Photo from Kathy Rapp’s Facebook page State Rep. Kathy Rapp speaks in a Health Committee hearing last week in opposition to a bill that would mandate nurse staffing ratios in hospital.

A bill aimed at guaranteeing nursing staffing ratios in Pennsylvania’s hospitals has cleared the House Health Committee.

The Patient Safety Act – HB 106 – is similar to a provision that then-Committee Chair Kathy Rapp refused to advance during the General Assembly’s last session.

The Committee approved the bill in a party-line 12-9 vote last week with Rapp, the Republican chair of the committee, voting in opposition.

“Forcing nurse staffing mandates on our hospitals will not change the fact that we are mired in a nationwide nursing shortage,” Rapp said in a statement. “Health systems want fully staffed nursing teams, but there simply aren’t enough of them to go around. This mandate doesn’t account for this reality. In order to avoid losing their license, I fear hospitals would have no choice but to close beds or stop offering certain specialty services altogether to ensure they meet these strict nurse staffing requirements.”

The bill would set ratios depending on the acuity of patients in a given unit. It was referred to the Health Committee on April 28. It has more than 100 co-sponsors, or a majority of the members of the House.

The legislation outlines specific ratios for many types of hospital units – one nurse to one patient in the operating room, one-to-two in an ICU and one-to-four in an ER, for example. It also outlines a procedure for where hospitals can be fined for not complying with the statute. The bill was amended at committee before it was passed.

A section that required the creation of a nursing staffing committee that would be tasked with developing a staffing plan was struck. The plan is still required but the legislation now lays that responsibility on the hospital itself.

“The hospital’s primary goal in developing the staffing plan shall be to ensure that the hospital is staffed to meet the health care needs of patients,” the legislation states.

The penalty language was also amended. Initially, the first violation would be issued a warning with $7,500 fines for a second offense and $15,000 for third and subsequent violations. The amendment now sets the penalty at “not less than $2,000 per violation and does not appear to include a cap. Rapp was highly critical of that change in a video posted to her Facebook page.

“For any hospital, whether it’s a small community hospital or one that is part of a big health care system, this is unsustainable,” she said. “This money is not being allocated to specific patient programs or to help struggling hospitals pay for more nurses.”

Language was also added to the bill to give hospitals some flexibility in case of emergencies – “If an emergency causes a significant and atypical change in the number of patients on a unit, the hospital shall demonstrate that immediate and diligent efforts were made to maintain required staffing levels. The hospital must maintain such diligent efforts to meet the requirements of this chapter for the full duration of the emergency.”

The bill was recommitted to the Rules Committee after it was approved by the Health Committee.

Rapp highlighted an additional piece of legislation reported out of committee that aims to help “families navigate the financial realities of admitting a loved one to a nursing home,” according to a statement.

HB 754 would provide a notice to residents and their representatives regarding the option to have legal representation to assist with applying for Medicaid benefits.

“Unlike House Bill 106, this is the type of common sense legislation this committee should be producing,” Rapp said. “Medicaid eligibility rules are extremely complex. Every Pennsylvanian should know help is available to pay the high costs for skilled nursing home care.”