Version:

Existing law prohibits specified conduct inside public buildings owned and occupied, or leased and occupied, by the state. Existing law provides that a judicial officer has the power to preserve and enforce order in judicial proceedings and to compel obedience to judicial orders, as specified.

This bill would clarify the power of judicial officers to prevent activities that threaten access to courthouses, including by protecting the privilege from arrest. The bill would provide that no person shall be subject to civil arrest in a courthouse while attending a court proceeding or having legal business in the courthouse, and that a violation of these provisions constitutes contempt of court. The bill would also authorize the Attorney General to bring a civil action to obtain equitable and declaratory relief for a violation of this section, and it would allow a party in a successful action to enforce liability for a violation of this section to recover court costs and reasonable attorneys fees.

By expanding the scope of an existing crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

By expanding the scope of an existing crime, this bill would impose a state-mandated local program.

This bill would provide that no reimbursement is required by this act for a specified reason.

(1)Existing law establishes the State Department of Public Health and sets forth its powers and duties, including, but not limited to, the licensure and regulation of chronic dialysis clinics. Existing law requires the department to adopt regulations to implement these provisions, and requires those regulations to prescribe, among other things, minimum standards for staffing with duly qualified personnel. Violation of these provisions is a crime.This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the chief executive officer or administrator, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year. The bill would authorize the department to assess an administrative penalty for a violation of these provisions and other licensing provisions and would require the department to promulgate regulations to establish criteria for assessing these penalties. The bill would authorize a chronic dialysis clinic that disputes an alleged deficiency or failure to correct a deficiency, or the reasonableness of a proposed deadline for correction of a violation or an amount of an administrative penalty, to request a hearing. Because failure to comply with the minimum staffing and minimum transition time requirements would be a crime, this bill would impose a state-mandated local program. (2)Existing law requires every clinic for which a license or special permit has been issued to be periodically inspected, with the frequency to be determined based on the type and complexity of the clinic or special service to be inspected. Existing law makes this provision inapplicable to an end-stage renal disease facility.This bill would delete that exception and require the department to conduct an inspection of a chronic dialysis clinic at least once per year and as often as necessary to, among other things, ensure compliance with the minimum staffing and minimum transition time requirements and ensure the adequacy of care being provided.The bill would generally require the department to issue regulations necessary to implement the bill no later than 2 years following its effective date.(3)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the chief executive officer or administrator, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year. The bill would authorize the department to assess an administrative penalty for a violation of these provisions and other licensing provisions and would require the department to promulgate regulations to establish criteria for assessing these penalties. The bill would authorize a chronic dialysis clinic that disputes an alleged deficiency or failure to correct a deficiency, or the reasonableness of a proposed deadline for correction of a violation or an amount of an administrative penalty, to request a hearing. Because failure to comply with the minimum staffing and minimum transition time requirements would be a crime, this bill would impose a state-mandated local program.

(2)Existing law requires every clinic for which a license or special permit has been issued to be periodically inspected, with the frequency to be determined based on the type and complexity of the clinic or special service to be inspected. Existing law makes this provision inapplicable to an end-stage renal disease facility.

This bill would delete that exception and require the department to conduct an inspection of a chronic dialysis clinic at least once per year and as often as necessary to, among other things, ensure compliance with the minimum staffing and minimum transition time requirements and ensure the adequacy of care being provided.

The bill would generally require the department to issue regulations necessary to implement the bill no later than 2 years following its effective date.

(3)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the chief executive officer or administrator, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year. The bill would authorize the department to assess an administrative penalty for a violation of these provisions and would require the department to promulgate regulations to establish criteria for assessing these penalties. The bill would authorize a chronic dialysis clinic that disputes an alleged deficiency or failure to correct a deficiency, or the reasonableness of a proposed deadline for correction of a violation, violation or an amount of an administrative penalty penalty, to request a hearing. Because failure to comply with the minimum staffing and minimum transition time requirements would be a crime, this bill would impose a state-mandated local program.

The bill would generally require the department to issue regulations necessary to implement the bill no later than 180 days 2 years following its effective date.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing

This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the chief executive officer or administrator, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year. The bill would establish a schedule of penalties and actions to be taken for failing to comply with the minimum staffing and minimum transition time requirements, including, among other things, the imposition of civil fines and the requirement that a chronic dialysis clinic submit a corrective action plan. authorize the department to assess an administrative penalty for a violation of these provisions and would require the department to promulgate regulations to establish criteria for assessing these penalties. The bill would authorize a chronic dialysis clinic that disputes an alleged deficiency or failure to correct a deficiency, or the reasonableness of a proposed deadline for correction of a violation, or an amount of an administrative penalty to request a hearing. Because failure to comply with the minimum staffing and minimum transition time requirements would be a crime, this bill would impose a state-mandated local program.

Existing

The bill would generally require the department to issue regulations necessary to implement the bill no later than 180 days following its effective date.

The

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law establishes the State Department of Public Health and sets forth its powers and duties, including, but not limited to, the licensure and regulation of chronic dialysis clinics. Existing law requires the department to adopt regulations to implement these provisions, and requires those regulations to prescribe, among other things, minimum standards for staffing with duly qualified personnel. Violation of these provisions is a crime.

Existing law requires every clinic for which a license or special permit has been issued to be periodically inspected, with the frequency to be determined based on the type and complexity of the clinic or special service to be inspected. Existing law makes this provision inapplicable to an end-stage renal disease facility.

The bill would require the department to issue regulations necessary to implement the bill no later than 180 days following its effective date.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the chief executive officer or administrator under penalty of perjury, administrator, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year. The bill would establish a schedule of penalties and actions to be taken for failing to comply with the minimum staffing and minimum transition time requirements, including, among other things, the imposition of civil fines and the requirement that a chronic dialysis clinic submit a corrective action plan. Because failure to comply with the minimum staffing and minimum transition time requirements would be a crime, and by expanding the crime of perjury, this bill would impose a state-mandated local program.

The bill would require the department to issue regulations necessary to implement the bill no later than 180 days following its effective date.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.This bill would make legislative findings to that effect.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the medical director and the chief executive officer or administrator under penalty of perjury, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year. The bill would establish a schedule of penalties and actions to be taken for failing to comply with the minimum staffing and minimum transition time requirements, including, among other things, the imposition of civil fines and the requirement that a chronic dialysis clinic submit a correction corrective action plan. Because failure to comply with the minimum staffing and minimum transition time requirements would be a crime, and by expanding the crime of perjury, this bill would impose a state-mandated local program.

