SF 4444

2nd Engrossment - 93rd Legislature (2023 - 2024) Posted on 04/03/2024 11:17am

A bill for an act
relating to health; requiring continued publication of the annual adverse health
event report; prohibiting retaliation against patient care staff; providing for
enforcement; amending Minnesota Statutes 2022, sections 144.05, subdivision 7;
144.7065, subdivision 8; 144.7067, subdivision 2; Minnesota Statutes 2023
Supplement, section 177.27, subdivision 4; proposing coding for new law in
Minnesota Statutes, chapter 181.

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

Section 1.

Minnesota Statutes 2022, section 144.05, subdivision 7, is amended to read:

Subd. 7.

Expiration of report mandates.

(a) If the submission of a report by the
commissioner of health to the legislature is mandated by statute and the enabling legislation
does not include a date for the submission of a final report, the mandate to submit the report
shall expire in accordance with this section.

(b) If the mandate requires the submission of an annual report and the mandate was
enacted before January 1, 2021, the mandate shall expire on January 1, 2023. If the mandate
requires the submission of a biennial or less frequent report and the mandate was enacted
before January 1, 2021, the mandate shall expire on January 1, 2024.

(c) Any reporting mandate enacted on or after January 1, 2021, shall expire three years
after the date of enactment if the mandate requires the submission of an annual report and
shall expire five years after the date of enactment if the mandate requires the submission
of a biennial or less frequent report, unless the enacting legislation provides for a different
expiration date.

(d) The commissioner shall submit a list to the chairs and ranking minority members of
the legislative committees with jurisdiction over health by February 15 of each year,
beginning February 15, 2022, of all reports set to expire during the following calendar year
in accordance with this section. new text begin The mandate to submit a report to the legislature under this
paragraph does not expire.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from January 1, 2024.
new text end

Sec. 2.

Minnesota Statutes 2022, section 144.7065, subdivision 8, is amended to read:

Subd. 8.

Root cause analysis; corrective action plan.

new text begin (a) new text end Following the occurrence of
an adverse health care event, the facility must conduct a root cause analysis of the event.
In conducting the root cause analysis, the facility must consider as one of the factors staffing
levels and the impact of staffing levels on the event. Following the analysis, the facility
must deleted text begin : deleted text end (1) implement a corrective action plan to implement the findings of the analysis or
(2) report to the commissioner any reasons for not taking corrective action. If the root cause
analysis and the implementation of a corrective action plan are complete at the time an event
must be reported, the findings of the analysis and the corrective action plan must be included
in the report of the event. The findings of the root cause analysis and a copy of the corrective
action plan must otherwise be filed with the commissioner within 60 days of the event.

new text begin (b) During the root cause analysis, the facility must notify any individual whose conduct
may be under review no less than three days in advance of any meeting or interview with
the individual about the adverse event. The notice shall inform the individual of the subject,
purpose, date, and time of the meeting or interview.
new text end

Sec. 3.

Minnesota Statutes 2022, section 144.7067, subdivision 2, is amended to read:

Subd. 2.

Duty to analyze reports; communicate findings.

new text begin (a) new text end The commissioner shall:

(1) analyze adverse event reports, corrective action plans, and findings of the root cause
analyses to determine patterns of systemic failure in the health care system and successful
methods to correct these failures;

(2) communicate to individual facilities the commissioner's conclusions, if any, regarding
an adverse event reported by the facility;

(3) communicate with relevant health care facilities any recommendations for corrective
action resulting from the commissioner's analysis of submissions from facilities; and

(4) publish an annual report:

(i) describing, by institution, adverse events reported;

(ii) outlining, in aggregate, corrective action plans and the findings of root cause analyses;
and

(iii) making recommendations for modifications of state health care operations.

new text begin (b) Notwithstanding section 144.05, subdivision 7, the mandate to publish an annual
report under this subdivision does not expire.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from January 1, 2023.
new text end

Sec. 4.

Minnesota Statutes 2023 Supplement, section 177.27, subdivision 4, is amended
to read:

Subd. 4.

Compliance orders.

