BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 718| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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. CONTINUED SB 718 Page 2 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 CONTINUED SB 718 Page 3 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 CONTINUED SB 718 Page 4 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. CONTINUED SB 718 Page 5 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 CONTINUED SB 718 Page 6 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 CONTINUED SB 718 Page 7 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 CONTINUED SB 718 Page 8 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 CONTINUED SB 718 Page 9 workplace injuries. JL:ej 5/15/13 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED