S T A T E   O F   N E W   Y O R K
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                                 3839--A

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              April 2, 2009
                               ___________

Introduced  by  Sens.  DUANE,  ADDABBO,  DIAZ,  FOLEY,  KLEIN,  KRUEGER,
  MAZIARZ, MONTGOMERY, OPPENHEIMER, PARKER, PERALTA,  PERKINS,  STACHOW-
  SKI,  THOMPSON  -- read twice and ordered printed, and when printed to
  be committed to the Committee on Health -- recommitted to the  Commit-
  tee  on  Health  in accordance with Senate Rule 6, sec. 8 -- committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN ACT to amend the public health law and the education law, in relation
  to a safe patient handling policy for health care facilities

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. Article 29-D of the public health law is amended by adding
a new title 4 to read as follows:
                                 TITLE 4
                      SAFE PATIENT HANDLING POLICY
SECTION 2999-G. LEGISLATIVE INTENT.
        2999-H. DEFINITIONS.
        2999-I. NEW YORK STATE SAFE PATIENT HANDLING TASK FORCE.
        2999-J. STATEWIDE SAFE PATIENT HANDLING POLICY.
        2999-K. HEALTH CARE FACILITY SAFE PATIENT HANDLING COMMITTEES.
        2999-L. ENFORCEMENT.
  S  2999-G.  LEGISLATIVE  INTENT.  THE  LEGISLATURE  HEREBY  FINDS  AND
DECLARES  THAT  IT  IS  IN THE PUBLIC INTEREST TO ENACT A STATEWIDE SAFE
PATIENT HANDLING POLICY FOR HEALTH CARE FACILITIES IN  NEW  YORK  STATE.
WITHOUT  SAFE  PATIENT  HANDLING  LEGISLATION,  IT IS PREDICTED THAT THE
DEMAND FOR NURSING SERVICES WILL EXCEED  THE  SUPPLY  BY  NEARLY  THIRTY
PERCENT  BY  THE YEAR TWO THOUSAND TWENTY THUS DECREASING THE QUALITY OF
HEALTH CARE IN NEW YORK STATE.   THERE ARE MANY  BENEFITS  THAT  CAN  BE
DERIVED  FROM  SAFE PATIENT HANDLING PROGRAMS.  PATIENTS BENEFIT THROUGH
IMPROVED QUALITY OF CARE AND QUALITY OF LIFE BY  REDUCING  THE  RISK  OF
FALLS, BEING DROPPED, FRICTION BURNS, SKIN TEARS AND BRUISES. CAREGIVERS