The bill would require the department to issue regulations necessary to implement the bill no later than 180 days following its effective date.

This bill would make legislative findings to that effect.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the medical director and the chief executive officer or administrator under penalty of perjury, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year. The bill would establish a schedule of penalties and actions to be taken for failing to comply with the minimum staffing and minimum transition time requirements, including, among other things, the imposition of civil fines and the requirement that a chronic dialysis clinic submit a correction action plan. The bill would also establish a private right of action to enforce the minimum staffing and minimum transition time requirements. Because failure to comply with the minimum staffing and minimum transition time requirements would be a crime, and by expanding the crime of perjury, this bill would impose a state-mandated local program.

The bill would require the department to issue regulations necessary to implement the bill no later than 180 days following its effective date.

This bill would make legislative findings to that effect.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the medical director and the chief executive officer or administrator under penalty of perjury, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year. The bill would establish a schedule of penalties and actions to be taken for failing to comply with the minimum staffing and minimum transition time requirements, including, among other things, the imposition of civil fines and the requirement that chronic dialysis clinic submit a correction action plan. The bill would also establish a private right of action to enforce the minimum staffing and minimum transition time requirements. Because failure to comply with the minimum staffing and minimum transition time requirements would be a crime, and by expanding the crime of perjury, this bill would impose a state-mandated local program.

The bill would require the department to issue regulations necessary to implement the bill no later than 180 days following its effective date.

This bill would make legislative findings to that effect.

This bill would provide that no reimbursement is required by this act for a specified reason.

Version:

The people of the State of California do enact as follows:SECTION 1.

The Legislature finds and declares the following:

(a)The threat that persons may be subject to civil arrest while in Californias courthouses or attending judicial proceedings is a threat to the proper functioning of Californias government and to the rights enjoyed by all Californians.

(b)The United States Supreme Court has recognized that the unhindered and untrammeled functioning of our courts is part of the very foundation of our constitutional democracy, and that a state may therefore adopt measures necessary and appropriate to safeguarding the administration of justice by its courts. (United States v. Grace (1983) 461 U.S. 171, 178.)

(c)The United States Supreme Court has likewise acknowledged that a state has the power to preserve the property under its control for the use to which it is lawfully dedicated, and that [t]here is little doubt that in some circumstances the Government may ban the entry on to public property that is not a public forum of all persons except those who have legitimate business on the premises. (United States v. Grace (1983) 461 U.S. 171, 178.)

(d)Accordingly, California may regulate entry and access to the courts, and activity on courthouse premises and vicinities, that threatens the fair and nondiscriminatory administration of justice or the openness of courts.

(e)Proceedings in Californias courts in both criminal and civil matters have historically been open to the public, and this presumption of openness has been codified under the Code of Civil Procedure section 124, which provides that, with certain exceptions, the sittings of every court shall be public.

(f)The United States Supreme Court has said that, courts of justice ought everywhere to be open, accessible, free from interruption, and to cast a perfect protection around every [person] who necessarily approaches them. (Stewart v. Ramsay (1916) 242 U.S. 128, 129.)

(g)Public access to courts serves a vital role in the functioning of Californias judicial process and the preservation of our republican form of government, which is a government of lawslaws for California and Californians.

(h)Public scrutiny of judicial proceedings allows the public to observe the functioning of their government and determine whether justice is meted out fairly.

(i)Access fosters an appearance of fairness, promoting public confidence in, and respect for, the judicial process.

(j)Providing this transparency also serves as a critical check on the use and abuse of judicial powera check that is essential to our structure of self-government.

(k)Public access to Californias courts also enhances the truth-finding function of judicial proceedings, safeguarding their integrity.

(l)Accordingly, protecting persons from civil arrest while in Californias courthouses or attending judicial proceedings is necessary to preserve the vital role served by public access to courts.

(m)Protecting persons from civil arrest while in Californias courthouses or attending judicial proceedings is also necessary to ensure that litigants, witnesses, and others are not deterred from participating in such proceedings which are often necessary to protect and vindicate rights guaranteed by the laws of California; that courts and parties have access to testimony and other evidence critical to factfinding; and that the dignity of judicial proceedings is upheld and not disturbed or diminished, all of which ensures California courts ability to administer justice.

(n)Protecting persons from civil arrest while in Californias courthouses or attending judicial proceedings is also necessary to preserve the individual rights of all Californians.

(o)Access to courts is part of the right to free speech enshrined in the California and United States constitutions, because access to government ensures that Californians constitutionally protected right to discuss the government is the right to engage in informed discussion.

(p)Access, being vital, should be universal in so far as possible, to protect Californians rights to equal protection of the lawsand Californias right to benefit from the informed views of all.

(q)Access is necessary to preserve the right to petition government for redress, and to preserve numerous trial rights of individuals, including the right to be present, to present claims and defenses, to testify at trial, to call witnesses, to compulsory process, and of course to have a public trial.

(r)Civil arrests of persons in Californias courthouses or attending judicial proceedings threatens all of the foregoing public and private values of public access as well as the core functions of California courts, and must be considered unreasonable and unlawful seizures whether undertaken by local, state, or federal officers.

(s)The provisions of this act are thus necessary to protect and preserve the integrity of the proceedings of the judicial branch of California government.

(t)Courts being essential to a republican form of government and to the functioning of Californias government, California has the reserved power under the Tenth Amendment to protect their proceedings, as well as the obligation under the United States Constitution to preserve Californias republican form of government.

(u)A person who is arrested or detained in violation of this act may, like any other person unlawfully arrested or detained, seek a writ of habeas corpus.

SEC. 2.Section 177 of the Code of Civil Procedure is amended to read:177.

A judicial officer shall have power:

1.To preserve and enforce order in the officers immediate presence, and in proceedings before the officer, when the officer is engaged in the performance of official duty;

2.To compel obedience to the officers lawful orders as provided in this code;

3.To compel the attendance of persons to testify in a proceeding before the officer, in the cases and manner provided in this code;

4.To administer oaths to persons in a proceeding pending before the officer, and in all other cases where it may be necessary in the exercise of his powers and duties.

