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		<ns0:Id>20250SB__059693CHP</ns0:Id>
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				<ns0:ActionText>INTRODUCED</ns0:ActionText>
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			<ns0:SessionYear>2025</ns0:SessionYear>
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			<ns0:MeasureType>SB</ns0:MeasureType>
			<ns0:MeasureNum>596</ns0:MeasureNum>
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			<ns0:ChapterNum>773</ns0:ChapterNum>
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		<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Senator Menjivar</ns0:AuthorText>
		<ns0:Authors>
			<ns0:Legislator>
				<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
				<ns0:House>SENATE</ns0:House>
				<ns0:Name>Menjivar</ns0:Name>
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		<ns0:Title>An act to amend Section 1280.3 of the Health and Safety Code, relating to health facilities. </ns0:Title>
		<ns0:RelatingClause>health facilities</ns0:RelatingClause>
		<ns0:GeneralSubject>
			<ns0:Subject>Health facilities: administrative penalties.</ns0:Subject>
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			<html:p>Existing law provides for the licensure of various health facilities, including general acute care hospitals, acute psychiatric hospitals, and special hospitals, by the State Department of Public Health. Existing law requires the department to adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for all general acute
			 care hospitals, acute psychiatric hospitals, and special hospitals. Existing law requires the department to assess an administrative penalty of $15,000 for the first violation and $30,000 for the second and each subsequent violation if the department determines that a specified health facility has violated nurse-to-patient ratios, as specified. Under existing law, an acute general hospital is not subject to this administrative penalty if the hospital demonstrates it has met specified requirements, including that any fluctuation in required staffing levels was unpredictable and uncontrollable, prompt efforts were made to maintain required staffing levels, and the hospital immediately used and subsequently exhausted the hospital’s on-call list of nurses and the charge nurse. Existing law specifies that multiple violations found on the same inspection survey constitute a single violation for purposes of determining whether the violation was a first, 2nd, or subsequent violation.</html:p>
			<html:p>This bill would define “on-call list” for the above purpose and would specify that a hospital contacting, or attempting to contact, licensed nurses who are not scheduled to be on call and who are not assigned to a float pool for the unit and shift where an alleged violation occurred is not considered as exhausting an on-call list. The bill would require the department to treat violations on separate days as separate violations.</html:p>
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			<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
			<ns0:Appropriation>NO</ns0:Appropriation>
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	<ns0:Bill id="bill">
		<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
		<ns0:BillSection id="id_7126FEBC-949E-43AD-9004-4348A13BE12E">
			<ns0:Num>SECTION 1.</ns0:Num>
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				Section 1280.3 of the 
				<ns0:DocName>Health and Safety Code</ns0:DocName>
				 is amended to read:
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					<ns0:Num>1280.3.</ns0:Num>
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								(a)
								<html:span class="EnSpace"/>
								Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall
						be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.
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							<html:p>
								(b)
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								Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part
						2 of Division 107 or the rules and regulations promulgated thereunder.
							</html:p>
							<html:p>The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								The patient’s physical and mental condition.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								The probability and severity of the risk that the violation presents to the patient.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								The actual financial harm to patients, if any.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								The nature, scope, and severity of the violation.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								The facility’s history of compliance with related state and federal statutes and regulations.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								Factors beyond the facility’s control that restrict the facility’s ability to comply with this chapter or the rules and regulations promulgated thereunder.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								The demonstrated willfulness of the violation.
							</html:p>
							<html:p>
								(8)
								<html:span class="EnSpace"/>
								The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								The department shall not assess an administrative penalty for minor violations.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								The regulations shall not change the
						definition of immediate jeopardy as established in this section.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								The regulations shall apply only to incidents occurring on or after the effective date of the regulations.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation
						was a first, second, or subsequent violation. For purposes of this subdivision, the department shall treat violations on separate days as separate violations.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A violation occurring more than three years after the date of the last violation shall be treated as a first violation.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								(A)
								<html:span class="EnSpace"/>
								Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an
						administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								That any fluctuation in required staffing levels was unpredictable and uncontrollable.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								Prompt efforts were made to maintain required staffing levels.
							</html:p>
							<html:p>
								(iii)
								<html:span class="EnSpace"/>
								In making those efforts, the hospital immediately used and subsequently exhausted the hospital’s on-call list of nurses and the charge nurse. For purposes of this paragraph, an “on-call list” shall be comprised of nurses who are scheduled to be on call for the shift and unit where an alleged violation occurred, or nurses who are assigned to a regularly scheduled float pool shift to cover any shortages across
						one or more specified units. A hospital contacting, or attempting to contact, licensed nurses who are not scheduled to be on call and who are not assigned to a float pool for the unit and shift where an alleged violation occurred shall not be considered as exhausting an on-call list for purposes of this paragraph.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the department’s position has been upheld.
							</html:p>
							<html:p>
								(h)
								<html:span class="EnSpace"/>
								For purposes of this section, “immediate jeopardy” means a situation in which the licensee’s noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration
						the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals.
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