EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).

1-1 Section 1. Chapter 449 of NRS is hereby amended by adding thereto

1-2 the provisions set forth as sections 2 to 13, inclusive, of this act.

1-3 Sec. 2. 1. A medical facility shall document and report to the board

1-4 any adverse outcome to a patient that receives care from the facility.

1-5 2. The board shall adopt regulations which:

1-6 (a) Define the circumstances that constitute an adverse outcome to a

1-7 patient that receives care from a medical facility. The definition must

1-8 include, without limitation, such circumstances as:

1-9 (1) An injury to or death of a patient;

1-10 (2) An error in the administration of medication or a biological

1-11 substance;

1-12 (3) The development of decubitus ulcers by a patient; and

1-13 (4) The development by a patient of an infection that is resistant to

1-14 antibiotics.

1-15 (b) Establish procedures for the documentation and reporting by

1-16 medical facilities of adverse outcomes to patients that received care at the

1-17 facilities.

2-1 3. The board shall prescribe a form that a medical facility shall use

2-2 to document and report an adverse outcome to a patient pursuant to

2-3 subsection 1.

2-4 4. The board shall review the regulations that it adopts pursuant to

2-5 this section at least once each year to determine whether it should repeal

2-6 or amend any of the regulations.

2-7 Sec. 3. 1. In accordance with regulations adopted by the board

2-8 pursuant to subsection 2, a medical facility shall report to the board the

2-9 number of employees assigned to each unit of service of the medical

2-10 facility that provides care to patients and the licensure status and the

2-11 number of hours worked by each of those employees. For each unit of

2-12 nursing service, the report must identify the employees who are assigned

2-13 to provide care directly to patients.

2-14 2. The board shall adopt regulations which:

2-15 (a) Define the units of service in a medical facility that provide care to

2-16 patients; and

2-17 (b) Establish procedures for the reporting of the information required

2-18 pursuant to subsection 1 by medical facilities.

2-19 3. The board shall prescribe a form that a medical facility shall use

2-20 to report the information required pursuant to subsection 1.

2-21 Sec. 4. 1. A medical facility shall maintain daily records of:

2-22 (a) The number of patients to which a unit of service of the facility

2-23 provided care; and

2-24 (b) The classification of those patients based on the severity of their

2-25 conditions, and shall report the information to the board.

2-26 2. The board shall prescribe a form that a medical facility shall use

2-27 to report the information required pursuant to subsection 1.

2-28 Sec. 5. A medical facility shall report all occupational injuries

2-29 sustained and diseases contracted by its employees to the board on the

2-30 form prescribed by and in the manner required by the board.

2-31 Sec. 6. The board shall publish annually a report that compiles the

2-32 information reported to it by medical facilities pursuant to sections 2 to 5,

2-33 inclusive, of this act.

2-34 Sec. 7. 1. Except as otherwise provided in subsection 2, all

2-35 information reported to the board by medical facilities pursuant to

2-36 sections 2 to 5, inclusive, of this act is public information. The board

2-37 shall provide this information to any person who requests the

2-38 information. The board may charge a reasonable fee for providing the

2-39 information.

2-40 2. Information must not be provided pursuant to subsection 1 in a

2-41 manner that discloses the name of a patient or other identifying

2-42 information.

3-1 Sec. 8. 1. A medical facility shall institute a system for classifying

3-2 its patients. The system must classify a patient based upon the severity of

3-3 the condition of the patient.

3-4 2. A medical facility shall keep and maintain a staffing plan that is

3-5 approved by the board. The staffing plan must be based on the system of

3-6 classification of patients established pursuant to subsection 1 and

3-7 conform to the ratios established by the board pursuant to section 9 of

3-8 this act.

3-9 Sec. 9. 1. The board shall establish annually by regulation the

3-10 following minimum ratios for the staffing of a medical facility:

3-11 (a) The ratio of licensed employees to patients for each unit of service

3-12 of the medical facility, as defined pursuant to section 3 of this act; and

3-13 (b) The ratio of licensed and nonlicensed employees to patients for all

3-14 units of service of the medical facility.

3-15 2. In establishing the ratios pursuant to subsection 1, the board shall

3-16 consider:

3-17 (a) Information provided by medical facilities pursuant to the

3-18 regulations adopted pursuant to sections 2, 3 and 4 of this act;

3-19 (b) Information derived from medical research;

3-20 (c) Comments received from the general public; and

3-21 (d) The existing requirements for staffing of medical facilities.

3-22 3. The ratio established by the board for an intensive care unit of

3-23 service must not be less than one registered nurse for each two patients.

3-24 Sec. 10. 1. A person shall not retaliate or discriminate in any

3-25 manner against an employee of a medical facility or a person acting on

3-26 behalf of the employee who in good faith:

3-27 (a) Disclosed information relating to the care or services provided by

3-28 or conditions at a medical facility;

3-29 (b) Advocated on behalf of a patient with respect to the care or

3-30 services provided by or conditions at a medical facility; or

3-31 (c) Initiated, cooperated or otherwise participated in an investigation

3-32 or proceeding conducted by a governmental entity relating to the care or

3-33 services provided by or conditions at a medical facility.

3-34 2. A person shall not retaliate or discriminate in any manner against

3-35 an employee of a medical facility because the employee has attempted to

3-36 or intends to engage in an action described in subsection 1.

3-37 3. A person shall not prohibit, restrict or attempt to prohibit or

3-38 restrict by contract, policy, procedure or any other manner the right of an

3-39 employee of a medical facility to engage in an action described in

3-40 subsection 1.

3-41 4. The identity of an employee of a medical facility who discloses

3-42 information in good faith to a governmental entity regarding the care or

4-1 services provided by or conditions at a medical facility is confidential and

4-2 must not be disclosed by any person unless:

4-3 (a) The employee consents in writing to the disclosure; or

4-4 (b) There is imminent danger to public health or safety or the threat of

4-5 physical harm.

4-6 5. The provisions of this act do not protect the disclosure of

4-7 information that would violate federal or state law or diminish or impair

4-8 the rights of a person to the continued protection of confidentiality of

4-9 communications provided by federal or state law.

4-10 6. For the purposes of this section, an employee of a medical facility

4-11 acts in "good faith" if he reasonably believes that:

4-12 (a) The information is true; and

4-13 (b) The information disclosed by the employee:

4-14 (1) Evidences a violation of any law, rule, regulation or generally

4-15 recognized professional or clinical standard; or

4-16 (2) Relates to care or services provided by or conditions at a

4-17 medical facility that potentially endanger one or more patients or

4-18 employees or the public.

4-19 Sec. 11. 1. An employee of a medical facility who believes that he

4-20 has been retaliated or discriminated against in violation of section 10 of

4-21 this act may file an action in a court of competent jurisdiction.

4-22 2. If a court determines that a violation of section 10 of this act has

4-23 occurred, the court shall award such damages as it determines to have

4-24 resulted from the violation, including, without limitation, compensatory

4-25 damages, reinstatement, reimbursement of any wages, salary,

4-26 employment benefits or other compensation denied to or lost by the

4-27 employee as a result of the violation, attorney’s fees and costs, including,

4-28 without limitation, fees for expert witnesses and punitive damages, if the

4-29 facts warrant. The court shall award interest on the amount of damages

4-30 awarded at the prevailing rate.

4-31 3. The court may grant any equitable relief it considers appropriate,

4-32 including, without limitation, issue temporary, preliminary or permanent

4-33 injunctive relief.

4-34 4. An action must be brought pursuant to this section within 2 years

4-35 after the date of the last event constituting the alleged violation for which

4-36 the action is brought.

4-37 Sec. 12. 1. A person who violates the provisions of section 10 of

4-38 this act is subject to a civil penalty of not more than $10,000 for each

4-39 violation.

4-40 2. A person who willfully and repeatedly violates section 10 of this

4-41 act, if the violation is related to:

4-42 (a) A pattern or practice of such violations;

5-1 (b) The quality of care or services provided by or conditions at a

5-2 medical facility that would likely lead to serious injury or death for

5-3 patients or employees of the medical facility; or

5-4 (c) Retaliation against an employee of a medical facility that could

5-5 lead to serious injury or death,

5-6 is guilty of a gross misdemeanor.

5-7 Sec. 13. 1. The board shall prepare and disseminate to medical

5-8 facilities:

5-9 (a) A notice that sets forth and summarizes the provisions of sections

5-10 10, 11 and 12 of this act.

5-11 (b) A notice that sets forth summaries of or excerpts from the most

5-12 recent report published by the board pursuant to section 6 of this act.

5-13 2. A medical facility shall post in a conspicuous place the notices

5-14 prepared by the board pursuant to subsection 1. A medical facility that

5-15 willfully fails to post such a notice is subject to a civil fine not to exceed

5-16 $100 for each day that it continues to willfully fail to post the notice.

5-17 Sec. 14. The amendatory provisions of this act do not apply to

5-18 offenses that were committed before October 1, 1999.