BILL ANALYSIS Ó
AB 30
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Date of Hearing: March 22, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 30 (Hayashi) - As Amended: March 14, 2011
SUBJECT : Health facilities: security plans.
SUMMARY : Expands existing law regarding hospital safety and
security plans to protect personnel, patients, and visitors from
aggressive or violent behavior. Creates new standards to
protect health care personnel employed in correctional
facilities. Specifically, this bill :
1)Requires hospitals to track their response to incidents of
aggressive or violent behavior against hospital personnel,
patients, and visitors as part of the security and safety
assessment and security plan, required under existing law, to
deter and manage further aggressive or violent acts of a
similar nature.
2)Requires, instead of authorizes, the security plan to include
various security considerations.
3)Requires, as part of the security plan, a hospital to adopt
security policies, including, but not limited to, all of the
following:
a) Personnel training policies designed to protect
personnel, patients, and visitors from aggressive or
violent behavior including education on how to recognize
the potential for violence, how and when to seek assistance
to prevent or respond to violence, and how to report
incidents of violence to the appropriate law enforcement
officials;
b) A system for responding to incidents and situations
involving violence or the risk of violence, including, but
not limited to, procedures for rapid response by which an
employee is provided with immediate assistance if the
threat of violence against that employee appears to be
imminent, or if a violent act has occurred or is occurring;
c) A system for investigating violent incidents and
situations involving violence. Requires the employer, when
investigating these incidents, to interview any employee
who was involved in the incident or situation;
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d) A system for reporting, monitoring, and record keeping
of violent incidents and situations involving the risk of
violence;
e) A system for reporting incidents of violence to the
Department of Public Health (DPH); and,
f) Modifications to job design, staffing, security,
equipment, or facilities as determined necessary to prevent
or address violence against hospital employees.
4)Changes the time frame from within 72 hours to within 24 hours
of the incident for hospitals to report to local law
enforcement any assault or battery against a hospital employee
which results in injury or involves a firearm or other
dangerous weapon.
5)Requires each hospital to provide evaluation and treatment for
an employee who is injured or is otherwise a victim of a
violent incident. Requires the hospital, upon the request of
the employee, to provide access to follow-up counseling to
address trauma or distress experienced by the employee,
including, but not limited to, individual crisis counseling,
support group counseling, peer assistance, and professional
referrals.
6)Requires that a hospital not prohibit an employee from, or
take punitive or retaliatory action against an employee for,
seeking assistance and intervention from local emergency
services or law enforcement when a violent incident occurs.
7)Requires a hospital to report to DPH within 72 hours any
incident of assault or battery against a hospital employee or
patient. Requires the report to include the date and time of
the incident, whether the victim was a hospital employee or a
patient, the unit in which the incident occurred, a
description of the circumstances surrounding the incident, and
the hospital's response to the incident.
8)Requires a hospital to report to DPH within 24 hours any
incident of assault or battery against a hospital employee or
patient that results in injury, involves the use of a firearm
or other dangerous weapon, or presents an urgent or emergent
threat to the welfare, health, or safety of patients,
personnel, or visitors.
9)Requires DPH to make an onsite inspection or investigation
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within 48 hours, or two business days, whichever is greater,
of the receipt of a report from a hospital that indicates an
ongoing, urgent, or emergent threat of imminent danger of
death or serious bodily harm to patients, personnel, or
visitors.
10)Stipulates that if a hospital fails to report an incident of
assault and battery, DPH is authorized to assess a civil
penalty against the hospital in an amount not to exceed
$100.00 per day for each day that the incident is not reported
following the initial 72-hour or 24-hour period.
11)Requires, beginning January 1, 2014, and annually,
thereafter, DPH to report to the relevant fiscal and policy
committees of the Legislature information, in a manner that
protects patient and employee confidentiality, regarding
incidents of violence at hospitals. Makes this reporting
requirement inoperative January 1, 2018.
12)Requires all hospital employees who provide direct care to
patients at least annually to receive security education and
training.
13)Stipulates that members of the medical staff of each hospital
and all other practitioners, including, but not limited to,
nurse practitioners, physician assistants, and other personnel
are required to receive the same training as that provided to
hospital employees or, at a minimum, training determined to be
sufficient pursuant to the security plan.
14)Requires the minimum standards for state and local
correctional facilities, required under existing law, to be
established by the Corrections Standards Authority (CSA) to
include requirements for a safety and security plan designed
to prevent and protect, from aggression and violence, health
care personnel who provide care to persons confined in state
and local correctional facilities, including, but not limited
to, correctional treatment centers. Requires the safety and
security plan to include various security considerations.
