BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                    THIRD READING


          Bill No:  SB 718
          Author:   Yee (D)
          Amended:  5/15/13
          Vote:     21


           SENATE HEALTH COMMITTEE  :  5-2, 4/17/13
          AYES:  Hernandez, Beall, De León, DeSaulnier, Monning
          NOES:  Anderson, Nielsen
          NO VOTE RECORDED:  Pavley, Wolk

           SENATE LABOR & INDUSTRIAL RELATIONS COMMITTEE  :  3-1, 4/24/13
          AYES:  Lieu, Leno, Yee
          NOES:  Wyland
          NO VOTE RECORDED:  Padilla

           SENATE APPROPRIATIONS COMMITTEE  :  5-0, 5/13/13
          AYES:  De León, Hill, Lara, Padilla, Steinberg
          NO VOTE RECORDED:  Walters, Gaines


           SUBJECT  :    Hospitals:  workplace violence prevention plan

           SOURCE  :     California Nurses Association


           DIGEST  :    This bill requires all hospitals, except as  
          specified, 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.

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           ANALYSIS  :    

          Existing law:

          Under 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  
            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, the DPH may assess  

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            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.
          
          Under 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 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  

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             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, as specified.

          4.Requires a hospital, as part of its WVP plan, to adopt safety  
            and security policies, as specified.

          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 DPH.

          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.

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          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 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.

           11.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.

           12.Permits Cal/OSHA, at its discretion, to conduct an  
             inspection for any violent incident that is reported pursuant  
             to this bill.

           13.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.

           14.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  

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             incident is reported, regardless of whether the employee  
             sustains an injury.

           15.Exempts hospitals operated by the Department of State  
             Hospitals, the Department of Corrections and Rehabilitation,  
             and the Department of Developmental Services from the bill's  
             requirements.

           16.Requires Cal/OSHA to adopt regulations by January 1, 2015,  
             to implement the provisions of this bill.

           Background
           
           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 are two 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, tobacco or alcohol use.

           Prior Legislation  

          AB 30 (Hayashi, 2011) was similar to this bill.  However, AB 30  
          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 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 requires hospitals to consult  
          with affected employees and members of the medical staff in  
          developing their security plans, and for their plans to include  

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          efforts to cooperate with local law enforcement regarding  
          violent acts at the facility.

          AB 508 (Speier, Chapter 936, Statutes of 1993), requires  
          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.
          
           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

          According to the Senate Appropriations Committee:

                 One-time costs of $85,000 over two years for the  
               adoption of regulations by the Department of Industrial  
               Relations (Occupational Safety and Health Fund).

                 Ongoing costs of about $50,000 per year to provide  
               required reports to the Legislature by the Department of  
               Industrial Relations (Occupational Safety and Health Fund).

           SUPPORT  :   (Verified  5/14/13)

          California Nurses Association (source)
          California Association of Psychiatric Technicians 
          California Labor Federation 
          Consumer Attorneys of California 
          Employment Law Center 
          Legal Aid Society
          National Association of Social Workers - California Chapter 
          United Nurses Association of California/Union of Health Care  
          Professionals

           OPPOSITION  :    (Verified  5/14/13)

          Association of California Healthcare Districts
          California Association of Joint Powers Authorities 
          California Hospital Association 
          Tenet Healthcare Corporation

           ARGUMENTS IN SUPPORT  :    This bill is sponsored by the  
          California Nurses Association (CNA), which states that the risk  

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          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.
          
           ARGUMENTS IN 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  

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          workplace injuries.
          

          JL:ej  5/15/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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