SB227 is a piece of legislation that the ACNL Health Policy Committee has been monitoring over the 2019 legislative session. This legislation became law and was signed by Governor Newsom on October 12, 2019, amending the Health and Safety Code Sections 1279 and 1280.3. Under already existing law, when non-compliance poses a risk of harm to patients, the California Department of Public Health (CDPH) can — and does — issue a deficiency and/or administrative penalty. SB227 will create a duplicative penalty system for hospitals that do not meet the nurse staffing ratios, even for a short period with no risk of patient harm.
SB227 will allow the California Department of Public Health to audit hospitals to insure compliance with staffing ratios. These audits will be unannounced. The penalties for violations start at $15,000 and go up to $30,000 per violation. The only exemption allowance is for “uncontrollable and unforeseeable” fluctuations in staffing events. The definitions for “uncontrollable and unforeseeable” have yet to be defined. It will place a heavy burden on hospitals to keep detailed records supporting all efforts used to bring in more staff which were exhausted prior to initiating a ratio violation.
Shortly after this bill was presented and worked its way through the state legislature, ACNL members took a position and actively advocated against it. As written, hospitals could have additional fines imposed based on terms in the law that have not yet been defined and are currently open to interpretation. To support hospital nurse leaders, the California Hospital Association (CHA) provided education on the bill and its implications. Nurse leaders were encouraged to meet with and educate their legislators and then ask for their support in opposing the bill. The Health Policy Committee members and ACNL members at large wrote letters in opposition to the bill expressing their concerns about the potential impact to our hospital operations state-wide.
We urge all nurse leaders to continue to assess the impact on hospital operations, be consistent in your staffing processes, prepare for scrutiny, and communicate any concerns to your Health Policy committee members. Work continues to clarify the definition of “unpredictable and uncontrollable”. If this or any other legislation affects you, ACNL strongly supports the work of nurses to advocate and become involved in the political process.