Chapter 463

2006 -- H 7386 SUBSTITUTE A AS AMENDED

Enacted 07/07/06

A N A C T

RELATING TO HEALTH AND SAFETY -- SAFE PATIENT HANDLING LEGISLATION

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

Date Introduced: February 16, 2006

It is enacted by the General Assembly as follows:

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

amended by adding thereto the following chapter:

CHAPTER 80

SAFE PATIENT HANDLING ACT OF 2006

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

Patient Handling Act of 2006."

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

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

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

significantly reduce other injuries to patients as well.

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

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

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

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

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

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

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

considering leaving nursing due to back pain and injuries.

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

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

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

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

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

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

23-17-59. Safe patient handling. – (1) Definitions. - As used in this chapter:

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

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

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

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

handling.

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

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

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

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

muscles, and supporting structures of the body.

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

following as a condition of licensure:

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

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

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

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

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

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

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

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

program, each licensed health care facility shall:

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

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

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

otherwise exceptional circumstances;

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

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

environment of patient care areas;

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

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

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

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

particular patients;

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

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

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

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

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

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

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

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

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

to increase the program's effectiveness; and

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

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

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

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

of a patient.

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

assigned during their shift.

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

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

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

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

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

annual performance evaluation.

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

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

is hereby amended to read as follows:

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

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

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

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

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

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

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

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

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

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

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

determine if the health maintenance organization meets the criteria.

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

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

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

affordable by the people of the state.

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

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

6(b)(6) are made.

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

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

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

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

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

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

conducting reviews and determining need:

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

state agency;

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

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

served or proposed to be served by the applicant;

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

for the equipment or services;

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

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

from feasible cooperative or shared services;

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

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

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

system of the state;

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

population area to be served by the applicant;

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

services or equipment proposed to be offered;

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

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

service or new equipment;

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

equipment proposed, to ancillary or support services;

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

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

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

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

osteopathic facilities and services within the state;

      (13) In the case of a construction project:

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

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

health services by the person proposing the construction project; and

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

renovated space to be constructed.

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

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

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

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

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

issued by the state agency;

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

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

proposal;

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

health care facility applicant.

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

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

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

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

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

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

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

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

determination of the health services council.

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

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

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

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

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

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

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

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

services or new health care equipment proposed; provided that:

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

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

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

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

so in writing.

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

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

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

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

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

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

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

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

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

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

licensing statutes.

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

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

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

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

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

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

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

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

chapter.

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

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

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

new health care equipment after disapproval by the state agency.

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

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LC01442/SUB A/2

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