BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2399|
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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 :
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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.
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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.
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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.
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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
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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
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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
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NO VOTE RECORDED: Fletcher, Bonnie Lowenthal, Norby, Perea,
Skinner, Yamada
CTW:m 8/21/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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