May 4--California nurses and hospitals are locked in a precedent-setting fight over injury compensation that could benefit nurses but cost hospitals hundreds of millions annually.
Proposed legislation would declare that various infectious diseases or back and neck injuries suffered by nurses stemmed from their job and are eligible for workers' compensation benefits unless hospitals can prove otherwise.
Assembly Bill 1994, pushed by the powerful California Nurses Association, piggybacks upon an exception in state law adopted years ago for peace officers and firefighters.
AB 1994, applying to more than 350,000 hospital workers, would break new ground in two ways: It would apply to private employees and target public health, rather than public safety, workers.
Opponents argue that if such exceptions are granted to nurses, other private workers in risky jobs will demand them, creating a fiscal nightmare for a stressed workers' comp system.
"This is a huge deal. This is a game-changer in terms of allowing presumptions into the private sector," said Thomas Vu of the California Chamber of Commerce, which opposes the measure.
Dozens of Capitol groups are taking sides: Supporters include the California Labor Federation and an association of workers' comp attorneys. Opponents include the California Hospital Association and California State Association of Counties.
The Assembly Appropriations Committee estimates AB 1994 could raise costs to 400 acute care hospitals -- including 22 public facilities -- by $250 million to $500 million annually.
Besides nurses, AB 1994 would apply to nurses' aides, respiratory therapists and others providing patient care at acute care hospitals -- except doctors, who are not generally employees.
"It adds to health care costs without necessarily any benefits or justification," Gail Blanchard-Saiger of the California Hospital Association said of AB 1994.
Risk, gender-equity arguments
But Assemblywoman Nancy Skinner, a Berkeley Democrat who crafted the bill, contends that nurses deserve the exception because of extraordinary daily exposure to infection and to risk of injury from lifting or moving patients.
Skinner also sees the issue as one of gender equity, saying it is unfair for the state to grant "rebuttable presumptions" to the male-dominated public safety profession but not to the female-dominated hospital profession.
Kathryn Donahue, a Humboldt County intensive care nurse, said she experienced the frustration firsthand this year. She was stricken with a job-related infection, she said, but turned down by an insurance adjuster when she sought workers' comp payment of her medical bills.
"I just feel that it's wrong, morally wrong," Donahue said of a process that can force injured nurses to expend their time and money fighting for benefits that they are entitled to under state law. She ultimately abandoned her claim.
"It's such a complicated system, you have to know how to (navigate it) -- you almost have to hire a lawyer," Donahue said. "Who can afford that?"
AB 1994 would not increase the compensation to nurses injured on the job, but opponents contend that shifting the burden of proof would result in substantially more claims confirmed for injuries or illnesses contracted outside the workplace.
Specifically, AB 1994 applies to neck or back injuries, blood-borne infectious diseases, H1N1 influenza virus, and a virulent type of antibiotic-resistant staph infection known as MRSA -- or methicillin-resistant Staphylococcus aureus.
The presumption for blood-borne infectious diseases would apply for up to 180 days after patient-care providers leave their jobs, and for a shorter period -- 90 days -- for back, neck and other covered health problems.
Similar legislation failed before
The bill is similar to one that got shelved last year by the Assembly Appropriations Committee, but since then, the Assembly has a new speaker, John A. Perez, and a new appropriations chairman, Assemblyman Felipe Fuentes, D-Los Angeles.
AB 1994, approved on a party-line vote last month by the Assembly Insurance Committee, with Republicans opposed, will be heard Wednesday by the Appropriations Committee.
Under current law, California's workers' comp insurance system pays for medical care, compensates for temporary or permanent disability, and provides death or other benefits for employees who can show that an illness or injury stemmed from their job, regardless of who was at fault.
For many years, however, peace officers and firefighters have had a "rebuttable presumption" under state law that their heart trouble, pneumonia, tuberculosis, meningitis, blood-borne infectious diseases, or various other illness or injuries stemmed from their job.
The only exception granted to non-public employees involved a small group of firefighters who worked for a private contractor due to a quirk in federal law, and the only exception for neither police nor firefighters involved public- employee lifeguards whose presumption is limited to skin cancer, according to a legislative analysis of AB 1994.
Blanchard-Saiger, of the hospital association, said AB 1994's supporters have no statistics showing that nurses are unfairly denied benefits. Forcing hospitals to prove that an impairment was not job-related would be a costly and impractical investigative burden, she said.
"How do you prove a negative?" she said.
But Bonnie Castillo, the nursing association's government relations director, said "more and more, we are seeing nurses having to fight their employer" in filing for workers' comp, which can delay benefits or needed medical care.
"We want nurses and other health-care providers to feel protected when they go to their workplace," Castillo said.
Call Jim Sanders, Bee Capitol Bureau, (916) 326-5538.
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Copyright (c) 2010, The Sacramento Bee, Calif.
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