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 15, inclusive, of this act.

1-3 Sec. 2. For the purposes of sections 2 to 15, inclusive, of this act,

1-4 "medical facility" is limited to a:

1-5 1. Facility for intermediate care;

1-6 2. Facility for skilled nursing;

1-7 3. Independent center for emergency medical care; or

1-8 4. Hospital.

1-9 Sec. 3. 1. A medical facility shall document and report to the

1-10 board any adverse outcome to a patient that receives care from the

1-11 facility.

1-12 2. The board shall adopt regulations which:

1-13 (a) Define the circumstances that constitute an adverse outcome to a

1-14 patient that receives care from a medical facility. The definition must

1-15 include, without limitation, such circumstances as:

1-16 (1) An injury to or death of a patient;

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

2-2 substance that results in harm or injury to the patient;

2-3 (3) The development of decubitus ulcers by a patient; and

2-4 (4) The development by a patient of an infection that is resistant to

2-5 antibiotics,

2-6 while the patient was under the direct care of the medical facility.

2-7 (b) Establish procedures for the documentation and reporting by

2-8 medical facilities of adverse outcomes to patients that received care at the

2-9 facilities.

2-10 3. The board shall prescribe a form that a medical facility shall use

2-11 to document and report an adverse outcome to a patient pursuant to

2-12 subsection 1.

2-13 4. The board shall review the regulations that it adopts pursuant to

2-14 this section at least once each year to determine whether it should repeal

2-15 or amend any of the regulations.

2-16 Sec. 4. 1. In accordance with regulations adopted by the board

2-17 pursuant to subsection 2, a medical facility shall report to the board the

2-18 number of employees assigned to each unit of service of the medical

2-19 facility that provides care to patients and the licensure status and the

2-20 number of hours worked by each of those employees. For each unit of

2-21 nursing service, the report must identify the employees who are assigned

2-22 to provide care directly to patients.

2-23 2. The board shall adopt regulations which:

2-24 (a) Define the units of service in a medical facility that provide care to

2-25 patients; and

2-26 (b) Establish procedures for the reporting of the information required

2-27 pursuant to subsection 1 by medical facilities.

2-28 3. The board shall prescribe a form that a medical facility shall use

2-29 to report the information required pursuant to subsection 1.

2-30 Sec. 5. 1. A medical facility shall maintain daily records of:

2-31 (a) The number of patients to which a unit of service of the facility

2-32 provided care; and

2-33 (b) The classification of those patients based on the severity of their

2-34 conditions, and shall report the information to the board.

2-35 2. The board shall prescribe a form that a medical facility shall use

2-36 to report the information required pursuant to subsection 1.

2-37 Sec. 6. A medical facility shall report all occupational injuries

2-38 sustained and diseases contracted by its employees to the board on the

2-39 form prescribed by and in the manner required by the board.

2-40 Sec. 7. The board shall publish annually a report that compiles the

2-41 information reported to it by medical facilities pursuant to sections 3 to 6,

2-42 inclusive, of this act. The report must include factors for adjusting risk

2-43 based upon the population and patients served by the medical facility.

3-1 Sec. 8. 1. Except as otherwise provided in subsection 2, all

3-2 information reported to the board by medical facilities pursuant to

3-3 sections 3 to 6, inclusive, of this act is public information. The board

3-4 shall provide this information to any person who requests the

3-5 information. The board may charge a reasonable fee for providing the

3-6 information.

3-7 2. Information must not be provided pursuant to subsection 1 in a

3-8 manner that discloses the name of a patient or other identifying

3-9 information.

3-10 Sec. 9. 1. A medical facility shall institute a system for classifying

3-11 its patients based on the severity of their conditions that establishes a

3-12 method of determining required number of employees for each unit of

3-13 service, patient and shift. The system must include:

3-14 (a) A method to determine the requirements for nursing care for a

3-15 patient.

3-16 (b) An established method by which the amount of nursing care

3-17 needed for each category of patient is validated for each unit of service

3-18 and each shift.

3-19 (c) An established method to discern trends and patterns of delivery of

3-20 nursing care by each unit of service, shift and level of licensed and

3-21 nonlicensed employee.

