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1 | AN ACT concerning health facilities.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | 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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7 | of the following:
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8 | (1) Health care services are becoming complex and it is
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9 | increasingly difficult for patients to access integrated
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10 | services.
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11 | (2) Quality of patient care could be impacted by
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12 | staffing changes implemented in response to managed care.
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13 | (3) To ensure the adequate protection of patients in
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14 | acute care settings, it is essential that qualified
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15 | registered nurses be accessible and available to meet the
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16 | needs of patients.
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17 | (4) The basic principles of staffing in the acute care
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18 | setting should be based on the patient's care needs, the
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19 | 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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24 | Section 10. Definitions. In this Act: | |||||||||||||||||||
25 | "Hospital" means an entity licensed under the Hospital
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26 | Licensing Act or a University of Illinois hospital as defined
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27 | in the University of Illinois Hospital Act.
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28 | "Nurse" means a person licensed as a licensed practical
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29 | nurse or registered professional nurse under the Nursing and
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30 | Advanced Practice Nursing Act.
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31 | "Overtime" means work in excess of an agreed-to,
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1 | 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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5 | "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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8 | "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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16 | "Workplace design to prevent and mitigate errors" means a
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17 | nursing work environment and care process to reduce errors and
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18 | enhance patient safety.
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19 | "Written staffing plan for nursing services" means a
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20 | 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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23 | under normal and emergent circumstances.
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24 | Section 15. Written staffing plan for nursing services. | ||||||
25 | (a) Every hospital is responsible for the development and
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26 | implementation of a hospital-wide written staffing plan for
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27 | 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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32 | organizational plan and shall be available to all nursing
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33 | 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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1 | 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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15 | (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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20 | (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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26 | (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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31 | (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.
| ||||||
36 | (5) The plan must provide that registered professional |
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1 | nurses must
be present whenever patient care is delivered.
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2 | (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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10 | (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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16 | 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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21 | (1) Patient outcome indicators that have been shown
to | ||||||
22 | correlate with nurse staffing, as those indicators are
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23 | developed by nationally recognized nursing organizations.
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24 | (2) Acceptable and prevailing standards of safe
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25 | nursing care.
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26 | (3) Hospital reports and analysis of incidents and
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27 | injuries to patients, nursing staff, and other nursing | ||||||
28 | personnel.
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29 | (4) Available reports and surveys of patient
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30 | satisfaction and nurse satisfaction that correlate to the
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31 | quality of nursing care provided in the hospital.
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32 | (5) Criteria required by State or federal law for
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33 | assessing the quality of patient care provided by a
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34 | hospital.
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35 | (6) American Nurse Credentialing Center Magnet
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36 | Hospital elements and
American Nurses Association |
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1 | Principles for Nurse Staffing. | ||||||
2 | (7) Any other criteria the committee considers | ||||||
3 | appropriate.
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4 | (d) Not later than 6 months after the effective date of
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5 | 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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12 | (e) Whenever the committee determines that the staffing
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13 | plan that the committee has selected for the hospital no longer
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14 | meets the staffing requirements necessary to meet the health
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15 | 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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18 | (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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21 | (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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26 | (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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30 | for the purpose of selecting the patient classification system
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31 | to be used in establishing staffing requirements pursuant to
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32 | Section 15. A hospital shall appoint members
of the committee | ||||||
33 | in accordance with the following:
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34 | (1) At least 50% of the members of the
committee shall | ||||||
35 | be comprised of registered professional nurses
who are |
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1 | staff nurses providing direct patient care.
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2 | (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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6 | 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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9 | (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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13 | (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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17 | (3) Includes methods to ensure the validity and | ||||||
18 | reliability
of its projection of staffing requirements.
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19 | (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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27 | 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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29 | excess of 60 hours in any 7-day period.
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30 | (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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34 | (c) A hospital may not require a nurse to work:
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1 | (1) more than 12 hours in any 24-hour period; or
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2 | (2) more than 60 hours in any 7-day period.
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3 | (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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8 | (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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11 | (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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15 | (1) The hospital must comply with the staffing | ||||||
16 | requirements established under
subsection (b) of Section | ||||||
17 | 15.
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18 | (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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22 | (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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29 | employment decision adverse to the employee.
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30 | (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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1 | (c) The provisions of this Section do not apply to nursing
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2 | staff needs in the event of a national or State emergency or
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3 | circumstances requiring the implementation of a hospital
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4 | 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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10 | 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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12 | 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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17 | (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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20 | less than $2,000 for each week in which the violation occurs.
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21 | 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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27 | day in the immediately preceding week.
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28 | (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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31 | (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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34 | (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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1 | 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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5 | to the Department of Public Health for nursing scholarships
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6 | awarded pursuant to the Nursing Education Scholarship Law.
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7 | Section 99. Effective date. This Act takes effect upon | ||||||
8 | becoming law.
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