIENCE  TO  SAFELY  FULFILL  THE  ASSIGNMENT WITHOUT COMPROMISING OR
    7  JEOPARDIZING PATIENT SAFETY, THE NURSE'S  ABILITY  TO  MEET  FORESEEABLE
    8  PATIENT NEEDS OR THE NURSE'S LICENSE; OR
    9    (B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS.
   10    3.  MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
   11  CONTAIN PROCEDURES FOR THE FOLLOWING:
   12    (A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR
   13  REGARDING THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING  RELIEVED
   14  OF AN ASSIGNMENT OR CONTINUED DUTY;
   15    (B)  WHERE  FEASIBLE,  AN OPPORTUNITY FOR THE SUPERVISOR TO REVIEW THE
   16  SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH-
   17  ER TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT,  OR
   18  TO  DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR CONTIN-
   19  UED DUTY;
   20    (C) A PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT  TO  REFUSE
   21  THE  ASSIGNMENT  OR  CONTINUED ON-DUTY STATUS WHEN THE SUPERVISOR DENIES
   22  THE REQUEST TO BE RELIEVED IF:
   23    (I) THE SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A  REMEDY  OR
   24  THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY,
   25    (II)  THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY AGENCY
   26  WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND
   27    (III) THE EMPLOYEE IN GOOD FAITH BELIEVES THAT  THE  ASSIGNMENT  MEETS
   28  CONDITIONS JUSTIFYING REFUSAL; AND
   29    (D)  RECOGNITION  THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT TO A
   30  WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED,
   31  BY REASON THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR  INCOMPETENT  ACTION,
   32  PATIENT  ABANDONMENT,  OR OTHERWISE TO HAVE VIOLATED ANY LAW RELATING TO
   33  NURSING.
   34    S 2833. PUBLIC DISCLOSURE OF STAFFING REQUIREMENTS. EVERY  ACUTE  CARE
   35  FACILITY SHALL:
   36    1.  POST  IN  A  CONSPICUOUS  PLACE  READILY ACCESSIBLE TO THE GENERAL
   37  PUBLIC A NOTICE PREPARED BY THE DEPARTMENT SETTING FORTH  A  SUMMARY  OF
   38  THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT FACILITY TOGETHER WITH
   39  INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE FACILITY'S STAFF-
   40  ING PLAN AND ACTUAL STAFFING MAY BE OBTAINED;
   41    2.  UPON  REQUEST,  MAKE  COPIES OF THE DOCUMENTED STAFFING PLAN FILED
   42  WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND
   43    3. UPON REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF  WITHIN  A
   44  DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION:
   45    (A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT,
   46    (B)  DOCUMENTATION  OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED TO BE
   47  PRESENT DURING THE SHIFT, BASED ON THE APPROVED ADOPTED  ACUITY  SYSTEM,
   48  AND
   49    (C)  DOCUMENTATION  OF THE ACTUAL NUMBER OF DIRECT-CARE NURSES PRESENT
   50  DURING THE SHIFT.
   51    S 2834. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL  NOT  DELE-
   52  GATE  ITS  RESPONSIBILITIES  TO  ENFORCE  THE SAFE STAFFING REQUIREMENTS
   53  PROMULGATED PURSUANT TO THIS ARTICLE.
   54    S 2835. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT
   55  HUNDRED THIRTY-TWO OF THIS  ARTICLE.    ANY  ACUTE  CARE  FACILITY  THAT
   56  VIOLATES  THE  RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGN-
       A. 1548                             8
    1  MENT POLICY UNDER SECTION TWENTY-EIGHT HUNDRED THIRTY-TWO OF THIS  ARTI-
    2  CLE  MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A COURT
    3  OF COMPETENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS  MAY  BE
    4  APPROPRIATE  TO  EFFECTUATE  THE  PURPOSES OF THE SAFE STAFFING REQUIRE-
    5  MENTS, INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION, LOST WAGES
    6  AND BENEFITS, AND COMPENSATORY AND CONSEQUENTIAL DAMAGES RESULTING  FROM
    7  THE  VIOLATION  TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED DAMAGES. THE
    8  COURT IN SUCH ACTION SHALL, IN ADDITION TO ANY  JUDGMENT  AWARDED  TO  A
    9  PREVAILING  PLAINTIFF,  AWARD  REASONABLE  ATTORNEYS'  FEES AND COSTS OF
   10  ACTION TO BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO  INSTITUTE  A
   11  PRIVATE  ACTION PURSUANT TO THIS SUBDIVISION SHALL NOT BE LIMITED BY ANY
   12  OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
   13    S 4. Section 2801-a of the public health law is amended  by  adding  a
   14  new subdivision 3-b to read as follows:
   15    3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNI-
   16  TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH AND HEALTH
   17  PLANNING  COUNCIL SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL
   18  RULES, REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE  RELATIONS,
   19  WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRAC-
   20  TICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING
   21  COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF
   22  THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS.
   23    S  5. Section 2805 of the public health law is amended by adding a new
   24  subdivision 3 to read as follows:
   25    3. IN DETERMINING WHETHER TO ISSUE OR RENEW AN  OPERATING  CERTIFICATE
   26  TO  AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN ACCORD-
   27  ANCE WITH  THIS  ARTICLE,  THE  COMMISSIONER  SHALL  CONSIDER  ANY  PAST
   28  VIOLATIONS  OF  STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING
   29  TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE  BARGAINING
   30  OR  ANY  OTHER  LABOR RELATED PRACTICES, OBLIGATIONS OR IMPERATIVES. THE
   31  PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL  WEIGHT
   32  TO  VIOLATIONS  OF THE PROVISIONS OF THIS CHAPTER CONCERNING NURSE STAFF
   33  AND SUPPORTIVE STAFF RATIOS.
   34    S 6. The public health law is amended by adding a new  section  2895-b
   35  to read as follows:
   36    S  2895-B.  RESIDENTIAL HEALTH CARE FACILITY STAFFING LEVELS. 1. DEFI-
   37  NITIONS. AS USED IN THIS SECTION, THE FOLLOWING  TERMS  SHALL  HAVE  THE
   38  FOLLOWING MEANINGS:
   39    (A)  "CERTIFIED  NURSE AIDE" MEANS ANY PERSON INCLUDED IN THE RESIDEN-
   40  TIAL HEALTH CARE FACILITY NURSE AIDE REGISTRY PURSUANT TO SECTION  TWEN-
   41  TY-EIGHT HUNDRED THREE-J OF THIS CHAPTER.
   42    (B)  "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL IN
   43  A PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD  IN
   44  A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT
   45  THAT TIME.
   46    2.  COMMISSIONER  AND RESIDENTIAL HEALTH CARE FACILITY COUNCIL; POWERS
   47  AND DUTIES. THE COMMISSIONER SHALL: APPOINT A  RESIDENTIAL  HEALTH  CARE
   48  FACILITY  COUNCIL  CONSISTING  OF  THIRTEEN  MEMBERS.  NO  LESS THAN TWO
   49  MEMBERS SHALL BE DIRECT  CARE LICENSED PRACTICAL NURSES,  NO  LESS  THAN
   50  TWO  MEMBERS SHALL BE DIRECT CARE CERTIFIED NURSE ASSISTANTS AND NO LESS
   51  THAN  ONE MEMBER SHALL BE A DIRECT CARE REGISTERED  PROFESSIONAL  NURSE.
   52  THE  COUNCIL  SHALL ALSO INCLUDE NO LESS THAN ONE REPRESENTATIVE EACH OF
   53  RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF REGISTERED NURS-
   54  ES, OF NON-REGISTERED NURSE DIRECT CARE STAFF AND  A  REPRESENTATIVE  OF
   55  NURSING  PROFESSIONAL  ASSOCIATIONS.  THE  COUNCIL SHALL ALSO INCLUDE NO
   56  LESS THAN TWO REPRESENTATIVES OF RESIDENTIAL HEALTH CARE FACILITY OPERA-
       A. 1548                             9
    1  TORS, TWO REPRESENTATIVES OF  RESIDENTIAL  HEALTH  CARE  FACILITY  NURSE
    2  ADMINISTRATORS  AND  ONE  REPRESENTATIVE  OF  CONSUMERS. THE RESIDENTIAL
    3  HEALTH CARE FACILITY COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVEL-
    4  OPMENT  OF  REGULATIONS  RELATING  TO  THE STAFFING STANDARDS UNDER THIS
    5  SECTION; AND MAY FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE LEGISLA-
    6  TURE, THE PUBLIC AND  THE  COMMISSIONER  ANY  RECOMMENDATIONS  REGARDING
    7  STAFFING LEVELS IN RESIDENTIAL HEALTH CARE FACILITIES.
    8    3. STAFFING STANDARDS.  (A) THE COMMISSIONER, IN CONSULTATION WITH THE
    9  COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR RESIDEN-
   10  TIAL  HEALTH  CARE  FACILITY  MINIMUM STAFFING LEVELS TO MEET APPLICABLE
   11  STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAIN-
   12  TAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BE-
   13  ING OF EACH RESIDENT  OF  THE  FACILITY.  THE  COMMISSIONER  SHALL  ALSO
   14  REQUIRE  BY REGULATION THAT EVERY RESIDENTIAL HEALTH CARE FACILITY MAIN-
   15  TAIN RECORDS ON ITS STAFFING LEVELS,  REPORT  ON  SUCH  RECORDS  TO  THE
   16  DEPARTMENT,  AND  MAKE  SUCH  RECORDS  AVAILABLE  FOR  INSPECTION BY THE
   17  DEPARTMENT.
   18    (B) EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL:
   19    (I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND
   20    (II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF
   21  SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES
   22  TO ATTAIN OR MAINTAIN THE  HIGHEST  PRACTICABLE  PHYSICAL,  MENTAL,  AND
   23  PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY.
   24    (C)  SUBJECT  TO  SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS
   25  UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS  UNDER
   26  SUBDIVISION FOUR OF THIS SECTION.
   27    (D)  IN  DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS
   28  SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED  WHILE  PERFORMING  SERVICES
   29  THAT  ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD
   30  PREPARATION,  HOUSEKEEPING,  LAUNDRY,  MAINTENANCE  SERVICES,  OR  OTHER
   31  ACTIVITIES THAT ARE NOT DIRECT NURSING CARE.
   32    4.    STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE
   33  OF THIS SECTION, EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL MAINTAIN A
   34  STAFFING RATIO EQUAL TO AT LEAST THE FOLLOWING:
   35    (A) 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED NURSE AIDE;
   36    (B) 1.3 HOURS OF CARE PER RESIDENT PER DAY  BY  A  LICENSED  PRACTICAL
   37  NURSE OR A REGISTERED NURSE;
   38    (C) 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGISTERED NURSE; THE
   39  MINIMUM  OF  0.75  HOURS  OF  CARE PER RESIDENT PROVIDED BY A REGISTERED
   40  NURSE SHALL BE DIVIDED AMONG ALL SHIFTS TO ENSURE AN  APPROPRIATE  LEVEL
   41  OF  REGISTERED  NURSE CARE TWENTY-FOUR HOURS PER DAY, SEVEN DAYS A WEEK,
   42  TO MEET RESIDENT NEEDS; AND
   43    (D) RESIDENTIAL HEALTH CARE FACILITIES THAT CARE FOR SUBACUTE PATIENTS
   44  SHALL MAINTAIN AT A MINIMUM, THE FOLLOWING DIRECT-CARE  NURSE-TO-PATIENT
   45  RATIO: ONE NURSE TO FIVE PATIENTS.
   46    5.    ANY RESIDENTIAL HEALTH CARE FACILITY THAT VIOLATES THE RIGHTS OF
   47  AN EMPLOYEE PURSUANT TO AN ADOPTED WORK  ASSIGNMENT  POLICY  UNDER  THIS
   48  SECTION  MAY  BE  HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A
   49  COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR  EQUITABLE  RELIEF  AS
   50  MAY  BE  APPROPRIATE  TO  EFFECTUATE  THE  PURPOSES OF THE SAFE STAFFING
   51  REQUIREMENTS, INCLUDING BUT NOT  LIMITED  TO  REINSTATEMENT,  PROMOTION,
   52  LOST  WAGES  AND  BENEFITS,  AND  COMPENSATORY AND CONSEQUENTIAL DAMAGES
   53  RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED
   54  DAMAGES. THE COURT IN SUCH ACTION SHALL, IN  ADDITION  TO  ANY  JUDGMENT
   55  AWARDED  TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND
   56  COSTS OF ACTION TO BE PAID BY THE  DEFENDANT.  AN  EMPLOYEE'S  RIGHT  TO
       A. 1548                            10
    1  INSTITUTE  A  PRIVATE  ACTION  PURSUANT TO THIS SUBDIVISION SHALL NOT BE
    2  LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
    3    6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A RESIDENTIAL HEALTH CARE
    4  FACILITY SHALL POST INFORMATION REGARDING NURSE STAFFING THAT THE FACIL-
    5  ITY   IS  REQUIRED  TO  MAKE  AVAILABLE  TO  THE  PUBLIC  UNDER  SECTION
    6  TWENTY-EIGHT HUNDRED FIVE-T OF THIS CHAPTER.    INFORMATION  UNDER  THIS
    7  PARAGRAPH SHALL BE DISPLAYED IN A FORM APPROVED BY THE DEPARTMENT AND BE
    8  POSTED  IN  A MANNER WHICH IS VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR
    9  FAMILIES AND THE STAFF, AS REQUIRED BY THE COMMISSIONER.
   10    (B) A RESIDENTIAL HEALTH CARE FACILITY SHALL POST A  SUMMARY  OF  THIS
   11  SECTION,  PROVIDED  BY  THE  DEPARTMENT,  IN  PROXIMITY  TO EACH POSTING
   12  REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVISION.
   13    S 7. If any provision of this act, or any application of any provision
   14  of this act, is held to be invalid, or ruled by any  federal  agency  to
   15  violate  or  be  inconsistent  with  any applicable federal law or regu-
   16  lation, that shall not affect the validity or effectiveness of any other
   17  provision of this act, or of any other application of any  provision  of
   18  this act.
   19    S 8. This act shall take effect on the one hundred eightieth day after
   20  it shall have become a law, provided that any rules and regulations, and
   21  any  other  actions necessary to implement the provisions of this act on
   22  its effective date are authorized and directed to  be  completed  on  or
   23  before such date.
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