RELATING TO LABOR STANDARDS AT HEALTH CARE FACILITIES.

HB1244

HOUSE OF REPRESENTATIVES

H.B. NO.

1244

THIRTY-THIRD LEGISLATURE, 2025

STATE OF HAWAII

A BILL FOR AN ACT

relating
to labor standards at health care FACILITIES
.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

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SECTION 1.
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The legislature finds that the health and
safety of the State's residents depend on ensuring that registered nurses are
supported in providing high-quality, patient-centered care.
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Adequate patient-nurse staffing ratios are
critical to achieving this goal, as they directly impact patient safety, reduce
nurse burnout, and promote nurse retention in the workforce.
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The legislature recognizes that improving
patient-to-nurse ratios leads to better patient outcomes, enhanced care
quality, and a more sustainable health care system.
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By establishing minimum patient-to-nurse
staffing ratios and requiring hospitals to implement and adhere to enforceable
staffing plans, the State can protect its health care workforce, reduce
turnover, and ensure that patients receive the safe, timely care they deserve.

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Accordingly, the
purpose of this Act is to:

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(1)
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Establish minimum registered nurse staffing
standards for hospitals;

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(2)
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Require hospitals to create hospital
registered nurse staffing committees and develop and implement annual
registered nurse staffing plans; and

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(3)
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Appropriate funds to the department of labor
and industrial relations to enforce these requirements.

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SECTION
2.
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The Hawaii Revised Statutes is
amended by adding a new chapter to be appropriately designated and to read as
follows:

"
Chapter

MINIMUM STAFFING STANDARDS FOR HEALTH CARE
FACILITIES

PART
I.
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GENERAL PROVISIONS

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� -1
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Definitions.
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As used in this chapter, unless the context
otherwise requires:

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"Acuity"
means the level of patient need for nursing care, as determined by a nursing
assessment.

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"Charge
nurse" means a direct care registered nurse who coordinates patient care
responsibilities among nurses in a hospital.

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"Department"
means the department of labor and industrial relations.

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"Director"
means the director of labor and industrial relations.

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"Health
care personnel" includes registered nurses, nurse aides, respiratory
therapists, dialysis technicians, and dialysis nurses to whom minimum staffing
levels apply pursuant to section ‑11.

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"Hospital"
means a hospital regulated by the department of health pursuant to section
321-11(10) and licensed pursuant to section 321-14.5.

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"Hospital
registered nurse staffing committee" or "staffing committee"
means the committee established by a hospital under section ‑21.

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"Nursing
and ancillary health care personnel" means a person who is providing
direct care or supportive services to patients but is not a physician licensed
under chapter 453; a physician assistant licensed under chapter 453; or an
advanced practice registered nurse licensed under chapter 457, unless the
person is working as a registered nurse who provides direct care to patients.

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"Patient
care unit" means any unit or area of a hospital that provides patient
care.

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"Reasonable
efforts" means that the hospital exhausts and documents all of the
following but is unable to obtain staffing coverage:

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(1)
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Seeks individuals to volunteer to work extra
time from all available qualified staff who are working;

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(2)
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Contracts qualified employees who have made
themselves available to work extra time;

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(3)
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Seeks the use of per diem staff; and

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(4)
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Seeks personnel from a contracted temporary
agency:

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(A)
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To the extent this staffing is permitted by
law or an applicable collective bargaining agreement; and

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(B)
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When the hospital regularly uses a contracted
temporary agency.

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"Registered
nurse" means a "nurse", as defined in section 457-2, who
provides direct care to patients.

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"Skill
mix" means the experience of, and number and relative percentages of,
nursing and ancillary health personnel.

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"Unforeseeable
emergent circumstances" means:

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(1)
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Any unforeseen national, state, or county
emergency; or

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(2)
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When a hospital's disaster plan is activated.

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� -2
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Rules.
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The department shall adopt rules pursuant to chapter 91 to effectuate
the purposes of this chapter.

PART
II.
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MINIMUM STAFFING STANDARDS

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� -11
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Minimum registered nurse staffing standards.
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(a)
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A hospital
shall comply with the minimum staffing standards established in this section;
provided that a charge nurse shall not be included as part of the
patient-to-nurse staffing ratio.

