2006 -- H 7386 SUBSTITUTE A AS AMENDED

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LC01442/SUB A/2

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2006

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A N A C T

RELATING TO HEALTH AND SAFETY -- SAFE PATIENT HANDLING LEGISLATION

     Introduced By: Representatives Diaz, Moura, Rice, Ajello, and Sullivan

     Date Introduced: February 16, 2006

     Referred To: House Health, Education & Welfare

It is enacted by the General Assembly as follows:

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     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

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amended by adding thereto the following chapter:

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     CHAPTER 80

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SAFE PATIENT HANDLING ACT OF 2006

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     23-80-1. Short title. – (a) This chapter shall be known and may be cited as the "Safe

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Patient Handling Act of 2006."

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     23-80-2. Legislative findings. – (a) Patients are at greater risk of injury, including skin

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tears, falls, and musculoskeletal injuries, when being lifted, transferred, or repositioned manually.

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     (b) Safe patient handling can reduce skin tears suffered by patients by threefold, and can

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significantly reduce other injuries to patients as well.

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     (c) Health care workers lead the nation in work-related musculoskeletal disorders.

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Between thirty-eight percent (38%) and fifty percent (50%) of nurses and other health care

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workers will suffer a work-related back injury during their career. Forty-four percent (44%) of

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these workers will be unable to return to their pre-injury position.

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     (d) Research indicates that nurses lift an estimated 1.8 tons per shift. Eighty-three percent

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(83%) of nurses work in spite of back pain, and sixty percent (60%) of nurses fear a disabling

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back injury. Twelve percent (12%) to thirty-nine percent (39%) of nurses not yet disabled are

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considering leaving nursing due to back pain and injuries.

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     (e) Safe patient handling reduces injuries and costs. In nine (9) case studies evaluating the

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impact of lifting equipment, injuries decreased sixty percent (60%) to ninety-five percent (95%),

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Workers' Compensation costs dropped by ninety-five percent (95%), and absenteeism due to

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lifting and handling was reduced by ninety-eight percent (98%).

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     SECTION 2. Chapter 23-17 of the General Laws entitled "Licensing of Health Care

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Facilities" is hereby amended by adding thereto the following section:

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     23-17-58. Safe patient handling. – (1) Definitions. - As used in this chapter:

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     (a) "Safe patient handling" means the use of engineering controls, transfer aids, or

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assistive devices whenever feasible and appropriate instead of manual lifting to perform the acts

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of lifting, transferring, and/or repositioning health care patients and residents.

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     (b) "Safe patient handling policy" means protocols established to implement safe patient

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handling.

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     (c) "Health care facility" means a hospital or a nursing facility.

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     (d) "Lift team" means health care facility employees specially trained to perform patient

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lifts, transfers, and repositioning in accordance with safe patient handling policy.

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     (e) "Musculoskeletal disorders" means conditions that involve the nerves, tendons,

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muscles, and supporting structures of the body.

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     (2) Licensure requirements. - Each licensed health care facility shall comply with the

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following as a condition of licensure:

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     (a) Each licensed health care facility shall establish a safe patient handling committee,

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which shall be chaired by a professional nurse or other appropriate licensed health care

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professional. A health care facility may utilize any appropriately configured committee to

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perform the responsibilities of this section. At least half of the members of the committee shall be

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hourly, non-managerial employees who provide direct patient care.

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     (b) By July 1, 2007, each licensed health care facility shall develop a written safe patient

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handling program, with input from the safe patient handling committee, to prevent

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musculoskeletal disorders among health care workers and injuries to patients. As part of this

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program, each licensed health care facility shall:

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     (i) By July 1, 2008, implement a safe patient handling policy for all shifts and units of the

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facility that will achieve the maximum reasonable reduction of manual lifting, transferring, and

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repositioning of all or most of a patient's weight, except in emergency, life-threatening, or

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otherwise exceptional circumstances;

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     (ii) Conduct a patient handling hazard assessment. This assessment should consider such

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variables as patient-handling tasks, types of nursing units, patient populations, and the physical

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environment of patient care areas;

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     (iii) Develop a process to identify the appropriate use of the safe patient handling policy

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based on the patient's physical and mental condition, the patient's choice, and the availability of

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lifting equipment or lift teams. The policy shall include a means to address circumstances under

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which it would be medically contraindicated to use lifting or transfer aids or assistive devices for

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particular patients;

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     (iv) Designate and train a registered nurse or other appropriate licensed health care

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professional to serve as an expert resource, and train all clinical staff on safe patient handling

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policies, equipment, and devices before implementation, and at least annually or as changes are

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made to the safe patient handling policies, equipment and/or devices being used;

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     (v) Conduct an annual performance evaluation of the safe patient handling with the

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results of the evaluation reported to the safe patient handling committee or other appropriately

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designated committee. The evaluation shall determine the extent to which implementation of the

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program has resulted in a reduction in musculoskeletal disorder claims and days of lost work

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attributable to musculoskeletal disorder caused by patient handling, and include recommendations

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to increase the program's effectiveness; and

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     (vi) Submit an annual report to the safe patient handling committee of the facility, which

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shall be made available to the public upon request, on activities related to the identification,

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assessment, development, and evaluation of strategies to control risk of injury to patients, nurses

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and other health care workers associated with the lifting, transferring, repositioning, or movement

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of a patient.

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     (c) Nothing in this section precludes lift team members from performing other duties as

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assigned during their shift.

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     (d) An employee may, in accordance with established facility protocols, report to the

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committee, as soon as possible, after being required to perform a patient handling activity that

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he/she believes in good faith exposed the patient and/or employee to an unacceptable risk of

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injury. Such employee reporting shall not be cause for discipline or be subject to other adverse

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consequences by his/her employer. These reportable incidents shall be included in the facility's

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annual performance evaluation.

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     SECTION 3. Section 23-15-4 of the General Laws in Chapter 23-15 entitled

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"Determination of Need for New Health Care Equipment and New Institutional Health Services"

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is hereby amended to read as follows:

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     23-15-4. Review and approval of new health care equipment and new institutional

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health services. -- (a) No health care provider or health care facility shall develop or offer new

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health care equipment or new institutional health services in Rhode Island, the magnitude of

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which exceeds the limits defined by this chapter, without prior review by the health services

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council and approval by the state agency; except that review by the health services council may

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be waived in the case of expeditious reviews conducted in accordance with section 23-15-5, and

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except that health maintenance organizations which fulfill criteria to be established in rules and

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regulations promulgated by the state agency with the advice of the health services council shall be

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exempted from the review and approval requirement established in this section upon approval by

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the state agency of an application for exemption from the review and approval requirement

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established in this section which contain any information that the state agency may require to

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determine if the health maintenance organization meets the criteria.

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      (b) No approval shall be made without an adequate demonstration of need by the

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applicant at the time and place and under the circumstances proposed, nor shall the approval be

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made without a determination that a proposal for which need has been demonstrated is also

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affordable by the people of the state.

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      (c) No approval of new institutional health services for the provision of health services to

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inpatients shall be granted unless the written findings required in accordance with section 23-15-

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6(b)(6) are made.

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      (d) Applications for determination of need shall be filed with the state agency on a date

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fixed by the state agency together with plans and specifications and any other appropriate data

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and information that the state agency shall require by regulation, and shall be considered in

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relation to each other no less than once a year. A duplicate copy of each application together with

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all supporting documentation shall be kept on file by the state agency as a public record.

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      (e) The health services council shall consider, but shall not be limited to, the following in

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conducting reviews and determining need:

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      (1) The relationship of the proposal to state health plans that may be formulated by the

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state agency;

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      (2) The impact of approval or denial of the proposal on the future viability of the

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applicant and of the providers of health services to a significant proportion of the population

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served or proposed to be served by the applicant;

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      (3) The need that the population to be served by the proposed equipment or services has

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for the equipment or services;

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      (4) The availability of alternative, less costly, or more effective methods of providing

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services or equipment, including economies or improvements in service that could be derived

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from feasible cooperative or shared services;

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      (5) The immediate and long term financial feasibility of the proposal, as well as the

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probable impact of the proposal on the cost of, and charges for, health services of the applicant;

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      (6) The relationship of the services proposed to be provided to the existing health care

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system of the state;

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      (7) The impact of the proposal on the quality of health care in the state and in the

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population area to be served by the applicant;

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      (8) The availability of funds for capital and operating needs for the provision of the

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services or equipment proposed to be offered;

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      (9) The cost of financing the proposal including the reasonableness of the interest rate,

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the period of borrowing, and the equity of the applicant in the proposed new institutional health

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service or new equipment;

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      (10) The relationship, including the organizational relationship of the services or

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equipment proposed, to ancillary or support services;

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      (11) Special needs and circumstances of those entities which provide a substantial

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portion of their services or resources, or both, to individuals not residing within the state;

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      (12) Special needs of entities such as medical and other health professional schools,

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multidisciplinary clinics, and specialty centers; also, the special needs for and availability of

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osteopathic facilities and services within the state;

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      (13) In the case of a construction project:

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      (i) The costs and methods of the proposed construction, and

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      (ii) The probable impact of the construction project reviewed on the costs of providing

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health services by the person proposing the construction project; and

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     (iii) The proposed availability and use of safe patient handling equipment in the new or

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renovated space to be constructed.