3-22 (d) A mechanism by which the accuracy of the method described in

3-23 paragraph (a) can be tested. The mechanism must address:

3-24 (1) The amount of nursing care needed by category of patient and

3-25 pattern of delivery of care, reviewed on an annual basis or more often if

3-26 warranted by changes in the number of patients or the severity of their

3-27 conditions;

3-28 (2) The skill of the staff; and

3-29 (3) The model for delivery of care to patients.

3-30 (e) A method to determine allocation of staff resources based on the

3-31 requirements for nursing care for each shift and each unit of service.

3-32 (f) A method by which the medical facility validates the reliability of

3-33 the system for classifying patients for each shift and each unit of service.

3-34 2. The administrator of nursing services within the medical facility

3-35 or a designee of the administrator shall develop a written staffing plan

3-36 based on the need for care of patients determined by the system for

3-37 classifying patients. The staffing plan must be developed and used for

3-38 each unit of patient care and must specify the requirements for care of

3-39 patients and the required level of staffing for licensed and nonlicensed

3-40 employees. The plan must include:

3-41 (a) Requirements for staffing as determined by the system for

3-42 classifying patients for each unit of service, documented each day and

3-43 each shift.

4-1 (b) The actual staffing provided, documented each day and each shift.

4-2 (c) The variance between the required and actual staffing,

4-3 documented each day and each shift.

4-4 The plan must be retained for 7 years.

4-5 3. The system for classifying patients must be reviewed at least

4-6 annually by a committee appointed by the administrator of nursing

4-7 services to determine whether the system accurately measures needed

4-8 care for patients. At least one-half of the members of the committee must

4-9 be registered nurses who provide direct care to patients.

4-10 4. If a review pursuant to subsection 3 reveals that adjustments are

4-11 necessary in the system for classifying patients to ensure accuracy in

4-12 measuring needed care for patients, the adjustments must be made within

4-13 30 days. The medical facility must have a policy and procedure to

4-14 determine how such adjustments will be made. The policy and procedure

4-15 must be retained for 7 years.

4-16 Sec. 10. 1. A person shall not retaliate or discriminate in any

4-17 manner against an employee of a medical facility or a person acting on

4-18 behalf of the employee who in good faith:

4-19 (a) Disclosed information relating to the care or services provided by

4-20 or conditions at a medical facility;

4-21 (b) Advocated on behalf of a patient with respect to the care or

4-22 services provided by or conditions at a medical facility; or

4-23 (c) Initiated, cooperated or otherwise participated in an investigation

4-24 or proceeding conducted by a governmental entity relating to the care or

4-25 services provided by or conditions at a medical facility.

4-26 2. A person shall not retaliate or discriminate in any manner against

4-27 an employee of a medical facility because the employee has attempted to

4-28 or intends to engage in an action described in subsection 1.

4-29 3. A person shall not prohibit, restrict or attempt to prohibit or

4-30 restrict by contract, policy, procedure or any other manner the right of an

4-31 employee of a medical facility to engage in an action described in

4-32 subsection 1.

4-33 4. The identity of an employee of a medical facility who discloses

4-34 information in good faith to a governmental entity regarding the care or

4-35 services provided by or conditions at a medical facility is confidential and

4-36 must not be disclosed by any person unless:

4-37 (a) The employee consents in writing to the disclosure; or

4-38 (b) There is imminent danger to public health or safety or the threat

4-39 of physical harm.

4-40 5. The provisions of sections 2 to 15, inclusive, of this act do not

4-41 protect the disclosure of information that would violate federal or state

4-42 law or diminish or impair the rights of a person to the continued

5-1 protection of confidentiality of communications provided by federal or

5-2 state law.

5-3 6. For the purposes of this section, an employee of a medical facility

5-4 acts in "good faith" if he reasonably believes that:

5-5 (a) The information is true; and

5-6 (b) The information disclosed by the employee:

5-7 (1) Evidences a violation of any law, rule, regulation or generally

5-8 recognized professional or clinical standard; or

5-9 (2) Relates to care or services provided by or conditions at a

5-10 medical facility that potentially endanger one or more patients or

5-11 employees or the public.