15)Requires CSA to seek advice for the safety and security plans
for health care personnel from DPH, the Division of
Occupational Safety and Health (Cal/OSHA), registered nurses,
other relevant health care personnel, and other interested
persons.
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EXISTING LAW :
1)Requires all licensed hospitals to conduct a security and
safety assessment not less than annually, and using the
assessment, develop and annually update a security plan to
protect patients, staff, and visitors to the hospital from
aggressive or violent behavior.
2)Specifies that the security and safety assessment examine
trends of aggressive/violent behavior and track violent
incidents at the facility.
3)Authorizes the security plan to review the hospital's physical
layout, staffing, availability of security personnel, and
staff training for responding to violent incidents.
4)Directs hospitals to consider applicable guidelines and
standards from the DPH, Cal/OSHA, and the federal Occupational
Safety and Health Administration.
5)Requires security plans to include personnel training policies
designed to protect personnel, patients, and visitors.
6)Requires the hospital, in developing the plan and the
assessment, to consult with affected employees, including the
recognized collective bargaining agent or agents and any
members of the hospital medical staff.
7)Specifies that hospital staff or contractors developing the
plan be familiar with hospital operations and organization,
protective equipment and alarms, management of disturbed
patients and visitors, documenting and reporting of crimes,
identification of aggressive and violent predicting factors,
and hospital safety and emergency preparedness.
8)Requires hospitals to have sufficient personnel to provide
security consistent with the security plan and security
personnel to be trained in applicable techniques and skills.
9)Requires hospitals to report any assault or battery against
any hospital employee which results in injury to local law
enforcement within 72 hours of the incident.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
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COMMENTS :
1)PURPOSE OF THIS BILL . According to the author and sponsor of
this bill, the California Nurses Association (CNA), violence
in health care settings has been an area of concern for some
time, as risk of workplace violence is a serious occupational
hazard for Registered Nurses (RNs) and other health care
workers. According to CNA, countless acts of assault,
battery, and aggression that routinely take place in health
care settings demonstrate a frightening trend of increasing
violence faced by health care workers in California and
throughout the country. CNA maintains that recent incidences
of violence against RNs and other health care workers has
called into question the efforts of health care employers to
have the appropriate standards and policies in place.
According to CNA, this bill puts forth reasonable provisions
that will improve the safety and security of RNs and health
care workers throughout the state.
2)BACKGROUND . Data developed by the Bureau of Labor Statistics
(BLS) indicate that hospital workers are at high risk for
violence in the workplace. The BLS estimates that in a
typical year, 2,637 nonfatal assaults are made on hospital
workers in this country, a rate of 8.3 assaults per 10,000
workers. This rate is much higher than the same rate for all
other private sector industries which is only two nonfatal
assaults per 10,000 workers. Nurses and aides with direct
patient contact are at higher risk for violence as are
emergency response personnel, hospital security officers, and
other providers.
Violence in health care work settings has been the focus of
several policy initiatives in California. In 1990 a survey of
emergency departments was conducted by the California
Emergency Nurses Association to determine the magnitude of
violence against emergency nurses and the security practices
in place at the time. This survey precipitated the passage of
SB 508 (Speier), Chapter 936, Statutes of 1993, which required
hospitals to conduct security assessments and develop security
plans by July 1995. A follow-up survey in 2002 found that
security measures had increased since passage of SB 508, but
that substantial gaps still existed. SB 1083 (John. A.
Perez), Chapter 506, Statutes of 2009, required hospital
security and safety assessments and plans to be conducted and
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updated annually, required hospitals to consult with affected
employees and members of the medical staff in developing their
security plans and assessments and provided that hospital
security plans could additionally include efforts to cooperate
with local law enforcement regarding violent acts at a
hospital facility.
3)RECENT INCIDENCES OF VIOLENCE . Several incidences of violence
against health care workers have been highlighted in the media
in the last six months. In October of 2010, a psychiatric
nurse technician was strangled to death and robbed at Napa
State Hospital. The Napa State Hospital employee was
allegedly attacked by a mentally ill patient on hospital
grounds. This incident was followed days later by the death
of a registered nurse who was allegedly assaulted by an inmate
at Contra Costa County's correctional facility in Martinez
while attempting to provide him care. In November of 2010, a
Santa Cruz County inmate being transported to the Santa Cruz's
Dominican Hospital escaped custody outside of the hospital,
using a stun gun on a sheriff's deputy and shooting at a woman
who tried to help.
