S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  6571

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             April 10, 2013
                               ___________

Introduced  by  M.  of  A.  GOTTFRIED,  GUNTHER, MILLMAN, CLARK, JACOBS,
  PEOPLES-STOKES,  ROSENTHAL,  BRINDISI,  BRONSON,  COLTON,   BENEDETTO,
  CAMARA, GABRYSZAK, JAFFEE, MAGNARELLI, MARKEY, MILLER, WEPRIN, RIVERA,
  ROBERTS,  RYAN,  SKARTADOS  --  Multi-Sponsored by -- M. of A. ABBATE,
  ABINANTI, ARROYO,  BARRON,  BOYLAND,  BRENNAN,  BROOK-KRASNY,  BUTLER,
  CAHILL,  COOK,  CRESPO,  CUSICK,  CYMBROWITZ,  DINOWITZ,  ENGLEBRIGHT,
  FARRELL, GIGLIO, GLICK, GRAF, HEASTIE, HOOPER, JOHNS, KEARNS, KELLNER,
  LAVINE, LIFTON, LUPARDO, MAGEE, MAISEL, McDONOUGH, McKEVITT,  MONTESA-
  NO,  NOLAN,  ORTIZ,  PAULIN, PERRY, PRETLOW, RA, RABBITT, RAIA, RAMOS,
  ROBINSON, RUSSELL, SALADINO, SCARBOROUGH, SCHIMEL,  SWEENEY,  TEDISCO,
  THIELE,  TITONE, TITUS, WEINSTEIN, WEISENBERG, WRIGHT -- read once and
  referred to the Committee on Health

AN ACT to amend the public health law, in relation to enacting the "safe
  staffing for quality care act"

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Short  title. This act shall be known and may be cited as
the "safe staffing for quality care act".
  S 2. Paragraphs (a) and (b) of subdivision 2 of section  2805  of  the
public  health  law, paragraph (a) as amended by chapter 923 of the laws
of 1973 and paragraph (b) as added by chapter 795 of the laws  of  1965,
are amended to read as follows:
  (a)  Application  for an operating certificate for a hospital shall be
made upon forms prescribed by  the  department.  The  application  shall
[contain]  INCLUDE the name of the hospital, the kind or kinds of hospi-
tal service to be provided, the location and physical description of the
institution,  A  DOCUMENTED  STAFFING  PLAN,  AS  DEFINED   IN   SECTION
TWENTY-EIGHT  HUNDRED TWENTY-FOUR OF THIS ARTICLE, and such other infor-
mation as the department may require.
  (b) An operating certificate shall not be  issued  by  the  department
unless  it  finds  that  the  premises, equipment, personnel, DOCUMENTED

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02578-04-3
              

A. 6571                             2

STAFFING PLAN, rules and by-laws, standards of medical care, and  hospi-
tal  service are fit and adequate and that the hospital will be operated
in the manner required by this article and rules and regulations  there-
under.
  S  3.  The  public  health  law is amended by adding nine new sections
2823-a, 2824, 2825, 2826, 2827, 2828, 2829, 2830 and  2831  to  read  as
follows:
  S  2823-A.  POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL
OF THE FOLLOWING:
  1. HEALTH CARE SERVICES ARE BECOMING COMPLEX AND  IT  IS  INCREASINGLY
DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES;
  2.  THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE STAFF-
ING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES;
  3. TO ENSURE THE  ADEQUATE  PROTECTION  OF  PATIENTS  IN  HEALTH  CARE
SETTINGS,  IT  IS  ESSENTIAL  THAT QUALIFIED REGISTERED NURSES AND OTHER
LICENSED NURSES BE  ACCESSIBLE  AND  AVAILABLE  TO  MEET  THE  NEEDS  OF
PATIENTS; AND
  4.  THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING SHOULD
BE BASED ON  THE  PATIENT'S  CARE  NEEDS,  THE  SEVERITY  OF  CONDITION,
SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES.
  S  2824.  SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS AND PHRASES,
AS USED IN THIS ARTICLE, SHALL HAVE THE FOLLOWING  MEANINGS  UNLESS  THE
CONTEXT OTHERWISE PLAINLY REQUIRES:
  1.  "ACUTE  CARE FACILITY" SHALL MEAN A HOSPITAL OTHER THAN A RESIDEN-
TIAL HEALTH CARE FACILITY AND  SHALL  ALSO  INCLUDE  ANY  FACILITY  THAT
PROVIDES  HEALTH CARE SERVICES PURSUANT TO THE MENTAL HYGIENE LAW, ARTI-
CLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION LAW IF SUCH FACIL-
ITY IS OPERATED BY THE STATE OR A POLITICAL SUBDIVISION OF THE STATE  OR
A PUBLIC AUTHORITY OR PUBLIC BENEFIT CORPORATION.
  2.  "ACUITY  SYSTEM"  SHALL MEAN AN ESTABLISHED MEASUREMENT INSTRUMENT
WHICH (A) PREDICTS NURSING CARE  REQUIREMENTS  FOR  INDIVIDUAL  PATIENTS
BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND
TECHNOLOGY,   INTENSITY  OF  NURSING  INTERVENTIONS  REQUIRED,  AND  THE
COMPLEXITY OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT  AND
EVALUATE  THE  PATIENT'S  NURSING  CARE  PLAN; (B) DETAILS THE AMOUNT OF
NURSING CARE NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND  IN  SKILL
MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN
A  NURSING  DEPARTMENT  OR UNIT; AND (C) IS STATED IN TERMS THAT READILY
CAN BE USED AND UNDERSTOOD BY  DIRECT-CARE  NURSES.  THE  ACUITY  SYSTEM
SHALL  TAKE  INTO  CONSIDERATION  THE PATIENT CARE SERVICES PROVIDED NOT
ONLY BY REGISTERED PROFESSIONAL NURSES BUT ALSO  BY  LICENSED  PRACTICAL
NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL.
  3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE
STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT
NURSING  CARE  REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF AN ACUITY
SYSTEM.
  4. "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN  ANY
NURSE  WHO  HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY OUT MEDICAL
REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS.
  5. "DOCUMENTED STAFFING PLAN"  SHALL  MEAN  A  DETAILED  WRITTEN  PLAN
SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURS-
ES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN AN ACUTE CARE FACILITY
FOR  A  GIVEN  YEAR,  BASED  ON  REASONABLE PROJECTIONS DERIVED FROM THE
PATIENT CENSUS AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT  OR  UNIT
DURING  THE  PRIOR  YEAR, THE DEPARTMENT OR UNIT SIZE AND GEOGRAPHY, THE