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10860-05-0
              

S. 3839--A                          2

BENEFIT FROM THE REDUCED RISK OF CAREER ENDING AND DEBILITATING INJURIES
LEADING  TO INCREASED MORALE, IMPROVED JOB SATISFACTION AND LONGEVITY IN
THE PROFESSION. HEALTH CARE FACILITIES REALIZE A QUICK RETURN  ON  THEIR
INVESTMENT  THROUGH  REDUCED WORKERS' COMPENSATION MEDICAL AND INDEMNITY
COSTS, REDUCED LOST WORKDAYS AND IMPROVED RECRUITMENT AND  RETENTION  OF
CAREGIVERS.  ALL  OF THIS WILL LEAD TO FISCAL IMPROVEMENT IN HEALTH CARE
IN NEW YORK STATE.
  S 2999-H. DEFINITIONS. FOR THE PURPOSES OF THIS TITLE:
  1. "HEALTH CARE FACILITY"  SHALL  MEAN  ANY  INDIVIDUAL,  PARTNERSHIP,
ASSOCIATION,  CORPORATION,  LIMITED  LIABILITY  COMPANY OR ANY PERSON OR
GROUP OF PERSONS ACTING DIRECTLY OR INDIRECTLY ON BEHALF OF  OR  IN  THE
INTEREST  OF  THE  EMPLOYER,  WHICH  PROVIDES  HEALTH CARE SERVICES IN A
FACILITY LICENSED OR OPERATED PURSUANT TO ARTICLE TWENTY-EIGHT,  TWENTY-
EIGHT-A  OR  THIRTY-SIX  OF THIS CHAPTER, OR THE MENTAL HYGIENE LAW, THE
EDUCATION LAW OR THE CORRECTION LAW, INCLUDING ANY FACILITY OPERATED  BY
THE  STATE,  A  POLITICAL SUBDIVISION OR A PUBLIC BENEFIT CORPORATION AS
DEFINED BY SECTION SIXTY-SIX OF THE GENERAL CONSTRUCTION LAW.
  2. "NURSE" SHALL MEAN A REGISTERED PROFESSIONAL NURSE  OR  A  LICENSED
PRACTICAL  NURSE  AS  DEFINED  BY ARTICLE ONE HUNDRED THIRTY-NINE OF THE
EDUCATION LAW.
  3. "DIRECT CARE WORKER" SHALL MEAN  ANY  EMPLOYEE  OF  A  HEALTH  CARE
FACILITY  THAT IS RESPONSIBLE FOR PATIENT HANDLING OR PATIENT ASSESSMENT
AS A REGULAR OR INCIDENTAL  PART  OF  THEIR  EMPLOYMENT,  INCLUDING  ANY
LICENSED OR UNLICENSED HEALTH CARE WORKER.
  4.  "EMPLOYEE  REPRESENTATIVE"  SHALL MEAN THE RECOGNIZED OR CERTIFIED
COLLECTIVE BARGAINING AGENT FOR NURSES  OR  DIRECT  CARE  WORKERS  OF  A
HEALTHCARE FACILITY.
  5. "SAFE PATIENT HANDLING" SHALL MEAN THE USE OF ENGINEERING CONTROLS,
LIFTING  AND  TRANSFER  AIDS,  OR ASSISTIVE DEVICES, BY NURSES OR DIRECT
CARE WORKERS, INSTEAD OF MANUAL LIFTING TO PERFORM THE ACTS OF  LIFTING,
TRANSFERRING AND REPOSITIONING OF HEALTH CARE PATIENTS AND RESIDENTS.
  6. "SAFE PATIENT HANDLING PROGRAM" SHALL INCLUDE:
  (A) A WRITTEN POLICY STATEMENT; AND
  (B) MANAGEMENT COMMITMENT AND EMPLOYEE INVOLVEMENT; AND
  (C) COMMITTEES; AND
  (D) RISK ASSESSMENTS; AND
  (E) INCIDENT INVESTIGATION; AND
  (F)  PROCUREMENT OF ENGINEERING CONTROLS, LIFTING AND TRANSFER AIDS OR
ASSISTIVE DEVICES TO ENSURE SAFE PATIENT HANDLING; AND
  (G) EMPLOYEE TRAINING AND EDUCATION ON SAFE PATIENT HANDLING; AND
  (H) PROGRAM EVALUATION AND MODIFICATION.
  S 2999-I. NEW YORK STATE SAFE PATIENT HANDLING TASK FORCE.  1.  A  NEW
YORK STATE SAFE PATIENT HANDLING TASK FORCE IS HEREBY CREATED WITHIN THE
DEPARTMENT.   SUCH TASK FORCE SHALL CONSIST OF A TOTAL OF ELEVEN MEMBERS
AND SHALL INCLUDE THE COMMISSIONER OR HIS OR HER DESIGNEE;  THE  COMMIS-
SIONER  OF  LABOR OR HIS OR HER DESIGNEE; THREE MEMBERS APPOINTED BY THE
GOVERNOR, TWO SUCH MEMBERS  SHALL  BE  REPRESENTATIVES  OF  HEALTH  CARE
ORGANIZATIONS,  ONE  SUCH  MEMBER SHALL BE FROM AN EMPLOYEE ORGANIZATION
REPRESENTING NURSES AND ONE SUCH MEMBER SHALL BE FROM AN EMPLOYEE ORGAN-
IZATION REPRESENTING DIRECT CARE WORKERS;  TWO  SUCH  MEMBERS  SHALL  BE
CERTIFIED ERGONOMIST EVALUATION SPECIALISTS; TWO MEMBERS TO BE APPOINTED
BY  THE  TEMPORARY  PRESIDENT OF THE SENATE, WHO SHALL HAVE EXPERTISE IN
FIELDS OF DISCIPLINE RELATED TO HEALTH CARE OR OCCUPATIONAL  SAFETY  AND
ONE  SUCH  APPOINTEE SHALL BE FROM AN ORGANIZATION REPRESENTING EITHER A
NURSE OR DIRECT CARE WORKER; TWO MEMBERS TO BE APPOINTED BY THE  SPEAKER
OF  THE  ASSEMBLY,  WHO  SHALL  HAVE  EXPERTISE  IN FIELDS OF DISCIPLINE