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(b)
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Registered nurses shall not be assigned more
patients than the following for any shift:

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(1)
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For an emergency department:

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(A)
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One direct care registered nurse to no more
than one trauma or critical care patient;

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(B)
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One direct care registered nurse to an average
of no more than four patients over a twelve-hour shift; and

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(C)
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One direct care registered nurse to no more
than five patients at one time;

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(2)
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For an intensive care unit, such as a critical
care unit, special care unit, coronary care unit, pediatric intensive care,
neonatal intensive care, neurological critical care unit, or burn unit:

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(A)
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One registered nurse to two patients or one
registered nurse to one patient, depending on the stability of the patient as
assessed by the registered nurse on the unit;

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(3)
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For labor and delivery:
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one direct care registered nurse to no more
than:

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(A)
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Two patients if the patients are not in active
labor or experiencing complications; and

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(B)
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One patient if the patient is in active labor or
in any stage of labor and is experiencing complications;

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(4)
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For postpartum, antepartum, and well-baby
nursery:
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One registered nurse to six
patients in postpartum, antepartum, and well-baby nursery; provided that the
mother and the baby shall be each counted as separate patients for purposes of
this paragraph;

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(5)
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For an operating room:
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One registered nurse to one patient;

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(6)
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For oncology:
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One registered nurse to four patients;

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(7)
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For a post-anesthesia care unit:
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One registered nurse to two patients;

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(8)
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For a progressive care unit, intensive
specialty care unit, or stepdown unit:
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One
registered nurse to three patients;

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(9)
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For a medical-surgical unit:
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One registered nurse to four patients;

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(10)
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For a telemetry unit:
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One registered nurse to three patients;

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(11)
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For a psychiatric unit:
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One registered nurse to four patients; provided
that staffing may be adjusted during high patient acuity in scenarios including
but not limited to:

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(A)
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A patient who is on 1:1 observation;

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(B)
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A patient who is in an acute-manic phase;

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(C)
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A patient who is volatile; or

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(D)
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A patient who is physically compromised;

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(12)
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For pediatrics:
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One registered nurse to three patients; and

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(13)
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For inpatient hemodialysis:
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One registered nurse to one patient.

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(c)
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The personnel assignment limits established
in this section:

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(1)
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Are based on the type of care provided in
these patient care units, regardless of the specific name or reference by the hospital
for these units; and

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(2)
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Represent the maximum number of patients to
which a registered nurse may be assigned at any time during a shift.

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(d)
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A hospital shall not average the number of
patients and the total number of registered nurses assigned to patients in a
patient care unit during any one shift or over any period of time in order to
meet the personnel assignment limits established in this section.

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(e)
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Nothing in this section precludes a hospital
from assigning fewer patients to registered nurses than the limits established
in this section; provided that a hospital shall not reduce the nurse
aide-to-patient ratio it currently utilizes to staff its units based on the
registered nurse-to-patient ratio established by this section or in any
collective bargaining agreement.

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(f)
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The personnel assignment limits established
in this section shall not decrease any existing registered nurse-to-patient
staffing levels:

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(1)
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In effect pursuant to a collective bargaining
agreement; or

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(2)
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Established under a hospital's staffing plan,
except by a majority vote of the staffing committee.

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(g)
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Registered nurses shall not be assigned to a
patient care unit or clinical area unless those nurses have first received
orientation in that clinical area sufficient to provide competent care to
patients in that area and have demonstrated current competence in providing
care in that area.

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(h)
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The department shall enforce compliance with
this section under section ‑28 or part IV of this
chapter, as appropriate.

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� -12
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Variances.
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(a)
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The department may grant a variance from the minimum registered nurse
staffing standards of section ‑11 if the department
determines there is good cause for doing so.

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(b)
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A hospital may seek a variance from the
minimum registered nurse staffing standards by submitting a written application
to the department.
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The application shall
contain:

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(1)
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A justification that establishes good cause
for the variance and for not complying with minimum registered nurse staffing
standards;

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(2)
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The alternative minimum registered nurse staffing
standards that will be imposed;

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(3)
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The group of employees for whom the variance
is sought;

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(4)
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Evidence that infeasibility and the underlying
data supporting the claim of infeasibility were discussed at least twice by the
hospital's registered nurse staffing committee and a statement from the
staffing committee where consensus exists or statements where there is dispute;
and

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(5)
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Evidence that ten working days prior to its
request for a variance, the hospital provided to the involved employees and, if
applicable, to their union representatives, the following:

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(A)
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A copy of the written request for a variance;

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(B)
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Information about the right of the involved
employees and, if applicable, their union representatives, to be heard by the
department during the variance application review process;

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(C)
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Information about the process by which
involved employees and, if applicable, their union representatives, may make a
written request to the director for reconsideration, subject to the provisions
established in subsection (g); and

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(D)
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The department's address and phone number, or
other contact information.