The commissioner may issue an order requiring an
employer to comply with sections 177.21 to 177.435, 179.86, 181.02, 181.03, 181.031,
181.032, 181.101, 181.11, 181.13, 181.14, 181.145, 181.15, 181.165, 181.172, paragraph
(a) or (d), 181.214 to 181.217, 181.275, subdivision 2a, new text begin 181.2751, new text end 181.635, 181.722, 181.79,
181.85 to 181.89, 181.939 to 181.943, 181.9445 to 181.9448, 181.987, 181.991, 268B.09,
subdivisions 1 to 6, and 268B.14, subdivision 3, with any rule promulgated under section
177.28, 181.213, or 181.215. The commissioner shall issue an order requiring an employer
to comply with sections 177.41 to 177.435, 181.165, or 181.987 if the violation is repeated.
For purposes of this subdivision only, a violation is repeated if at any time during the two
years that preceded the date of violation, the commissioner issued an order to the employer
for violation of sections 177.41 to 177.435, 181.165, or 181.987 and the order is final or
the commissioner and the employer have entered into a settlement agreement that required
the employer to pay back wages that were required by sections 177.41 to 177.435. The
department shall serve the order upon the employer or the employer's authorized
representative in person or by certified mail at the employer's place of business. An employer
who wishes to contest the order must file written notice of objection to the order with the
commissioner within 15 calendar days after being served with the order. A contested case
proceeding must then be held in accordance with sections 14.57 to 14.69 or 181.165. If,
within 15 calendar days after being served with the order, the employer fails to file a written
notice of objection with the commissioner, the order becomes a final order of the
commissioner. For the purposes of this subdivision, an employer includes a contractor that
has assumed a subcontractor's liability within the meaning of section 181.165.

Sec. 5.

new text begin [181.2751] ADDITIONAL PATIENT ASSIGNMENTS; RETALIATION
AGAINST PATIENT CARE STAFF PROHIBITED.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Assignment" means the designation of nursing tasks or activities to be performed
by a nurse or unlicensed assistive person.
new text end

new text begin (c) "Emergency" means a period when replacement staff are not able to report for duty
for the next shift or increased patient need, because of unusual, unpredictable, or unforeseen
circumstances such as, but not limited to, an act of terrorism, a disease outbreak, adverse
weather conditions, or natural disasters which impact continuity of patient care.
new text end

new text begin (d) "Emergency medical condition" means a condition manifesting itself by acute
symptoms of sufficient severity, including severe pain, such that the absence of immediate
medical attention could reasonably be expected to result in placing the individual's health
in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily
organs.
new text end

new text begin (e) "Facility" means:
new text end

new text begin (1) an acute care hospital licensed under sections 144.50 to 144.58; or
new text end

new text begin (2) any facility, regardless of the type of facility and regardless of the facility's license,
where patient care staff employed by the state provide patient care.
new text end

new text begin (f) "Nurse" has the meaning given in section 148.171, subdivision 9, and includes nurses
employed by the state of Minnesota.
new text end

new text begin (g) "Patient" means a patient of a facility.
new text end

new text begin (h) "Patient care staff" means a person in a nonsupervisory and nonmanagerial position
who provides direct care; who provides supportive, rehabilitative, or therapeutic services
to patients; or who directly provides nursing care to patients more than 60 percent of the
time, but who is not:
new text end

new text begin (1) a licensed physician;
new text end

new text begin (2) a physician assistant licensed under chapter 147A; or
new text end

new text begin (3) an advanced practice registered nurse licensed under sections 148.171 to 148.285,
unless working as a registered nurse.
new text end

new text begin Subd. 2. new text end

new text begin Prohibited actions. new text end

new text begin Except as provided in subdivision 5 and subject to
compliance with the process established in subdivision 3, as applicable, a facility and the
facility's agent shall not discharge, discipline, penalize, interfere with, threaten, restrain,
coerce, or otherwise retaliate or discriminate because the patient care staff:
new text end

new text begin (1) makes a request to engage in the process established in subdivision 3; or
new text end

new text begin (2) fails to accept an assignment of one or more additional patients after following the
process established in subdivision 3 because the patient care staff reasonably determines
that accepting an additional patient assignment, may create an unnecessary danger to a
patient's life, health, or safety or may otherwise constitute a ground for disciplinary action
under section 148.261.
new text end

