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CDPH Issues Notice on Mandated Fines for Hospitals Not in Compliance With Nurse Staffing Ratios

For CNOs, licensing & certification staff, human resources executives

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The California Department of Public Health (CDPH) has issued All Facilities Letter 20-04, detailing the new administrative penalties it will enforce for general acute care hospitals that fail to comply with nurse-to-patient staffing ratios, and clarifying certain provisions of the requirements.

Senate Bill (SB) 227 (2019) became effective Jan. 1, requiring CDPH to impose penalties of $15,000 for the first violation and $30,000 for each subsequent violation of nurse staffing ratios. Under the law, multiple staffing violations found on the same inspection constitute a single violation, and any violation that happens more than three years after the last violation will be considered a first violation.

Hospitals are not subject to penalties if they can demonstrate all of the following:

  • The fluctuation in required staffing levels was unpredictable and uncontrollable.
  • Prompt efforts were made to maintain required staffing levels.
  • The hospital immediately used and subsequently exhausted the hospital’s on-call list of nurses and the charge nurse.

SB 227 authorizes CDPH to implement or clarify the bill’s requirements through an AFL. To that end, CDPH defines:

  • “Unpredictable” as: unable to know in advance
  • “Uncontrollable” as: outside the facility’s control
  • “Unpredictable and uncontrollable” as: the facility had no way to know or control the staffing shortage that occurred.