BILL ANALYSIS Ó
AB 2399
Page 1
Date of Hearing: April 17, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2399 (Allen) - As Amended: April 9, 2012
SUBJECT : Mental health: state hospitals: injury and illness
prevention plan.
SUMMARY : Requires each of the five state hospitals under the
jurisdiction of the Department of Mental Health (DMH) to update
its injury and illness prevention plan (IIPP) at least once a
year and establish an IIPP committee to provide recommendations
for updates to the plan. Specifically, this bill :
1)Requires each state hospital to update its IIPP at least once
a year to include necessary safeguards to prevent workplace
safety hazards related to workplace violence associated with
patient assaults on employees.
2)Requires updated plans to at least address all of the
following:
a) Control of physical access throughout the hospital and
grounds;
b) Alarm systems;
c) Presence of security personnel;
d) Training;
e) Buddy systems;
f) Communication; and,
g) Emergency responses.
3)Requires DMH to submit the updated plans to the Legislature
every two years. Specifies that the requirement for
submitting the updated plans is inoperative four years after
the date the first report is due, as specified. Indicates
that the plans must comply with existing reporting
requirements.
4)Directs each state hospital to establish an IIPP committee
comprised of hospital management and employees designated by
the hospital's director in consultation with the employee
bargaining units.
5)Makes the IIPP committee responsible for providing
recommendations to the hospital director for updates to the
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IIPP. Requires the committee to meet at least four times per
year.
6)Requires each state hospital to develop an incident reporting
system that can be used, at a minimum, to report patient
assaults on employees and report identified risks of patient
assaults on employees.
7)Provides that the reporting system must be widely accessible
to staff and be designed to provide hospital management with
immediate notification of reported incidents and identified
risks.
8)Requires each state hospital to provide for timely and
efficient responses and investigations to incident reports
made under the reporting system. Requires the incident
reports to be forwarded to the IIPP committee.
EXISTING LAW :
1)Charges DMH with managing the care and treatment of mentally
ill patients at California's five state mental hospitals:
Atascadero (ASH); Coalinga (CSH); Metropolitan (MSH); Napa
(NSH); and, Patton (PSH).
9)Designates NSH and MSH to only treat low-to-moderate risk
patients and requires high-risk patients to only be treated at
ASH or PSH, a correctional facility, or other secure facility.
10)Establishes, within the Department of Industrial Relations,
the Division of Occupational Safety and Health, known as
Cal/OSHA, to conduct inspections of California workplaces in
response to a report of an industrial accident; a complaint
about an occupational safety and health hazard; or, in
conjunction with an inspection program targeting high-risk
industries.
11)Requires, in regulations, every employer to establish,
implement, and maintain an effective injury and illness
prevention program that includes methods and procedures for
correcting unsafe or unhealthy conditions, work practices, and
procedures in a timely manner, based on the severity of the
hazard when observed or discovered; and, when an imminent
hazard exists, as specified.
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FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The author asserts that an increasing
forensic population, insufficient staff levels, and facilities
that were not originally designed or maintained for forensic
patients are the major causes of increases in violent
incidents at state hospitals. The author maintains that
creating a safer environment has a significant impact on the
well-being of both patients and staff and can reap significant
financial benefits associated with reductions in overtime,
fewer missed work days, and fewer workers' compensation claims
from staff injuries relating to patient aggression. The
author states that this bill seeks to improve worker safety by
requiring state hospitals to update their IIPPs annually with
important safeguards against workplace hazards posed by
patient assaults and establishing a formal process, through an
IIPP committee, to enable employees to work with management to
make improvements.
2)BACKGROUND . DMH oversees the operation of the five state
hospital campuses as well as two acute psychiatric programs
that provide treatment to a combined patient population of
over 5,000. There has been a dramatic shift in the patient
population at state hospitals in the last decade as the number
of patients committed by way of the criminal justice system
has risen while the number of patients referred by counties
under civil commitments has declined. DMH reports that the
forensic population now comprises 92% of the state hospital
system.
3)PROPOSED DEPARTMENT OF STATE HOSPITALS . DMH commissioned a
report released in December 2011 to assist in the proposal for
a new Department of State Hospitals to be included in the
2012-13 Governor's Budget and provide recommendations related
to this new department's administrative structure. The
Governor's Administration states that a new and separate
department is needed to administer these facilities in order
to comprehensively focus on mitigating significant health and
public safety issues, centralize administrative functions, and
address core patient population management and fiscal
administration. According to the DMH report, the primary
issues affecting clinical services are patient aggression
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management with the related concern of a safe working
environment. The report notes that central staffing directors
and hospital administrative staff expressed serious concern
regarding the need to enforce consequences for assaulting
medical staff as threats from patients make it difficult for
medical staff to provide effective care.
4)INCIDENCES OF VIOLENCE . Due to the increased forensic
population, incidences of violence towards patients and staff
have increased. Since the death of psychiatric technician,
Donna Gross, at NSH in October 2010, much attention has been
focused on the level of assaults on state hospital staff and
patients. According to data that DMH reported to the Assembly
Budget Subcommittee on Health and Human Services, patients at
NSH committed 75 physically aggressive acts against staff in
2010-11 and there were nearly four times as many
patient-on-staff assaults, and twice as many
patient-on-patient aggressive incidents, than in 2009. DMH
reports that there were almost 4,600 aggressive acts against
staff and nearly 9,400 aggressive acts against others
system-wide in 2010.
5)Cal/OSHA . Cal/OSHA is charged with enforcing occupational
safety and health laws, orders, and standards and
investigating alleged violations. Cal/OSHA issues a citation
when an employer causes an employee to suffer or potentially
suffer, among other things, serious injury or illness or
serious physical harm.
According to a March 2012 article in the Los Angeles Times,
Cal/OSHA has issued nearly $100,000 in fines against PSH and
ASH for their alleged failure to protect staff from patient
assaults and deficient employee alarm systems. These latest
citations are similar to those issued last year against NSH
and MSH. According to the citations, the most serious
violations were for inadequate IIPPs that contributed to an
average of 20 patient-caused staff injuries a month at PSH
from January 2006 to September 2011, and an average of eight a
month at ASH between January 2007 and October 2011, all
involving severe head trauma, fractures, contusions,
lacerations, and bites. The citations indicate that
corrective measures, such as a buddy system, adequate alarms,
sufficient security personnel and sufficient back-up staffing,
were not taken to improve conditions. Cal/OSHA also cited ASH
for failing to adequately staff patient units on swing and
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overnight shifts, and PSH for an employee alarm system that
was not capable of being detected at all on hospital grounds,
while ASH's did not work in a number of areas, including
restrooms and stairwells. Additionally, Cal/OSHA levied more
than $20,000 in fines against CSH last month for safety lapses
related to an ineffective IIPP, inadequate employee alarm
systems, and failure to implement corrective actions to
prevent serious physical assaults to staff and identify the
unsafe conditions created by privacy curtains, blankets and
other means to conceal individuals from employees.
DMH reports that each hospital campus has its own individual
IIPP. Each hospital's IIPP contains policies regarding a
variety of health and safety topics including health and
safety policies of each hospital, inspection procedures,
disaster responses, patient interventions, hazard assessment
and correction, emergency responses, injury reporting, return
to work policies, and violence in the workplace. DMH states
that it is working with Cal/OSHA and patient and employee
groups to revise the IIPPs, per Cal/OSHA's recommendations and
findings. DMH indicates that this is an ongoing process that
involves numerous changes to policies and procedures, as well
as physical infrastructure changes, some of which may be
implemented in the short term and some of which will be
implemented over the long term. DMH has reached an agreement
with Cal/OSHA to establish workgroups, with employee
representation, to address the identified deficiencies. The
workgroups are charged with, among other things, developing
instructions for each hospital to assess the adequacy of
policies regarding current alarms, both personal and
facility-wide; developing safety assessments to identify the
areas, activities, and factors that present increased risk of
violence, including buildings and grounds, in order to abate
the hazards of assaults and other unsafe workplace conditions;
and, developing a tool or instrument to be used by all the
hospitals to capture and identify the greatest risks of
serious injury in a format that can be readily analyzed to
identify both geographic and programmatic risk factors in each
facility.
According to DMH, there has been discussion about an overarching
settlement agreement that would require DMH to adopt measures
based on these workgroup recommendations and other discussions
between DMH and Cal/OSHA relating to larger structural changes
governing health and safety at the hospitals. Both sides
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believe a settlement agreement is preferable to DMH litigating
appeals of each hospital's citations because the citations are
similar and, as a result, resolution and abatement would also
be similar and more effective if it encompassed system-wide
changes.
6)CURRENT HOSPITAL SAFETY EFFORTS . According to DMH's Strategic
Plan for Statewide Aggression Reduction that was provided to
the Assembly Budget Subcommittee on Health and Human Services,
DMH has already completed a number of administrative steps to
reduce aggression system-wide. Specifically, DMH reports that
the transfer of 30 high aggression risk patients out of NSH to
other state hospitals is complete; analyses from the Executive
Directors of each facility regarding clinical and physical
resources and subsequent ideal patient populations for each
facility have been submitted; implementation of new personal
duress alarm systems is currently 60% completed at NSH and
approved for roll-out at the remaining four facilities; and
efforts are ongoing with regard to evaluating resource needs
for specialized units and making improvements to ground safety
at NSH, PSH, and MSH. With regard to clinical steps, DMH
reports that an auditing tool to monitor for appropriate
assessment and treatment has already been developed; a
statewide curriculum for treatment of aggression is in the
process of being developed; a pre-admission violence risk
screening tool has already been developed and is in the
process of being implemented; and two specialized treatment
units have been opened at ASH and CSH for the treatment and
containment of psychotic, impulsive, and predatory aggression.
7)SUPPORT . The California Association of Psychiatric
Technicians writes in support that this bill will provide the
swift action that is needed to rectify safety concerns
identified by Cal/OSHA that affect staff and the patients who
depend upon them to provide a secure, therapeutic environment.
The California Psychiatric Association supports a prior
version of this bill, stating that it provides a more
comprehensive approach to addressing the violence in state
hospitals. The California Statewide Law Enforcement
Association notes that this bill will ensure that safety
procedures and other changes at state hospitals are
implemented in a manner that evolves with the forensic nature
of the patient population.
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8)RELATED LEGISLATION . AB 2397 (Allen) requires state hospitals
to have, at a minimum, an ancillary clinical staff-to-patient
ratio of 1-to-25 for each applicable staff classification,
based on the facility's licensed bed capacity with a specified
shift relief factor. AB 2397 is scheduled to be heard in this
committee on April 17, 2012.
9)DOUBLE-REFERRAL . This bill is double-referred. Should it
pass out of this committee, it will be referred to the
Assembly Labor and Employment Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Psychiatric Technicians
California Psychiatric Association (prior version)
California Psychological Association
California Statewide Law Enforcement Association
Opposition
None on file.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097