HB 457

1	A bill to be entitled
2	An act relating to hospitals; providing legislative
3	findings; providing definitions; providing that
4	information concerning nursing care for patients be made
5	available to the public; providing for staffing schedules
6	and patterns; providing criteria for staffing schedules of
7	nursing personnel and a daily census for patient-care
8	units; requiring each hospital to make staffing levels and
9	schedules available to the public for a certain period of
10	time; requiring that records be made available to the
11	public upon request; requiring hospitals to provide
12	quarterly reports; requiring hospitals to provide the
13	Agency for Health Care Administration with certain
14	information regarding nursing personnel; requiring the
15	agency to make certain information regarding hospital
16	staff and operations available to the public on its
17	Internet website and upon request; providing criteria
18	governing the provision of such information; providing
19	rights for hospital employees; authorizing the agency to
20	inspect and audit certain books and records of a hospital;
21	providing a penalty for a hospital's refusal to file a
22	report, timely file a report, file a false report, file an
23	incomplete report, or produce certain requested documents
24	or records to the agency; authorizing the agency to grant
25	an extension of a deadline for a hospital to file a
26	report; providing an appropriation; providing an effective
27	date.
28
29	Be It Enacted by the Legislature of the State of Florida:
30
31	Section 1.  (1)  SHORT TITLE.--This section may be cited as
32	the "Patients' Right-to-Know Act."
33	(2)  LEGISLATIVE FINDINGS.--The Legislature finds that
34	consumers in this state have a right to obtain access to
35	information concerning the quality and safety of the health care
36	provided in hospitals in this state in order to make better
37	decisions about their choice of health care provider.
38	(3)  DEFINITIONS.--As used in this section, the term:
39	(a)  "Agency" means Agency for Health Care Administration.
40	(b)  "Average daily census" means the average number of
41	inpatients receiving services in any given 24-hour period,
42	beginning at midnight, in each clinical service area of the
43	hospital.
44	(c)  "Agency nurse" means any direct-care nurse who is not
45	directly employed by the hospital, who provides care in the
46	hospital, and who is working for purposes of providing
47	supplemental staffing in a hospital.
48	(d)  "Direct-care nurse" means any registered nurse who has
49	direct responsibility to oversee or carry out medical regimens
50	or nursing care for one or more patients. A nurse administrator,
51	nurse supervisor, nurse educator, charge nurse, or other
52	registered nurse who does not have a specific patient assignment
53	may not be included in calculating the staffing level.
54	(e)  "Hospital" means an acute care hospital that is
55	licensed under s. 395.003, Florida Statutes.
56	(f)  "Nurse" means a registered nurse.
57	(g)  "Nursing care" means care that falls within the scope
58	of practice set forth in chapter 464, Florida Statutes, and
59	other laws and rules or care that is otherwise encompassed
60	within recognized professional standards of nursing practice,
61	including assessment, nursing diagnosis, planning, intervention,
62	evaluation, and patient advocacy.
63	(h)  "Retaliate" means to discipline, discharge, suspend,
64	demote, harass, deny employment or promotion, lay off, or take
65	any other adverse action against a direct-care nurse as a result
66	of that nurse taking any action described in this section.
67	(i)  "Staffing level" means the actual numerical registered
68	nurse-to-patient ratio within a nursing department or unit.
69	(j)  "Unit" means a functional division or area of a
70	hospital in which nursing care is provided.
71	(4)  PUBLIC AVAILABILITY OF STAFFING LEVELS AND
72	SCHEDULES.--     (a)  The number of registered professional
73	nurses, licensed practical nurses, and other nursing personnel
74	assigned to each patient-care unit shall be consistent with the
75	types of nursing care needed by the patients and the
76	capabilities of the staff. Patients on each unit shall be
77	evaluated near the end of each change of shift by criteria
78	developed by the hospital. There shall be staffing schedules
79	reflecting the actual nursing personnel required for the
80	hospital and for each patient unit. Staffing patterns must
81	reflect consideration of nursing goals, standards of nursing
82	practice, and the needs of the patients.
83	(b)  The current staffing level and anticipated staffing
84	schedule shall be available upon request for each patient-care
85	unit for the effective date of that schedule. Each schedule must
86	list the assigned nursing personnel and the average daily census
87	for each patient-care unit. The hospital shall retain and make
88	available to the public the historic staffing level and
89	schedules for the prior 5 years.
90	(c)  All records required under this section, including
91	anticipated staffing schedules and the methods to determine and
92	adjust staffing levels, shall be made available to the public
93	upon request.
94	(d)  All records required under this section shall be
95	maintained by the facility for at least 5 years.
96	(5)  HOSPITAL REPORTS.--Each hospital shall prepare a
97	quarterly report that includes the average daily staffing levels
98	by unit, the percentage of nursing hours that are completed by
99	agency nurses by unit, the number and description of OSHA
100	violations, the nurse vacancy rate, the nurse turnover rate, and
101	the number and description of complaints made to the Joint
102	Commission on Accreditation of Healthcare Organizations or to
103	the agency.