new text begin Subd. 3. new text end

new text begin Process. new text end

new text begin (a) A patient care staff may decline to accept an additional patient
assignment if the following process is met:
new text end

new text begin (1) the patient care staff notifies the charge nurse, or their direct supervisor if a charge
nurse is unavailable, stating in writing that the patient care staff reasonably determines that
the additional patient assignment may create an unnecessary danger to a patient's life, health,
or safety or may otherwise constitute a ground for disciplinary action under section 148.261.
The notification must include:
new text end

new text begin (i) the name of the requesting patient care staff;
new text end

new text begin (ii) the date and time of the request; and
new text end

new text begin (iii) a brief explanation of why the patient care staff is requesting to decline the additional
patient assignment under the process in this subdivision; and
new text end

new text begin (2) the charge nurse or direct supervisor must evaluate the relevant factors to assess and
determine the adequacy of resources and invoke any chain of command policy to meet
patient care needs. Any chain of command policy must be available on all units in a place
that is accessible to workers and must include contact information for all individuals in the
chain of command.
new text end

new text begin (b) If the issue cannot be resolved through reallocation of resources or by other possible
measures by the charge nurse or direct supervisor and the patient care staff reasonably
determines that accepting an additional patient assignment may create an unnecessary danger
to a patient's life, health, or safety, the patient care staff may decline to accept the additional
patient assignment.
new text end

new text begin (c) If a patient care staff is unable to complete a written request due to immediate patient
care needs, the patient care staff may orally invoke the process under this subdivision by
notifying the charge nurse or direct supervisor of the request. A written request that meets
the requirements of this subdivision must be completed before leaving the work setting at
the end of the work period.
new text end

new text begin (d) A retrospective review of any process request, including an examination of the
reasonableness of the patient care staff's determination pursuant to paragraph (a) or (b), may
be initiated by the individuals involved and may be completed at the unit level or at the
hospital nurse staffing committee level.
new text end

new text begin Subd. 4. new text end

new text begin State patient care staff. new text end

new text begin Subdivision 2 applies to patient care staff employed
by the state regardless of the type of facility where the patient care staff is employed and
regardless of the facility's license, if the patient care staff is involved in patient care.
new text end

new text begin Subd. 5. new text end

new text begin Collective bargaining rights. new text end

new text begin (a) This section does not diminish or impair the
rights of a person under any collective bargaining agreement.
new text end

new text begin (b) At any point in the process provided under subdivision 3 or during any retrospective
review of a process under subdivision 3, paragraph (d), involving patient care staff covered
by a collective bargaining agreement, the patient care staff has the right to have a
representative of the labor organization present at any meeting and have reasonable time to
consult with a labor organization representative regarding the subject and purpose of the
meeting.
new text end

new text begin Subd. 6. new text end

new text begin Emergency. new text end

new text begin A patient care staff may be required to accept an additional patient
assignment in an emergency or when there is an emergency medical condition that has not
been stabilized.
new text end

new text begin Subd. 7. new text end

new text begin Enforcement. new text end

new text begin The commissioner may enforce this section by issuing a
compliance order under section 177.27, subdivision 4. The commissioner may defer
investigation and enforcement while the parties participate in alternative dispute resolution
services to resolve disputes of alleged violations of this section. The commissioner may
assess a fine of up to $5,000 for each violation of this section.
new text end

new text begin Subd. 8. new text end

new text begin Professional obligations. new text end

new text begin (a) Nothing in this section modifies a nurse's
professional obligations under sections 148.171 to 148.285.
new text end

new text begin (b) It is not a violation of the Nurse Practice Act under sections 148.171 to 148.285 or
of any duty to a patient if a nurse, in good faith, makes a request under subdivision 3,
paragraph (a), clause (1); fails to accept an assignment under subdivision 3, paragraph (a),
clause (2); or declines an assignment after following the process in subdivision 3.
new text end

new text begin (c) Nothing in this section shall be construed to allow discrimination against classes and
status protected by the Minnesota Human Rights Act, chapter 363A.
new text end