A. 6571                             3

NATURE OF SERVICES PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR
UNIT SIZE OR FUNCTION DURING THE CURRENT YEAR.
  6.  "NURSE"  SHALL  MEAN  A  REGISTERED PROFESSIONAL NURSE OR LICENSED
PRACTICAL NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE  OF
THE EDUCATION LAW.
  7.  "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE DEFINITION
OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF
THE EDUCATION LAW, OR OTHERWISE ENCOMPASSED WITH THE  RECOGNIZED  STAND-
ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN-
NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY.
  8.  "SAFE STAFFING REQUIREMENTS" SHALL MEAN THE PROVISIONS OF SECTIONS
TWENTY-EIGHT HUNDRED TWENTY-THREE-A THROUGH TWENTY-EIGHT  HUNDRED  THIR-
TY-ONE  OF  THIS  ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSUANT
THERETO.
  9. "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY  AND
EXPERIENCE AMONG DIRECT-CARE NURSES.
  10.  "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO PATIENT
RATIO WITHIN A NURSING DEPARTMENT OR UNIT.
  11. "UNIT" SHALL MEAN A PATIENT CARE  COMPONENT,  AS  DEFINED  BY  THE
DEPARTMENT, WITHIN AN ACUTE CARE FACILITY.
  12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT
A  NURSE  OR  OTHER PERSON LICENSED, CERTIFIED OR REGISTERED UNDER TITLE
EIGHT OF THE EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY  IS  TO  CARRY
OUT  PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT ASSISTANCE
IN THE DELIVERY OF PATIENT CARE.
  S 2825. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE  COMMISSIONER
SHALL:
  1.  APPOINT  AN  ACUTE  CARE  FACILITY  COUNCIL CONSISTING OF THIRTEEN
MEMBERS. NO LESS THAN SEVEN MEMBERS  SHALL  BE  REGISTERED  PROFESSIONAL
NURSES,  THREE  OF WHOM SHALL BE DIRECT CARE REGISTERED NURSES, THREE OF
WHOM SHALL BE NURSE MANAGERS AND ONE OF WHOM SHALL BE A  NURSE  ADMINIS-
TRATOR.  NO  LESS  THAN  TWO  MEMBERS OF THE ACUTE CARE FACILITY COUNCIL
SHALL BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE  BARGAIN-
ING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO
REPRESENTATIVES  OF ACUTE CARE FACILITIES, ONE REPRESENTATIVE OF A NURS-
ING PROFESSIONAL ASSOCIATION, AND ONE REPRESENTATIVE OF A RECOGNIZED  OR
CERTIFIED  BARGAINING  AGENT  OF NURSES. THE ACUTE CARE FACILITY COUNCIL
SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS, INCLUD-
ING REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING  REQUIREMENTS  AND
NON-NURSING  DIRECT-CARE  STAFF TO PATIENT RATIOS THAT ARE NOT SPECIFIED
IN THIS ARTICLE; THE EFFICACY OF ACUITY SYSTEMS SUBMITTED  FOR  APPROVAL
BY THE COMMISSIONER; THE DEVELOPMENT OF AN ASSESSMENT TOOL USED TO EVAL-
UATE THE EFFICACY OF ACUITY SYSTEMS; AND REVIEW AND MAKE RECOMMENDATIONS
ON  APPROVAL  OF  STAFFING  PLANS  PRIOR TO THE GRANTING OF AN OPERATING
CERTIFICATE BY THE DEPARTMENT.
  2. PROMULGATE, AFTER CONSULTATION WITH THE ACUTE CARE  FACILITY  COUN-
CIL,  THE  RULES AND REGULATIONS NECESSARY TO CARRY OUT THE PURPOSES AND
PROVISIONS OF THE  SAFE  STAFFING  REQUIREMENTS,  INCLUDING  REGULATIONS
DEFINING  TERMS,  SETTING  FORTH  DIRECT-CARE  NURSE  TO PATIENT RATIOS,
SETTING FORTH  NON-NURSING  DIRECT-CARE  STAFF  TO  PATIENT  RATIOS  AND
PRESCRIBING  THE PROCESS FOR APPROVING FACILITY SPECIFIC ACUITY SYSTEMS;
AND
  3. ASSURE THAT  THE  PROVISIONS  OF  SAFE  STAFFING  REQUIREMENTS  ARE
ENFORCED,  INCLUDING  THE  ISSUANCE  OF  REGULATIONS  WHICH AT A MINIMUM
PROVIDE FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE  FAILURE
TO  COMPLY  WITH  SUCH  REQUIREMENTS  AND  PUBLIC  ACCESS TO INFORMATION

