Hospital staffing bill heads to governor’s desk

By Paul Gottlieb

Special to the Peninsula Daily News

OLYMPIA — State lawmakers approved hospital workplace legislation this week that eluded them a year ago.

Engrossed Second Substitute Senate Bill 5236 gives smaller, workforce-challenged rural medical centers like those on the North Olympic Peninsula a pass on reporting requirements for nurse staffing compliance but mandates that all hospitals provide generally uninterrupted meal breaks and limit mandatory overtime.

The new law is headed to Gov. Jay Inslee’s desk after House members approved it 92-7 Thursday and Senators 35-13 on March 6.

Democratic Reps. Mike Chapman of Port Angeles and Steve Tharinger of Port Townsend voted for the measure.

“It was highly negotiated between the [Washington State] Hospital Association and the nursing unions,” Tharinger said Friday.

“They are all in agreement. It’s come out with really strong votes in all chambers, committees and everything. It was really negotiated down to the comma, so I’m sure the governor will [sign] it.”

Chapman said Friday he voted for the bill because the opposing parties made the pact.

“It seemed to being the hospital association and the nurses together, so who am I to say they didn’t reach a good agreement?”

The three hospitals on the North Olympic Peninsula do not have to report staffing compliance.

Sen. Kevin Van De Wege of Port Angeles, the lone Democratic opponent in House and Senate, has said smaller hospitals should adhere to compliance reporting requirements for staffing plans, just like larger medical centers. Van De Wege was unavailable Thursday and Friday for comment.

Meal, rest breaks

Under 5236, all hospitals must provide meal and rest breaks except for unforeseeable emergent circumstances or because of a clinical issue that requires immediate action. The meal and rest break provision expands the definition of employee to include persons who are employed in direct patient care or clinical services, receive an hourly wage or are covered by a collective bargaining agreement. It allows employees to combine meals and rest breaks upon agreement with a supervisor.

Beginning Oct. 1, 2024, the North Olympic Peninsula’s three hospitals would have to provide quarterly reports to Labor and Industries (L&I) on total meal and rest periods missed and meal and rest periods required during the quarter. L&I would enforce the meal and rest period and reporting requirements.

If L&I determines a hospital is less than 80 percent compliant, the agency must provide technical support to bring it into line.

After July 1, 2026, a hospital the size of Olympic Medical Center could be fined $10,000, and the size of Jefferson Healthcare Medical Center and Forks Community Hospital, $5,000, for not complying with the break requirements. They also could be fined for not filing a report within 30 days of the most recent quarter.

Overtime cannot be required in cases of low staffing levels unless an employer “documents it has used reasonable efforts to obtain staffing,” according to 5236’s final report at leg.wa.gov.

“An employer has not used reasonable efforts if overtime work is used to fill vacancies resulting from chronic staff shortages; or when an employee must work overtime to complete a patient procedure,” according to the report.

The overtime restrictions also cover hospices, psychiatric hospitals, and health care facilities owned and operated by the state Department of Corrections.

Under 5236, L&I would investigate an employee complaint and issue a determination within 90 days.

The maximum penalty is $1,000 for each of up to three violations, $2,500 for the fourth violation and $5,000 for each subsequent violation.

Impact on hospitals

OMC spokesperson Bobby Beeman said the hospital — the largest employer in Clallam and Jefferson counties — will put together a policy implementing 5236 if it becomes law.

“The significant change for us is primarily the reporting piece for meals and rest breaks,” she said in an email.

Also important, Beeman said, was a mandatory overtime provision restricting prescheduled on-call time. The on-call time could not be used at the beginning of a medical procedure that would be expected to exceed the scheduled hours of work, excluding a non-emergent procedure during which a delay would cause a negative outcome to the patient.

Jefferson Healthcare spokeswoman Amy Yaley said she did not anticipate the hospital having problems fulfilling the law’s requirements.

“We are comfortable with the framework of the law and will continue to work with our staffing committee to operationalize the details,” she said in an email.

Forks Community Hospital CEO Heidi Anderson did not return calls for comment nor respond via email regarding the impacts of 5236 on hospital operations.

Legislation in 2022, aimed at relieving a nursing workforce beleaguered by patients workloads and unfilled positions during the Covid epidemic, proposed ratio by statute.

In its first iteration, 5236 tasked the state Department of Labor and Industries to set ratios.

Both proposals failed under stiff opposition from the Washington State Hospital Association (WSHA).

WSHA worked with labor groups including the Service Employees International Union to come up with the current compromise on 5236.

Hospitals are required under present law to name 50-50 staffing committees of nurses and administrative staff under the jurisdiction of the Department of Health.

The new law requires all hospitals to name staffing committees comprised of 50 percent non-managerial nursing and patient-care staff and 50 percent of members determined by the hospital administration, whose appointees must include the chief financial officer.

The staffing plan would be reviewed by the CEO, adopted annually by the committee and submitted to DOH beginning Jan. 1, 2025. It would be implemented by July 1, 2025.

Patient and nursing care must be assigned according to the plan except for “unforeseeable emergent circumstances,” defined as “any unforeseen declared national, state or municipal emergency,” according to the bill, at leg.wa.gov.

Hospitals must document when nursing and patient-care assignments are out of compliance with staffing plans. If a larger hospital is out of compliance less than 80 percent of the time in a month, it must be reported to DOH with the consent of a staffing committee co-chair.

The smaller hospitals such as those with fewer than 26 beds are exempt from the compliance reporting. Also exempt are 39 critical access hospitals such as Jefferson Healthcare and Forks Community Hospital as well as certain sole community hospitals such as OMC.

Penalties of up to $10,000 per 30 days could be imposed on the hospital for failing to submit a corrective action plan. Labor and Industries could assess a $50,000 penalty per 30 days for not following a corrective action plan.

A state Department of Health advisory committee on hospital staffing, established by Sept. 1, 2023, would revisit applying compliance reporting to smaller hospitals after July 1, 2029.

The committee would be comprised of six members selected from a list of names submitted by the Washington State Hospital Association and six from a list put together by union representatives of frontline hospital nursing staff.

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Legislative Reporter Paul Gottlieb, a former senior reporter at Peninsula Daily News, can be reached at cpaulgottlieb@gmail.com.