S. 3839--A                          3

RELATED TO HEALTH CARE OR OCCUPATIONAL SAFETY  AND  ONE  SUCH  APPOINTEE
SHALL BE FROM AN ORGANIZATION REPRESENTING EITHER A NURSE OR DIRECT CARE
WORKER; ONE MEMBER TO BE APPOINTED BY THE MINORITY LEADER OF THE SENATE,
WHO  SHALL HAVE EXPERTISE IN FIELDS OF DISCIPLINE RELATED TO HEALTH CARE
OR OCCUPATIONAL SAFETY; AND ONE MEMBER APPOINTED BY THE MINORITY  LEADER
OF  THE  ASSEMBLY,  WHO  SHALL  HAVE  EXPERTISE  IN FIELDS OF DISCIPLINE
RELATED TO HEALTH CARE OR OCCUPATIONAL SAFETY.
  2.  TASK  FORCE  MEMBERS  SHALL  RECEIVE  NO  COMPENSATION  FOR  THEIR
SERVICES,  BUT  SHALL  BE  REIMBURSED  FOR ACTUAL AND NECESSARY EXPENSES
INCURRED IN THE PERFORMANCE OF THEIR DUTIES.
  3. THE TASK FORCE SHALL BE APPOINTED NO LATER  THAN  JULY  FIRST,  TWO
THOUSAND ELEVEN AND SHALL SERVE FOR A PERIOD OF TWO YEARS; ANY VACANCIES
ON  THE  TASK  FORCE  SHALL  BE FILLED IN THE MANNER PROVIDED FOR IN THE
INITIAL APPOINTMENT.
  4. THE CHAIRPERSON OF THE TASK FORCE SHALL BE THE COMMISSIONER OR  HIS
OR HER DESIGNEE.
  5. THE TASK FORCE SHALL MEET NO LESS THAN THREE TIMES A YEAR.
  6.  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF  LAW, A MAJORITY OF THE
MEMBERS OF THE TASK FORCE THEN IN OFFICE SHALL CONSTITUTE A  QUORUM  FOR
THE  TRANSACTION OF BUSINESS OR THE EXERCISE OF POWER OR FUNCTION OF THE
TASK FORCE. AN ACT, DETERMINATION OR DECISION OF  THE  MAJORITY  OF  THE
MEMBERS  OF THE TASK FORCE SHALL BE HELD TO BE THE ACT, DETERMINATION OR
DECISION OF THE TASK FORCE.
  7. THE TASK FORCE SHALL:
  (A) PREPARE A POLICY STATEMENT REQUIRING A COMPREHENSIVE SAFE  PATIENT
HANDLING  PROGRAM  TO  BE  IMPLEMENTED AT ALL HEALTH CARE FACILITIES, AS
DEFINED IN SUBDIVISION ONE OF SECTION TWENTY-NINE HUNDRED  NINETY-NINE-H
OF  THIS TITLE.  THE POLICY STATEMENT SHALL INCLUDE THE REQUIREMENTS FOR
DEVELOPING AND IMPLEMENTING AN EFFECTIVE SAFE PATIENT  HANDLING  PROGRAM
THAT  SHALL INCLUDE ALL ELEMENTS SPECIFIED IN SUBDIVISION SIX OF SECTION
TWENTY-NINE HUNDRED NINETY-NINE-H OF THIS TITLE;
  (B) REVIEW  EXISTING  SAFE  PATIENT  HANDLING  PROGRAMS  OR  POLICIES,
INCLUDING  DEMONSTRATION PROGRAMS PREVIOUSLY AUTHORIZED BY CHAPTER SEVEN
HUNDRED THIRTY-EIGHT OF THE LAWS OF TWO THOUSAND FIVE;
  (C) CONSULT WITH  ANY  ORGANIZATION,  EDUCATIONAL  INSTITUTION,  OTHER
GOVERNMENT ENTITY OR AGENCY OR PERSON;
  (D) CONDUCT PUBLIC HEARINGS, AS IT DEEMS NECESSARY;
  (E)  IDENTIFY OR DEVELOP TRAINING MATERIALS AND PROCEDURES WITH REGARD
TO THE EQUIPMENT OR TECHNOLOGY REQUIRED BY THE STATEWIDE POLICY;
  (F) REVIEW RULES AND REGULATIONS PRIOR TO ADOPTION BY THE DEPARTMENT;
  (G) REVIEW AND UPDATE THE POLICY STATEMENT ON A BI-ANNUAL BASIS; AND
  (H) SUBMIT A REPORT TO THE COMMISSIONER BY JULY  FIRST,  TWO  THOUSAND
TWELVE  IDENTIFYING SAFE PATIENT HANDLING PROGRAM ELEMENTS AND RECOMMEN-
DATIONS OF SAFE PATIENT LIFTING EQUIPMENT, TECHNIQUES OR DEVICES.
  8. ALL STATE DEPARTMENTS, COMMISSIONS, AGENCIES AND PUBLIC AUTHORITIES
SHALL PROVIDE THE TASK FORCE WITH ANY REASONABLY REQUESTED ASSISTANCE OF
ADVICE IN A TIMELY MANNER.
  S 2999-J. STATEWIDE SAFE PATIENT HANDLING POLICY. 1. THE COMMISSIONER,
IN CONSULTATION WITH THE TASK FORCE, SHALL PROMULGATE  RULES  AND  REGU-
LATIONS  FOR  A  STATEWIDE  SAFE PATIENT HANDLING POLICY FOR HEALTH CARE
FACILITIES COVERED BY THIS TITLE. SUCH POLICY SHALL BE MADE AVAILABLE TO
ALL FACILITIES COVERED BY THIS TITLE ON OR  BEFORE  JANUARY  FIRST,  TWO
THOUSAND THIRTEEN.
  2.  THE STATEWIDE SAFE PATIENT HANDLING POLICY SHALL INCLUDE STANDARDS
WITH REGARD TO:

S. 3839--A                          4

  (A) THE EQUIPMENT, DEVICES OR TECHNOLOGY TO BE  USED  BY  A  NURSE  OR
DIRECT CARE WORKER WHO IS ENGAGED IN PATIENT HANDLING;
  (B)  THE  RATIO OF SUCH EQUIPMENT OR TECHNOLOGY BASED UPON THE TYPE OF
FACILITY, THE NUMBER OF BEDS IN A FACILITY, THE NUMBER  OF  PATIENT-HAN-
DLING  TASKS, TYPES OF CARE UNITS, PATIENT POPULATIONS, AND PATIENT CARE
AREAS;
  (C) THE MINIMUM NUMBER OF DEVICES  TO  ENSURE  THAT  CURRENT  ASSESSED
HAZARDS ARE ELIMINATED OR MITIGATED;
  (D)  ESTABLISHING  PROCEDURES  FOR  THE  SUBMISSION  AND  REPORTING OF
COMPLIANCE BY EACH HEALTH CARE FACILITY COVERED BY THIS TITLE; AND
  (E) ESTABLISHING PROCEDURES FOR COMPLAINTS  OR  VIOLATIONS,  INCLUDING
THE FILING PROCESS, REVIEW, AND EVALUATION AND CORRECTIVE ACTION OF SUCH
COMPLAINTS.
  3.  EACH  HEALTH  CARE FACILITY SHALL FILE WITH THE DEPARTMENT BY JULY
FIRST, TWO THOUSAND THIRTEEN A DETAILED PLAN TO COMPLY  WITH  THE  RULES
AND  REGULATIONS  OF  THE  STATEWIDE  SAFE  PATIENT HANDLING POLICY. THE
DEPARTMENT SHALL ACCEPT SUCH PLAN BY JULY FIRST, TWO THOUSAND FOURTEEN.
  S 2999-K. HEALTH CARE FACILITY SAFE PATIENT  HANDLING  COMMITTEES.  1.
EACH  HEALTH  CARE  FACILITY  SHALL  ESTABLISH  A  SAFE PATIENT HANDLING
COMMITTEE EITHER BY CREATING A NEW COMMITTEE OR ASSIGNING THE POWERS AND
DUTIES TO AN EXISTING COMMITTEE.  AT LEAST ONE-HALF OF  THE  MEMBERS  OF
THE  SAFE  PATIENT  HANDLING COMMITTEE SHALL BE FRONTLINE NON-MANAGERIAL
NURSES OR DIRECT CARE WORKERS. AT LEAST ONE NON-MANAGERIAL NURSE AND ONE
NON-MANAGERIAL DIRECT CARE WORKER SHALL BE ON THE SAFE PATIENT  HANDLING
COMMITTEE.  THE COMMITTEE SHALL HAVE TWO CO-CHAIRS WITH ONE FROM MANAGE-
MENT AND ONE FRONTLINE NON-MANAGERIAL NURSE OR DIRECT CARE WORKER.
  2. THE SAFE PATIENT HANDLING COMMITTEE SHALL:  (A)  SET  CRITERIA  FOR
EVALUATION  OF  PATIENTS AND/OR RESIDENTS TO DETERMINE WHICH LIFT AND/OR