5.To prevent activities that threaten access to state courthouses and court proceedings, and to prevent interruption of judicial administration, including protecting the privilege from civil arrest at courthouses and court proceedings.

SEC. 3.Section 43.54 is added to the Civil Code, to read:43.54.

(a)A person shall not be subject to civil arrest of any type in a courthouse while attending a court proceeding or having legal business in the courthouse.

(b)This section does not narrow, or in any way lessen, any existing common law privilege.

(c)A violation of this section is a contempt of the authority of the court as provided in Title 5 of Part 3 of the Code of Civil Procedure.

(d)The Attorney General may bring a civil action in the name of the people to obtain appropriate equitable and declaratory relief if the Attorney General has reasonable cause to believe that a violation of this section has occurred.

(e)A party in a successful action to enforce liability for a violation of this section may recover court costs and reasonable attorneys fees.

SEC. 4.

The provisions of this act are severable. If any provision of this act or its application is held invalid, that invalidity shall not affect other provisions or applications that be given effect without the invalid provision or application.

SEC. 5.

No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.

The people of the State of California do enact as follows:SECTION 1.

The Legislature finds and declares the following:

(h)Public scrutiny of judicial proceedings allows the public to observe the functioning of their government and determine whether justice is meted out fairly.

(i)Access fosters an appearance of fairness, promoting public confidence in, and respect for, the judicial process.

(j)Providing this transparency also serves as a critical check on the use and abuse of judicial powera check that is essential to our structure of self-government.

(k)Public access to Californias courts also enhances the truth-finding function of judicial proceedings, safeguarding their integrity.

(l)Accordingly, protecting persons from civil arrest while in Californias courthouses or attending judicial proceedings is necessary to preserve the vital role served by public access to courts.

(m)Protecting persons from civil arrest while in Californias courthouses or attending judicial proceedings is also necessary to ensure that litigants, witnesses, and others are not deterred from participating in such proceedings which are often necessary to protect and vindicate rights guaranteed by the laws of California; that courts and parties have access to testimony and other evidence critical to fact-finding; and that the dignity of judicial proceedings is upheld and not disturbed or diminished, all of which ensures California courts ability to administer justice.

(n)Protecting persons from civil arrest while in Californias courthouses or attending judicial proceedings is also necessary to preserve the individual rights of all Californians.

(p)Access, being vital, should be universal in so far as possible, to protect Californians rights to equal protection of the lawsand Californias right to benefit from the informed views of all.

(s)The provisions of this act are thus necessary to protect and preserve the integrity of the proceedings of the judicial branch of California government.

(u)A person who is arrested or detained in violation of this act may, like any other person unlawfully arrested or detained, seek a writ of habeas corpus.

SEC. 2.Section 177 of the Code of Civil Procedure is amended to read:177.

Every A judicial officer shall have power:

1.To preserve and enforce order in his the officers immediate presence, and in proceedings before him, the officer, when he the officer is engaged in the performance of official duty;

2.To compel obedience to his the officers lawful orders as provided in this Code; code;

3.To compel the attendance of persons to testify in a proceeding before him, the officer, in the cases and manner provided in this Code; code;

4.To administer oaths to persons in a proceeding pending before him, the officer, and in all other cases where it may be necessary in the exercise of his powers and duties.

SEC. 3.Section 43.54 is added to the Civil Code, to read:43.54.

(a)A person shall not be subject to civil arrest of any type in a courthouse while attending a court proceeding or having legal business in the courthouse.

(b)This section does not narrow, or in any way lessen, any existing common law privilege.

(c)A violation of this section is a contempt of the authority of the court as provided in Title 5 of Part 3 of the Code of Civil Procedure.

(e)A party in a successful action to enforce liability for a violation of this section may recover court costs and reasonable attorneys fees.

SEC. 4.

SEC. 5.