4)SUPPORT . CNA writes in support of this bill that in addition
to countless anecdotal accounts, recent research and surveys
document the prevalence of violence against health care
workers in health facilities. CNA states that, according to
the National Institute of Occupational Health, among
California hospitals, surveillance of workplace violence
events were "uncoordinated and inefficient," employee training
programs rarely included review of violence trends within
their specific hospital, few hospitals had effective systems
to communicate about the presence of violence, and security
programs and training were often less complete in psychiatric
units than in emergency departments. CNA maintains that this
bill will address these issues and is aimed at protecting RNs
and health care workers from violence in the workplace.
The United Nurses Association of California/Union of Health Care
Professionals (UNAC/UHCP), the National Lawyers Guild and the
Consumer Attorneys of California support this legislation and
write that they believe that it will improve worker health and
safety with regard to violence in health care facility
workplaces. According to the UNAC/UHCP, their members report
experiencing increased incidents of verbal assaults and
threatening behaviors by patients, their family members and
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friends in patient care areas beyond the emergency rooms.
UNAC/UHCP maintains that direct patient care staff need the
skills for early detection of potential violence and the tools
to address the situation and processes to engage security
staff.
5)SUPPORT IF AMENDED . The Disability Rights California (DRC),
while supportive of this legislation, writes that they are
currently working with the sponsors of this bill to include
some of their amendments. DRC would like this bill to include
a training requirement in appropriate de-escalation techniques
as a means of preventing violence. DRC would also like to see
uniform protections for employees, patients and visitors.
Finally, DRC would like this bill to include some clean-up
language in existing law with respect to restraining patients.
The California Psychiatric Association writes they strongly
support this bill's concept of strengthening safety and
security plans for state hospitals, however they recommend
extending the hospital reporting requirement to DPH in the
bill to monthly or quarterly in order to avoid overly
administrative demands on clinical staff.
6)OPPOSITION . The California Hospital Association (CHA) writes
in opposition that this bill imposes substantial burdens,
without evidence that they will provide corresponding
benefits, and duplicates existing law, establishing multiple
conflicting oversight entities. CHA cites existing law
surrounding adverse events and asserts that this bill creates
redundant reporting requirements for hospitals and a redundant
fine authority. CHA moreover states that under existing
workers' compensation law, hospitals must provide evaluation
and treatment for workplace injuries and illnesses. CHA
argues that this bill is duplicative and in some respects in
conflict with the workers compensation process as it
authorizes the employee, rather than the healthcare provider,
to dictate treatment. CHA also states that this bill requires
training and education for all staff, rather than those in
high risk areas. CHA maintains that this bill fails to take
into account the myriad of existing training and education
obligations of hospitals related to patient and staff safety.
7)RELATED LEGISLATION
a) SB 60 (Evans) expresses the intent of the Legislature to
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enact legislation that would address the safety of workers
and patients in state hospitals under the jurisdiction of
the state Department of Mental Health. SB 60 has not yet
been referred to a policy committee.
b) AB 366 (Allen) requires the Department of Mental Health
Director to direct the superintendent or other person in
charge of each state hospital to create, implement, review,
and update a system that includes measures to ensure the
health and safety of both the patient population and the
employees of the facility. AB 366 is currently scheduled
to be heard by the Assembly Health Committee on April 5,
2011.
c) AB 908 (Achadjian) states the intent of the Legislature
to enact legislation that would address the safety of staff
and other individuals in state hospitals under the
jurisdiction of the state Department of Mental Health. AB
908 has not yet been referred to a policy committee.
8)PREVIOUS LEGISLATION .
a) AB 508 (Speier), Chapter 936, Statutes of 1993, requires
hospitals to conduct security assessments, develop security
plans, and have sufficient personnel to provide security.
Requires hospitals to report any act of assault against
on-duty personnel to a local law enforcement agency within
a specified time frame.
b) AB 74 X1 (Speier), Chapter 19, Statutes of 1994,
provides clean-up and clarification for AB 508.
c) AB 1083 (John A. Perez), Chapter 506, Statutes of 2009,
requires hospital security and safety assessments to be
conducted not less than annually, and requires hospital
security plans to be updated annually. Requires hospitals
to consult with affected employees and members of the
medical staff in developing their security plans. Provides
that hospital security plans may additionally include
efforts to cooperate with local law enforcement regarding
violent acts at the facility.
REGISTERED SUPPORT / OPPOSITION :
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Support
California Nurses Association (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
Board of Registered Nursing
California Association of Psychiatric Technicians
Consumer Attorneys of California
National Lawyers Guild Labor & Employment Committee
United Nurses Association of California/Union of Health Care
Professionals
Opposition
California Hospital Association
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097