February 28, 2007, Introduced by Reps. Wojno and Hood and referred to the Committee on Labor.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending section 21513 (MCL 333.21513), as amended by 2002 PA
125, and by adding section 21525.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 21513. The owner, operator, and governing body of a
hospital licensed under this article:
(a) Are responsible for all phases of the operation of the
hospital, selection of the medical staff, and quality of care
rendered in the hospital.
(b) Shall cooperate with the department in the enforcement of
this part, and require that the physicians, dentists, and other
personnel working in the hospital who are required to be licensed
or registered are in fact currently licensed or registered.
(c) Shall assure that physicians and dentists admitted to
practice in the hospital are granted hospital privileges consistent
with their individual training, experience, and other
qualifications.
(d) Shall assure that physicians and dentists admitted to
practice in the hospital are organized into a medical staff to
enable an effective review of the professional practices in the
hospital for the purpose of reducing morbidity and mortality and
improving the care provided in the hospital for patients. The
review shall include the quality and necessity of the care provided
and the preventability of complications and deaths occurring in the
hospital.
(e) Shall not discriminate because of race, religion, color,
national origin, age, or sex in the operation of the hospital
including employment, patient admission and care, room assignment,
and professional or nonprofessional selection and training
programs, and shall not discriminate in the selection and
appointment of individuals to the physician staff of the hospital
or its training programs on the basis of licensure or registration
or professional education as doctors of medicine, osteopathic
medicine and surgery, or podiatry.
(f) Shall assure that the hospital adheres to medical control
authority protocols according to section 20918.
(g) Shall assure that the hospital develops and maintains a
plan for biohazard detection and handling.
(h) Shall assure that the hospital develops and maintains a
staffing plan according to section 21525.
Sec. 21525. (1) The department may refuse to license a
hospital under this part if the hospital fails to develop an acuity
system that is approved by the department or to submit an annual
staffing plan as prescribed under this section. The department
shall promulgate rules prescribing the process for approving a
hospital's acuity system and staffing plan and any other rules
reasonably necessary to carry out its functions and duties under
this section.
(2) The staffing plan shall be based on reasonable projections
derived from the patient census and nursing care needs within each
hospital unit for the previous year and shall take into
consideration any foreseeable changes within the hospital unit for
the next year. The staffing plan shall include, at a minimum, the
following nurse-to-patient ratios:
(a) One nurse for each patient in an operating room or trauma
emergency unit.
(b) One nurse for every 2 patients in each critical care unit
including, but not limited to, a labor and delivery unit or a
postanesthesia unit.
(c) One nurse for every 3 patients in an antepartum, emergency
room, pediatrics, step-down, or telemetry unit.
(d) One nurse for every 4 patients in an intermediate care
nursery or a medical, surgical, or acute care psychiatric unit.
(e) One nurse for every 5 patients in a rehabilitation unit.
(f) One nurse for every 6 patients in a postpartum or well-
baby nursery unit.
(3) The department may establish minimum nurse-to-patient
ratios for any other hospital unit not included under subsection
(2).
(4) A hospital shall post in a conspicuous place readily
accessible to the public a notice that is developed and provided by
the department and that outlines the mandatory minimum nurse-to-
patient ratios required to be maintained under this section. The
notice shall include information about the confidential reporting
system established under subsection (6). Upon request, the hospital
shall provide copies of the staffing plan filed with the department
to the public.
(5) Each hospital unit shall maintain a daily log that
reflects the number of patients admitted, released, and present in
the unit, the acuity level of the patients in the unit, the number
of registered professional nurses and licensed practical nurses on
duty in the unit, and the average nurse-to-patient ratio for that
day. These records shall be retained for a period of 7 years and
shall be made available to the department and the public upon
request, provided that the information released complies with
applicable state and federal privacy laws and regulations.
(6) The department shall develop and implement a confidential
system that is available to the public for reporting a hospital's
failure to comply with its staffing plan or any other requirements
under this section. The department shall investigate each complaint
received and shall notify the complainant in writing of the results
of a review or investigation of the complaint and any action
proposed to be taken. If the department determines that a hospital
failed to maintain its staff in accordance with the staffing plan
and staffing standards established under this section, the
department may assess the hospital an administrative fine of not
more than $1,000.00 for each violation or for each day that the
violation continues.
(7) If a hospital fails to submit an annual staffing plan as
required under this section, the department shall assess the
hospital an administrative fine of up to $10,000.00 for each
violation and, if the staffing plan remains unfiled, for each day
of continued noncompliance.
(8) As used in this section:
(a) "Acuity system" means a system established to measure and
predict the hospital's nursing care needs for its patients in each
hospital unit based on the severity of the illnesses, the need for
specialized equipment and technology, the intensity of nursing
interventions required, and the complexity of the clinical judgment
needed to design, implement, and evaluate a patient care plan. It
shall include a means to address fluctuations in patient levels and
nursing care needs due to other hospital unit activity including,
but not limited to, discharges, transfers, and admissions.
(b) "Department" means the department of community health.
(c) "Hospital unit" means each patient care component within a
hospital.
(d) "Staffing plan" means a written plan that establishes the
minimum specific number of registered professional nurses and
licensed practical nurses required for each hospital unit based on
the nursing care needs of that unit to ensure sufficient nursing
staff to provide adequate protection and care for all of the
hospital's patients.