A. 6571                             4

REGARDING REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND  CORRECTIONS
PURSUANT TO SUCH REQUIREMENTS.
  S  2826.  STAFFING  REQUIREMENTS. 1. STAFFING REQUIREMENTS. EACH ACUTE
CARE FACILITY SHALL ENSURE THAT IT IS STAFFED IN A MANNER THAT  PROVIDES
SUFFICIENT,  APPROPRIATELY  QUALIFIED DIRECT-CARE NURSES IN EACH DEPART-
MENT OR UNIT WITHIN SUCH FACILITY IN ORDER TO  MEET  THE  INDIVIDUALIZED
CARE  NEEDS  OF  THE  PATIENTS THEREIN. AT A MINIMUM, EACH SUCH FACILITY
SHALL MEET THE REQUIREMENTS  OF  SUBDIVISIONS  TWO  AND  THREE  OF  THIS
SECTION.
  2.  STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING CERTIF-
ICATE TO ANY ACUTE CARE FACILITY UNLESS SUCH FACILITY  ANNUALLY  SUBMITS
TO THE DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN CERTIFICATION
THAT  THE  SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE ADEQUATE AND
APPROPRIATE DELIVERY OF HEALTH CARE SERVICES TO PATIENTS FOR THE ENSUING
YEAR. THE DOCUMENTED STAFFING PLAN SHALL:
  (A) MEET THE MINIMUM REQUIREMENTS SET FORTH IN  SUBDIVISION  THREE  OF
THIS SECTION;
  (B)  BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY OTHER
LAWS, RULES OR REGULATIONS;
  (C) EMPLOY AND IDENTIFY AN ACUITY SYSTEM FOR  ADDRESSING  FLUCTUATIONS
IN  ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS REQUIRING
INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE PLAN;
  (D) FACTOR IN OTHER UNIT OR DEPARTMENT ACTIVITY  SUCH  AS  DISCHARGES,
TRANSFERS  AND  ADMISSIONS,  STAFF  BREAKS,  MEALS, ROUTINE AND EXPECTED
ABSENCES FROM THE UNIT AND ADMINISTRATIVE AND  SUPPORT  TASKS  THAT  ARE
EXPECTED  TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT NURSING
CARE;
  (E) INCLUDE A PLAN TO MEET  NECESSARY  STAFFING  LEVELS  AND  SERVICES
PROVIDED  BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE NEEDS
PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE
STAFFING PLAN SHALL NOT INCORPORATE OR ASSUME THAT  NURSING  CARE  FUNC-
TIONS  REQUIRED  BY LAWS, RULES OR REGULATIONS, OR ACCEPTED STANDARDS OF
PRACTICE TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE  ARE  TO  BE
PERFORMED BY OTHER PERSONNEL;
  (F)  IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL STAFFING
ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT;
  (G) INCLUDE A WRITTEN ASSESSMENT OF THE ACCURACY OF THE  PRIOR  YEAR'S
STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS;
  (H)  IDENTIFY  EACH NURSE STAFF CLASSIFICATION REFERENCED IN SUCH PLAN
TOGETHER WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR  EACH
SUCH CLASSIFICATION; AND
  (I)  BE  DEVELOPED  IN CONSULTATION WITH A MAJORITY OF THE DIRECT-CARE
NURSES WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE  REPRES-
ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING
REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER
SUPPORTIVE AND ASSISTIVE STAFF.
  3.  MINIMUM  STAFFING  REQUIREMENTS.  (A) THE DOCUMENTED STAFFING PLAN
SHALL INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE  NURSE-TO-PA-
TIENT RATIOS:
  (I)  ONE  NURSE  TO  ONE  PATIENT: OPERATING ROOM AND TRAUMA EMERGENCY
UNITS AND MATERNAL/CHILD CARE UNITS FOR THE SECOND  OR  THIRD  STAGE  OF
LABOR;
  (II)  ONE  NURSE  TO TWO PATIENTS:   MATERNAL/CHILD CARE UNITS FOR THE
FIRST STAGE OF LABOR, AND ALL CRITICAL CARE  AREAS  INCLUDING  EMERGENCY
CRITICAL CARE AND ALL INTENSIVE CARE UNITS AND POSTANESTHESIA UNITS;

A. 6571                             5

  (III)  ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA-
TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME-
DIATE CARE NURSERY UNITS;
  (IV)  ONE  NURSE  TO THREE PATIENTS:   POSTPARTUM MOTHER/BABY COUPLETS
(MAXIMUM SIX PATIENTS PER NURSE);
  (V) ONE NURSE TO  FOUR  PATIENTS:  NON-CRITICAL  ANTEPARTUM  PATIENTS,
POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHI-
ATRIC UNITS;
  (VI)  ONE  NURSE  TO  FIVE PATIENTS: REHABILITATION UNITS AND SUBACUTE
PATIENTS; AND
  (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS.
  FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED
TO, PSYCHIATRIC UNITS, AND ACUTE CARE FACILITIES  OPERATED  PURSUANT  TO
THE  MENTAL  HYGIENE  LAW  OR  THE  CORRECTION LAW, THE DEPARTMENT SHALL
ESTABLISH BY REGULATION  THE  APPROPRIATE  DIRECT-CARE  NURSE-TO-PATIENT
RATIO.
  (B)  THE  NURSE-TO-PATIENT  RATIOS  SET FORTH IN PARAGRAPH (A) OF THIS
SUBDIVISION SHALL REFLECT THE MAXIMUM NUMBER OF  PATIENTS  THAT  MAY  BE
ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT AT ANY ONE TIME.
  (C)  THERE  SHALL  BE  NO  AVERAGING OF THE NUMBER OF PATIENTS AND THE
TOTAL NUMBER OF NURSES ON THE UNIT DURING ANY ONE  SHIFT  NOR  OVER  ANY
PERIOD OF TIME.
  (D)  THE  COMMISSIONER,  IN  CONSULTATION WITH THE ACUTE CARE FACILITY
COUNCIL, SHALL ESTABLISH REGULATIONS PROVIDING FOR  THE  MAINTENANCE  OF
MINIMUM NURSE-TO-PATIENT RATIOS, AS SET FORTH IN THIS SECTION, INCLUDING
DURING  ROUTINE  OR  EXPECTED  ABSENCES  FROM THE UNIT, SUCH AS MEALS OR
BREAKS.
  4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC-
TICAL NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY  PATIENTS
ASSIGNED  TO  THE  LICENSED  PRACTICAL  NURSE  SHALL ALSO BE INCLUDED IN
CALCULATING THE NUMBER OF PATIENTS ASSIGNED TO  ANY  REGISTERED  PROFES-
SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC-
TICE  TO  SUPERVISE  OR  OVERSEE THE DIRECT-NURSING CARE PROVIDED BY THE
LICENSED PRACTICAL NURSE.
  5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURS-
ING CARE FUNCTIONS REQUIRED BY SECTION SIXTY-NINE  HUNDRED  TWO  OF  THE
EDUCATION  LAW  OR  ACCEPTED  STANDARDS OF PRACTICE TO BE PERFORMED BY A
REGISTERED PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED  PRACTI-
CAL  NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE FUNC-
TIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR
ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A  LICENSED  PRACTICAL
NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL.
  6.  ADJUSTMENTS  BY  FACILITY.    THE MINIMUM STAFFING REQUIREMENT AND
NURSE-TO-PATIENT RATIO SET FORTH IN THIS SECTION SHALL  BE  ADJUSTED  BY
THE  ACUTE CARE FACILITY AS NECESSARY TO REFLECT THE NEED FOR ADDITIONAL
DIRECT-CARE NURSES.  ADDITIONAL STAFF SHALL BE  ASSIGNED  IN  ACCORDANCE
WITH THE APPROVED, FACILITY-SPECIFIC PATIENT ACUITY SYSTEM FOR DETERMIN-
ING  NURSING  CARE  REQUIREMENTS, INCLUDING THE SEVERITY OF THE ILLNESS,
THE NEED FOR SPECIALIZED EQUIPMENT AND  TECHNOLOGY,  THE  COMPLEXITY  OF
CLINICAL  JUDGMENT  NEEDED TO DESIGN, IMPLEMENT AND EVALUATE THE PATIENT
CARE PLAN AND THE ABILITY  FOR  SELF-CARE,  AND  THE  LICENSURE  OF  THE
PERSONNEL REQUIRED FOR CARE.
  7.  COMMISSIONER  REGULATIONS.    THE  COMMISSIONER  MAY BY REGULATION
REQUIRE A DOCUMENTED  STAFFING  PLAN  TO  HAVE  HIGHER  NURSE-TO-PATIENT
RATIOS THAN THOSE SET FORTH IN THIS SECTION.

