Full Text of HB4245 93rd General Assembly
HB4245 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 HB4245
Introduced 1/28/2004, by Angelo Saviano SYNOPSIS AS INTRODUCED: |
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Creates the Patient Safety Act. Requires hospitals to implement a written staffing plan for nursing services, and sets forth requirements for the plan. Requires a hospital to establish a committee to develop and monitor implementation of the plan. Restricts a hospital's authority to require nurses to work overtime, making exceptions for emergencies. Provides for civil penalties for violations of the Act. Effective immediately.
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A BILL FOR
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HB4245 |
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LRB093 16079 DRJ 45097 b |
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| AN ACT concerning health facilities.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the | 5 |
| Patient Safety Act. | 6 |
| Section 5. Findings. The legislature finds and declares all
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| of the following:
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| (1) Health care services are becoming complex and it is
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| increasingly difficult for patients to access integrated
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| services.
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| (2) Quality of patient care could be impacted by
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| staffing changes implemented in response to managed care.
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| (3) To ensure the adequate protection of patients in
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| acute care settings, it is essential that qualified
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| registered nurses be accessible and available to meet the
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| needs of patients.
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| (4) The basic principles of staffing in the acute care
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| setting should be based on the patient's care needs, the
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| severity of the condition, prevailing national standards | 20 |
| of nursing care, services needed, and the complexity | 21 |
| surrounding those services, as well as the
experience | 22 |
| level, clinical competencies, and education of
the | 23 |
| licensed nurses providing patient care services.
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| Section 10. Definitions. In this Act: | 25 |
| "Hospital" means an entity licensed under the Hospital
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| Licensing Act or a University of Illinois hospital as defined
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| in the University of Illinois Hospital Act.
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| "Nurse" means a person licensed as a licensed practical
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| nurse or registered professional nurse under the Nursing and
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| Advanced Practice Nursing Act.
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| "Overtime" means work in excess of an agreed-to,
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| predetermined scheduled work shift not to exceed 12 hours,
or | 2 |
| work in excess of 40 hours in one work week, except in
the case | 3 |
| of an unforeseen emergent circumstance when
overtime is used | 4 |
| only as a last resort.
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| "Patient classification system" means a mechanism used
by a | 6 |
| health care facility to determine and differentiate
health care | 7 |
| needs of all patients receiving care within the facility.
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| "Unforeseen emergent circumstance" means a circumstance
in | 9 |
| which the employer has no foreseeable control, as in the | 10 |
| instance
of war, a national disaster, or a declared state of | 11 |
| emergency.
The term does not mean a situation in which the | 12 |
| employer has reasonable
knowledge of a decreased facility | 13 |
| staffing plan, for reasons including, but not
limited to, | 14 |
| scheduled vacations, employee illness, or increased patient | 15 |
| census.
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| "Workplace design to prevent and mitigate errors" means a
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| nursing work environment and care process to reduce errors and
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| enhance patient safety.
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| "Written staffing plan for nursing services" means a
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| written plan of direct care personnel staffing
requirements | 21 |
| that are appropriate to ensure that all patients
receive | 22 |
| quality health care based on the patient classification system
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| under normal and emergent circumstances.
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| Section 15. Written staffing plan for nursing services. | 25 |
| (a) Every hospital is responsible for the development and
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| implementation of a hospital-wide written staffing plan for
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| nursing services. The hospital shall appoint a patient | 28 |
| classification
committee as provided in Section 20 to develop | 29 |
| and implement its written staffing plan for
nursing services by | 30 |
| creating a patient classification system.
The staffing plan | 31 |
| shall be an integral part of the overall hospital
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| organizational plan and shall be available to all nursing
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| personnel. The staffing plan shall be developed
in a manner | 34 |
| that enables the patient care unit to meet or
exceed the nurse | 35 |
| staffing requirements that are derived
from the computation |
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| used in the patient classification system.