SECTION 1.The Legislature finds and declares all of the following:(a)Dialysis is a critical, lifesaving treatment for Californians suffering from end-stage renal disease.(b)There are currently more than 66,000 dialysis patients, and more than 570 licensed outpatient dialysis clinics, in California.(c)There is broad consensus among medical professionals, academics, and other experts that higher ratios of direct caregiving staff to patients at outpatient dialysis clinics improve patient outcomes, including by reducing the rate at which patients suffer infections or must be hospitalized.(d)There is also broad consensus among medical professionals, academics, and other experts that adequate time to prepare a treatment station for a patient to be dialyzed is necessary to ensure safety and hygiene protocols are followed, and directly improve patient outcomes, including by reducing the rate at which patients suffer infections or must be unnecessarily hospitalized.(e)Worker safety is also enhanced by higher ratios of caregiving staff to patients and transition time between patients, including by reducing the risk of injury on the job.(f)Current staffing levels in outpatient dialysis clinics in California are inadequate to protect patient health and worker safety, and therefore are presently causing harm to dialysis patients, including unnecessary and avoidable deaths, hospitalizations, infections, and medication errors.(g)Other states mandate minimum direct care staffing requirements in order to enhance patient safety and health at outpatient dialysis clinics.SEC. 2.Section 1226 of the Health and Safety Code is amended to read:1226.(a)The regulations shall prescribe the kinds of services which may be provided by clinics in each category of licensure and shall prescribe minimum standards of adequacy, safety, and sanitation of the physical plant and equipment, and, subject to Section 1226.4, minimum standards for staffing with duly qualified personnel and minimum standards for providing the services offered. These minimum standards shall be based on the type of facility, the needs of the patients served, and the types and levels of services provided.(b)The Office of Statewide Health Planning and Development, in consultation with the Community Clinics Advisory Committee, shall prescribe minimum construction standards of adequacy and safety for the physical plant of clinics as found in the California Building Standards Code.(c)(1)A city or county, as applicable, shall have plan review and building inspection responsibilities for the construction or alteration of buildings described in paragraphs (1) and (2) of subdivision (b) of Section 1204 and shall apply the provisions of the latest edition of the California Building Standards Code in conducting these plan review responsibilities. For these buildings, construction and alteration shall include conversion of a building to a purpose specified in paragraphs (1) and (2) of subdivision (b) of Section 1204.(2)Upon the initial submittal to a city or county by the governing authority or owner of these clinics for plan review and building inspection services, the city or county shall reply in writing to the clinic whether or not the plan review by the city or county will include a certification as to whether or not the clinic project submitted for plan review meets the standards as propounded by the office in the California Building Standards Code.(3)If the city or county indicates that its review will include this certification, it shall do both of the following:(A)Apply the applicable clinic provisions of the latest edition of the California Building Standards Code.(B)Certify in writing, to the applicant within 30 days of completion of construction whether or not these standards have been met.(d)If upon initial submittal, the city or county indicates that its plan review will not include this certification, the governing authority or owner of the clinic shall submit the plans to the Office of Statewide Health Planning and Development, which shall review the plans for certification whether or not the clinic project meets the standards, as propounded by the office in the California Building Standards Code.(e)When the office performs review for certification, the office shall charge a fee in an amount that does not exceed its actual costs.(f)The Office of the State Fire Marshal shall prescribe minimum safety standards for fire and life safety in surgical clinics.(g)Notwithstanding subdivision (c), the governing authority or owner of a clinic may request the office to perform plan review services for buildings described in subdivision (c). If the office agrees to perform these services, after consultation with the local building official, the office shall charge an amount not to exceed its actual costs. The construction or alteration of these buildings shall conform to the applicable provisions of the latest edition of the California Building Standards Code for purposes of the plan review by the office pursuant to this subdivision.(h)Regulations adopted pursuant to this chapter establishing standards for laboratory services shall not be applicable to any clinic that operates a clinical laboratory licensed pursuant to Section 1265 of the Business and Professions Code.SEC. 3.Section 1226.4 is added to the Health and Safety Code, to read:1226.4.(a)For purposes of this section, the following terms have the following meanings:(1)At all times includes times during which employees, including, but not limited to, nurses and technicians, are provided meal periods and rest or other breaks.(2)Charge nurse means a charge nurse as described in Section 494.140(b)(3) of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.(3)Direct care means initiating and discontinuing dialysis, monitoring patients during treatment, and administering medications, and physical presence in the dialysis treatment area.(4)Full-time equivalent means employment by a chronic dialysis clinic for 2,080 hours of work in 12 consecutive months.(5)Nurse means a registered nurse licensed pursuant to Chapter 6 (commencing with Section 2700) of Division 2 of the Business and Professions Code.(6)Nurse manager means a nurse manager as described in Section 494.140(b)(1) of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.(7)Registered dietitian means a dietitian as described in Section 494.140(c) of Title 42 of the Code of Federal Regulations, as it read on December 31, 2016.(8)Rural county means a county that has a population of less than 250,000 and does not have a single urbanized area with a population of greater than 50,000.(9)Social worker means a social worker as described in Section 494.140(d) of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.(10)Technician means a person who holds both of the following qualifications:(A)The person is a patient care dialysis technician, as described in Section 494.140(e) of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.(B)The person is a Certified Hemodialysis Technician certified pursuant to Article 3.5 (commencing with Section 1247) of Chapter 3 of Division 2 of the Business and Professions Code.(11)Trainee means a person who is undergoing training to become a technician, but who has not yet been certified as a Certified Hemodialysis Technician pursuant to Article 3.5 (commencing with Section 1247) of Chapter 3 of Division 2 of the Business and Professions Code.(12)Transition time means the period of time beginning when one patient has completed treatment and has been disconnected from the dialysis machine and ending when the next patient is placed in the treatment station, but does not mean the period of time after the last patient of the day leaves the treatment station.(13)Treatment station means a physical location within a chronic dialysis clinic where an individual patient is dialyzed.(b)(1)Commencing January 1, 2020, a chronic dialysis clinic shall ensure that the following minimum staffing ratios are met at all times that patients are receiving, or preparing to receive, direct care:(A)At least one nurse is providing direct care for every eight patients. A nurse shall only count toward this ratio during time periods the nurse has no responsibilities other than direct care. A nurse manager or charge nurse shall not count toward this ratio.(B)At least one technician is providing direct care for every three patients. A technician shall only count toward this ratio during time periods the technician has no responsibilities other than direct care. Trainees shall not count toward this ratio. Nurses counted toward the nurse-to-patient ratio shall not count toward this ratio.(2)Commencing January 1, 2020, a chronic dialysis clinic shall ensure that a full-time equivalent individual social worker is not assigned more than 75 patients receiving care from the chronic dialysis clinic, regardless of the location where each patient undergoes dialysis.(3)Commencing January 1, 2020, a chronic dialysis clinic shall ensure that a full-time equivalent individual registered dietitian is not assigned more than 75 patients receiving care from the chronic dialysis clinic, regardless of the location where each patient undergoes dialysis.(4)The ratios described in paragraphs (1), (2), and (3) shall constitute the minimum number of nurses, technicians, social workers, and registered dietitians assigned to patients at all times. Additional nurses, technicians, social workers, and registered dietitians shall be assigned to the extent necessary to ensure the patient-to-staff ratio is appropriate to the level of dialysis care given and meets the needs of patients.(5)No later than January 1, 2020, the department shall issue regulations that specify an appropriate minimum transition time. This appropriate minimum transition time shall give patients sufficient time to recuperate after treatment and provide sufficient time to comply with safety and hygiene protocols, including, but not limited to, compliance with recommendations from the Centers for Disease Control and Prevention regarding hygiene practices. If the department has not issued those regulations on or before January 1, 2020, a chronic dialysis clinic shall ensure that the minimum transition time is at least 45 minutes.(c)The department shall not issue a license to any chronic dialysis clinic unless that chronic dialysis clinic demonstrates the ability and intention to comply with this section.(d)(1)Every chronic dialysis clinic for which a license has been issued shall maintain, and provide to the department on a form prescribed by the department, at a minimum, the following information:(A)Actual staffing ratio and transition time data for the period covered by the submission, which shall include, at a minimum, all of the following: (1) daily totals of the total number and actual hours worked by nurses and technicians; (2) the total number of patients and actual hours receiving direct care; (3) the daily average transition time for each treatment station; and (4) for each week, the total number of full-time equivalent social workers and registered dietitians and the total number of patients assigned to social workers and registered dietitians.