HB 1244: RELATING TO LABOR STANDARDS AT HEALTH CARE FACILITIES.

HOUSE OF REPRESENTATIVES	H.B. NO.	1244
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII

A BILL FOR AN ACT

 

 

relating to labor standards at health care FACILITIES.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  The legislature finds that the health and safety of the State's residents depend on ensuring that registered nurses are supported in providing high-quality, patient-centered care.  Adequate patient-nurse staffing ratios are critical to achieving this goal, as they directly impact patient safety, reduce nurse burnout, and promote nurse retention in the workforce.  The legislature recognizes that improving patient-to-nurse ratios leads to better patient outcomes, enhanced care quality, and a more sustainable health care system.  By establishing minimum patient-to-nurse staffing ratios and requiring hospitals to implement and adhere to enforceable staffing plans, the State can protect its health care workforce, reduce turnover, and ensure that patients receive the safe, timely care they deserve.

     Accordingly, the purpose of this Act is to:

     (1)  Establish minimum registered nurse staffing standards for hospitals;

     (2)  Require hospitals to create hospital registered nurse staffing committees and develop and implement annual registered nurse staffing plans; and

     (3)  Appropriate funds to the department of labor and industrial relations to enforce these requirements.

     SECTION 2.  The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

MINIMUM STAFFING STANDARDS FOR HEALTH CARE FACILITIES

PART I.  GENERAL PROVISIONS

     §   -1  Definitions.  As used in this chapter, unless the context otherwise requires:

     "Acuity" means the level of patient need for nursing care, as determined by a nursing assessment.

     "Charge nurse" means a direct care registered nurse who coordinates patient care responsibilities among nurses in a hospital.

     "Department" means the department of labor and industrial relations.

     "Director" means the director of labor and industrial relations.

     "Health care personnel" includes registered nurses, nurse aides, respiratory therapists, dialysis technicians, and dialysis nurses to whom minimum staffing levels apply pursuant to section    ‑11.

     "Hospital" means a hospital regulated by the department of health pursuant to section 321-11(10) and licensed pursuant to section 321-14.5.

     "Hospital registered nurse staffing committee" or "staffing committee" means the committee established by a hospital under section    ‑21.

     "Nursing and ancillary health care personnel" means a person who is providing direct care or supportive services to patients but is not a physician licensed under chapter 453; a physician assistant licensed under chapter 453; or an advanced practice registered nurse licensed under chapter 457, unless the person is working as a registered nurse who provides direct care to patients.

     "Patient care unit" means any unit or area of a hospital that provides patient care.

     "Reasonable efforts" means that the hospital exhausts and documents all of the following but is unable to obtain staffing coverage:

     (1)  Seeks individuals to volunteer to work extra time from all available qualified staff who are working;

     (2)  Contracts qualified employees who have made themselves available to work extra time;

     (3)  Seeks the use of per diem staff; and

     (4)  Seeks personnel from a contracted temporary agency:

          (A)  To the extent this staffing is permitted by law or an applicable collective bargaining agreement; and

          (B)  When the hospital regularly uses a contracted temporary agency.

     "Registered nurse" means a "nurse", as defined in section 457-2, who provides direct care to patients.

     "Skill mix" means the experience of, and number and relative percentages of, nursing and ancillary health personnel.

     "Unforeseeable emergent circumstances" means:

     (1)  Any unforeseen national, state, or county emergency; or

     (2)  When a hospital's disaster plan is activated.

     §   -2  Rules.  The department shall adopt rules pursuant to chapter 91 to effectuate the purposes of this chapter.

PART II.  MINIMUM STAFFING STANDARDS

     §   -11  Minimum registered nurse staffing standards.  (a)  A hospital shall comply with the minimum staffing standards established in this section; provided that a charge nurse shall not be included as part of the patient-to-nurse staffing ratio.

     (b)  Registered nurses shall not be assigned more patients than the following for any shift:

     (1)  For an emergency department:

          (A)  One direct care registered nurse to no more than one trauma or critical care patient;

          (B)  One direct care registered nurse to an average of no more than four patients over a twelve-hour shift; and

          (C)  One direct care registered nurse to no more than five patients at one time;

     (2)  For an intensive care unit, such as a critical care unit, special care unit, coronary care unit, pediatric intensive care, neonatal intensive care, neurological critical care unit, or burn unit:

          (A)  One registered nurse to two patients or one registered nurse to one patient, depending on the stability of the patient as assessed by the registered nurse on the unit;

     (3)  For labor and delivery:  one direct care registered nurse to no more than:

          (A)  Two patients if the patients are not in active labor or experiencing complications; and

          (B)  One patient if the patient is in active labor or in any stage of labor and is experiencing complications;

     (4)  For postpartum, antepartum, and well-baby nursery:  One registered nurse to six patients in postpartum, antepartum, and well-baby nursery; provided that the mother and the baby shall be each counted as separate patients for purposes of this paragraph;

     (5)  For an operating room:  One registered nurse to one patient;

     (6)  For oncology:  One registered nurse to four patients;

     (7)  For a post-anesthesia care unit:  One registered nurse to two patients;

     (8)  For a progressive care unit, intensive specialty care unit, or stepdown unit:  One registered nurse to three patients;

     (9)  For a medical-surgical unit:  One registered nurse to four patients;

    (10)  For a telemetry unit:  One registered nurse to three patients;

    (11)  For a psychiatric unit:  One registered nurse to four patients; provided that staffing may be adjusted during high patient acuity in scenarios including but not limited to:

          (A)  A patient who is on 1:1 observation;

          (B)  A patient who is in an acute-manic phase;

          (C)  A patient who is volatile; or

          (D)  A patient who is physically compromised;

    (12)  For pediatrics:  One registered nurse to three patients; and

    (13)  For inpatient hemodialysis:  One registered nurse to one patient.

     (c)  The personnel assignment limits established in this section:

     (1)  Are based on the type of care provided in these patient care units, regardless of the specific name or reference by the hospital for these units; and

     (2)  Represent the maximum number of patients to which a registered nurse may be assigned at any time during a shift.

     (d)  A hospital shall not average the number of patients and the total number of registered nurses assigned to patients in a patient care unit during any one shift or over any period of time in order to meet the personnel assignment limits established in this section.

     (e)  Nothing in this section precludes a hospital from assigning fewer patients to registered nurses than the limits established in this section; provided that a hospital shall not reduce the nurse aide-to-patient ratio it currently utilizes to staff its units based on the registered nurse-to-patient ratio established by this section or in any collective bargaining agreement.

     (f)  The personnel assignment limits established in this section shall not decrease any existing registered nurse-to-patient staffing levels:

     (1)  In effect pursuant to a collective bargaining agreement; or

     (2)  Established under a hospital's staffing plan, except by a majority vote of the staffing committee.

     (g)  Registered nurses shall not be assigned to a patient care unit or clinical area unless those nurses have first received orientation in that clinical area sufficient to provide competent care to patients in that area and have demonstrated current competence in providing care in that area.

     (h)  The department shall enforce compliance with this section under section    ‑28 or part IV of this chapter, as appropriate.

     §   -12  Variances.  (a)  The department may grant a variance from the minimum registered nurse staffing standards of section    ‑11 if the department determines there is good cause for doing so.

     (b)  A hospital may seek a variance from the minimum registered nurse staffing standards by submitting a written application to the department.  The application shall contain:

     (1)  A justification that establishes good cause for the variance and for not complying with minimum registered nurse staffing standards;

     (2)  The alternative minimum registered nurse staffing standards that will be imposed;

     (3)  The group of employees for whom the variance is sought;

     (4)  Evidence that infeasibility and the underlying data supporting the claim of infeasibility were discussed at least twice by the hospital's registered nurse staffing committee and a statement from the staffing committee where consensus exists or statements where there is dispute; and

     (5)  Evidence that ten working days prior to its request for a variance, the hospital provided to the involved employees and, if applicable, to their union representatives, the following:

          (A)  A copy of the written request for a variance;

          (B)  Information about the right of the involved employees and, if applicable, their union representatives, to be heard by the department during the variance application review process;

          (C)  Information about the process by which involved employees and, if applicable, their union representatives, may make a written request to the director for reconsideration, subject to the provisions established in subsection (g); and

          (D)  The department's address and phone number, or other contact information.

