BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2399
AUTHOR: Allen
AMENDED: April 9, 2012
HEARING DATE: June 20, 2012
CONSULTANT: Rubin
SUBJECT : Mental health: state hospitals: injury and illness
prevention plan.
SUMMARY : Requires each state hospital to update its injury and
illness prevention (IIP) plan at least once a year, as
specified, establish an IIP committee to recommend updates to
the plan, and develop an incident reporting system to report
patient assaults on employees and provide feedback to the
committee.
Existing law:
1.Gives the Department of Mental Health (DMH) jurisdiction over
five state hospitals: Atascadero State Hospital (ASH),
Coalinga State Hospital (CSH), Metropolitan State Hospital
(MSH), Napa State Hospital (NSH), and Patton State Hospital
(PSH).
2.Requires, under regulations, every California employer to
establish, implement, and maintain a written IIP plan to, at a
minimum:
a. Identify the person or persons responsible for
implementing the IIP plan;
b. Include a system for ensuring that employees comply with
safe and healthy work practices;
c. Include a system for communicating with employees in a
form readily understandable by all affected employees on
matters relating to occupational safety and health,
including provisions designed to encourage employees to
inform the employer of hazards at the workplace without
fear of reprisal;
d. Include procedures for identifying and evaluating
workplace hazards, including scheduled inspections
periodically and after specified events to identify unsafe
work practices;
e. Include a procedure to investigate occupational injury
or occupational illness;
f. Include methods and/or procedures for correcting unsafe
Continued---
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or unhealthy conditions, work practices, and work
procedures in a timely manner based on the severity of the
hazard, as specified;
g. Provide training and instruction, as specified; and
h. Include records of the steps taken to implement and
maintain the IIP plan, as specified.
This bill:
1.Requires each state hospital to update its IIP plan at least
once a year to include necessary safeguards to prevent
workplace safety hazards in connection with workplace violence
associated with patient assaults on employees.
2.Requires each updated IIP plan to address at a minimum the
control of physical access throughout the hospital and
grounds, alarm systems, the presence of security personnel,
training, buddy systems, communication, and emergency
responses.
3.Requires DMH to submit updated IIP plans to the Legislature
every two years. Makes this provision inoperative four years
after the date the first report is due, as specified.
4.Requires each state hospital to establish an IIP committee
comprised of hospital management and employees designated by
the hospital's director in consultation with the employee
bargaining units.
5.Requires IIP committees to meet at least four times per year
and to provide recommendations to the hospital director for
updates to the plan.
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 identified risks of patient assaults
on employees.
7.Requires incident reporting systems to be widely accessible to
staff and be designed to provide hospital management with
immediate notification of reported incidents and identified
risks.
8.Requires hospitals to provide for timely and efficient
responses and investigations to incident reports made under
the reporting systems. Requires incident reports to be
forwarded to the IIP committees.
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FISCAL EFFECT : According to the Assembly Committee on
Appropriations:
1.Based on variation among hospitals, it is unclear precisely
what modifications or upgrades would be required of the
existing incident reporting systems and related equipment, but
potential costs associated with changes appear to be fairly
minor given that these systems already exist. At least two of
the five state hospitals have incident reporting systems that
appear to meet this bill's requirements.
2.Costs related to IIP plans and reports should be minor and
absorbable.
PRIOR VOTES :
Assembly Health: 10- 0
Assembly Labor and Employment: 5- 0
Assembly Appropriations: 12- 0
Assembly Floor: 74- 0
COMMENTS :
1.Author's statement. AB 2399 will require state hospitals to
update their current IIP plans in an effort to better protect
employees from workplace safety hazards associated with
patient assaults. A study performed jointly by the University
of California, Davis and Napa State Hospital showed that in
2010 there were over 8,300 incidents at the five state
hospitals where an aggressor was identified, resulting in over
5,100 injuries, including over 1,000 staff injuries and one
death. There is little debate that the primary cause in the
increase in violent incidents is due to the increasing
forensic population and insufficient staff levels, combined
with facilities and safety infrastructure that were not
designed or maintained for this patient population.
While creating a safer environment has a significant impact on
the well-being of both patients and staff, there are also
significant financial benefits. Since the 2003-04 fiscal year,
overtime expenditures from the five state hospitals and the
two state psychiatric facilities went from $40 million to $101
million, with much of this increase attributed to the time
missed due to increased workers' compensation claims. At Napa
State Hospital there were 384 staff injuries in 2010,
resulting in 289 workers' compensation claims and 10,724
missed work days. The Select Committee on State Hospital
Safety recently reviewed the existing IIP plans for each state
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hospital and verified that addressing workplace hazards
related to patient assaults is incomplete or non-existent in
each plan. AB 2399 simply requires that the state hospitals
update their IIP plans to include comprehensive elements to
safeguard against workplace hazards related to patient
assaults and provides a mechanism to regularly update them.
2.State hospitals under DMH jurisdiction. The five state
hospitals under DMH's jurisdiction serve different populations
and needs. According to a report on oversight and
accountability at state hospitals by the Legislative Analyst's
Office (LAO), as of January 2012, ASH treats an all-male,
maximum-security, forensic patient population of over 1,000;
CSH houses over 900 patients, most of whom are sexually
violent predators (SVPs); MSH houses over 400 patients that do
not have histories of escape, sex crimes, or murder; NSH is a
low- to moderate-security hospital of just under 100 patients;
and PSH treats approximately 1,500 forensic patients and is
primarily a forensic hospital. Under the Governor's 2012-2013
budget plan, community mental health functions and related
state functions would be eliminated or shifted to other
departments, offices, and commissions; since the
administration of state hospitals is mainly what would remain,
the Governor has proposed to change the department's name from
DMH to the Department of State Hospitals, with the intent that
this new structure would allow the administration to better
focus on the fiscal and programmatic issues unique to state
hospitals.
3.Challenges faced by state hospitals. The LAO report describes
three challenges that state hospitals have faced over the past
decade. First, workload for state hospitals has increased due
to the commitment and treatment of sexually violent predators.
In 2006, Proposition 83, also known as Jessica's Law, was
approved by voters to increase the criminal penalties for sex
offenses and strengthen the state's oversight of sex
offenders. Jessica's Law more than doubled the workload
related to screening and evaluating sex offenders for a SVP
commitment.
Second, pursuant to the Civil Rights of Institutionalized
Persons Act (CRIPA), the U.S. Department of Justice took a
series of actions affecting California's state hospital
system. In 2006, four of the five state hospitals were found
to be in violation of CRIPA, and the judgment that followed
required these hospitals to implement an Enhancement Plan to
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fix the problems. The change in treatment model coupled with
the necessary documentation increased the workload for
hospital workers.
Third, state hospitals have seen a shift in their population,
with the forensic population increasing steadily and civil
commitments in decline. For example, according to data
supplied by DMH, between 1995 and 2012, forensic commitments
increased from 341 to 976 at NSH while civil commitments
declined from 444 to 206; over the same period, forensic
commitments increased from 2 to 453 at MSH while civil
commitments decreased from 547 to 177.
4.Workplace safety in state hospitals. In 2010, DMH reported
that there was an average of 23 incidents of violence per day
toward both patients and workers in state hospitals, with
almost three staff injuries per day. Los Angeles Times, New
York Times, and other papers recently reported the
asphyxiation death of an employee in October 2010 at NSH and
the beating of another employee resulting in severe injuries
just six week later at the same facility, which have
underscored the inherent danger for both patients and staff at
the state hospitals.
The Division of Occupational Safety and Health (Cal/OSHA),
which is charged with protecting the public and workers from
safety hazards, investigated the incidents and issued
citations for inadequate IIP plans. According to Cal/OSHA's
website, in the first NSH incident, factors believed to be
involved in the fatality include lack of adequate employee
alarm systems on the unit, non-existent alarm systems outside
the units, inadequate police presence in the event of
assaults, and no enforcement of written policies and
procedures by the employer. In the second incident, serious
citations were issued for failure to correct the unsafe work
practices of employees escorting individuals with poor violent
impulse control without proper protective methods and failure
to have an emergency alarm system to provide proper,
effective, and timely warning to police and emergency
responders when an employee is experiencing an assault by an
individual.
5.State hospital IIP plans. According to DMH, each state
hospital has its own IIP plan. While the IIP plans vary, each
contains policies regarding a variety of health and safety
topics including outlining health and safety policies of each
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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 is currently working to revise
the IIP plans and has been participating in four workgroups
with Cal/OSHA and the unions representing the various staff
employees of the state hospitals. The groups are examining
statewide safety assessments, incident, alarms and emergency,
and NSH. DMH anticipates that the workgroups will reach
agreement on steps DMH needs to take to meet statutory and
regulatory requirements for the prevention of workplace
violence at the hospitals. DMH states that it has been
negotiating an agreement that would require DMH to adopt
measures based on workgroup recommendations and other
discussions between DMH and Cal/OSHA relating to hospital
health and safety.
6.Related legislation. AB 2531 (Allen) would permit a state
hospital under the jurisdiction of DMH to develop a list of
items that are considered contraband and prohibited on
hospital grounds, would require each hospital to form a
contraband committee to develop the list, and would specify
the update, review, posting, and provision of the list. AB
2351 is pending in the Senate Health Committee.
7.Prior legislation. AB 888 (Rogan), Chapter 763, Statutes of
1995, and SB 1143 (Mountjoy), Chapter 762, Statutes of 1995,
permit the Department of Corrections (now Department of
Corrections and Rehabilitation) to refer a person who has
committed a sexually violent predatory offense to DMH for a
full evaluation; establish procedures and standard for the
review of a petition of commitment and the rights of the
person who is subject to the petition, including a trial by
jury; and specify that a person who is committed for such an
offense be held in a secure facility by DMH for two years and
subject to annual evaluations until his or her mental disorder
has changed.
8.Support. The California Association of Psychiatric
Technicians (CAPT) states that all of California's five state
hospitals have been cited with major employee-safety
violations, resulting in more than $200,000 in fines and the
death of one of CAPT's members; swift action is needed to
rectify safety concerns that not only affect CAPT's members
and coworkers, but also the patients that depend on them to
provide a secure, therapeutic environment. The California
Statewide Law Enforcement Association argues that over the
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last two decades, the population of the state hospital system
has evolved to one consisting almost entirely of forensic
patients, resulting in the hospitals becoming much more
violent, while procedural and other changes have not kept up
with the changing population. The National Association of
Social Workers, California Chapter, asserts that recent
incidents have shown that this bill is an important measure
for employee and patient health and safety and would ensure
up-to-date incident reporting and the safety and wellness of
employees and patients. The California Psychological
Association (CPA) adds that this bill is a step in the right
direction in providing a better environment for the hundreds
of state-employed psychologists in CPA's membership.
9.Author's amendment. The author has agreed to:
a. Following Page 2, Line 16, insert: "(3) Each state
hospital shall submit its updated injury and illness
prevention program to the department."
b. On Page 2, Line 17, strike out "(3)" and insert "(4)".
1.Technical amendment. In order to maintain consistency with
existing law, the committee staff recommends replacing all
references to "injury and illness prevention plan" with
"injury and illness prevention program".
SUPPORT AND OPPOSITION :
Support: California Association of Psychiatric Technicians
California Psychological Association
California Statewide Law Enforcement Association
National Association of Social Workers, California
Chapter
Oppose: None received.
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