BILL ANALYSIS �
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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 Le�n, 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 Le�n, 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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