BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 718
AUTHOR: Yee
AMENDED: April 4, 2013
HEARING DATE: April 17, 2010
CONSULTANT: Marchand
SUBJECT : Hospitals: workplace violence prevention plan.
SUMMARY : Requires all hospitals, as part of the injury
prevention program required of all employers and enforced by the
Division of Occupational Safety and Health (Cal/OSHA), to adopt
a workplace violence prevention (WVP) plan designed to protect
health care workers and others from aggressive or violent
behavior.
Existing law:
Health and Safety Code
1.Requires all hospitals, as defined, to conduct an annual
security and safety assessment, and using that assessment, to
develop and annually update a security plan with measures to
protect personnel, patients, and visitors from aggressive or
violent behavior.
2.Requires a hospital's security plan to include specified
security considerations, including those relating to staffing,
security personnel availability, policy and training related
to appropriate responses to violent acts, and efforts to
cooperate with local law enforcement regarding violent acts in
the facility.
3.Requires a hospital, in developing the plan, to consult with
affected employees, including the recognized collective
bargaining agent, if any.
4.Requires all hospital employees regularly assigned to the
emergency department to receive security education and
training, as specified.
5.Requires any act of assault or battery, as these terms are
defined in the Penal Code, that results in injury or involves
the use of a firearm or other dangerous weapon, against any
on-duty hospital personnel, to be reported to the local law
enforcement agency within 72 hours of the incident. Permits
Continued---
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other acts of assault or battery to be reported to local law
enforcement. Prohibits any health facility or employee of a
health facility from being held civilly or criminally liable
for making a report pursuant to this provision.
6.Establishes a structure under which the Department of Public
Health (DPH) is permitted to assess administrative fines to
hospitals for violation of any of their licensing laws and
regulations. For violations constituting immediate jeopardy
of serious injury or death to a patient, DPH may assess fines
of up to $50,000 for the first penalty, $75,000 for the second
penalty, and $100,000 for the third and subsequent penalties.
Labor Code
7.Establishes Cal/OSHA within the Department of Industrial
Relations, and gives Cal/OSHA the power, jurisdiction, and
supervision over every place of employment in this state which
is necessary to enforce and administer all laws requiring
places of employment to be safe, and requiring the protection
of the life, safety, and health of every employee.
8.Requires every employer to establish, implement, and maintain
an effective injury prevention program, which is required to
include, among other elements, a training program designed to
provide instruction with respect to hazards specific to each
employee's job assignment, and the employer's system for
communicating with employees on health and safety matters,
including provisions designed to encourage employees to inform
the employer of hazards at the worksite without fear of
reprisal.
9.Requires every employer to file a complete report with
Cal/OSHA of every occupational injury or occupational illness
to each employee which results in lost time beyond the date of
the injury or illness, or which requires medical treatment
beyond first aid. In addition to this report, in every case
involving a serious injury or illness, or death, the employer
is required to make an immediate report to Cal/OSHA by
telephone.
10.Specifies that every employer and every supervisor that has
direction over any other employee who knowingly or negligently
violates any labor standard that is deemed to be a serious
violation, as defined, is guilty of a misdemeanor punishable
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by up to six months in a county jail and/or a $5,000 fine.
11.Specifies that other violations, such as failing to report a
death to Cal/OSHA, or repeated violations of a standard that
causes a hazard to employees, is subject to penalties of up to
one year in jail and/or a $15,000 fine for an individual, or
up to a $150,000 fine for a corporation or limited liability
company.
This bill:
1.Requires all general acute care hospitals, all acute
psychiatric hospitals, and all special hospitals, as defined,
as part of their required injury prevention program, to adopt
a WVP plan designed to protect health care workers, other
facility personnel, patients, and visitors from aggressive or
violent behavior.
2.Defines "violent incident," for purposes of this bill, as
including the use of physical force against a hospital
employee by a patient or a person accompanying a patient that
results in or has a high likelihood of resulting in injury,
psychological trauma, or stress, regardless of whether the
employee sustains an injury; and an incident involving the use
of a firearm or other dangerous weapon, regardless of whether
the employee sustains an injury.
3.Requires the WVP plan to include specified security
considerations, including the following:
a. Staffing, including staffing patterns and patient
classification systems that contribute to, or are
insufficient to address, the risk of violence;
b. The adequacy of facility security systems, including
security personnel availability and employee alarm systems;
potential security risks associated with specific units or
areas;
c. Uncontrolled public access to any part of the facility;
employee security in areas surrounding the facility; and
d. The use of a trained response team that can
assist employees in violent situations.
