BILL ANALYSIS Ó ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 2399| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ THIRD READING Bill No: AB 2399 Author: Allen (D) Amended: 8/21/12 in Senate Vote: 21 SENATE HEALTH COMMITTEE : 8-1, 6/20/12 AYES: Hernandez, Alquist, Anderson, Blakeslee, De León, DeSaulnier, Rubio, Wolk NOES: Harman SENATE APPROPRIATIONS COMMITTEE : 5-2, 8/16/12 AYES: Kehoe, Alquist, Lieu, Price, Steinberg NOES: Walters, Dutton ASSEMBLY FLOOR : 74-0, 5/17/12 - See last page for vote SUBJECT : Mental health: state hospitals: injury and illness prevention plan SOURCE : Author DIGEST : This bill 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 procedure to report patient assaults on employees and provide feedback to the committee. ANALYSIS : CONTINUED AB 2399 Page 2 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 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. CONTINUED AB 2399 Page 3 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 procedures. Requires incident reports to be forwarded to the IIP committees. CONTINUED AB 2399 Page 4 Background 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 2012-13 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. 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 fix the problems. The change in treatment model coupled with the necessary documentation increased the workload for hospital workers. CONTINUED AB 2399 Page 5 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. 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 Web site, 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. 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 hospital, inspection procedures, disaster CONTINUED AB 2399 Page 6 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. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: No According to the Senate Appropriations Committee, unknown, likely minor costs to update plans and report data on incidents (General Fund). SUPPORT : (Verified 8/21/12) California Association of Psychiatric Technicians California Psychological Association California Statewide Law Enforcement Association National Association of Social Workers, California Chapter ARGUMENTS IN 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 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 CONTINUED AB 2399 Page 7 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. ASSEMBLY FLOOR : 74-0, 5/17/12 AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill Berryhill, Block, Blumenfield, Bonilla, Bradford, Brownley, Buchanan, Butler, Charles Calderon, Campos, Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson, Donnelly, Eng, Feuer, Fong, Fuentes, Furutani, Beth Gaines, Galgiani, Garrick, Gatto, Gordon, Gorell, Grove, Hagman, Halderman, Hall, Harkey, Hayashi, Roger Hernández, Hill, Huber, Hueso, Huffman, Jeffries, Jones, Knight, Lara, Logue, Ma, Mansoor, Mendoza, Miller, Mitchell, Monning, Morrell, Nestande, Nielsen, Olsen, Pan, V. Manuel Pérez, Portantino, Silva, Smyth, Solorio, Swanson, Torres, Valadao, Wagner, Wieckowski, Williams, John A. Pérez NO VOTE RECORDED: Fletcher, Bonnie Lowenthal, Norby, Perea, Skinner, Yamada ASSEMBLY FLOOR : 74-0, 05/17/12 AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill Berryhill, Block, Blumenfield, Bonilla, Bradford, Brownley, Buchanan, Butler, Charles Calderon, Campos, Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson, Donnelly, Eng, Feuer, Fong, Fuentes, Furutani, Beth Gaines, Galgiani, Garrick, Gatto, Gordon, Gorell, Grove, Hagman, Halderman, Hall, Harkey, Hayashi, Roger Hernández, Hill, Huber, Hueso, Huffman, Jeffries, Jones, Knight, Lara, Logue, Ma, Mansoor, Mendoza, Miller, Mitchell, Monning, Morrell, Nestande, Nielsen, Olsen, Pan, V. Manuel Pérez, Portantino, Silva, Smyth, Solorio, Swanson, Torres, Valadao, Wagner, Wieckowski, Williams, John A. Pérez CONTINUED AB 2399 Page 8 NO VOTE RECORDED: Fletcher, Bonnie Lowenthal, Norby, Perea, Skinner, Yamada CTW:m 8/21/12 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED