S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3330
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                             January 20, 2017
                                ___________
 
 Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
   printed to be committed 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".
   § 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-EIGHT OF THIS ARTICLE, and such other information
 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
 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.
   §  3.  The  public  health  law is amended by adding nine new sections
 2827, 2828, 2829, 2830, 2831, 2832, 2833,  2834  and  2835  to  read  as
 follows:
   §  2827. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL OF
 THE FOLLOWING:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02902-03-7
              

 S. 3330                             2
 
   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.
   §  2828.  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
 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.

 S. 3330                             3
 
   8. "SAFE STAFFING REQUIREMENTS" SHALL  MEAN  THE  PROVISIONS  OF  THIS
 SECTION  AND  SECTIONS  TWENTY-EIGHT  HUNDRED TWENTY-SEVEN, TWENTY-EIGHT
 HUNDRED TWENTY-NINE, TWENTY-EIGHT HUNDRED THIRTY,  TWENTY-EIGHT  HUNDRED
 THIRTY-ONE,  TWENTY-EIGHT HUNDRED THIRTY-TWO, TWENTY-EIGHT HUNDRED THIR-
 TY-THREE,  TWENTY-EIGHT  HUNDRED  THIRTY-FOUR  AND  TWENTY-EIGHT HUNDRED
 THIRTY-FIVE OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSU-
 ANT 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.
   § 2829. 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
 REGARDING REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND  CORRECTIONS
 PURSUANT TO SUCH REQUIREMENTS.
   §  2830.  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

 S. 3330                             4
 
 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;
   (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;

 S. 3330                             5
 
   (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.
   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.
   § 2831. 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 THIRTY 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,

 S. 3330                             6
 
 NOR  SHALL  THE  REQUIREMENTS  SET  FORTH  IN  SUCH SECTION TWENTY-EIGHT
 HUNDRED THIRTY 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 THIRTY OF THIS ARTI-
 CLE, 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.
   § 2832. 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
 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.

 S. 3330                             7
 
   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.
   §  2833.  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.
   §  2834.  ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL NOT DELE-
 GATE ITS RESPONSIBILITIES TO  ENFORCE  THE  SAFE  STAFFING  REQUIREMENTS
 PROMULGATED PURSUANT TO THIS ARTICLE.
   § 2835. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT
 HUNDRED  THIRTY-TWO  OF  THIS  ARTICLE.    ANY  ACUTE CARE FACILITY THAT
 VIOLATES THE RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED  WORK  ASSIGN-
 MENT  POLICY UNDER SECTION TWENTY-EIGHT HUNDRED THIRTY-TWO OF THIS ARTI-
 CLE 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  REQUIRE-
 MENTS, 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

 S. 3330                             8
 
 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.
   §  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.
   § 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.
   §  6.  The public health law is amended by adding a new section 2895-b
 to read as follows:
   § 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-
 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-

 S. 3330                             9
 
 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
 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.

 S. 3330                            10
 
   (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.
   § 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.
   § 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.