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(c)
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The department shall allow the hospital, any
involved employees and, if applicable, their union representatives, the
opportunity for oral or written presentation during the variance application
review process if warranted under the circumstances.

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(d)
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No later than fifteen days after the date on
which the department received the application for a variance, the department
shall issue a written decision either granting or denying the variance.
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The department may extend the fifteen-day
time period by providing advance written notice to the hospital and, if
applicable, the union representatives of any involved employees, setting forth
a reasonable justification for an extension of the fifteen-day time period, and
specifying the duration of the extension, which shall be no more than an
additional fifteen days.
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The hospital
shall provide involved employees with notice of any extension.

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(e)
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Variances shall be granted if the department
determines that there is good cause for allowing a hospital to not comply with
the minimum staffing standards in section ‑11.
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The variance order shall state the following:

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(1)
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The alternative minimum registered nurse staffing
standards approved in the variance;

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(2)
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The basis for a finding of good cause;

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(3)
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The group of employees impacted; and

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(4)
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The period of time for which the variance will
be valid, not to exceed thirty days from the date of issuance.

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(f)
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Upon making a determination for issuance of a
variance, the department shall provide notification in writing to the hospital
and, if applicable, the union representatives of any involved employees.
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If the variance is denied, the written
notification shall include a stated basis for the denial.

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(g)
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A hospital, involved employee, and, if
applicable, their union representative, may file with the director a request
for reconsideration within five days after receiving notice of the variance
determination.
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The request for
reconsideration shall set forth the grounds upon which the request is being
made.
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If reasonable grounds exist, the
director may grant a review and, to the extent deemed appropriate, afford all
interested parties an opportunity to be heard.
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If the director grants a review, the written decision of the department
shall remain in place until the reconsideration process is complete, which
shall be no more than ten days after the date the request for reconsideration
is filed with the department.

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(h)
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Unless subject to the reconsideration
process, the director may revoke or terminate the variance order at any time
after giving the hospital at least five days' notice before revoking or
terminating the order.

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(i)
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Where immediate action is necessary pending
further review by the department, the department may issue a temporary
variance.
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The temporary variance shall
remain valid until the department determines whether good cause exists for
issuing a variance.
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A hospital need not
meet the requirement in subsection (b)(4) in order to be granted a temporary
variance.
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If a temporary variance is
approved, the department must issue the temporary variance within the
fifteen-day period set forth in subsection (d) and the temporary variance shall
be part of the thirty-day variance period set forth in subsection (e)(4).
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No extension for the temporary variance shall
be permitted.

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(j)
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If a hospital obtains a variance under this
section, the hospital shall provide the involved employees with information
about the minimum registered nurse staffing standards that apply within five
days of receiving notification of variance approval from the department.
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A hospital shall make this information
readily available to all employees.

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(k)
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The director may adopt rules to establish
additional variance eligibility criteria.

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(l)
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As used in this section, "good
cause" means situations where a hospital can establish that compliance
with the minimum registered nurse staffing standards is not feasible, and that
granting a variance does not have a significant harmful effect on the health,
safety, and welfare of the involved employees and patients.

PART
III.
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REGISTERED NURSE STAFFING PLANS FOR
HOSPITALS

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� -21
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Hospital registered nurse staffing committee;
membership.
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(a)
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No later than September 1, 2025, each
hospital shall establish a hospital registered nurse staffing committee.

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(b)
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A majority of members of a hospital registered
nurse staffing committee shall be registered nurses who are nonsupervisory,
nonmanagerial, and currently providing direct patient care.
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The selection of the nursing personnel shall
be appointed by the registered nurses' collective bargaining representative or
representatives if there is one or more at the hospital.
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If there is no collective bargaining
representative, the members of the hospital registered nurse staffing committee
shall be nursing personnel providing direct patient care and shall be selected
by their peers.

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(c)
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The remaining members of the staffing
committee shall be determined by the hospital administration and shall include
the chief financial officer, chief nursing officer, and patient care unit
directors or managers, or their designees.