4.Requires a hospital, as part of its WVP plan, to adopt safety
and security policies, including the following:
a. Personnel training policies that include education on
how to recognize the potential for violence, how to seek
assistance, and how to report violent incidents to the
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appropriate law enforcement officials;
b. A system for responding to violent incidents, including
procedures by which an employee is provided with immediate
assistance if the threat of violence against that employee
appears to be imminent;
c. A system for investigating violent incidents and
situations involving the risk of violence, including a
requirement that the hospital interview any employee
involved in the incident or situation;
d. A system for reporting, monitoring, and recordkeeping of
violent incidents and situations involving the risk of
violence, including a system for reporting violent
incidents to Cal/OSHA; and
e. Modifications to job design, staffing, security,
equipment, or facilities as determined necessary to prevent
or address violence against hospital employees.
5.Requires the WVP plan to be developed in conjunction with
affected employees, including their recognized collective
bargaining agents, if any. Requires the hospital to consider
guidelines on violence in health care facilities issued by
Cal/OSHA, the federal Occupational Safety and Health
Administration, and the Department of Public Health.
6.Requires all medical staff and health care workers who provide
direct care to patients to receive WVP education and training
at least annually, and requires this training to include,
among other things, aggression and violence predicting
factors, obtaining patient history from a patient with violent
behavior, verbal and physical maneuvers to diffuse and avoid
violent behavior, restraining techniques, and appropriate use
of medications as chemical restraints.
7.Requires all temporary personnel to be oriented to the WVP
plan.
8.Requires hospitals to provide evaluation and treatment for an
employee who is injured or is otherwise a victim of a violent
incident, and upon the request of the employee, to provide
access to follow-up counseling to address trauma or distress,
including individual crisis counseling, support group
counseling, peer assistance, and professional referrals.
9.Prohibits a hospital from taking punitive or retaliatory
action against an employee for seeking assistance and
intervention from local emergency services or law enforcement
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when a violent incident occurs.
10.Requires a hospital, in addition to specified reports
described under Existing Law #10 above, to document and keep
for a period of five years a written record of any violent
incident against a hospital employee immediately after the
incident is reported, regardless of whether the employee
sustains an injury.
11.Requires a hospital to report to Cal/OSHA within 72 hours
regarding a violent incident, or within 24 hours if the
incident results in physical injury, involves the use of a
firearm or other dangerous weapon, or presents an urgent
threat to the safety of hospital personnel.
12.Permits Cal/OSHA to assess a civil penalty against a hospital
who fails to report a violent incident of up to $100 per day
for each day that the incident is not reported.
13.Permits Cal/OSHA, at its discretion, to conduct an inspection
for any violent incident that is reported pursuant to this
bill.
14.Requires Cal/OSHA, by January 1, 2015, and annually
thereafter, to report to the Legislature, in a manner that
protects patient and employee confidentiality, information
regarding violent incidents at hospitals, that includes, but
is not limited to, the total number of reports and which
specific hospitals filed reports, the outcome of any related
inspection or investigation, citations levied against a
hospital based on a violent incident, and recommendation on
how to prevent violent incidents at hospitals. Sunsets this
reporting requirement on January 1, 2019, in accordance with
existing law that requires all reports to the Legislature
sunset after four years.
15.Requires Cal/OSHA to adopt regulations by January 1, 2015, to
implement the provisions of this bill.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the "Evaluation of Safety
and Security Programs to Reduce Violence in Health Care
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Settings," a 2007 report commissioned by the National
Institute of Occupational and Environmental Health which
assessed California hospital security programs and violent
event surveillance, health care workers have long been
recognized as having a high risk of work-related assault.
Nurses are at particularly high risk, with the highest rate of
victimization among occupations in the healthcare industry.
The rate of assault injuries to psychiatric nurses has been
estimated at 16 per 100 employees per year, which exceeds the
annual rate of all injuries found in many high risk
occupations. Violence in health care settings is a continuing
national problem, and the risk of workplace violence is a
serious occupational hazard for registered nurses and other
health care workers. 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. This bill, in response to these issues, is calling
for reforms to crack down on a disturbing trend of violence in
facilities where medical care is provided.