     (c)  The department shall allow the hospital, any involved employees and, if applicable, their union representatives, the opportunity for oral or written presentation during the variance application review process if warranted under the circumstances.

     (d)  No later than fifteen days after the date on which the department received the application for a variance, the department shall issue a written decision either granting or denying the variance.  The department may extend the fifteen-day time period by providing advance written notice to the hospital and, if applicable, the union representatives of any involved employees, setting forth a reasonable justification for an extension of the fifteen-day time period, and specifying the duration of the extension, which shall be no more than an additional fifteen days.  The hospital shall provide involved employees with notice of any extension.

     (e)  Variances shall be granted if the department determines that there is good cause for allowing a hospital to not comply with the minimum staffing standards in section    ‑11.  The variance order shall state the following:

     (1)  The alternative minimum registered nurse staffing standards approved in the variance;

     (2)  The basis for a finding of good cause;

     (3)  The group of employees impacted; and

     (4)  The period of time for which the variance will be valid, not to exceed thirty days from the date of issuance.

     (f)  Upon making a determination for issuance of a variance, the department shall provide notification in writing to the hospital and, if applicable, the union representatives of any involved employees.  If the variance is denied, the written notification shall include a stated basis for the denial.

     (g)  A hospital, involved employee, and, if applicable, their union representative, may file with the director a request for reconsideration within five days after receiving notice of the variance determination.  The request for reconsideration shall set forth the grounds upon which the request is being made.  If reasonable grounds exist, the director may grant a review and, to the extent deemed appropriate, afford all interested parties an opportunity to be heard.  If the director grants a review, the written decision of the department shall remain in place until the reconsideration process is complete, which shall be no more than ten days after the date the request for reconsideration is filed with the department.

     (h)  Unless subject to the reconsideration process, the director may revoke or terminate the variance order at any time after giving the hospital at least five days' notice before revoking or terminating the order.

     (i)  Where immediate action is necessary pending further review by the department, the department may issue a temporary variance.  The temporary variance shall remain valid until the department determines whether good cause exists for issuing a variance.  A hospital need not meet the requirement in subsection (b)(4) in order to be granted a temporary variance.  If a temporary variance is approved, the department must issue the temporary variance within the fifteen-day period set forth in subsection (d) and the temporary variance shall be part of the thirty-day variance period set forth in subsection (e)(4).  No extension for the temporary variance shall be permitted.

     (j)  If a hospital obtains a variance under this section, the hospital shall provide the involved employees with information about the minimum registered nurse staffing standards that apply within five days of receiving notification of variance approval from the department.  A hospital shall make this information readily available to all employees.

     (k)  The director may adopt rules to establish additional variance eligibility criteria.

     (l)  As used in this section, "good cause" means situations where a hospital can establish that compliance with the minimum registered nurse staffing standards is not feasible, and that granting a variance does not have a significant harmful effect on the health, safety, and welfare of the involved employees and patients.

PART III.  REGISTERED NURSE STAFFING PLANS FOR HOSPITALS

     §   -21  Hospital registered nurse staffing committee; membership.  (a)  No later than September 1, 2025, each hospital shall establish a hospital registered nurse staffing committee.

     (b)  A majority of members of a hospital registered nurse staffing committee shall be registered nurses who are nonsupervisory, nonmanagerial, and currently providing direct patient care.  The selection of the nursing personnel shall be appointed by the registered nurses' collective bargaining representative or representatives if there is one or more at the hospital.  If there is no collective bargaining representative, the members of the hospital registered nurse staffing committee shall be nursing personnel providing direct patient care and shall be selected by their peers.

