September 3, 2014

The Honorable Edmund G. Brown, Jr.

Governor, State of California
State Capitol
Sacramento, California 95814

SUBJECT: AB 2616 (Skinner) REQUEST FOR VETO

Dear Governor Brown:

The California Hospital Association (CHA), representing nearly 400 hospitals and health systems,
respectfully requests your veto on AB 2616 (Skinner). This bill would establish a presumption for
Methicillin-resistant staphylococcus aureus (MRSA) skin infection in the workers compensation system
for most public and private hospital employees.

AB 2616 would relieve employees from having to demonstrate that a MRSA skin infection arose out of
their work when seeking the full range of workers compensation benefits, which can range from $4500 to
$300,000 for an individual case.

Previous efforts to establish this presumption have failed. There is absolutely no data to support this
presumption:

The sponsors have not produced any evidence that it is necessary or appropriate to extend
presumptions outside public safety positions and into the private sector. Currently, public sector
employees are granted a presumption because they are first responders and are among those
responsible for going immediately to the scene of an accident where the conditions are unknown.
Nurses in acute care hospitals are not first responders and work in a controlled, sterile
environment with numerous infection control and prevention protocols in place.

There is absolutely no clinical or scientific basis upon which to support this presumption. The
data with respect to hospital-acquired MRSA infections pertains only to hospitalized patients.
MRSA skin infections of the type identified in AB 2616 are caused by a unique strain of MRSA
which is most often contracted in the community.

There is no data whatsoever to support the idea that health care workers following accepted
infection prevention behaviors are at risk for developing MRSA skin infections as a result of their
occupation. Given the documented increase in community-acquired MRSA infection rates as well
as the known risk factors for community exposure, health care workers who contract a MRSA
skin infection are far more likely to have contracted the infection outside of work than during the
course of their occupation.







The Honorable Edmund G. Brown, Jr. September 3, 2014 Page 2


Application of this presumption in the context of the workers compensation system poses additional
challenges. While styled as a rebuttable presumption, a hospital could only overcome the presumption by
proving the complete absence of a relationship to work. Given the realities of the workplace and the
workers compensation system, this would be an insurmountable hurdle. Another serious problem arises
from the fact that a large percentage of direct patient care workers are employed by two or more hospitals.
This bill would burden one hospital with the entire claim.

Lastly, approximately 75 percent of Californias public and private hospitals, from small, rural hospitals
to large state and county hospitals self-insure for workers compensation. Under California law, an
employer that self-insures for workers compensation must reserve for the worst case scenario on each
claim for the employees life expectancy. Thus, any increase in workers compensation costs will have a
direct and immediate impact on the hospitals budget and the amount of resources available for patient
care. It is unreasonable to add this additional burden to hospitals, particularly when over 50 percent of
California hospitals operate in the red.

AB 2616 is a bill with a solution in search of a problem. The sponsors of this bill have not provided any
documentation that substantiates that legitimate MRSA workers compensation claims are being denied at
a rate that would warrant such a divergence from existing law.

For these reasons, CHA respectfully asks for your veto on AB 2616.

Sincerely,
Kathryn Scott
Legislative Advocate

KAS:dlv