Health facilities: administrative penalties.

Senator Menjivar shapes SB 596 as a targeted reform of California’s health-facility penalties regime, centering a formal on-call exhaustion standard, the treatment of violations on separate days as distinct offenses, and a clearly tiered penalty schedule that includes a three-year reset if no further immediate-jeopardy violations occur. The measure applies to facilities licensed under the health department, including general acute care hospitals, acute psychiatric hospitals, and special hospitals, and it directs regulatory action to establish the accompanying penalty criteria and implementation guidance.

The bill introduces several key mechanisms. It defines an on-call list for the purposes of determining whether staffing deficiencies have been adequately exhausted, specifying that contacting nurses who are not scheduled to be on call or who are not part of a unit’s float pool does not count as exhausting the on-call list. It requires that violations observed on separate days be counted as separate violations for penalty purposes. It sets an escalating penalty framework for immediate-jeopardy deficiencies, with a first penalty cap at set levels, a higher cap for the second violation, and a still higher cap for the third and subsequent violations, alongside a three-year reset provision if no additional IJ findings occur and the facility remains substantially compliant. For non-immediate-jeopardy violations, penalties may be assessed up to a defined per-violation amount, with a statutory criteria set guiding factors such as patient condition, risk, harm, and a facility’s compliance history. The bill preserves a hearing process for disputes and reiterates that nothing changes a hospital’s broader staffing obligations under existing state regulations; it also allows the department to implement or interpret these provisions through All Facilities Letters or similar guidance.

Implementation and enforcement would proceed through departmental regulations to establish the detailed penalty criteria and the operational rules for applying the new framework, including the use of AFLs for guidance. The on-call exhaustion provisions create a regulatory pathway for determining when penalties may or may not be imposed, and the separate-day counting feature expands how violations are tallied within enforcement actions. The measure explicitly accounts for small and rural hospitals in its enforcement approach, signaling an intent to tailor application in those contexts while maintaining core staffing requirements. There is no explicit new appropriation, and fiscal effects would hinge on enforcement activity, the volume of violations, and the costs associated with regulatory adoption and guidance implementation.