(B)Every instance, no matter how brief, during the period covered by the submission when staffing ratios or transition times did not meet the requirements of subdivision (b) and the reasons and circumstances therefor.(2)The chief executive officer or administrator of the chronic dialysis clinic shall personally certify that he or she is satisfied, after review, that all information submitted pursuant to paragraph (1) is accurate and complete.(3)The chronic dialysis clinic shall periodically submit the information described in paragraph (1) to the department on a schedule and in a format prescribed by the department, provided that the clinic shall submit that information no less frequently than four times per year.(e)The department may grant a waiver of subdivisions (b), (c), and (d) to a chronic dialysis clinic in a rural county if the waiver does not jeopardize the health, safety, and well-being of affected patients and is needed for increased operational efficiency.(f)The department shall inspect each chronic dialysis clinic for which a license has been issued at least once per year, and shall conduct such inspections as often as necessary to ensure compliance with the requirements of subdivision (b), the accuracy and completeness of information provided pursuant to subdivision (d), and the adequacy of the quality of care being provided.(g)Within 60 days of receiving a complaint from an employee, an association of employees, a vendor, a contractor, a patient, an association of patients, or a family member of a patient of a chronic dialysis clinic that the chronic dialysis clinic has committed a violation of the requirements of this chapter, the department shall investigate the chronic dialysis clinic and, if the evidence shows a violation has occurred, the department shall impose discipline pursuant to Section 1240.1.(h)(1)Any writing, record, or document received, owned, used, or retained by the department in connection with subdivisions (c), (d), and (f) of this section, subdivisions (b) to (g), inclusive, of Section 1240.1, and Section 1240.2, is a public record within the meaning of subdivision (e) of Section 6252 of the Government Code, and, as such, is open to public inspection pursuant to the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).(2)The department shall redact from any writing, record, or document described in this subdivision personal identifying information associated with named individuals to the extent required to prevent an unwarranted invasion of personal privacy, as that term is used in subdivision (c) of Section 6254 of the Government Code, but the department shall not withhold any such writing, record, or document in its entirety under subdivision (c) of Section 6254 of the Government Code.(3)Information required to be submitted under subdivision (d), and complaints submitted under subdivision (g), shall not be withheld on the basis of subdivision (f) of Section 6254 of the Government Code.(i)(1)With the exception of paragraphs (2) and (3) of subdivision (b), the provisions of this section shall not apply to home dialysis, as defined in Section 494.10 of Title 42 of the Code of Federal Regulations, as it read on December 31, 2016, and home dialysis-related services and training, as described in Section 494.100 of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.(2)Home dialysis-related services and training, as described in Section 494.100 of Title 42 of the Code of Federal Regulations, as it read on December 31, 2016, are not included within the definition of direct care for the purposes of this section.SEC. 4.Section 1228 of the Health and Safety Code is amended to read:1228.(a)Except as provided in subdivision (c), every clinic for which a license or special permit has been issued shall be periodically inspected. Except as provided in Section 1226.4, the frequency of inspections shall depend upon the type and complexity of the clinic or special service to be inspected. Inspections shall be conducted no less often than once every three years and as often as necessary to ensure the quality of care being provided.(b) (1)During inspections, representatives of the department shall offer any advice and assistance to the clinic as they deem appropriate. The department may contract with local health departments for the assumption of any of the departments responsibilities under this chapter. In exercising this authority, the local health department shall conform to the requirements of this chapter and to the rules, regulations, and standards of the department.(2)The department shall reimburse local health departments for services performed pursuant to this section, and these payments shall not exceed actual cost. Reports of each inspection shall be prepared by the representative conducting it upon forms prepared and furnished by the department and filed with the department.(c)This section shall not apply to any of the following:(1)A rural health clinic.(2)A primary care clinic accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Accreditation Association for Ambulatory Health Care (AAAHC), or any other accrediting organization recognized by the department.(3)An ambulatory surgical center.(4)A comprehensive outpatient rehabilitation facility that is certified to participate either in the Medicare Program under Title XVIII (42 U.S.C. Sec. 1395 et seq.) of the federal Social Security Act, or the Medicaid program under Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act, or both.(d)Notwithstanding paragraph (2) of subdivision (c), the department shall retain the authority to inspect a primary care clinic pursuant to Section 1227, or as necessary to ensure the quality of care being provided.SEC. 5.The heading of Article 5 (commencing with Section 1240) of Chapter 1 of Division 2 of the Health and Safety Code is repealed.SEC. 6.The heading of Article 5 (commencing with Section 1240) is added to Chapter 1 of Division 2 of the Health and Safety Code, to read:5.Suspension, Revocation, and PenaltiesSEC. 7.Section 1240.1 is added to the Health and Safety Code, to read:1240.1.(a)The director may assess an administrative penalty against a chronic dialysis clinic for a violation of this chapter. Each penalty issued pursuant to this chapter shall be classified as a major violation, an intermediate violation, or a minor violation according to the nature of the violation and the threat of harm to patients. A major violation shall be subject to an administrative penalty of up to ten thousand dollars ($10,000), and an intermediate violation shall be subject to an administrative penalty of up to five thousand dollars ($5,000). The director shall not assess an administrative penalty for a minor violation.(b)The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a chronic dialysis clinic that shall include, but not be limited to, a consideration of all the following:(1)The probability and severity of the risk that the violation presents to the patient.(2)The actual harm to patients, if any.(3)The nature, scope, and severity of the violation.(4)The chronic dialysis clinics history of compliance with related state and federal statutes and regulations, including, but not limited to, the similarity in circumstances of the violation to any previous violation by the chronic dialysis clinic within a 24-month period.(5)Factors beyond the control of the chronic dialysis clinic that restricts its ability to comply with this chapter or the rules and regulations promulgated thereunder.(6)The demonstrated willfulness of the violation.(7)The extent to which the chronic dialysis clinic detected the violation and took immediate action to correct the violation and prevent that type of violation from recurring.(c)If a chronic dialysis clinic disputes a determination by the director regarding an alleged deficiency or failure to correct a deficiency, or the reasonableness of a proposed deadline for correction of a violation or an amount of an administrative penalty, the chronic dialysis clinic may, within 10 working days, request a hearing pursuant to Section 131071. A chronic dialysis clinic shall pay all administrative penalties when all appeals have been exhausted and the departments position has been upheld.SEC. 8.Section 1240.2 is added to the Health and Safety Code, to read:1240.2.(a)Subject to subdivision (d), prior to the effective date of regulations adopted to implement Section 1240.1, if a chronic dialysis clinic receives a notice of deficiency constituting an immediate jeopardy to the health or safety of a patient or employee and is required to submit a plan of correction, the department may assess the licensee an administrative penalty of up to ten thousand dollars ($10,000).(b)If a licensee disputes a determination by the department regarding an alleged deficiency or the 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 days, request an administrative hearing pursuant to Section 131071. Penalties shall be paid when appeals have been exhausted and if the departments position has been upheld.(c)For purposes of this section immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to one or more patients or employees.(d)This section shall only apply to incidents occurring on or after January 1, 2018, except that this section shall only apply to violations of subdivision (b) of Section 1226.4 occurring on or after January 1, 2020.(e)Notwithstanding Section 11 of the act that added this section, new regulations are not required or authorized for implementation of this section.(f)This section shall become inoperative on the effective date of regulations promulgated by the department pursuant to Section 1240.1.SEC. 9.Section 1266.2 is added to the Health and Safety Code, to read:1266.2.It is the intent of the Legislature that California taxpayers not be financially responsible for implementation and enforcement of minimum staffing requirements at chronic dialysis clinics. In order to effectuate that intent, when calculating, assessing, and collecting fees imposed on chronic dialysis clinics pursuant to Section 1266, the department shall take into account all costs associated with implementing and enforcing Sections 1226.4 and 1240.1.SEC. 10.Nothing in this act is intended to impact nurse-to-patient ratios applicable to health facilities licensed pursuant to subdivision (a), (b), or (f) of Section 1250 of the Health and Safety Code.SEC. 11.The State Department of Public Health shall issue regulations necessary to implement this act no later than two years following its effective date.SEC. 12.The provisions of this act are severable. If any provision of this act or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.SEC. 13.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.