The staffing plan | 2 |
| developed for each patient care
unit for each work shift must | 3 |
| be consistent with acceptable
and prevailing standards of safe | 4 |
| nursing care and with the
American Nurses Association's | 5 |
| Principles for Nurse Staffing.
After developing the staffing | 6 |
| plan, the committee shall monitor the implementation of the | 7 |
| plan, with no less
than an annual evaluation and requisite | 8 |
| modification. | 9 |
| (b) The staffing plan must be developed for each patient | 10 |
| care unit for each work shift
and must be consistent with | 11 |
| acceptable and prevailing standards of
safe nursing care and | 12 |
| with the American Nurses Association's
Principles for Nurse | 13 |
| Staffing. The staffing plan must take into account,
but need | 14 |
| not be limited to, all of the following:
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| (1) The plan must be based on the nursing care required | 16 |
| by the
aggregate and individual needs of patients in each | 17 |
| nursing
unit. This nursing care shall be the major | 18 |
| consideration in
determining the number and categories of | 19 |
| nursing staff needed.
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| (2) The plan must establish minimum numbers of nursing | 21 |
| staff,
including licensed nurses and nursing assistants, | 22 |
| on
specified shifts. The number of nursing staff on duty | 23 |
| shall
be sufficient (as determined by the committee | 24 |
| established
under Section 20) to ensure that the nursing | 25 |
| care needs
of each patient are met
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| (3) The plan must be based on the specialized | 27 |
| qualifications and
competencies of the nursing staff. The | 28 |
| skill mix and the
competency of the staff shall ensure that | 29 |
| the nursing care
needs of the patients are met and shall | 30 |
| ensure patient
safety.
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| (4) The plan must be consistent with the scopes of | 32 |
| practice for
registered professional nurses and licensed | 33 |
| practical
nurses and with the authorized duties of nursing | 34 |
| assistants
as delegated by the registered professional | 35 |
| nursing staff.
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| (5) The plan must provide that registered professional |
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| nurses must
be present whenever patient care is delivered.
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| (6) The plan must require that the hospital | 3 |
| administration make provisions for replacement staff in | 4 |
| the event of sickness,
vacations, vacancies, breaks, and | 5 |
| other absences of nursing
staff, with the exception of | 6 |
| unforeseen emergent circumstances,
and that provides a | 7 |
| sufficient number of replacement staff
(as determined by | 8 |
| the committee established under Section 20)
for the | 9 |
| hospital on a regular basis.
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| (c) The patient classification committee established under | 11 |
| Section 20 shall develop
an internal review mechanism for use | 12 |
| in evaluating whether
the hospital's staffing plan results in | 13 |
| sufficient
staffing requirements to meet the health care needs | 14 |
| of the
hospital's patients. The committee shall develop a | 15 |
| review
mechanism that takes into account changes in the
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| characteristics of the hospital or the environment, as well as | 17 |
| changes
that may have occurred in the overall acuity level of | 18 |
| the patients
being treated in the hospital. Evaluation tools | 19 |
| that may be used
in the review mechanism shall include, but | 20 |
| need not be limited to, the following:
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| (1) Patient outcome indicators that have been shown
to | 22 |
| correlate with nurse staffing, as those indicators are
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| developed by nationally recognized nursing organizations.
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| (2) Acceptable and prevailing standards of safe
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| nursing care.
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| (3) Hospital reports and analysis of incidents and
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| injuries to patients, nursing staff, and other nursing | 28 |
| personnel.
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| (4) Available reports and surveys of patient
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| satisfaction and nurse satisfaction that correlate to the
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| quality of nursing care provided in the hospital.
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| (5) Criteria required by State or federal law for
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| assessing the quality of patient care provided by a
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| hospital.
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| (6) American Nurse Credentialing Center Magnet
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| Hospital elements and
American Nurses Association |
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| Principles for Nurse Staffing. | 2 |
| (7) Any other criteria the committee considers | 3 |
| appropriate.