A. 6571                             6

  8.   NOTHING CONTAINED IN THIS SECTION SHALL SUPERSEDE OR DIMINISH THE
TERMS OF A COLLECTIVE BARGAINING AGREEMENT THAT  PROVIDES  FOR  STAFFING
RATIOS THAT EXCEED THE RATIOS ESTABLISHED UNDER THIS SECTION.
  S  2827.  COMPLIANCE  WITH  STAFFING PLAN AND RECORDKEEPING. 1.   EACH
ACUTE CARE FACILITY SHALL AT ALL TIMES  STAFF  IN  ACCORDANCE  WITH  ITS
DOCUMENTED STAFFING PLAN AND THE STAFFING STANDARDS SET FORTH IN SECTION
TWENTY-EIGHT HUNDRED TWENTY-SIX OF THIS ARTICLE; PROVIDED, HOWEVER, THAT
NOTHING  IN  THIS  SECTION SHALL BE DEEMED TO PRECLUDE ANY SUCH FACILITY
FROM IMPLEMENTING HIGHER DIRECT-CARE NURSE-TO-PATIENT  STAFFING  LEVELS,
NOR  SHALL  THE  REQUIREMENTS  SET  FORTH  IN  SUCH SECTION TWENTY-EIGHT
HUNDRED TWENTY-SIX OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY
HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, REGULATION OR CONTRACT.
  2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM  STAFFING  REQUIREMENTS
STANDARDS  SET  FORTH IN SECTION TWENTY-EIGHT HUNDRED TWENTY-SIX OF THIS
ARTICLE, NO NURSE SHALL BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT
RATIO COUNT IN A NURSING UNIT OR A CLINICAL AREA WITHIN  AN  ACUTE  CARE
FACILITY  UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTI-
CLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION  LAW,  HAS  RECEIVED  PRIOR
ORIENTATION  IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURS-
ING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND  HAS  DEMON-
STRATED  CURRENT  COMPETENCE  IN PROVIDING CARE IN THAT UNIT OR CLINICAL
AREA. ACUTE CARE FACILITIES  THAT  UTILIZE  TEMPORARY  NURSING  AGENCIES
SHALL  HAVE  AND  ADHERE  TO  A WRITTEN PROCEDURE TO ORIENT AND EVALUATE
PERSONNEL FROM SUCH SOURCES TO ENSURE ADEQUATE ORIENTATION AND COMPETEN-
CY PRIOR TO INCLUSION IN THE NURSE-TO-PATIENT RATIO.  IN THE EVENT OF AN
EMERGENCY STAFFING SITUATION IN WHICH INSUFFICIENT STAFFING MAY LEAD  TO
UNSAFE  PATIENT  CARE, NURSES MAY BE TEMPORARILY ASSIGNED TO A DIFFERENT
UNIT OR CLINICAL AREA, PROVIDED  THAT  SUCH  NURSES  SHALL  BE  ASSIGNED
PATIENTS  APPROPRIATE  TO THEIR SKILL AND COMPETENCY LEVEL. THE FACILITY
SHALL ESTABLISH A CONSISTENT  PLAN  FOR  ADDRESSING  EMERGENCY  STAFFING
SITUATIONS  AND  MONITOR  OUTCOMES.   EMERGENCIES ARE DEFINED AS NATURAL
DISASTERS, DECLARED EMERGENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS
NOT REASONABLY ANTICIPATED AND PLANNED FOR AND NOT  REGULARLY  OCCURRING
WITHIN THE FACILITY.
  3.  EACH  ACUTE  CARE  FACILITY  SHALL MAINTAIN ACCURATE DAILY RECORDS
SHOWING:
  (A) THE NUMBER OF PATIENTS ADMITTED,  RELEASED  AND  PRESENT  IN  EACH
NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY;
  (B)  THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH NURS-
ING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; AND
  (C) THE IDENTITY AND DUTY HOURS OF  EACH  DIRECT-CARE  NURSE  IN  EACH
NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY.
  4.  EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURS-
ING DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY,  INFECTION,  ACCIDENT,
INJURY AND MEDICAL ERRORS.
  5.  ALL  RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE
MAINTAINED FOR A PERIOD OF SEVEN YEARS.
  6. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION  SHALL  BE
MADE  AVAILABLE  UPON  REQUEST  TO  THE  DEPARTMENT  AND  TO THE PUBLIC;
PROVIDED, HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL  COMPLY
WITH  THE  APPLICABLE  PATIENT  PRIVACY LAWS, RULES AND REGULATIONS, AND
THAT IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE  IDENTITY
AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC.
  S  2828. WORK ASSIGNMENT POLICY. 1. GENERAL.  EACH ACUTE CARE FACILITY
SHALL ADOPT, DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN
WORK ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS  TWO