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(d)
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A hospital registered nursing staffing
committee shall have two co-chairs to be appointed as follows:

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(1)
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One co-chair who is registered nurse, to be
selected by the registered nurses on the staffing committee; and

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(2)
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One co-chair who is not a registered nurse, to
be selected by the hospital administration.

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(e)
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A majority of members of the hospital
registered nurse staffing committee shall constitute a quorum to do business.

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(f)
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Participation in the hospital registered
nurse staffing committee by a hospital employee shall be on scheduled work time
and compensated at the appropriate rate of pay.
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Members of the staffing committee shall be relieved of all other work
duties during meetings of the committee.
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Additional staffing relief shall be provided if necessary to ensure
members are able to attend staffing committee meetings.

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� -22
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Registered nurse staffing plan; staffing committee responsibilities.
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(a)
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The primary responsibilities of the hospital registered
nurse staffing committee shall include:

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(1)
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Development
and oversight of an annual patient care unit and shift-based staffing plan, in
accordance with the minimum staffing standards established in section ‑11
and based on the needs of patients, to be used as the primary means to ensure
that the hospital is sufficiently staffed to meet the safety and health care
needs for all patients and health care providers;

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(2)
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Semiannual
review of the staffing plan against the ability to meet the staffing standards
established by section ‑11, patient need, and known
evidence-based staffing information, including the nursing sensitive quality
indicators collected by the hospital; and

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(3)
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Review,
assessment, and response to staffing variations or complaints presented to the
committee.

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(b)
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The staffing committee shall use a uniform
format or form, created by the department in consultation with stakeholders
from hospitals and labor organizations, when submitting the annual staffing
plan.
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The uniform format or form shall
provide space to include the factors in paragraphs (1) through (10) and allow
patients and the public to clearly understand and compare staffing patterns and
actual levels of staffing across facilities.
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Hospitals may include a description of additional resources available to
support unit-level patient care and a description of the hospital, including
the size and type of facility.
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Factors
to be considered in the development of the staffing plan shall include:

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(1)
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Census, including total numbers of patients on
the unit on each shift and activity such as patient discharges, admissions, and
transfers;

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(2)
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Level of acuity of all patients and nature of
the care to be delivered on each shift, as well as patient type;

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(3)
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Skill mix;

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(4)
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Level of experience and specialty
certification or training of nursing personnel providing care;

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(5)
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National standards, if applicable;

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(6)
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Ensuring patient's access to care;

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(7)
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The need for specialized or intensive
equipment;

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(8)
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The architecture and geography of the patient
care unit, including but not limited to placement of patient rooms, treatment
areas, nursing stations, medication preparation areas, and equipment;

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(9)
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Availability of other non-registered nurse personnel
supporting nursing services on the unit;

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(10)
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Ability to comply with the terms of an
applicable collective bargaining agreement, if any, and relevant state and
federal laws and rules, including those regarding meals and rest breaks and use
of overtime and on-call shifts; and

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(11)
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Hospital finances and resources.

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(c)
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The registered nurse staffing plan shall not
diminish other standards contained in federal or state law and rules or the
terms of an applicable collective bargaining agreement.

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(d)
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The committee shall produce a written,
hospital-wide registered nurse staffing plan annually.
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The registered nurse staffing plan shall be
adopted by a majority of members of the hospital registered nurse staffing
committee.
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If a quorum of members
present at a meeting comprises an unequal number of registered nurse members
and non-registered nurse members appointed by the hospital administration, a
vote shall be taken with a majority of the registered nurse members and a
minority of the non-registered nurse members voting.
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If this staffing plan is not adopted by
consensus of the hospital registered nurse staffing committee, the prior annual
registered nurse staffing plan shall remain in effect and the hospital shall be
subject to daily fines of $5,000 until the adoption of a new annual registered
nurse staffing plan by consensus of the committee; provided that the following
hospitals shall be subject to daily fines of $100 until the adoption of a new
annual staffing plan by consensus of the committee:

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(1)
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Hospitals certified by the Centers for
Medicare and Medicaid Services as critical access hospitals;

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(2)
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Hospitals having fewer than twenty-five acute
care beds in operation; and

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(3)
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Hospitals certified by the Centers for Medicare
and Medicaid Services as sole community hospitals that:

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(A)
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Have less than one hundred acute care licensed
beds;

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(B)
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Have a level III adult trauma service
designation from the department of health; and

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(C)
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Are
owned and operated by the State.