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| (d) Not later than 6 months after the effective date of
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| this Act, the committee shall complete its development of
the | 6 |
| internal review mechanism and conduct an internal review
of the | 7 |
| staffing plan it has selected.
Thereafter, the committee shall | 8 |
| conduct an internal review of
the plan at least once each year | 9 |
| and shall report to the hospital leaders
on the data analysis | 10 |
| regarding staffing effectiveness and any actions
taken to | 11 |
| improve staffing.
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| (e) Whenever the committee determines that the staffing
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| plan that the committee has selected for the hospital no longer
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| meets the staffing requirements necessary to meet the health
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| care needs of the hospital's patients, the committee shall | 16 |
| select
a different written staffing plan pursuant to this | 17 |
| Section.
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| (f) Staff nurses shall collect unit-level-specific data | 19 |
| for analysis of the patient classification committee on
a | 20 |
| routine basis.
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| (g) The hospital shall provide training to support
all | 22 |
| staff nurses in their roles in analyzing data and to provide | 23 |
| training on data
elements and their relevance to staffing to | 24 |
| best support the
development and ongoing review of the written | 25 |
| staffing plan.
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| (h) A hospital's staffing plan is subject to inspection by | 27 |
| the
Department of Public Health. | 28 |
| Section 20. Patient classification committee. Every | 29 |
| hospital shall establish a patient classification committee
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| for the purpose of selecting the patient classification system
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| to be used in establishing staffing requirements pursuant to
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| Section 15. A hospital shall appoint members
of the committee | 33 |
| in accordance with the following:
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| (1) At least 50% of the members of the
committee shall | 35 |
| be comprised of registered professional nurses
who are |
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| staff nurses providing direct patient care.
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| (2) If the hospital has entered into a collective | 3 |
| bargaining agreement
with its nursing staff, the | 4 |
| leadership of the collective bargaining unit shall
appoint | 5 |
| their own committee members.
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| Section 25. Patient classification system. The patient | 7 |
| classification committee of a hospital shall
select a patient | 8 |
| classification system that does all of the following:
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| (1) Computes staffing requirements that are | 10 |
| appropriate to
ensure that all patients in the hospital | 11 |
| receive quality health care
according to an analysis of | 12 |
| their individual and aggregate needs.
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| (2) Specifies staffing requirements to be filled by | 14 |
| licensed nurses
and other personnel utilized in the | 15 |
| provision of direct patient care
or the support of other | 16 |
| unit activities.
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| (3) Includes methods to ensure the validity and | 18 |
| reliability
of its projection of staffing requirements.
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| (4) Incorporates standards that are consistent with | 20 |
| acceptable
and prevailing standards of safe nursing care | 21 |
| and with the American
Nurses Association's Principles for | 22 |
| Nurse Staffing. | 23 |
| Section 30. Workplace design to prevent and mitigate | 24 |
| errors. | 25 |
| (a) To reduce error-producing fatigue, a hospital may not | 26 |
| require nursing staff to provide patient care in any
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| combination of scheduled shifts, mandatory overtime in excess | 28 |
| of
12 hours in any 24-hour period, and mandatory overtime in
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| excess of 60 hours in any 7-day period.
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| (b) The hospital administration is responsible for | 31 |
| implementing the staffing plan for nursing developed under | 32 |
| Section 15 to obtain registered
professional nurses for the | 33 |
| unfilled hours or shifts.
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| (c) A hospital may not require a nurse to work:
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| (1) more than 12 hours in any 24-hour period; or
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| (2) more than 60 hours in any 7-day period.
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| (d) A hospital must dedicate budgetary resources equal to | 4 |
| a defined
percentage of nursing payroll to support nursing | 5 |
| staff in their
ongoing acquisition and maintenance of knowledge | 6 |
| and skills.