The people of the State of California do enact as follows:SECTION 1.

The Legislature finds and declares all of the following:

(a)Dialysis is a critical, lifesaving treatment for Californians suffering from end-stage renal disease.

(b)There are currently more than 66,000 dialysis patients, and more than 570 licensed outpatient dialysis clinics, in California.

(c)There is broad consensus among medical professionals, academics, and other experts that higher ratios of direct caregiving staff to patients at outpatient dialysis clinics improve patient outcomes, including by reducing the rate at which patients suffer infections or must be hospitalized.

(d)There is also broad consensus among medical professionals, academics, and other experts that adequate time to prepare a treatment station for a patient to be dialyzed is necessary to ensure safety and hygiene protocols are followed, and directly improve patient outcomes, including by reducing the rate at which patients suffer infections or must be unnecessarily hospitalized.

(e)Worker safety is also enhanced by higher ratios of caregiving staff to patients and transition time between patients, including by reducing the risk of injury on the job.

(f)Current staffing levels in outpatient dialysis clinics in California are inadequate to protect patient health and worker safety, and therefore are presently causing harm to dialysis patients, including unnecessary and avoidable deaths, hospitalizations, infections, and medication errors.

(g)Other states mandate minimum direct care staffing requirements in order to enhance patient safety and health at outpatient dialysis clinics.

SEC. 2.Section 1226 of the Health and Safety Code is amended to read:1226.

(a)The regulations shall prescribe the kinds of services which may be provided by clinics in each category of licensure and shall prescribe minimum standards of adequacy, safety, and sanitation of the physical plant and equipment, and, subject to Section 1226.4, minimum standards for staffing with duly qualified personnel and minimum standards for providing the services offered. These minimum standards shall be based on the type of facility, the needs of the patients served, and the types and levels of services provided.

(b)The Office of Statewide Health Planning and Development, in consultation with the Community Clinics Advisory Committee, shall prescribe minimum construction standards of adequacy and safety for the physical plant of clinics as found in the California Building Standards Code.

(c)(1)A city or county, as applicable, shall have plan review and building inspection responsibilities for the construction or alteration of buildings described in paragraphs (1) and (2) of subdivision (b) of Section 1204 and shall apply the provisions of the latest edition of the California Building Standards Code in conducting these plan review responsibilities. For these buildings, construction and alteration shall include conversion of a building to a purpose specified in paragraphs (1) and (2) of subdivision (b) of Section 1204.

(2)Upon the initial submittal to a city or county by the governing authority or owner of these clinics for plan review and building inspection services, the city or county shall reply in writing to the clinic whether or not the plan review by the city or county will include a certification as to whether or not the clinic project submitted for plan review meets the standards as propounded by the office in the California Building Standards Code.

(3)If the city or county indicates that its review will include this certification, it shall do both of the following:

(A)Apply the applicable clinic provisions of the latest edition of the California Building Standards Code.

(B)Certify in writing, to the applicant within 30 days of completion of construction whether or not these standards have been met.

(d)If upon initial submittal, the city or county indicates that its plan review will not include this certification, the governing authority or owner of the clinic shall submit the plans to the Office of Statewide Health Planning and Development, which shall review the plans for certification whether or not the clinic project meets the standards, as propounded by the office in the California Building Standards Code.

(e)When the office performs review for certification, the office shall charge a fee in an amount that does not exceed its actual costs.

(f)The Office of the State Fire Marshal shall prescribe minimum safety standards for fire and life safety in surgical clinics.

(g)Notwithstanding subdivision (c), the governing authority or owner of a clinic may request the office to perform plan review services for buildings described in subdivision (c). If the office agrees to perform these services, after consultation with the local building official, the office shall charge an amount not to exceed its actual costs. The construction or alteration of these buildings shall conform to the applicable provisions of the latest edition of the California Building Standards Code for purposes of the plan review by the office pursuant to this subdivision.

(h)Regulations adopted pursuant to this chapter establishing standards for laboratory services shall not be applicable to any clinic that operates a clinical laboratory licensed pursuant to Section 1265 of the Business and Professions Code.

SEC. 3.Section 1226.4 is added to the Health and Safety Code, to read:1226.4.

(a)For purposes of this section, the following terms have the following meanings:

(1)At all times includes times during which employees, including, but not limited to, nurses and technicians, are provided meal periods and rest or other breaks.

(2)Charge nurse means a charge nurse as described in Section 494.140(b)(3) of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.

(3)Direct care means initiating and discontinuing dialysis, monitoring patients during treatment, and administering medications, and physical presence in the dialysis treatment area.

(4)Full-time equivalent means employment by a chronic dialysis clinic for 2,080 hours of work in 12 consecutive months.

(5)Nurse means a registered nurse licensed pursuant to Chapter 6 (commencing with Section 2700) of Division 2 of the Business and Professions Code.

(6)Nurse manager means a nurse manager as described in Section 494.140(b)(1) of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.

(7)Registered dietitian means a dietitian as described in Section 494.140(c) of Title 42 of the Code of Federal Regulations, as it read on December 31, 2016.

(8)Rural county means a county that has a population of less than 250,000 and does not have a single urbanized area with a population of greater than 50,000.

(9)Social worker means a social worker as described in Section 494.140(d) of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.

(10)Technician means a person who holds both of the following qualifications:

(A)The person is a patient care dialysis technician, as described in Section 494.140(e) of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.

(B)The person is a Certified Hemodialysis Technician certified pursuant to Article 3.5 (commencing with Section 1247) of Chapter 3 of Division 2 of the Business and Professions Code.

(11)Trainee means a person who is undergoing training to become a technician, but who has not yet been certified as a Certified Hemodialysis Technician pursuant to Article 3.5 (commencing with Section 1247) of Chapter 3 of Division 2 of the Business and Professions Code.

(12)Transition time means the period of time beginning when one patient has completed treatment and has been disconnected from the dialysis machine and ending when the next patient is placed in the treatment station, but does not mean the period of time after the last patient of the day leaves the treatment station.

(13)Treatment station means a physical location within a chronic dialysis clinic where an individual patient is dialyzed.

(b)(1)Commencing January 1, 2020, a chronic dialysis clinic shall ensure that the following minimum staffing ratios are met at all times that patients are receiving, or preparing to receive, direct care:

(A)At least one nurse is providing direct care for every eight patients. A nurse shall only count toward this ratio during time periods the nurse has no responsibilities other than direct care. A nurse manager or charge nurse shall not count toward this ratio.

(B)At least one technician is providing direct care for every three patients. A technician shall only count toward this ratio during time periods the technician has no responsibilities other than direct care. Trainees shall not count toward this ratio. Nurses counted toward the nurse-to-patient ratio shall not count toward this ratio.

(2)Commencing January 1, 2020, a chronic dialysis clinic shall ensure that a full-time equivalent individual social worker is not assigned more than 75 patients. patients receiving care from the chronic dialysis clinic, regardless of the location where each patient undergoes dialysis.

(3)Commencing January 1, 2020, a chronic dialysis clinic shall ensure that a full-time equivalent individual registered dietitian is not assigned more than 75 patients. patients receiving care from the chronic dialysis clinic, regardless of the location where each patient undergoes dialysis.

(4)The ratios described in paragraphs (1), (2), and (3) shall constitute the minimum number of nurses, technicians, social workers, and registered dietitians assigned to patients at all times. Additional nurses, technicians, social workers, and registered dietitians shall be assigned to the extent necessary to ensure that an adequate number of qualified personnel are present whenever patients are undergoing dialysis so that the patient-to-staff ratio is appropriate to the level of dialysis care given and meets the needs of patients.

(5)Commencing January 1, 2020, a chronic dialysis clinic shall ensure that the transition time is at least 45 minutes.

(5)No later than January 1, 2020, the department shall issue regulations that specify an appropriate minimum transition time. This appropriate minimum transition time shall give patients sufficient time to recuperate after treatment and provide sufficient time to comply with safety and hygiene protocols, including, but not limited to, compliance with recommendations from the Centers for Disease Control and Prevention regarding hygiene practices. If the department has not issued those regulations on or before January 1, 2020, a chronic dialysis clinic shall ensure that the minimum transition time is at least 45 minutes.

(c)The department shall not issue a license to any chronic dialysis clinic unless that chronic dialysis clinic demonstrates the ability and intention to comply with this section.

(d)(1)Every chronic dialysis clinic for which a license has been issued shall maintain, and provide to the department on a form prescribed by the department, at a minimum, the following information:

(A)Actual staffing ratio and transition time data for the period covered by the submission, which shall include, at a minimum,daily all of the following: (1) daily totals of the total number and actual hours worked by nurses, technicians, social workers, and registered dietitians, nurses and technicians; (2) the total number of patients and actual hours receiving direct care, and care; (3) the daily average transition time for each treatment station. station; and (4) for each week, the total number of full-time equivalent social workers and registered dietitians and the total number of patients assigned to social workers and registered dietitians.

(B)Every instance, no matter how brief, during the period covered by the submission when staffing ratios or transition times did not meet the requirements of subdivision (b) and the reasons and circumstances therefor.

(2)The chief executive officer or administrator of the chronic dialysis clinic shall personally certify that he or she is satisfied, after review, that all information submitted pursuant to paragraph (1) is accurate and complete.

(3)The chronic dialysis clinic shall periodically submit the information described in paragraph (1) to the department on a schedule and in a format prescribed by the department, provided that the clinic shall submit that information no less frequently than four times per year.

(e)The department may grant a waiver of subdivisions (b), (c), and (d) to a chronic dialysis clinic in a rural county if the waiver does not jeopardize the health, safety, and well-being of affected patients and is needed for increased operational efficiency.

(f)The department shall inspect each chronic dialysis clinic for which a license has been issued at least once per year, and shall conduct such inspections as often as necessary to ensure compliance with the requirements of subdivision (b), the accuracy and completeness of information provided pursuant to subdivision (d), and the adequacy of the quality of care being provided.

(g)Within 60 days of receiving a complaint from an employee, an association of employees, a vendor, a contractor, a patient, an association of patients, or a family member of a patient of a chronic dialysis clinic that the chronic dialysis clinic has committed a violation of the requirements of this chapter, the department shall investigate the chronic dialysis clinic and, if the evidence shows a violation has occurred, the department shall impose discipline pursuant to Section 1240.1.

(h)(1)Any writing, record, or document received, owned, used, or retained by the department in connection with subdivisions (c), (d), and (f) of this section, subdivisions (b) to (g), inclusive, of Section 1240.1, and Section 1240.2, is a public record within the meaning of subdivision (e) of Section 6252 of the Government Code, and, as such, is open to public inspection pursuant to the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).

(2)The department shall redact from any writing, record, or document described in this subdivision personal identifying information associated with named individuals to the extent required to prevent an unwarranted invasion of personal privacy, as that term is used in subdivision (c) of Section 6254 of the Government Code, but the department shall not withhold any such writing, record, or document in its entirety under subdivision (c) of Section 6254 of the Government Code.