A. 6571                             7

AND  THREE  OF  THIS  SECTION, DETAILING THE CIRCUMSTANCES UNDER WHICH A
DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT.
  2.  MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT:
  (A) FOR WHICH THE NURSE IS NOT  PREPARED  BY  EDUCATION,  TRAINING  OR
EXPERIENCE  TO  SAFELY  FULFILL  THE  ASSIGNMENT WITHOUT COMPROMISING OR
JEOPARDIZING PATIENT SAFETY, THE NURSE'S  ABILITY  TO  MEET  FORESEEABLE
PATIENT NEEDS OR THE NURSE'S LICENSE; OR
  (B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS.
  3.  MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
CONTAIN PROCEDURES FOR THE FOLLOWING:
  (A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR
REGARDING THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING  RELIEVED
OF AN ASSIGNMENT OR CONTINUED DUTY;
  (B)  WHERE  FEASIBLE,  AN OPPORTUNITY FOR THE SUPERVISOR TO REVIEW THE
SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH-
ER TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT,  OR
TO  DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR CONTIN-
UED DUTY;
  (C) A PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT  TO  REFUSE
THE  ASSIGNMENT  OR  CONTINUED ON-DUTY STATUS WHEN THE SUPERVISOR DENIES
THE REQUEST TO BE RELIEVED IF:
  (I) THE SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A  REMEDY  OR
THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY,
  (II)  THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY AGENCY
WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND
  (III) THE EMPLOYEE IN GOOD FAITH BELIEVES THAT  THE  ASSIGNMENT  MEETS
CONDITIONS JUSTIFYING REFUSAL; AND
  (D)  RECOGNITION  THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT TO A
WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED,
BY REASON THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR  INCOMPETENT  ACTION,
PATIENT  ABANDONMENT,  OR OTHERWISE TO HAVE VIOLATED ANY LAW RELATING TO
NURSING.
  S 2829. PUBLIC DISCLOSURE OF STAFFING REQUIREMENTS. EVERY  ACUTE  CARE
FACILITY SHALL:
  1.  POST  IN  A  CONSPICUOUS  PLACE  READILY ACCESSIBLE TO THE GENERAL
PUBLIC A NOTICE PREPARED BY THE DEPARTMENT SETTING FORTH  A  SUMMARY  OF
THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT FACILITY TOGETHER WITH
INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE FACILITY'S STAFF-
ING PLAN AND ACTUAL STAFFING MAY BE OBTAINED;
  2.  UPON  REQUEST,  MAKE  COPIES OF THE DOCUMENTED STAFFING PLAN FILED
WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND
  3. UPON REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF  WITHIN  A
DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION:
  (A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT,
  (B)  DOCUMENTATION  OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED TO BE
PRESENT DURING THE SHIFT, BASED ON THE APPROVED ADOPTED  ACUITY  SYSTEM,
AND
  (C)  DOCUMENTATION  OF THE ACTUAL NUMBER OF DIRECT-CARE NURSES PRESENT
DURING THE SHIFT.
  S 2830. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL  NOT  DELE-
GATE  ITS  RESPONSIBILITIES  TO  ENFORCE  THE SAFE STAFFING REQUIREMENTS
PROMULGATED PURSUANT TO THIS ARTICLE.
  S 2831. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT
HUNDRED TWENTY-EIGHT OF THIS ARTICLE.   ANY  ACUTE  CARE  FACILITY  THAT
VIOLATES  THE  RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGN-

