Home > 105th Congressional Bills > H.R. 746 (ih) To allow patients to receive any medical treatment they want under certain conditions, and for other purposes. ...H.R. 746 (ih) To allow patients to receive any medical treatment they want under certain conditions, and for other purposes. ...
108th CONGRESS
1st Session
H. R. 745
To amend title XVIII of the Social Security Act to provide for patient
protection by limiting the number of mandatory overtime hours a nurse
may be required to work in certain providers of services to which
payments are made under the Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 12, 2003
Mr. Stark (for himself, Mr. LaTourette, Mr. Rangel, Mr. Kleczka, Mr.
Waxman, Mr. Pallone, Ms. DeGette, Mr. Serrano, Mr. Simmons, Mr. Towns,
Mr. Weiner, Ms. Lee, Ms. Lofgren, Ms. Schakowsky, Mr. Moore, Ms.
Norton, Ms. Woolsey, Mr. Frost, Mr. Owens, Mr. Kildee, Ms. DeLauro, Mr.
Sanders, Mrs. Christensen, Mr. Grijalva, Mr. Lynch, Mr. Frank of
Massachusetts, Mr. Langevin, Mrs. Capps, Mr. Meehan, Mr. Filner, Mr.
Hinchey, Mr. Inslee, Mr. McDermott, Mr. Wexler, Mr. Nadler, Mr. Gordon,
Mr. Bishop of New York, Mr. Gutierrez, Mr. Sandlin, Ms. Kilpatrick, Mr.
Cardin, Mr. Andrews, Mr. Carson of Oklahoma, Mr. Davis of Illinois, Mr.
Kucinich, and Mr. Holt) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for patient
protection by limiting the number of mandatory overtime hours a nurse
may be required to work in certain providers of services to which
payments are made under the Medicare Program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Safe Nursing and Patient Care Act of
2003''.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) The Federal Government has a substantial interest in
assuring that delivery of health care services to patients in
health care facilities is adequate and safe.
(2) Research, including a recent study published in the
October 23-30, 2002 issue of the Journal of the American
Medical Association (JAMA), documents that higher nurse
staffing levels result in better patient outcomes, yet health
care providers report substantial difficulties in recruiting
and retaining sufficient nursing staff, as evidenced by the
approximately 500,000 licensed nurses who are not practicing
nursing.
(3) While job dissatisfaction and overtime work are
contributing to the departure of nurses from their profession,
as highlighted by a recent report of the Comptroller General of
the United States, health care providers continue to make use
of mandatory overtime as a staffing method.
(4) The widespread practice of requiring nurses to work
extended shifts and forego days off causes nurses to frequently
provide care in a state of fatigue, contributing to medical
errors and other consequences that compromise patient safety.
(5) Limitations on mandatory overtime will ensure that
health care facilities throughout the country operate in a
manner that safeguards public safety and guarantees the
delivery of quality health care services and facilitates the
retention and recruitment of nurses.
SEC. 3. LIMITATIONS ON MANDATORY OVERTIME FOR NURSES.
(a) Provider Agreements.--Section 1866 of the Social Security Act
(42 U.S.C. 1395cc) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (R), by striking ``and'' at the
end;
(B) in subparagraph (S), by striking the period and
inserting ``, and''; and
(C) by inserting after subparagraph (S), the
following:
``(T) to comply with the requirements of subsection (j)
(relating to limitations on mandatory overtime for nurses).'';
and
(2) by adding at the end the following new subsection:
``(j) Limitations on Mandatory Overtime for Nurses.--For purposes
of subsection (a)(1)(T), the requirements of this subsection are the
following:
``(1) Prohibition on mandatory overtime.--Except as
provided in this subsection, a provider of services shall not,
directly or indirectly, require a nurse to work in excess of
any of the following:
``(A) The scheduled work shift or duty period of
the nurse.
``(B) 12 hours in a 24-hour period.
``(C) 80 hours in a consecutive 14-day period.
``(2) Exceptions.--
``(A) In general.--Subject to subparagraph (B), the
requirements of paragraph (1) shall not apply to a
provider of services during a declared state of
emergency if the provider is requested, or otherwise is
expected, to provide an exceptional level of emergency
or other medical services to the community.
``(B) Limitations.--With respect to a provider of
services to which subparagraph (A) applies, a nurse may
only be required to work for periods in excess of the
periods described in paragraph (1) if--
``(i) the provider has made reasonable
efforts to fill the immediate staffing needs of
the provider through alternative means; and
``(ii) the duration of the work requirement
does not extend past the earlier of--
``(I) the date on which the
declared state of emergency ends; or
``(II) the date on which the
provider's direct role in responding to
the medical needs resulting from the
declared state of emergency ends.
``(3) Report of violations.--
``(A) Right to report.--
``(i) In general.--A nurse may file a
complaint with the Secretary against a provider
of services who violates the provisions of this
subsection.
``(ii) Procedure.--The Secretary shall
establish a procedure under which a nurse may
file a complaint under clause (i).
``(B) Investigation of complaint.--The Secretary
shall investigate complaints of violations filed by a
nurse under subparagraph (A).
``(C) Actions.--If the Secretary determines that a
provider of services has violated the provisions of
this subsection, the Secretary shall require the
provider to establish a plan of action to eliminate the
occurrence of such violation, and may seek civil money
penalties under paragraph (7).