(3)Information required to be submitted under subdivision (d), and complaints submitted under subdivision (g), shall not be withheld on the basis of subdivision (f) of Section 6254 of the Government Code.

(i)(1)With the exception of paragraphs (2) and (3) of subdivision (b), the provisions of this section shall not apply to home dialysis, as defined in Section 494.10 of Title 42 of the Code of Federal Regulations, as it read on December 31, 2016, and home dialysis-related services and training, as described in Section 494.100 of Title 42 of the Code of Federal Regulations as it read on December 31, 2016.

(2)Home dialysis-related services and training, as described in Section 494.100 of Title 42 of the Code of Federal Regulations, as it read on December 31, 2016, are not included within the definition of direct care for the purposes of this section.

SEC. 4.Section 1228 of the Health and Safety Code is amended to read:1228.

(a)Except as provided in subdivision (c), every clinic for which a license or special permit has been issued shall be periodically inspected. Except as provided in Section 1226.4, the frequency of inspections shall depend upon the type and complexity of the clinic or special service to be inspected. Inspections shall be conducted no less often than once every three years and as often as necessary to ensure the quality of care being provided.

(b) (1)During inspections, representatives of the department shall offer any advice and assistance to the clinic as they deem appropriate. The department may contract with local health departments for the assumption of any of the departments responsibilities under this chapter. In exercising this authority, the local health department shall conform to the requirements of this chapter and to the rules, regulations, and standards of the department.

(2)The department shall reimburse local health departments for services performed pursuant to this section, and these payments shall not exceed actual cost. Reports of each inspection shall be prepared by the representative conducting it upon forms prepared and furnished by the department and filed with the department.

(c)This section shall not apply to any of the following:

(1)A rural health clinic.

(2)A primary care clinic accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Accreditation Association for Ambulatory Health Care (AAAHC), or any other accrediting organization recognized by the department.

(3)An ambulatory surgical center.

(4)A comprehensive outpatient rehabilitation facility that is certified to participate either in the Medicare Program under Title XVIII (42 U.S.C. Sec. 1395 et seq.) of the federal Social Security Act, or the Medicaid program under Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act, or both.

(d)Notwithstanding paragraph (2) of subdivision (c), the department shall retain the authority to inspect a primary care clinic pursuant to Section 1227, or as necessary to ensure the quality of care being provided.

(a)The director may assess an administrative penalty against a chronic dialysis clinic for a violation of this chapter. Each penalty issued pursuant to this chapter shall be classified as a major violation, an intermediate violation, or a minor violation according to the nature of the violation and the threat of harm to patients. A major violation shall be subject to an administrative penalty of up to ten thousand dollars ($10,000), and an intermediate violation shall be subject to an administrative penalty of up to five thousand dollars ($5,000). The director shall not assess an administrative penalty for a minor violation.

(b)The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a chronic dialysis clinic, clinic that shall include, but not be limited to, a consideration of all of the following:

(1)The probability and severity of the risk that the violation presents to the patient.

(2)The actual harm to patients, if any.

(3)The nature, scope, and severity of the violation.

(4)The chronic dialysis clinics history of compliance with related state and federal statutes and regulations, including, but not limited to, the similarity in circumstances of the violation to any previous violation by the chronic dialysis clinic within a 24-month period.

(5)Factors beyond the control of the chronic dialysis clinic that restricts its ability to comply with this chapter or the rules and regulations promulgated thereunder.

(6)The demonstrated willfulness of the violation.

(7)The extent to which the chronic dialysis clinic detected the violation and took immediate action to correct the violation and prevent that type of violation from recurring.

(c)If a chronic dialysis clinic disputes a determination by the director regarding an alleged deficiency or failure to correct a deficiency, or the reasonableness of a proposed deadline for correction of a violation or an amount of an administrative penalty, the chronic dialysis clinic may, within 10 working days, request a hearing pursuant to Section 131071. A chronic dialysis clinic shall pay all administrative penalties when all appeals have been exhausted and the departments position has been upheld.

SEC. 8.Section 1240.2 is added to the Health and Safety Code, to read:1240.2.

(a)Subject to subdivision (d), prior to the effective date of regulations adopted to implement Section 1240.1, if a chronic dialysis clinic receives a notice of deficiency constituting an immediate jeopardy to the health or safety of a patient or employee and is required to submit a plan of correction, the department may assess the licensee an administrative penalty of up to ten thousand dollars ($10,000).

(b)If a licensee disputes a determination by the department regarding an alleged deficiency or the 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 days, request an administrative hearing pursuant to Section 131071. Penalties shall be paid when appeals have been exhausted and if the departments position has been upheld.

(c)For purposes of this section immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to one or more patients or employees.

(d)This section shall only apply to incidents occurring on or after January 1, 2018, except that this section shall only apply to violations of subdivision (b) of Section 1226.4 occurring on or after January 1, 2020.

(e)Notwithstanding Section 11 of the act that added this section, new regulations are not required or authorized for implementation of this section.

(f)This section shall become inoperative on the effective date of regulations promulgated by the department pursuant to Section 1240.1.

SEC. 9.Section 1266.2 is added to the Health and Safety Code, to read:1266.2.

It is the intent of the Legislature that California taxpayers not be financially responsible for implementation and enforcement of minimum staffing requirements at chronic dialysis clinics. In order to effectuate that intent, when calculating, assessing, and collecting fees imposed on chronic dialysis clinics pursuant to Section 1266, the department shall take into account all costs associated with implementing and enforcing Sections 1226.4 and 1240.1.

SEC. 10.

Nothing in this act is intended to impact nurse-to-patient ratios applicable to health facilities licensed pursuant to subdivision (a), (b), or (f) of Section 1250 of the Health and Safety Code.

SEC. 11.

The State Department of Public Health shall issue regulations necessary to implement this act no later than two years following its effective date.

SEC. 12.

The provisions of this act are severable. If any provision of this act or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.

SEC. 13.

The people of the State of California do enact as follows:SECTION 1.

The Legislature finds and declares all of the following:

(a)Dialysis is a critical, lifesaving treatment for Californians suffering from end-stage renal disease.

(b)There are currently more than 63,000 66,000 dialysis patients, and 562 more than 570 licensed outpatient dialysis clinics, in California.