These resources should be sufficient for and used | 7 |
| to implement
policies and practices that:
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| (1) assign experienced nursing staff to precept nurses | 9 |
| newly
practicing in a clinical area to address knowledge | 10 |
| and skill gaps; and
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| (2) provide education and training of staff as new | 12 |
| technology or
changes in the workplace are introduced. | 13 |
| Section 35. Compliance with staffing requirements. | 14 |
| (a) A hospital must do all of the following:
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| (1) The hospital must comply with the staffing | 16 |
| requirements established under
subsection (b) of Section | 17 |
| 15.
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| (2) The hospital must comply with the working | 19 |
| scheduling limitations by
employing a sufficient number of | 20 |
| employees to perform duties
that are non-nursing such as | 21 |
| housekeeping, clerical duties, and
administrative duties.
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| (3) The hospital may not require an employee to accept | 23 |
| overtime
work except in the case of an unforeseen emergent | 24 |
| circumstance
when overtime is required only as a last | 25 |
| resort. The acceptance
by any employee of overtime work | 26 |
| must be strictly voluntary,
and the refusal to accept such | 27 |
| overtime work may not be grounds
for discrimination, | 28 |
| dismissal, discharge, or retaliation, or any other
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| employment decision adverse to the employee.
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| (b) If subdivisions (1) and (2) of subsection (a) are both | 31 |
| violated in the
same work shift, each violation is a separate | 32 |
| violation for purposes of Section 40. If
subdivisions (1) and | 33 |
| (2) of subsection (a) are violated in different
patient care | 34 |
| units at the same time, each violation is a separate violation | 35 |
| for purposes of Section 40.
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| (c) The provisions of this Section do not apply to nursing
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| staff needs in the event of a national or State emergency or
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| circumstances requiring the implementation of a hospital
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| disaster plan. | 5 |
| Section 40. Violations; penalties. | 6 |
| (a) If the Department of Public Health determines, after
an | 7 |
| investigation, that a hospital has violated subdivision (1) or | 8 |
| (2) of
subsection (a) of Section 35, the Department shall | 9 |
| impose
a civil penalty against the hospital in accordance with
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| subsection (b) of this Section. In determining the amount
of | 11 |
| the civil penalty to be imposed, the Department shall consider
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| the severity of this violation, the hospital's efforts to | 13 |
| correct
the violation, whether the violation has been | 14 |
| corrected, and
whether the hospital's failure to correct the | 15 |
| violation is the
result of a willful disregard of the | 16 |
| requirements of this Act.
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| (b) In the case of a first violation of subdivision (1) or | 18 |
| (2) of subsection (a) of Section 35, the Department of Public | 19 |
| Health shall impose a civil penalty in an amount that is not
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| less than $2,000 for each week in which the violation occurs.
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| In the case of a subsequent violation, for each day of the | 22 |
| first week
in which the violation occurs, the Department shall | 23 |
| impose a civil penalty
in an amount that is not less than | 24 |
| $8,000 and not more
than $15,000. During each week thereafter, | 25 |
| the Department
shall impose a civil penalty for each day of the | 26 |
| violation in
an amount that is 3 times the amount imposed per
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| day in the immediately preceding week.
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| (c) The Department of Public Health may impose a civil | 29 |
| penalty
under this Section only after notice to the hospital | 30 |
| and an
opportunity for the hospital to be heard on the matter.
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| (d) The Attorney General may bring an action in the
circuit | 32 |
| court to enforce the collection of any civil penalty
imposed | 33 |
| under this Section.
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| (e) Notice of a hospital's violation of this Act shall be | 35 |
| posted in a public area of the hospital's premises.
Violations |
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| must also be included in a hospital's quarterly
reports to the | 2 |
| Department of Public Health under
Section 25 of the Hospital | 3 |
| Report Card Act. | 4 |
| (f) Amounts collected under this Section shall be allocated
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| to the Department of Public Health for nursing scholarships
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| awarded pursuant to the Nursing Education Scholarship Law.
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| Section 99. Effective date. This Act takes effect upon | 8 |
| becoming law.
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