``(4) Nurse nondiscrimination protections.--
``(A) In general.--A provider of services shall not
penalize, discriminate, or retaliate in any manner with
respect to any aspect of employment, including
discharge, promotion, compensation, or terms,
conditions, or privileges of employment against a nurse
who refuses to work mandatory overtime or who in good
faith, individually or in conjunction with another
person or persons--
``(i) reports a violation or suspected
violation of this subsection to a public
regulatory agency, a private accreditation
body, or the management personnel of the
provider of services;
``(ii) initiates, cooperates, or otherwise
participates in an investigation or proceeding
brought by a regulatory agency or private
accreditation body concerning matters covered
by this subsection; or
``(iii) informs or discusses with other
employees, with representatives of those
employees, or with representatives of
associations of health care professionals,
violations or suspected violations of this
subsection.
``(B) Retaliatory reporting.--A provider of
services may not file a complaint or a report against a
nurse with the appropriate State professional
disciplinary agency because the nurse refused to comply
with a request to work mandatory overtime.
``(C) Good faith.--For purposes of this paragraph,
a nurse is deemed to be acting in good faith if the
nurse reasonably believes--
``(i) that the information reported or
disclosed is true; and
``(ii) that a violation has occurred or may
occur.
``(5) Notice.--
``(A) Requirement to post notice.--Each provider of
services shall post conspicuously in an appropriate
location a sign (in a form specified by the Secretary)
specifying rights of nurses under this section.
``(B) Right to file complaint.--Such sign shall
include a statement that a nurse may file a complaint
with the Secretary against a provider of services who
violates the provisions of this subsection and
information with respect to the manner of filing such a
complaint.
``(6) Posting of nurse schedules.--A provider of services
shall regularly post in a conspicuous manner the nurse
schedules (for such periods of time that the Secretary
determines appropriate by type or class of provider of
services) for the department or unit involved, and shall make
available upon request to nurses assigned to the department or
unit the daily nurse schedule for such department or unit.
``(7) Civil money penalty.--
``(A) In general.--The Secretary may impose a civil
money penalty of not more than $10,000 for each knowing
violation of the provisions of this subsection
committed by a provider of services.
``(B) Patterns of violations.--Notwithstanding
subparagraph (A), the Secretary shall provide for the
imposition of more severe civil money penalties under
this paragraph for providers of services that establish
patterns of repeated violations of such provisions.
``(C) Administration of penalties.--The provisions
of section 1128A (other than subsections (a) and (b))
shall apply to a civil money penalty under this
paragraph in the same manner as such provisions apply
to a penalty or proceeding under section 1128A(a).
The Secretary shall publish on the Internet site of the
Department of Health and Human Services the names of providers
of services against which civil money penalties have been
imposed under this paragraph, the violation for which the
penalty was imposed, and such additional information as the
Secretary determines appropriate. With respect to a provider of
services that has had a change in ownership, as determined by
the Secretary, penalties imposed on the provider of services
while under previous ownership shall no longer be published by
the Secretary on such Internet site after the 1-year period
beginning on the date of change in ownership.
``(8) Rule of construction.--Nothing in this subsection
shall be construed as precluding a nurse from voluntarily
working more than any of the periods of time described in
paragraph (1) so long as such work is done consistent with
professional standards of safe patient care.
``(9) Definitions.--In this subsection:
``(A) Mandatory overtime.--The term `mandatory
overtime' means hours worked in excess of the periods
of time described in paragraph (1), except as provided
in paragraph (2), pursuant to any request made by a
provider of services to a nurse which, if refused or
declined by the nurse involved, may result in an
adverse employment consequence to the nurse, including
discharge, discipline, loss of promotion, or
retaliatory reporting of the nurse to the State
professional disciplinary agency involved.
``(B) Overtime.--The term `overtime' means time
worked in excess of the periods of time described in
paragraph (1).
``(C) Nurse.--The term `nurse' means a registered
nurse or a licensed practical nurse.
``(D) Provider of services.--The term `provider of
services' means--
``(i) a hospital,
``(ii) a hospital outpatient department,
``(iii) a critical access hospital,
``(iv) an ambulatory surgical center,
``(v) a home health agency,
``(vi) a rehabilitation agency,
``(vii) a clinic, including a rural health
clinic, or
``(viii) a Federally qualified health
center.
``(E) Declared state of emergency.--The term
`declared state of emergency' means an officially
designated state of emergency that has been declared by
the Federal Government or the head of the appropriate
State or local governmental agency having authority to
declare that the State, county, municipality, or
locality is in a state of emergency, but does not
include a state of emergency that results from a labor
dispute in the health care industry or consistent
understaffing.
``(F) Standards of safe patient care.--The term
`standards of safe patient care' means the recognized
professional standards governing the profession of the
nurse involved.''.
(b) Effective Date.--The amendments made by this section shall take
effect 1 year after the date of enactment of this Act.
SEC. 4. REPORTS.
(a) Standards on Safe Working Hours for Nurses.--
(1) Study.--The Secretary of Health and Human Services,
acting through the Director of the Agency for Healthcare
Research and Quality, shall conduct a study to establish
appropriate standards for the maximum number of hours that a
nurse, who furnishes health care to patients, may work without
compromising the safety of such patients. Such standards may
vary by provider of service and by department within a provider
of services, by duties or functions carried out by nurses, by
shift, and by other factors that the Director determines
appropriate. The Director may contract with an eligible entity
or organization to carry out the study under this paragraph.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Secretary shall submit to Congress a
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