2.Report on violence in hospitals. According to an April 2002
report from the National Institute for Occupational Safety and
Health (NIOSH), which is part of the federal Centers for
Disease Control and Prevention, data indicate that hospital
workers are at high risk for experiencing violence in the
workplace. NIOSH cited estimates from the Bureau of Labor
Statistics that 2,637 nonfatal assaults on hospital workers
occurred in 1999, a rate of 8.3 assaults per 10,000 workers.
This rate is much higher than the rate of nonfatal assaults
for all private-sector industries, which is 2 per 10,000
workers. NIOSH stated that several studies indicate that
violence often takes place during times of high activity and
interaction with patients, such as at meal times and during
visiting hours and patient transportation. Assaults may occur
when service is denied, when a patient is involuntarily
admitted, or when a health care worker attempts to set limits
on eating, drinking, or tobacco or alcohol use.
3.Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate
Committee on Labor and Industrial Relations.
4.Prior legislation. AB 30 (Hayashi) of 2011 was similar to
this bill. However, AB 30 proposed to expand on the existing
Health and Safety Code provisions requiring hospitals to
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develop a security plan, while this bill instead creates a new
provision of law in the Labor Code. AB 30 was held in Assembly
Appropriations Committee.
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. AB 1083 also required hospitals to consult
with affected employees and members of the medical staff in
developing their security plans, and for their plans to
include efforts to cooperate with local law enforcement
regarding violent acts at the facility.
AB 508 (Speier), Chapter 936, Statutes of 1993, required
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.
5.Support. This bill is sponsored by the California Nurses
Association (CNA), which states that the risk of workplace
violence is a serious occupational hazard for registered
nurses and other health care workers. 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. In response, CNA is sponsoring
this bill to establish new standards for hospitals to protect
registered nurses and other health care workers from violence
in their workplace.
The California Labor Federation states in support that as we ask
health care workers to provide care to every patient
regardless of their history, we must also ask hospitals to be
accountable to provide a safe work environment.
The United Nurses Associations of California/Union of Health
Care Professionals states in support that this bill would
prudently require a hospital, as part of its injury prevention
program and in conjunction with affected employees, to adopt a
workplace violence prevention plan designed to protect health
care workers, other facility personnel, patients, and visitors
from aggressive or violent behavior.
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6.Opposition. The California Hospital Association (CHA) opposes
this bill, stating that while California hospitals take very
seriously their duty to provide a safe, healthy environment
for their patients as well as their staff, they are concerned
that this bill would require duplicative and redundant
processes that will be both time consuming and resource
intensive, without accomplishing any measurable results. CHA
states that current Health and Safety Code provisions require
hospitals to develop and implement a security and safety
assessment, and to annually update a security plan based on
the assessment. CHA states that the training requirements
duplicate existing law, and unreasonably expands the scope by
requiring training for all medical staff, rather than just for
emergency department staff and other departments identified in
the security plan. This provision creates additional training
requirements for all staff without any evidence of a
corresponding benefit. CHA also states that this bill imposes
redundant reporting requirements and redundant fine authority.
Finally, CHA states that by permitting the employee to dictate
treatment, this bill conflicts with California's workers'
compensation law related to the evaluation and treatment for
workplace injuries.
7.Different requirements in different code sections. As
described in existing law, the Health and Safety Code contains
provisions requiring all hospitals, as defined, to conduct an
annual security and safety assessment, and using that
assessment, to develop and annually update a security plan
with measures to protect personnel, patients, and visitors
from aggressive or violent behavior. This bill does not amend
these provisions of law, but instead creates a similar
requirement in the Labor Code, to be enforced by Cal/OSHA,
which expands upon the requirements in the Health and Safety
Code. Given that the requirements in existing law in the
Health and Safety Code, for the most part, are also part of
the Labor Code provisions proposed by this bill, a hospital
that complies with this bill would likely also be complying
with existing Health and Safety Code requirements at the same
time. While there does not appear to be a direct conflict
between the two code sections, the author may wish to consider
whether the existing Health and Safety Code provisions will
continue to make sense if the these provisions in the Labor
Code were adopted.
SUPPORT AND OPPOSITION :
Support: California Nurses Association (sponsor)
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California Association of Psychiatric Technicians
California Labor Federation
National Association of Social Workers
Laborers' Locals 777 & 792
United Nurses Associations of California/Union of
Health Care Professionals
Oppose: California Hospital Association
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