     (c)  The remaining members of the staffing committee shall be determined by the hospital administration and shall include the chief financial officer, chief nursing officer, and patient care unit directors or managers, or their designees.

     (d)  A hospital registered nursing staffing committee shall have two co-chairs to be appointed as follows:

     (1)  One co-chair who is registered nurse, to be selected by the registered nurses on the staffing committee; and

     (2)  One co-chair who is not a registered nurse, to be selected by the hospital administration.

     (e)  A majority of members of the hospital registered nurse staffing committee shall constitute a quorum to do business.

     (f)  Participation in the hospital registered nurse staffing committee by a hospital employee shall be on scheduled work time and compensated at the appropriate rate of pay.  Members of the staffing committee shall be relieved of all other work duties during meetings of the committee.  Additional staffing relief shall be provided if necessary to ensure members are able to attend staffing committee meetings.

     §   -22  Registered nurse staffing plan; staffing committee responsibilities.  (a)  The primary responsibilities of the hospital registered nurse staffing committee shall include:

     (1)  Development and oversight of an annual patient care unit and shift-based staffing plan, in accordance with the minimum staffing standards established in section    ‑11 and based on the needs of patients, to be used as the primary means to ensure that the hospital is sufficiently staffed to meet the safety and health care needs for all patients and health care providers;

     (2)  Semiannual review of the staffing plan against the ability to meet the staffing standards established by section    ‑11, patient need, and known evidence-based staffing information, including the nursing sensitive quality indicators collected by the hospital; and

     (3)  Review, assessment, and response to staffing variations or complaints presented to the committee.

     (b)  The staffing committee shall use a uniform format or form, created by the department in consultation with stakeholders from hospitals and labor organizations, when submitting the annual staffing plan.  The uniform format or form shall provide space to include the factors in paragraphs (1) through (10) and allow patients and the public to clearly understand and compare staffing patterns and actual levels of staffing across facilities.  Hospitals may include a description of additional resources available to support unit-level patient care and a description of the hospital, including the size and type of facility.  Factors to be considered in the development of the staffing plan shall include:

     (1)  Census, including total numbers of patients on the unit on each shift and activity such as patient discharges, admissions, and transfers;

     (2)  Level of acuity of all patients and nature of the care to be delivered on each shift, as well as patient type;

     (3)  Skill mix;

     (4)  Level of experience and specialty certification or training of nursing personnel providing care;

     (5)  National standards, if applicable;

     (6)  Ensuring patient's access to care;

     (7)  The need for specialized or intensive equipment;

     (8)  The architecture and geography of the patient care unit, including but not limited to placement of patient rooms, treatment areas, nursing stations, medication preparation areas, and equipment;

     (9)  Availability of other non-registered nurse personnel supporting nursing services on the unit;

    (10)  Ability to comply with the terms of an applicable collective bargaining agreement, if any, and relevant state and federal laws and rules, including those regarding meals and rest breaks and use of overtime and on-call shifts; and

    (11)  Hospital finances and resources.

     (c)  The registered nurse staffing plan shall not diminish other standards contained in federal or state law and rules or the terms of an applicable collective bargaining agreement.

     (d)  The committee shall produce a written, hospital-wide registered nurse staffing plan annually.  The registered nurse staffing plan shall be adopted by a majority of members of the hospital registered nurse staffing committee.  If a quorum of members present at a meeting comprises an unequal number of registered nurse members and non-registered nurse members appointed by the hospital administration, a vote shall be taken with a majority of the registered nurse members and a minority of the non-registered nurse members voting.  If this staffing plan is not adopted by consensus of the hospital registered nurse staffing committee, the prior annual registered nurse staffing plan shall remain in effect and the hospital shall be subject to daily fines of $5,000 until the adoption of a new annual registered nurse staffing plan by consensus of the committee; provided that the following hospitals shall be subject to daily fines of $100 until the adoption of a new annual staffing plan by consensus of the committee:

     (1)  Hospitals certified by the Centers for Medicare and Medicaid Services as critical access hospitals;

     (2)  Hospitals having fewer than twenty-five acute care beds in operation; and

     (3)  Hospitals certified by the Centers for Medicare and Medicaid Services as sole community hospitals that:

          (A)  Have less than one hundred acute care licensed beds;

          (B)  Have a level III adult trauma service designation from the department of health; and

          (C)  Are owned and operated by the State.

     (e)  The chief executive officer of the hospital shall provide feedback to the hospital registered nurse staffing committee on a semiannual basis, prior to the staffing committee's semiannual review and adoption of an annual staffing plan.  The feedback shall:

     (1)  Identify those elements of the staffing plan the chief executive officer requests changes to, if any; and

     (2)  Provide a status report on the implementation of the staffing plan, including nursing sensitive quality indicators collected by the hospital, patient surveys, and recruitment and retention efforts.

     (f)  Beginning July 1, 2026, each hospital shall submit its staffing plan to the department.  Thereafter, each hospital shall submit its staffing plan to the department on an annual basis and at any time that the plan is updated.

     §   -23  Registered nurse staffing plan; implementation; complaints.  (a)  Beginning July 1, 2026, each hospital shall implement the registered nurse staffing plan and assign personnel to each patient care unit in accordance with the plan.

     (b)  A registered nurse, collective bargaining representative, patient, or other person may report to the staffing committee any variations where the registered nurse in a patient care unit is not in accordance with the adopted registered nurse staffing plan and may make a complaint to the staffing committee based on the variations.

     (c)  Shift-to-shift adjustments in staffing levels required by the staffing plan may be made by the appropriate hospital personnel overseeing patient care operations.  If a person who is covered by a registered nurse staffing plan on a patient care unit objects to a shift‑to‑shift adjustment, the person may submit the complaint to the staffing committee.

     (d)  Hospital registered nurse staffing committees shall develop a process to examine and respond to data submitted under subsections (b) and (c), including the ability to determine if a specific complaint is resolved or dismiss a complaint based on unsubstantiated data.  All complaints submitted to the hospital registered nurse staffing committee shall be reviewed, regardless of what format the complainant uses to submit the complaint.

     §   -24  Notice.  Each hospital shall post, in a public area on each patient care unit, the registered nurse staffing plan and the staffing schedule for that shift on that unit, as well as the relevant clinical staffing for that shift.  The staffing plan and current staffing levels shall also be made available to patients and visitors upon request.

     §   -25  Retaliation prohibited.  A hospital shall not discipline, take any adverse employment action, retaliate against, or engage in any form of intimidation against:

     (1)  An employee for performing any duties or responsibilities in connection with the staffing committee;

     (2)  An employee, patient, or other individual who notifies the staffing committee or the hospital administration of that person's concerns regarding nursing or ancillary health care personnel staffing; or

     (3)  A registered nurse who refuses to work overtime.

     §   -26  Critical access hospitals.  This part is not intended to create unreasonable burdens on critical access hospitals designated pursuant to title 42 United States Code section 1395i-4.  Critical access hospitals may develop flexible approaches to accomplish the requirements of this section including but not limited to having hospital registered nurse staffing committees work by video conference, telephone, or electronic mail.

     §   -27  Charter; filing requirements.  The hospital registered nurse staffing committee shall file with the department a charter that shall include:

     (1)  Roles, responsibilities, and processes by which the staffing committee functions, including processes to ensure adequate quorum and ability of committee members to attend;

     (2)  A schedule for monthly meetings, with more frequent meetings as needed, that ensures committee members have thirty days' notice of meetings;

     (3)  Processes for reviewing all staffing complaints, noting the date received as well as initial, contingent, and final disposition of complaints and a corrective action plan, where applicable;

     (4)  Processes for resolving all complaints within ninety days of receipt, or longer with a majority approval of the staffing committee, and ensuring a complainant receives a letter stating the outcome of the complaint;

     (5)  Processes for attendance by any employee, and a labor representative if requested by the employee, who is involved in a complaint;

     (6)  Processes for the staffing committee to conduct quarterly reviews of staff turnover rates, including new hire turnover rates during the first year of employment and hospital plans regarding workforce development;

     (7)  Standards for the staffing committee's approval of meeting documentation, including meeting minutes, attendance, and actions taken; and

     (8)  Policies for retention of meeting documentation for a minimum of three years; provided that the policy shall be consistent with each hospital's document retention policies.