REPOSITIONING EQUIPMENT, DEVICES OR TECHNOLOGY ARE TO BE USED;  AND  FOR
PERFORMANCE  OF  RISK  ASSESSMENTS  OF  THE  ENVIRONMENT,  JOB TASKS AND
PATIENT NEEDS;
  (B) ENSURE LIFT AND/OR REPOSITIONING EQUIPMENT IS  SET  UP,  USED  AND
MAINTAINED ACCORDING TO MANUFACTURER'S INSTRUCTIONS;
  (C) PROVIDE INITIAL AND ON-GOING YEARLY TRAINING AND EDUCATION ON SAFE
PATIENT  HANDLING  FOR  CURRENT EMPLOYEES AND NEW HIRES, AND ENSURE THAT
RETRAINING FOR THOSE FOUND TO BE DEFICIENT IS PROVIDED AS NEEDED WITHOUT
IMPACT TO THE EMPLOYMENT STATUS OF THE RETRAINED EMPLOYEES;
  (D) SET UP AND UTILIZE A PROCESS FOR INCIDENT INVESTIGATION AND  POST-
INVESTIGATION REVIEW WHICH INCLUDES A PLAN OF CORRECTION AND IMPLEMENTA-
TION OF CONTROLS;
  (E)  MAKE  RECOMMENDATIONS  FOR THE ACQUISITION OF EQUIPMENT OR PROCE-
DURES BEYOND THE MINIMUM STATE RECOMMENDATIONS; AND
  (F) PERFORM, AT MINIMUM, AN ANNUAL PROGRAM ASSESSMENT AND EVALUATION.
  S 2999-L. ENFORCEMENT. 1. ANY NURSE OR DIRECT CARE WORKER OR  EMPLOYEE
REPRESENTATIVE  WHO  BELIEVES  THE  HEALTH CARE FACILITY HAS NOT MET THE
STANDARDS SET FORTH IN THIS TITLE SHALL BRING THE MATTER TO  THE  ATTEN-
TION  OF  THE  HEALTH  CARE FACILITY IN THE FORM OF A WRITTEN NOTICE AND
SHALL AFFORD THE  HEALTH  CARE  FACILITY  A  REASONABLE  OPPORTUNITY  TO
CORRECT  SUCH  DEFICIENCIES,  PROVIDED  THAT  SUCH  NOTICE  NEED  NOT BE
PROVIDED WHERE THE NURSE OR DIRECT  WORKER  OR  EMPLOYEE  REPRESENTATIVE
REASONABLY BELIEVES THAT THE FAILURE TO MEET STANDARDS PRESENTS AN IMMI-
NENT  THREAT TO THE SAFETY OF A SPECIFIC NURSE OR DIRECT CARE WORKER, OR
TO THE GENERAL HEALTH OF A SPECIFIC  PATIENT,  AND  REPORTING  WILL  NOT
RESULT IN CORRECTIVE ACTION.
  2.  IN THE EVENT THAT THE HEALTH CARE FACILITY RECEIVING NOTICE PURSU-
ANT TO SUBDIVISION ONE OF THIS SECTION DOES NOT TAKE  CORRECTIVE  ACTION