104	(6)  HOSPITAL DATA.--
105	(a)  Each hospital shall submit to the agency, in a format
106	designated by the agency and in accordance with the timetable
107	specified by the agency, a statistical profile of registered
108	nurses and other nurses employed by the hospital in patient
109	care, including the nurse-vacancy rate and nurse-turnover rate.
110	The agency shall make each hospital's statistical profile
111	available on its website by July 1, 2008, and in hard-copy
112	format upon request. The agency shall update the data made
113	available pursuant to this paragraph annually.
114	(b)  Using available data or data voluntarily submitted by
115	hospitals and used as indicators by the Joint Commission on
116	Accreditation of Healthcare Organizations, the agency shall make
117	available for each hospital, on its website by October 1, 2008,
118	and in a hard-copy format upon request, the average daily
119	staffing levels by unit; the percentage of nursing hours that
120	are completed by contract or agency nurses by unit, number, and
121	a description of OSHA violations; and the number and a
122	description of complaints. The website must also list each
123	hospital's system affiliations if the hospital is affiliated
124	with a nonprofit, for-profit, or public health care system or
125	corporation. The agency shall update the data made available
126	pursuant to this paragraph annually.
127	(c)  The agency shall use available national standards when
128	designating the reporting format for the statistical profile
129	required by paragraph (a) and when making available the average
130	daily staffing levels by unit as required by paragraph (b). The
131	agency shall consult with the Comprehensive Health Information
132	System Advisory Council regarding the reporting format. The
133	agency shall calculate and make available the average daily
134	staffing levels by unit in a manner that health care research
135	has shown to have a significant effect on the quality of patient
136	care and patient outcomes.
137	(d)  The agency shall ensure that the nurse staffing data
138	made available pursuant to paragraph (b) is risk-adjusted for
139	patient acuity using the risk-adjustment methodology described
140	in s. 408.061(1)(a), Florida Statutes, or an equivalent
141	methodology consistent with national standards employed by the
142	Agency for Healthcare Research and Quality. The agency shall
143	consult with the Comprehensive Health Information System
144	Advisory Council regarding the methodology for risk-adjusting
145	the patient acuity used to comply with this paragraph.
146	(7)  EMPLOYEE RIGHTS.--
147	(a)  A hospital may not penalize, discriminate against, or
148	retaliate in any manner against a direct-care nurse for refusing
149	an assignment that would violate requirements set forth in this
150	section.
151	(b)  A hospital may not penalize, discriminate against, or
152	retaliate in any manner against an employee with respect to
153	compensation for, or terms, conditions, or privileges of,
154	employment if such an employee in good faith, individually or in
155	conjunction with another persons or persons:
156	1.  Reports a violation or suspected violation of this
157	section to a regulatory agency, a private accreditation body, or
158	management personnel of the hospital;
159	2.  Initiates, cooperates in, or otherwise participates in
160	an investigation or proceeding brought by a regulatory agency or
161	private accreditation body concerning matters covered by this
162	section;
163	3.  Informs or discusses violations or suspected violations
164	of this section with other employees, with any representative of
165	the employees, with a patient or patient representative, or with
166	the public; or
167	4.  Otherwise avails himself or herself of the rights set
168	forth in this section.
169
170	For purposes of this paragraph, an employee is acting in good
171	faith if the employee reasonably believes that the information
172	reported or disclosed is true and that a violation has occurred
173	or may occur.
174	(8)  IMPLEMENTATION AND ENFORCEMENT.--
175	(a)  In order to ensure compliance with this section, the
176	agency may inspect and audit books and records of individual or
177	corporate hospitals, including books and records of related
178	organizations with which a health care provider or a hospital
179	has had transactions. Upon presentation of a written request for
180	inspection to a health care provider or a hospital by the agency
181	or its staff, the health care provider or the hospital shall
182	make available to the agency or its staff for inspection,
183	copying, and review all books and records relevant to the
184	determination of whether the health care provider or the
185	hospital has complied with this section.
186	(b)  Any hospital that refuses to file a report, fails to
187	timely file a report, files a false report, or files an
188	incomplete report and, upon notification, fails to timely file a
189	complete report required under this section or a rule adopted
190	thereunder, or that fails to provide documents or records
191	requested by the agency under this section, shall be punished by
192	a fine not exceeding $1,000 per day for each day in violation,
193	to be imposed and collected by the agency. Pursuant to rules
194	adopted by the agency, the agency may, upon a showing of good
195	cause, grant a one-time extension of any deadline for a hospital
196	to timely file a report as required by this section.
197	Section 2.  The sum of $250,000 is appropriated from the
198	General Revenue Fund to the Agency for Health Care
199	Administration for the purpose of administering the provisions
200	of this act requiring the agency to collect, from hospitals or
201	other sources, information regarding the staffing or operation
202	of hospitals and to make such information available on its
203	website or upon request.
204	Section 3.  This act shall take effect upon becoming a law.

CODING: Words stricken are deletions; words underlined are additions.