BILL ANALYSIS Ó
Senate Committee on Labor and Industrial Relations
Ted W. Lieu, Chair
Date of Hearing: April 24, 2013 2013-2014 Regular
Session
Consultant: Alma Perez Fiscal:Yes
Urgency: No
Bill No: SB 718
Author: Yee
As Introduced/Amended: April 4, 2013
SUBJECT
Hospitals: workplace violence prevention plan
KEY ISSUES
Should the legislature require that hospitals adopt a Workplace
Violence Prevention Plan to protect health care workers and
others from aggressive or violent behavior at their facilities?
Should the legislature require hospitals to develop this plan in
conjunction with affected employees, including their recognized
collective bargaining agents, if any?
Should the Division of Occupational Safety and Health (Cal/OSHA)
be required to annually prepare a report to the Legislature
regarding violent incidents at hospitals, including total number
of incidents reported?
ANALYSIS
Existing law provides a framework for the protection of the
occupational safety and health of employees through the state's
Division of Occupational Safety and Health, better known as
Cal/OSHA, in the Department of Industrial Relations (DIR). The
California Occupational Safety and Health Act of 1973,
establishes certain safety and other responsibilities of
employers and employees necessary to render the employment safe.
Under existing law , California employers are required to
establish, implement and maintain an effective written,
industry-specific Illness and Injury Prevention Program (IIPP)
that contains certain mandatory provisions as part of an effort
to reduce workplace injuries. The IIPP shall include, among
other things, the employer's (Labor Code §6401.7):
System for identifying and evaluating workplace hazards,
including scheduled periodic inspections;
Methods and procedures for correcting unsafe or
unhealthy conditions and work practices in a timely manner;
Training program designed to provide instruction with
respect to hazards specific to each employee's job
assignment;
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.
Existing law requires every employer to file a complete report
with Cal/OSHA of every occupational injury or occupational
illness which results in lost time beyond the date of the injury
or illness, or which requires medical treatment beyond first
aid. (Labor Code §6409.1)
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.
An employer who fails to file this report as required is
guilty of a misdemeanor punishable by up to six months in a
county jail and/or a $5,000 fine. (Labor Code §6423)
Additionally, existing law , specifies that other violations,
such as 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. (Labor Code
§6423)
Existing law, under Health and Safety Code , requires hospitals
to conduct an annual security and safety assessment, and using
that assessment, develop and annually update a security plan
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Senate Committee on Labor and Industrial Relations
with measures to protect personnel, patients, and visitors from
aggressive or violent behavior. Additionally, the plan requires
hospitals to:
Include in its plan specified security considerations,
including those relating to staffing, security personnel
availability, education and training related to appropriate
responses to violent acts.
Include in its plan, efforts to cooperate with local law
enforcement when incidents occur.
In developing the plan, to consult with affected
employees, including the recognized collective bargaining
agent, if any.
Report to local law enforcement within 72 hours of an
incident, any act of assault or battery, as defined, that
results in injury or involves the use of a firearm or other
dangerous weapon against any on-duty hospital personnel.
Law 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.
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.
This Bill would require all hospitals, as part of their required
Illness and Injury Prevention Program, to adopt a Workplace
Violence Prevention Plan ("The Plan") designed to protect health
care workers, other facility personnel, patients and visitors
from aggressive or violent behavior.
Specifically, the bill:
1. Defines "violent incident" as including, but not limited
to, the use of physical force against a hospital employee
by a patient (or a person accompanying a patient) that
results in injury, psychological trauma, or stress,
regardless of whether the employee sustains an injury; and
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Senate Committee on Labor and Industrial Relations
an incident involving the use of a firearm or other
dangerous weapon, regardless of whether the employee
sustains an injury.
2. Requires the 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;
c. Potential security risks associated with
specific units or areas;
d. Uncontrolled public access to any part of the
facility; employee security in areas surrounding the
facility;
e. The use of a trained response team to assist
employees in violent situations; and
f. Efforts to cooperate with local law
enforcement regarding violent acts.
3. Requires the hospital to, as part of the plan, adopt
safety and security policies including, but not limited to,
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 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
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e. Modifications to job design, staffing,
security, equipment, or facilities as determined
necessary to prevent or address violence against
hospital employees.
4. Requires the plan to be developed in conjunction with
affected employees, including their recognized collective
bargaining agents, if any.
5. Requires the hospital, in developing the plan, 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 annual workforce
violence prevention education and training, 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
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 when a violent incident occurs.
10. Requires a hospital (in addition to incident reporting
requirements in current law) to document and keep for a
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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 staff.
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, as specified,
information regarding violent incidents at hospitals
including, but not limited to, the total number of reports,
the outcome of any related inspection or investigation,
citations levied based on a violent incident, and
recommendations on how to prevent violent incidents at
hospitals.
15. Requires Cal/OSHA to adopt regulations by January 1,
2015, to implement the provisions of this bill.
COMMENTS
1. Need for this bill?
According to the National Institute for Occupational Safety
and Health (NIOSH), which is part of the federal Centers for
Disease Control and Prevention, since the 1980s, violence has
been recognized as a leading cause of occupational mortality
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and morbidity. On average, 1.7 million workers are injured
each year (nationally), and more than 800 die as a result of
workplace violence [Bureau of Justice Statistics 2001; BLS
2005]. These tragic deaths and injuries stress the need for a
proactive and collaborative workplace prevention effort at the
national and state level. As part of its Workplace Prevention
Research and Prevention Initiative during 2003, NIOSH convened
a series of stakeholder meetings that focused on various types
of workplace violence and the industries and occupations at
risk.
According to the NIOSH website, data indicates that hospital
workers are at high risk for experiencing violence in the
workplace. 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.
In order to address this problem, this bill would direct all
hospitals, as part of their required Injury and Illness
Prevention Program, to adopt a Workplace Violence Prevention
plan designed to protect health care workers and others from
aggressive or violent behavior.
2. Proponent Arguments :
According to proponents, the risk of workplace violence is a
serious occupational hazard for registered nurses and other
health care workers. They argue that 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, the author has
introduced this bill to establish new standards for hospitals
to protect registered nurses and other health care workers
from violence in their workplace.
The author argues that current hospital surveillance of
workplace violence is uncoordinated and inefficient, employee
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training programs rarely include review of violence trends
within their hospital, and few have effective systems of
communication regarding the presence of violent patients. With
this bill, the author seeks to protect employees who are
victims of workplace violence by ensuring they are provided
evaluation and treatment, and retain the right to seek
assistance and intervention from local law enforcement.
Finally, proponents argue that this bill puts forth reasonable
provisions that will improve the safety and security of
registered nurses and health care workers throughout the
state.
3. Opponent Arguments :
The California Hospital Association (CHA) is opposed to this
measure and argues that it would require duplicative and
redundant processes that will be both time consuming and
resource intensive, without accomplishing any measurable
results. According to CHA, current law is very comprehensive
as the California Department of Public Health (CDPH) and the
Cal/OSHA both have jurisdiction over enforcement of safety
laws. Additionally, they argue that Cal/OSHA's enforcement
unit already conducts inspections in response to reports of a
workplace accident or injury or complaints about an
occupational safety and health hazard and issues citations.
Moreover, they argue that where the bill exceeds existing
requirements it imposes burdensome and unfunded mandates on
public and private hospitals. For example, CHA argues, one of
the most onerous and costly aspects of this bill is the
expanded training obligation. This bill would expand the
training obligation to include all medical staff and direct
patient care employees, rather than those in high risk areas
as currently required. They argue that this provision is
extremely costly, creating additional training requirements
for all staff without any evidence of a corresponding benefit.
Opponents argue that another example of redundancy and
potential conflicts is the reporting obligation since existing
law already requires hospitals to report adverse events to
CDPH and Cal/OSHA.
Opponents are also concerned that the provisions regarding
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treatment of an injured worker is also duplicative and in some
respects conflicts with California's workers' compensation
law, particularly the provision that authorizes the employee,
rather than the health care provider, to dictate treatment.
They believe there is already a well-developed body of law
related to the workers' compensation process, including
evaluation and treatment for workplace injuries and illnesses,
including psychological injury.
Overall, opponents argue that hospitals are already required
to manage security risks, provide staff training, and assess
and plan appropriately to mitigate and respond to violence in
the workplace. They believe that adding further training and
reporting obligations to the current statutory scheme is not a
responsible use of limited state and hospital resources.
4. Double Referral :
This bill has been double referred. It was previously heard
and passed by the Senate Health Committee.
5. Prior Legislation :
AB 30 (Hayashi) of 2011: Held in Assembly Appropriations
Committee
AB 30 was similar to this bill, however, that bill proposed to
expand on the existing Health and Safety Code provisions
requiring hospitals to develop a security plan, while this
bill instead creates a new provision of law in the Labor Code.
AB 1083 (John A. Perez): Chaptered
AB 1083 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): Chaptered
AB 508 required hospitals to conduct security assessments,
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develop security plans, and have sufficient personnel to
provide security. The bill also required hospitals to report
any act of assault against on-duty personnel to a local law
enforcement agency within a specified time frame.
SUPPORT
California Nurses Association - Sponsor
Consumer Attorneys of California
Union of Health Care Professionals
United Nurses Association of California/Union of Health Care
Professionals
OPPOSITION
California Hospital Association
Hearing Date: April 24, 2013 SB 718
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Senate Committee on Labor and Industrial Relations