     §   -28  Department investigations.  (a)  The department shall investigate a complaint submitted under this section for alleged violations of this part following receipt of a complaint with documented evidence of failure to:

     (1)  Form or establish a hospital registered nurse staffing committee;

     (2)  Conduct a semiannual review of a staffing plan;

     (3)  Submit a staffing plan on an annual basis and any updates; or

     (4)  Follow the personnel assignments in a patient care unit in violation of section    ‑11 or section    ‑23(a), or shift-to-shift adjustments in staffing levels in violation of section    ‑23(c).

     (b)  After an investigation conducted pursuant to subsection (a), if the department determines that there has been a violation, the department shall require the hospital to submit a corrective plan of action within thirty days of the presentation of findings from the department to the hospital.

     (c)  Hospitals shall not be found in violation of section    ‑11 or section    ‑23(a) if the department determines, following an investigation, that:

     (1)  There were unforeseeable emergent circumstances; or

     (2)  The hospital, after consultation with the hospital registered nurse staffing committee, documents that the hospital has made reasonable efforts to obtain and retain staffing to meet required personnel assignments but has been unable to do so.

     (d)  No later than thirty days after a hospital deviates from its staffing plan as adopted by the hospital registered nurse staffing committee, the hospital incident command shall report to the staffing committee an assessment of the staffing needs arising from the unforeseeable emergent circumstance and the hospital's plan to address those identified staffing needs.  Upon receipt of the report, the staffing committee shall convene to develop a contingency staffing plan to address the needs arising from the unforeseeable emergent circumstance.  The hospital's deviation from its staffing plan may not be in effect for more than ninety days without the approval of the staffing committee.

     (e)  If a hospital fails to submit, or submits but fails to follow, a corrective plan of action in response to a violation or violations found by the department based on a complaint filed pursuant to subsection (a), the department may impose, for all violations asserted against a hospital at any time, a civil penalty of $5,000 per day; provided that the fine shall be $100 per day for hospitals:

     (1)  Certified by the Centers for Medicare and Medicaid Services as critical access hospitals;

     (2)  Having fewer than twenty-five acute care beds in operation; and

     (3)  Certified by the Centers for Medicare and Medicaid Services as sole community hospitals that:

          (A)  Have less than one hundred fifty acute care licensed beds;

          (B)  Have a level III adult trauma service designation from the department of health; and

          (C)  Are owned and operated by the State.

Civil penalties shall apply until the hospital submits a corrective plan of action that has been approved by the department and follows the corrective plan of action for ninety days.  Once the approved corrective action plan has been followed by the hospital for ninety days, the department may reduce the accumulated fine.  The fine shall continue to accumulate until the ninety days has passed.

     (f)  The department shall:

     (1)  Maintain for public inspection records of any civil penalties and administrative actions imposed on hospitals under this section; and

     (2)  Report violations of this section on its website.

     (g)  Nothing in this section shall be construed to preclude the ability to otherwise submit a complaint to the department for failure to follow this chapter.

     §   -29  Review of staffing plans by the department.  (a)  The department shall review each staffing plan submitted by a hospital pursuant to section    -23(f) to ensure it is received by the appropriate deadline and is completed on the department-issued staffing plan form.

     (b)  A hospital shall complete all portions of the staffing plan form issued by the department.  The department may determine that a hospital has failed to timely submit its staffing plan if the staffing plan form is incomplete.

     (c)  Failure to submit the registered nurse staffing plan or registered nurse staffing committee charter by the appropriate deadline shall be a violation punishable by a civil penalty of $25,000 issued by the department.