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(e)
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The chief executive officer of the hospital
shall provide feedback to the hospital registered nurse staffing committee on a
semiannual basis, prior to the staffing committee's semiannual review and
adoption of an annual staffing plan.
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The
feedback shall:

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(1)
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Identify those elements of the staffing plan
the chief executive officer requests changes to, if any; and

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(2)
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Provide a status report on the implementation
of the staffing plan, including nursing sensitive quality indicators collected
by the hospital, patient surveys, and recruitment and retention efforts.

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(f)
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Beginning July 1, 2026, each hospital shall
submit its staffing plan to the department.
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Thereafter, each hospital shall submit its staffing plan to the
department on an annual basis and at any time that the plan is updated.

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� -23
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Registered nurse staffing plan; implementation;
complaints.
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(a)
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Beginning July 1, 2026, each hospital
shall implement the registered nurse staffing plan and assign personnel to each
patient care unit in accordance with the plan.

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(b)
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A registered nurse, collective bargaining
representative, patient, or other person may report to the staffing committee
any variations where the registered nurse in a patient care unit is not in
accordance with the adopted registered nurse staffing plan and may make a
complaint to the staffing committee based on the variations.

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(c)
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Shift-to-shift adjustments in staffing levels
required by the staffing plan may be made by the appropriate hospital personnel
overseeing patient care operations.
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If a
person who is covered by a registered nurse staffing plan on a patient care
unit objects to a shift‑to‑shift adjustment, the person may submit
the complaint to the staffing committee.

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(d)
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Hospital registered nurse staffing committees
shall develop a process to examine and respond to data submitted under
subsections (b) and (c), including the ability to determine if a specific
complaint is resolved or dismiss a complaint based on unsubstantiated data.
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All complaints submitted to the hospital
registered nurse staffing committee shall be reviewed, regardless of what
format the complainant uses to submit the complaint.

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� -24
�
Notice.
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Each hospital shall post, in a public area on each patient care unit,
the registered nurse staffing plan and the staffing schedule for that shift on
that unit, as well as the relevant clinical staffing for that shift.
�
The staffing plan and current staffing levels
shall also be made available to patients and visitors upon request.

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� -25
�
Retaliation prohibited.
�
A hospital shall not discipline, take any
adverse employment action, retaliate against, or engage in any form of
intimidation against:

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(1)
�
An employee for performing any duties or
responsibilities in connection with the staffing committee;

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(2)
�
An employee, patient, or other individual who
notifies the staffing committee or the hospital administration of that person's
concerns regarding nursing or ancillary health care personnel staffing; or

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(3)
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A registered nurse who refuses to work
overtime.

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� -26
�
Critical access hospitals.
�
This part is not intended to create
unreasonable burdens on critical access hospitals designated pursuant to title
42 United States Code section 1395i-4.
�

Critical access hospitals may develop flexible approaches to accomplish
the requirements of this section including but not limited to having hospital
registered nurse staffing committees work by video conference, telephone, or electronic
mail.

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� -27
�
Charter; filing requirements.
�
The hospital registered nurse staffing
committee shall file with the department a charter that shall include:

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(1)
�
Roles, responsibilities, and processes by
which the staffing committee functions, including processes to ensure adequate
quorum and ability of committee members to attend;

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(2)
�
A schedule for monthly meetings, with more
frequent meetings as needed, that ensures committee members have thirty days'
notice of meetings;

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(3)
�
Processes for reviewing all staffing
complaints, noting the date received as well as initial, contingent, and final
disposition of complaints and a corrective action plan, where applicable;

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(4)
�
Processes for resolving all complaints within
ninety days of receipt, or longer with a majority approval of the staffing committee,
and ensuring a complainant receives a letter stating the outcome of the
complaint;

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(5)
�
Processes for attendance by any employee, and
a labor representative if requested by the employee, who is involved in a
complaint;

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(6)
�
Processes for the staffing committee to
conduct quarterly reviews of staff turnover rates, including new hire turnover
rates during the first year of employment and hospital plans regarding
workforce development;

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(7)
�
Standards for the staffing committee's
approval of meeting documentation, including meeting minutes, attendance, and
actions taken; and

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(8)
�
Policies for retention of meeting
documentation for a minimum of three years; provided that the policy shall be
consistent with each hospital's document retention policies.

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� -28
�
Department investigations.
�
(a)
�

The department shall investigate a complaint submitted under this
section for alleged violations of this part following receipt of a complaint
with documented evidence of failure to:

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(1)
�
Form or establish a hospital registered nurse
staffing committee;

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(2)
�
Conduct a semiannual review of a staffing
plan;

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(3)
�
Submit a staffing plan on an annual basis and
any updates; or

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(4)
�
Follow the personnel assignments in a patient
care unit in violation of section ‑11 or section ‑23(a),
or shift-to-shift adjustments in staffing levels in violation of section ‑23(c).

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(b)
�
After an investigation conducted pursuant to
subsection (a), if the department determines that there has been a violation,
the department shall require the hospital to submit a corrective plan of action
within thirty days of the presentation of findings from the department to the
hospital.

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(c)
�
Hospitals shall not be found in violation of section
‑11 or section ‑23(a) if the
department determines, following an investigation, that:

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(1)
�
There were unforeseeable emergent
circumstances; or

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(2)
�
The hospital, after consultation with the
hospital registered nurse staffing committee, documents that the hospital has
made reasonable efforts to obtain and retain staffing to meet required
personnel assignments but has been unable to do so.

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(d)
�
No later than thirty days after a hospital
deviates from its staffing plan as adopted by the hospital registered nurse staffing
committee, the hospital incident command shall report to the staffing committee
an assessment of the staffing needs arising from the unforeseeable emergent
circumstance and the hospital's plan to address those identified staffing
needs.
�
Upon receipt of the report, the staffing
committee shall convene to develop a contingency staffing plan to address the
needs arising from the unforeseeable emergent circumstance.
�
The hospital's deviation from its staffing
plan may not be in effect for more than ninety days without the approval of the
staffing committee.

����
(e)
�
If a hospital fails to submit, or submits but
fails to follow, a corrective plan of action in response to a violation or
violations found by the department based on a complaint filed pursuant to
subsection (a), the department may impose, for all violations asserted against
a hospital at any time, a civil penalty of $5,000 per day; provided that the
fine shall be $100 per day for hospitals:

����
(1)
�
Certified by the Centers for Medicare and
Medicaid Services as critical access hospitals;

����
(2)
�
Having fewer than twenty-five acute care beds
in operation; and

����
(3)
�
Certified by the Centers for Medicare and Medicaid
Services as sole community hospitals that:

���������
(A)
�
Have less than one hundred fifty acute care
licensed beds;

���������
(B)
�
Have a level III adult trauma service
designation from the department of health; and

���������
(C)
�
Are owned and operated by the State.

Civil penalties shall apply until the hospital
submits a corrective plan of action that has been approved by the department
and follows the corrective plan of action for ninety days.
�
Once the approved corrective action plan has
been followed by the hospital for ninety days, the department may reduce the
accumulated fine.
�
The fine shall
continue to accumulate until the ninety days has passed.

����
(f)
�
The department shall:

����
(1)
�
Maintain for public inspection records of any
civil penalties and administrative actions imposed on hospitals under this
section; and

����
(2)
�
Report violations of this section on its
website.

����
(g)
�
Nothing in this section shall be construed to
preclude the ability to otherwise submit a complaint to the department for
failure to follow this chapter.

����
� -29
�
Review of staffing plans by the department.
�
(a)
�

The department shall review each staffing plan submitted by a hospital pursuant
to section -23(f) to ensure it is received by the appropriate
deadline and is completed on the department-issued staffing plan form.

����
(b)
�
A hospital shall complete all portions of the
staffing plan form issued by the department.
�

The department may determine that a hospital has failed to timely submit
its staffing plan if the staffing plan form is incomplete.

����
(c)
�
Failure to submit the registered nurse staffing
plan or registered nurse staffing committee charter by the appropriate deadline
shall be a violation punishable by a civil penalty of $25,000 issued by the
department.

����
(d)
�
The department shall post on its website:

����
(1)
�
Hospital registered nurse staffing plans;

����
(2)
�
Hospital registered nurse staffing committee
charters; and

����
(3)
�
Violations of this section.

