Legislature(2009 - 2010)CAPITOL 106

04/14/2009 03:00 PM House HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
<Bill Hearing Canceled>
Moved CSHB 50(HSS) Out of Committee
Moved CSHB 190(HSS) Out of Committee
Moved CSHB 71(HSS) Out of Committee
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Heard & Held
HB 50-LIMIT OVERTIME FOR REGISTERED NURSES                                                                                    
3:52:05 PM                                                                                                                    
CO-CHAIR HERRON announced  that the next order  of business would                                                               
be  HOUSE  BILL  NO.  50,  "An Act  relating  to  limitations  on                                                               
mandatory overtime  for registered nurses and  licensed practical                                                               
nurses in health care facilities;  and providing for an effective                                                               
CO-CHAIR KELLER moved to adopt  the proposed Committee Substitute                                                               
(CS)  for HB  50,  Version 26-LS0274\M,  Wayne,  4/14/09, as  the                                                               
working document.                                                                                                               
3:52:54 PM                                                                                                                    
CO-CHAIR HERRON objected for the purpose of discussion.                                                                         
3:53:30 PM                                                                                                                    
REPRESENTATIVE PEGGY  WILSON, Alaska State Legislature,  as joint                                                               
prime sponsor of HB 50,  explained Version M reflects a five-year                                                               
effort to  protect patients by  ensuring that nurses do  not work                                                               
an  excessive  amount  of  hours  without  adequate  rest.    The                                                               
proposed  legislation  strikes   a  balance  between  maintaining                                                               
flexibility  in  health  care facilities  and  improving  patient                                                               
safety and  healthful work  environments.   Under Version  M, she                                                               
relayed, nurses  could not  work more  than 14  consecutive hours                                                               
without  at   least  ten  hours   of  rest,  unless   needed  for                                                               
emergencies.   Nor would they be  forced to work overtime  if, in                                                               
their opinion, doing so would jeopardize patient safety.                                                                        
REPRESENTATIVE  WILSON   emphasized  that  the  bill   would  not                                                               
preclude the  use of  voluntary overtime and  on-call work.   She                                                               
said  she  has heard  the  concerns  of larger  hospitals,  rural                                                               
communities, and  Native facilities that flexibility  [is needed]                                                               
to provide for  situations such as working  on-call, dealing with                                                               
weather,   completing  an   ongoing  surgery,   or  accommodating                                                               
"reoccurring difficulties  in smaller communities."   She thanked                                                               
the  other sponsors  of the  bill and  deferred to  her staff  to                                                               
point out the specific changes made in Version M.                                                                               
3:55:10 PM                                                                                                                    
BECKY ROONEY,  Staff, Representative  Peggy Wilson,  Alaska State                                                               
Legislature,  highlighted the  changes made  in Version  M.   She                                                               
noted that  witnesses in opposition have  testified that although                                                               
hospitals  generally do  not use  mandatory overtime,  in certain                                                               
circumstances in remote, rural  facilities, mandatory overtime is                                                               
necessary.   Version  M reflects  three  changes addressing  that                                                               
concern.   On page  4, line  19, a new  exemption has  been added                                                               
called,  "Temporary  nurse  staffing   emergency."    Under  this                                                             
provision, she explained, facilities  would be allowed to declare                                                               
a  temporary nurse  staffing emergency  of up  to 30  days, after                                                               
making all reasonable efforts to  "avoid this circumstance."  The                                                               
facilities  would be  required to  file  a report  signed by  the                                                               
facility administrator, and send it  to the Department of Labor &                                                               
Workforce Development.   The report must  describe the facilities                                                               
efforts  to avoid  the staffing  emergencies.   The reports  must                                                               
also be  filed with the  legislature if  there are more  than two                                                               
such   emergencies  declared   within   six   months,  or   three                                                               
emergencies within one year.                                                                                                    
MS. ROONEY noted  that the second mitigation  provided in Version                                                               
M is  found on  page 8,  lines 19-21,  and is  a definition  of a                                                               
rural  village or  city as  one with  a population  of less  than                                                               
10,000  people, unless  the village  or city  is in  an organized                                                               
borough  with  a population  of  more  than  25,000.   The  third                                                               
mitigation provided in  Version M is an  exemption for unforeseen                                                               
weather conditions.   That definition is on page  3, lines 11-18.                                                               
The fourth  issue addressed occurs on  page 3, lines 2-3,  and is                                                               
an exemption for  a nurse participating in an  ongoing surgery of                                                               
medical procedure.                                                                                                              
MS.  ROONEY   noted  that  the  committee   had  heard  testimony                                                               
describing a situation  in which a "modified  Baylor program" was                                                               
used  by  North  Star  Behavioral  Health.    She  stated,  "This                                                               
staffing  situation is  used only  at  psychiatric hospitals  and                                                               
residential   treatment  centers   that  treat   adolescents  and                                                               
children - and  only on the weekends."  Language  on page 3, line                                                               
31,  through  page 4,  line  15,  describes a  specific  practice                                                               
exemption "for  just this situation."   Another concern expressed                                                               
during testimony  both by those  in support of and  in opposition                                                               
to the  bill was in regard  to mandatory on-call being  used more                                                               
frequently  as a  staffing  tool than  mandatory  overtime.   The                                                               
practice  often requires  nurses  to work  beyond  the number  of                                                               
hours  that are  safe for  both the  patient and  the nurse,  Ms.                                                               
Rooney said.  Language has been  added on page 3, lines 23-25, of                                                               
Version  M,  which  would  allow nurses  the  ability  to  refuse                                                               
mandatory on-call if  they believe they are too  tired to perform                                                               
their duties safely.                                                                                                            
MS. ROONEY  noted another concern expressed  during testimony was                                                               
that  an 80-hour  limitation  in  a 14-day  period  would not  be                                                               
flexible  enough  for  some facilities.    That  requirement  was                                                               
deleted and  replaced by a  provision that would allow  nurses to                                                               
work as many  shifts as they feel safe working,  as long as those                                                               
shifts  do  not   exceed  the  14  consecutive   hours  with  the                                                               
aforementioned 10-hour rest limit.                                                                                              
MS.  ROONEY  pointed out  that  a  Tanana Chief's  letter,  dated                                                               
4/10/09 and  the Alaska Native Tribal  Health Consortium position                                                               
paper,  dated  3/9/09, both  allude  to  possible legal  problems                                                               
pertaining to jurisdiction.  In  order to satisfy those concerns,                                                               
all  federal and  Native facilities  would be  exempted from  the                                                               
statute, as shown on page 7, lines 13-17.                                                                                       
MS. ROONEY relayed that during  the April 11, 2009, House Health,                                                               
Education and Social Services Standing  Committee meeting, it was                                                               
brought up  that the reporting  requirements for a  facility that                                                               
does not  use mandatory overtime  or mandatory  on-call practices                                                               
were much too arduous.  She said  a provision on page 7, lines 6-                                                               
10, of  Version M, would allow  a facility to submit  a statement                                                               
that there are no hours  to report.  Furthermore, the requirement                                                               
for the data  to be reported was changed to  overtime and on-call                                                               
hours only, with no distinction between mandatory and voluntary.                                                                
MS.  ROONEY highlighted  two other  changes.   First,  facilities                                                               
would  be  required to  post  signs  that describe  the  statutes                                                               
created  by  the  proposed  legislation.    The  signs  would  be                                                               
distributed by  the Department of  Labor (DOL) and would  have to                                                               
be  displayed  in a  conspicuous  work  area in  all  facilities.                                                               
Second, the language on page 4,  line 16, was changed from a one-                                                               
hour  exemption  to a  two-hour  exemption  while a  health  care                                                               
facility  is obtaining  another nurse  to  work in  place of  the                                                               
nurse in  overtime status.   She explained that the  extension to                                                               
two  hours was  made because  "we feel  that people  have to  get                                                               
their lives  together to  get back  to the  facility if  they are                                                               
called in."  Ms. Rooney concluded  by noting that there were also                                                               
a couple of typographical errors that were corrected.                                                                           
4:02:11 PM                                                                                                                    
CO-CHAIR  HERRON expressed  concern  that even  with the  changes                                                               
made  in Version  M, he  is still  concerned about  the reporting                                                               
requirements.   He  said  clarification is  needed  so that  pre-                                                               
scheduled on-call  is not counted  as part of  the aforementioned                                                               
14 consecutive hours.   In response to  Representative Cissna, he                                                               
said these are concerns that  he looks forward to addressing with                                                               
the sponsor in  the next committee of referral; he  does not want                                                               
to hold the bill up in this committee.                                                                                          
4:03:46 PM                                                                                                                    
REPRESENTATIVE CISSNA noted that her  district is the seat of the                                                               
health  consortium that  "looks over  the whole  state," and  she                                                               
emphasized  the importance  of  hearing from  as  many voices  as                                                               
possible, including those from rural communities.                                                                               
4:05:15 PM                                                                                                                    
CO-CHAIR HERRON said  no one has signed up  to testify presently.                                                               
He  noted  that  he  has   been  working  closely  with  all  the                                                               
stakeholders  who have  agreed to  "the federal  facilities carve                                                               
out" and the  tribes, but still has concern about  the issue.  He                                                               
indicated that  concern is  that the  exemption could  create two                                                               
classes of nurses.                                                                                                              
4:06:13 PM                                                                                                                    
REPRESENTATIVE SEATON told Representative  Cissna that one of the                                                               
reasons  the 80-hour  in 14  days requirement  was taken  out was                                                               
regarding scheduling conflict.                                                                                                  
4:07:10 PM                                                                                                                    
REPRESENTATIVE SEATON  asked about  the first  sentence beginning                                                               
on page 5, line 21, which read:                                                                                                 
          (b) A complaint alleging a violation of AS                                                                            
     18.20.400   -  18.20.499   must  be   filed  with   the                                                                    
     commissioner  within  30 days  after  the  date of  the                                                                    
     alleged violation.                                                                                                         
REPRESENTATIVE  SEATON said  the violations  might be  an ongoing                                                               
process.   He said he  would like the sponsor's  intent regarding                                                               
the 30-day filing date to be stated on the record.                                                                              
REPRESENTATIVE  WILSON  said  rules   would  be  posted  for  all                                                               
employees to see.                                                                                                               
4:09:55 PM                                                                                                                    
MS. ROONEY  said she  thinks the  intent is that  if there  is an                                                               
ongoing practice, "it's 30 days  from the last occurrence of that                                                               
incident."   Ms.  Rooney, in  response to  Representative Seaton,                                                               
indicated that the sponsor would make that intent clear.                                                                        
4:10:22 PM                                                                                                                    
CO-CHAIR HERRON removed his objection  to Version M.  There being                                                               
no further objection,  Version M was before the  committee as the                                                               
working document.                                                                                                               
4:10:42 PM                                                                                                                    
REPRESENTATIVE CISSNA  said she has visited  rural hospitals that                                                               
are  taking on  enormous challenges  beyond the  understanding of                                                               
urban Alaska.   She  said it is  possible that  these discussions                                                               
may not include all who will  be impacted, and she reiterated her                                                               
desire to  hear from a  wider range of  people.  She  stated that                                                               
she would probably object to Version  M, not because she does not                                                               
want it to pass, but because of a gut feeling.                                                                                  
4:12:36 PM                                                                                                                    
CO-CHAIR HERRON said he  shares Representative Cissna's concerns.                                                               
He reiterated  that he  has worked  with the  federal facilities.                                                               
Neither the federal  entity nor the nurses are  really happy with                                                               
the legislation,  but it  is a  work in  progress.   He expressed                                                               
confidence in moving the bill on to the next committee.                                                                         
4:13:27 PM                                                                                                                    
CO-CHAIR  KELLER moved  to report  CSHB 50,  Version 26-LS0274\M,                                                               
Wayne, 4/14/09, out of  committee with individual recommendations                                                               
and the accompanying fiscal notes.                                                                                              
4:13:49 PM                                                                                                                    
REPRESENTATIVE CISSNA objected.                                                                                                 
A  roll call  vote was  taken.   Representatives Keller,  Herron,                                                               
Lynn, Coghill,  Holmes, and  Seaton voted  in favor  of reporting                                                               
Committee Substitute (CS) for HB  50, Version 26-LS0274\M, Wayne,                                                               
4/14/09,  out of  committee with  individual recommendations  and                                                               
the  accompanying  fiscal  notes.   Representative  Cissna  voted                                                               
against  it.   Therefore, CSHB  50(HSS) was  reported out  of the                                                               
House Health and Social Services  Standing Committee by a vote of                                                               
The committee took an at-ease from 4:14 p.m. to 4:16 p.m.                                                                       

Document Name Date/Time Subjects
Backup.PDF HHSS 4/14/2009 3:00:00 PM
HB 126
Backup - Ca. study.PDF HHSS 4/14/2009 3:00:00 PM
HB 126
Sponsor Statement.PDF HHSS 4/14/2009 3:00:00 PM
HB 126
Sectional.PDF HHSS 4/14/2009 3:00:00 PM
HB 126
CS Version C.PDF HHSS 4/14/2009 3:00:00 PM
HB 126
CS version P.PDF HHSS 4/14/2009 3:00:00 PM
HB 126
Departments Affected.PDF HHSS 4/14/2009 3:00:00 PM
HB 126
Local Educational Agency Requirements.PDF HHSS 4/14/2009 3:00:00 PM
HB 126
Newspaper article.PDF HHSS 4/14/2009 3:00:00 PM
HB 126