     (d)  The department shall post on its website:

     (1)  Hospital registered nurse staffing plans;

     (2)  Hospital registered nurse staffing committee charters; and

     (3)  Violations of this section.

PART IV.  COMPLAINTS

     §   -31  Complaints.  (a)  If a complainant files a complaint with the department alleging a violation of this chapter, the department shall investigate the complaint; provided that nothing in this part shall prohibit the department from taking any other enforcement action authorized elsewhere in this chapter or pursuant to any other law.

     (b)  The department shall not investigate any alleged violation of rights that occurred more than sixty days before the date on which the complainant filed the complaint.

     (c)  Upon the investigation of a complaint, the department shall issue either a citation and notice of assessment or a closure letter, within ninety days after the date on which the department received the complaint, unless the complaint is otherwise resolved.  The department may extend the period by providing advance written notice to the complainant and the hospital setting forth good cause for an extension of the period and specifying the duration of the extension.

     (d)  The department shall send a citation and notice of assessment or the closure letter to both the hospital and the complainant by service of process or using a method by which the mailing can be tracked, or the delivery can be confirmed, to the hospital's and complainant's last known addresses.

     (e)  If the department's investigation finds that the complainant's allegation cannot be substantiated, the department shall issue a closure letter to the complainant and the hospital detailing that finding.

     (f)  If the department finds a violation of this chapter, the department shall order the hospital to pay the department a civil penalty.  Except as provided otherwise in this chapter, the maximum civil penalty shall be:

     (1)  $1,000 for each violation for the first three violations;

     (2)  $2,500 for a fourth violation; and

     (3)  $5,000 for each subsequent violation.

     (g)  At any time, the department may waive or reduce a civil penalty assessed under this section if the director determines that the hospital has taken corrective action to resolve the violation.

     §   -32  Appeals.  (a)  A person aggrieved by a citation and notice of assessment by the department under this chapter may appeal the citation and notice of assessment to the director by filing a notice of appeal with the director within thirty days of the department's issuance of the citation and notice of assessment.  A citation and notice of assessment not appealed within thirty days shall be final and binding, and shall not subject to further appeal.

     (b)  A notice of appeal filed with the director under this section shall stay the effectiveness of the citation and notice of assessment pending final review of the appeal by the director.

     (c)  Upon receipt of a notice of appeal, the director shall assign the hearing to a hearings officer to conduct a hearing and issue an initial order.  The hearing and review procedures shall be conducted in accordance with chapter 91.  Upon appeal, the citation and notice of assessment shall be subject to a de novo review by a hearings officer.  Any party who seeks to challenge an initial order shall file a petition for administrative review with the director within thirty days after service of the initial order.  The director shall conduct administrative review in accordance with chapter 91.

     (d)  The director shall issue all final orders after appeal of the initial order.  The final order of the director is subject to judicial review in accordance with chapter 91.

     (e)  Orders that are not appealed within the time period specified in this section and chapter 91 shall be final and binding and shall not be subject to further appeal.

     (f)  A hospital that fails to allow adequate inspection of records in an investigation by the department under this chapter within a reasonable time period shall not use those records in any appeal under this section to challenge the correctness of any determination by the department of the penalty assessed."

     SECTION 3.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 to implement and enforce section 2 of this Act.

     The sums appropriated shall be expended by the department of labor and industrial relations for the purposes of this Act.

     SECTION 4.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 5.  This Act shall take effect upon its approval; provided that section 3 shall take effect on July 1, 2025.

 

INTRODUCED BY:	_____________________________

 

 

Report Title:

DLIR; Registered Nurses; Hospitals; Staffing Requirements

 

Description:

Establishes certain minimum registered nurse-to-patient staffing requirements for hospitals.  No later than 9/1/2025, requires hospitals to create hospital registered nurse staffing committees.  Beginning 7/1/2026, requires hospitals to implement registered nurse staffing plans.  Appropriates funds.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.