S. 3839--A                          5

WITHIN  SIXTY  DAYS,  OR  IN  THE EVENT THAT NOTICE OF A FAILURE TO MEET
STANDARDS IS NOT REQUIRED PURSUANT TO SUBDIVISION ONE OF THIS SECTION, A
NURSE OR DIRECT CARE WORKER SHALL HAVE THE RIGHT TO REFUSE TO ENGAGE  IN
PATIENT HANDLING UNTIL THE HEALTH CARE FACILITY HAS ADEQUATELY ADDRESSED
THE  SPECIFIC  FAILURE  TO MEET STANDARDS.   UPON REFUSAL, SUCH NURSE OR
DIRECT CARE WORKER OR HIS OR HER REPRESENTATIVE SHALL FILE  A  COMPLAINT
TO  THE DEPARTMENT IN THE MANNER SET FORTH IN THE STATEWIDE SAFE PATIENT
HANDLING POLICY.
  3. NO EMPLOYER SHALL TAKE RETALIATORY  ACTION  AGAINST  ANY  NURSE  OR
DIRECT CARE WORKER FOR RAISING CONCERNS OR ISSUES REGARDING SAFE PATIENT
HANDLING, FILING A COMPLAINT OR REFUSING TO ENGAGE IN PATIENT HANDLING.
  4.  NURSES  AND DIRECT CARE WORKERS, AS DEFINED IN SECTION TWENTY-NINE
HUNDRED NINETY-NINE-H OF THIS TITLE SHALL BE  CONSIDERED  EMPLOYEES  FOR
THE PURPOSES OF SECTION SEVEN HUNDRED FORTY-ONE OF THE LABOR LAW.
  5.  THE  DEPARTMENT AND THE DEPARTMENT OF LABOR SHALL PUBLISH AND MAKE
PUBLIC WHICH HEALTH CARE FACILITIES ARE IN COMPLIANCE WITH THE STATEWIDE
SAFE PATIENT HANDLING POLICY.
  S 2. The education law is amended by adding a new  section  6510-f  to
read as follows:
  S  6510-F.  STATE  SAFE PATIENT HANDLING POLICY.   1. THE REFUSAL OF A
LICENSED PRACTICAL NURSE OR A REGISTERED  NURSE  TO  ENGAGE  IN  PATIENT
HANDLING  SHALL  NOT  CONSTITUTE  PATIENT ABANDONMENT OR NEGLECT IF SUCH
NURSE HAS, IN A MANNER CONSISTENT  WITH  ARTICLE  TWENTY-NINE-D  OF  THE
PUBLIC  HEALTH LAW AND THE RULES AND REGULATIONS PROMULGATED PURSUANT TO
SUCH  ARTICLE,  REFUSED  A  PATIENT  HANDLING  ASSIGNMENT  AND  FILED  A
COMPLAINT WITH THE DEPARTMENT OF HEALTH.
  2.  THE  REFUSAL  OF  A  LICENSED  OR UNLICENSED HEALTH CARE WORKER TO
ENGAGE IN PATIENT HANDLING NOT CONSISTENT WITH THE  STATE  SAFE  PATIENT
HANDLING  POLICY  OR A FACILITY'S SAFE PATIENT HANDLING POLICY SHALL NOT
BE CONSIDERED PROFESSIONAL MISCONDUCT. THE  REFUSAL  OF  A  LICENSED  OR
UNLICENSED  HEALTH  CARE  WORKER TO ENGAGE IN PATIENT HANDLING SHALL NOT
CONSTITUTE PATIENT ABANDONMENT OR NEGLECT  IF  SUCH  WORKER  HAS,  IN  A
MANNER  CONSISTENT  WITH  ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW
AND THE RULES AND REGULATIONS  PROMULGATED  PURSUANT  TO  SUCH  ARTICLE,
REFUSED  A  PATIENT  HANDLING  ASSIGNMENT AND FILED A COMPLAINT WITH THE
DEPARTMENT OF HEALTH.
  S 3. This act shall take effect on the one hundred twentieth day after
it shall have become a law.