A. 6571                             8

MENT POLICY UNDER SECTION  TWENTY-EIGHT  HUNDRED  TWENTY-EIGHT  OF  THIS
ARTICLE  MAY  BE  HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A
COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR  EQUITABLE  RELIEF  AS
MAY  BE  APPROPRIATE  TO  EFFECTUATE  THE  PURPOSES OF THE SAFE STAFFING
REQUIREMENTS, INCLUDING BUT NOT  LIMITED  TO  REINSTATEMENT,  PROMOTION,
LOST  WAGES  AND  BENEFITS,  AND  COMPENSATORY AND CONSEQUENTIAL DAMAGES
RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED
DAMAGES. THE COURT IN SUCH ACTION SHALL, IN  ADDITION  TO  ANY  JUDGMENT
AWARDED  TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND
COSTS OF ACTION TO BE PAID BY THE  DEFENDANT.  AN  EMPLOYEE'S  RIGHT  TO
INSTITUTE  A  PRIVATE  ACTION  PURSUANT TO THIS SUBDIVISION SHALL NOT BE
LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
  S 4. Section 2801-a of the public health law is amended  by  adding  a
new subdivision 3-b to read as follows:
  3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNI-
TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH AND HEALTH
PLANNING  COUNCIL SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL
RULES, REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE  RELATIONS,
WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRAC-
TICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING
COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF
THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS.
  S  5. Section 2805 of the public health law is amended by adding a new
subdivision 3 to read as follows:
  3. IN DETERMINING WHETHER TO ISSUE OR RENEW AN  OPERATING  CERTIFICATE
TO  AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN ACCORD-
ANCE WITH  THIS  ARTICLE,  THE  COMMISSIONER  SHALL  CONSIDER  ANY  PAST
VIOLATIONS  OF  STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING
TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE  BARGAINING
OR  ANY  OTHER  LABOR RELATED PRACTICES, OBLIGATIONS OR IMPERATIVES. THE
PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL  WEIGHT
TO  VIOLATIONS  OF THE PROVISIONS OF THIS CHAPTER CONCERNING NURSE STAFF
AND SUPPORTIVE STAFF RATIOS.
  S 6. The public health law is amended by adding a new  section  2895-b
to read as follows:
  S  2895-B.  RESIDENTIAL HEALTH CARE FACILITY STAFFING LEVELS. 1. DEFI-
NITIONS. AS USED IN THIS SECTION, THE FOLLOWING  TERMS  SHALL  HAVE  THE
FOLLOWING MEANINGS:
  (A)  "CERTIFIED  NURSE AIDE" MEANS ANY PERSON INCLUDED IN THE RESIDEN-
TIAL HEALTH CARE FACILITY NURSE AIDE REGISTRY PURSUANT TO SECTION  TWEN-
TY-EIGHT HUNDRED THREE-J OF THIS CHAPTER.
  (B)  "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL IN
A PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD  IN
A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT
THAT TIME.
  2.  COMMISSIONER  AND RESIDENTIAL HEALTH CARE FACILITY COUNCIL; POWERS
AND DUTIES. THE COMMISSIONER SHALL: APPOINT A  RESIDENTIAL  HEALTH  CARE
FACILITY  COUNCIL  CONSISTING  OF  THIRTEEN  MEMBERS.  NO  LESS THAN TWO
MEMBERS SHALL BE DIRECT  CARE LICENSED PRACTICAL NURSES,  NO  LESS  THAN
TWO  MEMBERS SHALL BE DIRECT CARE CERTIFIED NURSE ASSISTANTS AND NO LESS
THAN  ONE MEMBER SHALL BE A DIRECT CARE REGISTERED  PROFESSIONAL  NURSE.
THE  COUNCIL  SHALL ALSO INCLUDE NO LESS THAN ONE REPRESENTATIVE EACH OF
RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF REGISTERED NURS-
ES, OF NON-REGISTERED NURSE DIRECT CARE STAFF AND  A  REPRESENTATIVE  OF
NURSING  PROFESSIONAL  ASSOCIATIONS.  THE  COUNCIL SHALL ALSO INCLUDE NO
LESS THAN TWO REPRESENTATIVES OF RESIDENTIAL HEALTH CARE FACILITY OPERA-

A. 6571                             9

TORS, TWO REPRESENTATIVES OF  RESIDENTIAL  HEALTH  CARE  FACILITY  NURSE
ADMINISTRATORS  AND  ONE  REPRESENTATIVE  OF  CONSUMERS. THE RESIDENTIAL
HEALTH CARE FACILITY COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVEL-
OPMENT  OF  REGULATIONS  RELATING  TO  THE STAFFING STANDARDS UNDER THIS
SECTION; AND MAY FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE LEGISLA-
TURE, THE PUBLIC AND  THE  COMMISSIONER  ANY  RECOMMENDATIONS  REGARDING
STAFFING LEVELS IN RESIDENTIAL HEALTH CARE FACILITIES.
  3. STAFFING STANDARDS.  (A) THE COMMISSIONER, IN CONSULTATION WITH THE
COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR RESIDEN-
TIAL  HEALTH  CARE  FACILITY  MINIMUM STAFFING LEVELS TO MEET APPLICABLE
STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAIN-
TAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BE-
ING OF EACH RESIDENT  OF  THE  FACILITY.  THE  COMMISSIONER  SHALL  ALSO
REQUIRE  BY REGULATION THAT EVERY RESIDENTIAL HEALTH CARE FACILITY MAIN-
TAIN RECORDS ON ITS STAFFING LEVELS,  REPORT  ON  SUCH  RECORDS  TO  THE
DEPARTMENT,  AND  MAKE  SUCH  RECORDS  AVAILABLE  FOR  INSPECTION BY THE
DEPARTMENT.
  (B) EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL:
  (I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND
  (II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF
SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES
TO ATTAIN OR MAINTAIN THE  HIGHEST  PRACTICABLE  PHYSICAL,  MENTAL,  AND
PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY.
  (C)  SUBJECT  TO  SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS
UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS  UNDER
SUBDIVISION FOUR OF THIS SECTION.
  (D)  IN  DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS
SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED  WHILE  PERFORMING  SERVICES
THAT  ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD
PREPARATION,  HOUSEKEEPING,  LAUNDRY,  MAINTENANCE  SERVICES,  OR  OTHER
ACTIVITIES THAT ARE NOT DIRECT NURSING CARE.
  4.    STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE
OF THIS SECTION, EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL MAINTAIN A
STAFFING RATIO EQUAL TO AT LEAST THE FOLLOWING:
  (A) 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED NURSE AIDE;
  (B) 1.3 HOURS OF CARE PER RESIDENT PER DAY  BY  A  LICENSED  PRACTICAL
NURSE OR A REGISTERED NURSE;
  (C) 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGISTERED NURSE; THE
MINIMUM  OF  0.75  HOURS  OF  CARE PER RESIDENT PROVIDED BY A REGISTERED
NURSE SHALL BE DIVIDED AMONG ALL SHIFTS TO ENSURE AN  APPROPRIATE  LEVEL
OF  REGISTERED  NURSE CARE TWENTY-FOUR HOURS PER DAY, SEVEN DAYS A WEEK,
TO MEET RESIDENT NEEDS; AND
  (D) RESIDENTIAL HEALTH CARE FACILITIES THAT CARE FOR SUBACUTE PATIENTS
SHALL MAINTAIN AT A MINIMUM, THE FOLLOWING DIRECT-CARE  NURSE-TO-PATIENT
RATIO: ONE NURSE TO FIVE PATIENTS.
  5.    ANY RESIDENTIAL HEALTH CARE FACILITY THAT VIOLATES THE RIGHTS OF
AN EMPLOYEE PURSUANT TO AN ADOPTED WORK  ASSIGNMENT  POLICY  UNDER  THIS
SECTION  MAY  BE  HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A
COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR  EQUITABLE  RELIEF  AS
MAY  BE  APPROPRIATE  TO  EFFECTUATE  THE  PURPOSES OF THE SAFE STAFFING
REQUIREMENTS, INCLUDING BUT NOT  LIMITED  TO  REINSTATEMENT,  PROMOTION,
LOST  WAGES  AND  BENEFITS,  AND  COMPENSATORY AND CONSEQUENTIAL DAMAGES
RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED
DAMAGES. THE COURT IN SUCH ACTION SHALL, IN  ADDITION  TO  ANY  JUDGMENT
AWARDED  TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND
COSTS OF ACTION TO BE PAID BY THE  DEFENDANT.  AN  EMPLOYEE'S  RIGHT  TO

A. 6571                            10

INSTITUTE  A  PRIVATE  ACTION  PURSUANT TO THIS SUBDIVISION SHALL NOT BE
LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
  6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A RESIDENTIAL HEALTH CARE
FACILITY SHALL POST INFORMATION REGARDING NURSE STAFFING THAT THE FACIL-
ITY   IS  REQUIRED  TO  MAKE  AVAILABLE  TO  THE  PUBLIC  UNDER  SECTION
TWENTY-EIGHT HUNDRED FIVE-T OF THIS CHAPTER.    INFORMATION  UNDER  THIS
PARAGRAPH SHALL BE DISPLAYED IN A FORM APPROVED BY THE DEPARTMENT AND BE
POSTED  IN  A MANNER WHICH IS VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR
FAMILIES AND THE STAFF, AS REQUIRED BY THE COMMISSIONER.
  (B) A RESIDENTIAL HEALTH CARE FACILITY SHALL POST A  SUMMARY  OF  THIS
SECTION,  PROVIDED  BY  THE  DEPARTMENT,  IN  PROXIMITY  TO EACH POSTING
REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVISION.
  S 7. If any provision of this act, or any application of any provision
of this act, is held to be invalid, or ruled by any  federal  agency  to
violate  or  be  inconsistent  with  any applicable federal law or regu-
lation, that shall not affect the validity or effectiveness of any other
provision of this act, or of any other application of any  provision  of
this act.
  S 8. This act shall take effect on the one hundred eightieth day after
it shall have become a law, provided that any rules and regulations, and
any  other  actions necessary to implement the provisions of this act on
its effective date are authorized and directed to  be  completed  on  or
before such date.