5-12 Sec. 11. 1. An employee of a medical facility who believes that he

5-13 has been retaliated or discriminated against in violation of section 10 of

5-14 this act may file an action in a court of competent jurisdiction.

5-15 2. If a court determines that a violation of section 10 of this act has

5-16 occurred, the court shall award such damages as it determines to have

5-17 resulted from the violation, including, without limitation, compensatory

5-18 damages, reinstatement, reimbursement of any wages, salary,

5-19 employment benefits or other compensation denied to or lost by the

5-20 employee as a result of the violation, attorney’s fees and costs, including,

5-21 without limitation, fees for expert witnesses and punitive damages, if the

5-22 facts warrant. The court shall award interest on the amount of damages

5-23 awarded at the prevailing rate.

5-24 3. The court may grant any equitable relief it considers appropriate,

5-25 including, without limitation, issue temporary, preliminary or permanent

5-26 injunctive relief.

5-27 4. An action must be brought pursuant to this section within 2 years

5-28 after the date of the last event constituting the alleged violation for which

5-29 the action is brought.

5-30 Sec. 12. 1. A person who violates the provisions of section 10 of

5-31 this act is subject to a civil penalty of not more than $10,000 for each

5-32 violation.

5-33 2. A person who willfully and repeatedly violates section 10 of this

5-34 act, if the violation is related to:

5-35 (a) A pattern or practice of such violations;

5-36 (b) The quality of care or services provided by or conditions at a

5-37 medical facility that would likely lead to serious injury or death for

5-38 patients or employees of the medical facility; or

5-39 (c) Retaliation against an employee of a medical facility that could

5-40 lead to serious injury or death,

5-41 is guilty of a gross misdemeanor.

5-42 Sec. 13. 1. The board shall prepare and disseminate to medical

5-43 facilities:

6-1 (a) A notice that sets forth and summarizes the provisions of sections

6-2 10, 11 and 12 of this act.

6-3 (b) A notice that sets forth summaries of or excerpts from the most

6-4 recent report published by the board pursuant to section 7 of this act.

6-5 2. A medical facility shall post in a conspicuous place the notices

6-6 prepared by the board pursuant to subsection 1. A medical facility that

6-7 willfully fails to post such a notice is subject to a civil fine not to exceed

6-8 $100 for each day that it continues to willfully fail to post the notice.

6-9 Sec. 14. 1. A person who fails to report or falsifies information, or

6-10 coerces, threatens, intimidates or otherwise influences another person to

6-11 fail to report or falsify information required to be reported pursuant to

6-12 sections 3 to 6, inclusive, of this act, is subject to a civil penalty of not

6-13 more than $10,000 for each violation.

6-14 2. A person who willfully and repeatedly violates subsection 1, if the

6-15 violation is related to:

6-16 (a) A pattern or practice of such violations; or

6-17 (b) The quality of care or services provided by or conditions at a

6-18 medical facility that would likely lead to serious injury or death for

6-19 patients or employees of the medical facility,

6-20 is guilty of a gross misdemeanor, may be barred from accepting payment

6-21 pursuant to a state-financed health insurance program and may have his

6-22 license to operate a medical facility suspended or revoked.

6-23 Sec. 15. 1. A person in a position of responsibility for staffing in a

6-24 medical facility who fails to ensure that there is sufficient staff to fulfill

6-25 the requirements of a staffing plan developed pursuant to section 9 of

6-26 this act is subject to a civil penalty of not more than $10,000 for each

6-27 violation.

6-28 2. A person who willfully and repeatedly violates subsection 1, or

6-29 who coerces, threatens, intimidates or otherwise influences another

6-30 person to fail to fulfill the requirements of a staffing plan developed

6-31 pursuant to section 9 of this act, if the violation is related to:

6-32 (a) A pattern or practice of such violations; or

6-33 (b) The quality of care or services provided by or conditions at a

6-34 medical facility that would likely lead to serious injury or death for

6-35 patients or employees of the medical facility,

6-36 is guilty of a gross misdemeanor, may be barred from accepting payment

6-37 pursuant to a state-financed health insurance program and may have his

6-38 license to operate a medical facility suspended or revoked.

6-39 Sec. 16. The amendatory provisions of this act do not apply to

6-40 offenses that were committed before October 1, 1999.