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     (14) Those appropriate considerations that may be established in rules and regulations

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promulgated by the state agency with the advice of the health services council;

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      (15) The potential of the proposal to demonstrate or provide one or more innovative

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approaches or methods for attaining a more cost effective and/or efficient health care system;

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      (16) The relationship of the proposal to the need indicated in any requests for proposals

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issued by the state agency;

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      (17) The input of the community to be served by the proposed equipment and services

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and the people of the neighborhoods close to the health care facility who are impacted by the

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proposal;

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      (18) The relationship of the proposal to any long-range capital improvement plan of the

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health care facility applicant.

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      (f) In conducting its review, the health services council shall perform the following:

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      (1) Within one hundred and fifteen (115) days after initiating its review, which must be

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commenced no later than thirty-one (31) days after the filing of an application, the health services

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council shall determine as to each proposal whether the applicant has demonstrated need at the

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time and place and under the circumstances proposed, and in doing so may apply the criteria and

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standards set forth in subsection (e) of this section; provided however, that a determination of

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need shall not alone be sufficient to warrant a recommendation to the state agency that a proposal

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should be approved. The director shall render his or her decision within five (5) days of the

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determination of the health services council.

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      (2) Prior to the conclusion of its review in accordance with section 23-15-6(e), the health

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services council shall evaluate each proposal for which a determination of need has been

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established in relation to other proposals, comparing proposals with each other, whether similar

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or not, establishing priorities among the proposals for which need has been determined, and

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taking into consideration the criteria and standards relating to relative need and affordability as

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set forth in subsection (e) of this section and section 23-15-6(f).

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      (3) At the conclusion of its review, the health services council shall make

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recommendations to the state agency relative to approval or denial of the new institutional health

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services or new health care equipment proposed; provided that:

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      (i) The health services council shall recommend approval of only those proposals found

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to be affordable in accordance with the provisions of section 23-15-6(f); and

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      (ii) If the state agency proposes to render a decision that is contrary to the

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recommendation of the health services council, the state agency must render its reasons for doing

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so in writing.

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      (g) Approval of new institutional health services or new health care equipment by the

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state agency shall be subject to conditions that may be prescribed by rules and regulations

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developed by the state agency with the advice of the health services council, but those conditions

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must relate to the considerations enumerated in subsection (e) and to considerations that may be

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established in regulations in accordance with subsection (e)(14).

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      (h) The offering or developing of new institutional health services or health care

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equipment by a health care facility without prior review by the health services council and

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approval by the state agency shall be grounds for the imposition of licensure sanctions on the

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facility, including denial, suspension, revocation, or curtailment or for imposition of any

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monetary fines that may be statutorily permitted by virtue of individual health care facility

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licensing statutes.

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      (i) No government agency and no hospital or medical service corporation organized

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under the laws of the state shall reimburse any health care facility or health care provider for the

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costs associated with offering or developing new institutional health services or new health care

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equipment unless the health care facility or health care provider has received the approval of the

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state agency in accordance with this chapter. Government agencies and hospital and medical

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service corporations organized under the laws of the state shall, during budget negotiations, hold

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health care facilities and health care providers accountable to operating efficiencies claimed or

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projected in proposals which receive the approval of the state agency in accordance with this

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chapter.

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      (j) In addition, the state agency shall not make grants to, enter into contracts with, or

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recommend approval of the use of federal or state funds by any health care facility or health care

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provider which proceeds with the offering or developing of new institutional health services or

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new health care equipment after disapproval by the state agency.

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     SECTION 4. This act shall take effect on January 1, 2007.

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LC01442/SUB A/2

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY -- SAFE PATIENT HANDLING LEGISLATION

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     This act would establish the "Safe Patient Handling Act of 2006" to promote the safe

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handling of patients in health care facilities.

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     This act would take effect on January 1, 2007.

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LC01442/SUB A/2

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