PART IV.
�
COMPLAINTS

����
� -31
�
Complaints.
�
(a)
�
If
a complainant files a complaint with the department alleging a violation of
this chapter, the department shall investigate the complaint; provided that
nothing in this part shall prohibit the department from taking any other
enforcement action authorized elsewhere in this chapter or pursuant to any
other law.

����
(b)
�
The department shall not investigate any
alleged violation of rights that occurred more than sixty days before the date
on which the complainant filed the complaint.

����
(c)
�
Upon the investigation of a complaint, the
department shall issue either a citation and notice of assessment or a closure
letter, within ninety days after the date on which the department received the
complaint, unless the complaint is otherwise resolved.
�
The department may extend the period by
providing advance written notice to the complainant and the hospital setting
forth good cause for an extension of the period and specifying the duration of
the extension.

����
(d)
�
The department shall send a citation and
notice of assessment or the closure letter to both the hospital and the
complainant by service of process or using a method by which the mailing can be
tracked, or the delivery can be confirmed, to the hospital's and complainant's
last known addresses.

����
(e)
�
If the department's investigation finds that
the complainant's allegation cannot be substantiated, the department shall
issue a closure letter to the complainant and the hospital detailing that
finding.

����
(f)
�
If the department finds a violation of this
chapter, the department shall order the hospital to pay the department a civil
penalty.
�
Except as provided otherwise in
this chapter, the maximum civil penalty shall be:

����
(1)
�
$1,000 for each violation for the first three
violations;

����
(2)
�
$2,500 for a fourth violation; and

����
(3)
�
$5,000 for each subsequent violation.

����
(g)
�
At any time, the department may waive or
reduce a civil penalty assessed under this section if the director determines
that the hospital has taken corrective action to resolve the violation.

����
� -32
�
Appeals.
�

(a)
�
A person aggrieved by a
citation and notice of assessment by the department under this chapter may
appeal the citation and notice of assessment to the director by filing a notice
of appeal with the director within thirty days of the department's issuance of
the citation and notice of assessment.
�
A
citation and notice of assessment not appealed within thirty days shall be
final and binding, and shall not subject to further appeal.

����
(b)
�
A notice of appeal filed with the director
under this section shall stay the effectiveness of the citation and notice of
assessment pending final review of the appeal by the director.

����
(c)
�
Upon receipt of a notice of appeal, the
director shall assign the hearing to a hearings officer to conduct a hearing
and issue an initial order.
�
The hearing
and review procedures shall be conducted in accordance with chapter 91.
�
Upon appeal, the citation and notice of
assessment shall be subject to a de novo review by a hearings officer.
�
Any party who seeks to challenge an initial
order shall file a petition for administrative review with the director within
thirty days after service of the initial order.
�

The director shall conduct administrative review in accordance with
chapter 91.

����
(d)
�
The director shall issue all final orders
after appeal of the initial order.
�
The
final order of the director is subject to judicial review in accordance with
chapter 91.

����
(e)
�
Orders that are not appealed within the time
period specified in this section and chapter 91 shall be final and binding and shall
not be subject to further appeal.

����
(f)
�
A hospital that fails to allow adequate
inspection of records in an investigation by the department under this chapter
within a reasonable time period shall not use those records in any appeal under
this section to challenge the correctness of any determination by the
department of the penalty assessed."

����
SECTION
3.
�
There is appropriated out of the
general revenues of the State of Hawaii the sum of
$ or so much
thereof as may be necessary for fiscal year 2025-2026 and the same sum or so
much thereof as may be necessary for fiscal year 2026-2027 to implement and
enforce section 2 of this Act.

����
The sums

appropriated shall be expended by the
department of labor and industrial relations for the purposes of this Act.

����
SECTION 4.
�
This Act does not affect rights and duties
that matured, penalties that were incurred, and proceedings that were begun
before its effective date.

����
SECTION 5.
�
This Act shall take effect upon its approval;
provided that section 3 shall take effect on July 1, 2025.

INTRODUCED BY:

_____________________________

Report Title:

DLIR; Registered Nurses; Hospitals; Staffing Requirements

Description:

Establishes
certain minimum registered nurse-to-patient staffing requirements for
hospitals.
�
No later than 9/1/2025,
requires hospitals to create hospital registered nurse staffing committees.
�
Beginning 7/1/2026, requires hospitals to
implement registered nurse staffing plans.
�

Appropriates funds.

The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.