BILL ANALYSIS Ó
SB 718
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Date of Hearing: June 18, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 718 (Yee) - As Amended: May 15, 2013
SENATE VOTE : 21-13
SUBJECT : Hospitals: workplace violence prevention plan.
SUMMARY : Requires hospitals, as part of the injury prevention
program, to adopt a workplace violence prevention (WVP) plan
designed to protect health care workers and others from
aggressive or violent behavior. Specifically, this bill :
1)Requires all general acute care hospitals, acute psychiatric
hospitals, and special hospitals, as defined, as part of their
required injury prevention program, required of all employers
and enforced by the Division of Occupational Safety and Health
(Cal/OSHA), to adopt a WVP plan designed to protect health
care workers, other facility personnel, patients, and visitors
from aggressive or violent behavior.
2)Requires the WVP plan to include, but not be limited to,
security considerations such as staffing, the adequacy of
facility security systems, potential security risks associated
with specific units, risks related to working late night or
early morning hours, and efforts to cooperate with local law
enforcement.
3)Requires hospitals to adopt, as part of the WVP, personnel
training policies designed to protect personnel, patients, and
visitors from aggressive or violent behavior, a system for
responding to violent incidents, a system for investigating
violent incidents, and a system for reporting violent
incidents to Cal/OSHA.
4)Requires the 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 (OSHA),
and the Department of Public Health (DPH).
5)Requires all medical staff and health care workers who provide
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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.
6)Requires all temporary personnel to be oriented to the WVP
plan.
7)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.
8)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.
9)Requires a hospital, in addition to reports required by
existing law under the Labor Code, to document and keep for
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.
10)Requires a hospital to report to Cal/OSHA within 72 hours the
occurrence of 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
that 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
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protects patient and employee confidentiality, information
regarding violent incidents at hospitals, that include, 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 recommendations 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 to sunset
after four years.
14)Requires Cal/OSHA to adopt regulations by January 1, 2015, to
implement the provisions of this bill.
15)Defines "violent incident" for purposes of this section, to
include, but not be limited to 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,
including an incident involving the use of a firearm or other
dangerous weapon, regardless of whether the employee sustains
an injury.
16)Specifically exempts hospitals operated by the Department of
State Hospitals, Department of Developmental Services, or the
Department of Corrections and Rehabilitation from these
provisions.
EXISTING LAW :
Health and Safety Code:
1)Requires hospitals 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.
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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 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 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, allows DPH to 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 (DIR), 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.
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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, $5,000 fine,
or both.
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, $15,000 fine, or both for an individual, or
up to a $150,000 fine for a corporation or limited liability
company.
FISCAL EFFECT : According the Senate Appropriations Committee,
one-time costs of $85,000 over two years for the adoption of
regulations by DIR (Occupational Safety and Health Fund), and
ongoing costs of about $50,000 per year to provide required
reports to the Legislature by DIR (Occupational Safety and
Health Fund).
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, violence in
health care settings is a continuing national problem, and the
risk of workplace violence is a serious occupational hazard
for registered nurses (RNs) 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. At least 16
states have enacted laws aiming to address workplace violence
for health care workers. The requirements among these laws
vary widely, ranging from requiring health facilities to have
safety and security plans, establishing fair leave policies to
employee victims, and increasing criminal penalties for
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assaults against health care workers. The author states that
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)BACKGROUND . According to the U.S. Bureau of Labor Statistics
(BLS), a worker in health care and social assistance is nearly
five times more likely to be the victim of a nonfatal assault
or violent act by another person than the average worker in
all other major industries combined. The BLS reports that in
2011, the incidence rate for violence and other injuries of
persons in the private health and social assistance sector was
more than triple the overall rate for all of private industry.
In 2007, nearly 60% of all nonfatal assaults and violent acts
by persons occurred in the health care and social assistance
industry. Nearly 75% of these violent acts were assaults by
patients or residents of a health care facility. The majority
of violent acts in health care settings occur during the day,
but assaults suffered during the late evening hours (8:00 pm
to 12:00 am) resulted in a median of seven days away from
work, longer than any other number of days away from work as a
result of day or early evening assaults. The fatal injury
rate between 2003 and 2007 was twice the average rate for
workers in all industries combined.
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 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. According to the report, violence may
occur anywhere in the hospital, but it is most frequent in
psychiatric wards, emergency rooms, waiting rooms and
geriatric units. NIOSH recommends providing training for all
workers in recognizing and managing assaults, resolving
conflicts, and maintaining hazard awareness.
A January 2007 report sponsored by NIOSH, "Evaluation of
Safety and Security Programs to Reduce Violence in Health Care
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Settings," found that OSHA logs and employers' reports do not
provide detailed information about the circumstances of the
violent event, which could limit prevention efforts. For
example, the specific location of the event was unknown in
over 70% of all events and the activity at the time of the
event was unspecific in over 40% of all events.
A 2013 Journal of Safety Research article, "Perpetrator,
worker and workplace characteristics associated with patient
and visitor perpetrated violence on hospital workers: A review
of the literature and existing occupational injury data,"
found that non-fatal type II violence experienced by hospital
workers (patient/visitor-on-worker violence) is not well
described. Approximately 484 physical assaults were
identified in the data, however, only few details about events
were captured, while non-physical events were not captured.
The researchers concluded that the literature lacked rigorous
methods for examining incidence and circumstances surrounding
events or rates of events over time. The reports required by
this bill could help provide more data on the incidence of
violence in California hospitals.
3)SUPPORT . This bill is sponsored by the California Nurses
Association (CNA). CNA states that the risk of workplace
violence is a serious occupational hazard for RNs and other
health care workers. In response, CNA is sponsoring this bill
to establish new standards for hospitals to protect RNs and
other health care workers from violence in their workplace.
CNA argues that, while the Health and Safety Code provides
some requirements regarding hospital safety and security
plans, they believe it is appropriate to place the
aforementioned requirements in the California Labor Code,
enforced by Cal/OSHA, because workplace violence is a serious
occupational health and safety issue. While DPH may enforce
hospital safety and security plans from a perspective of
hospital licensure and certification, they believe that
Cal/OSHA, with its core mission to protect workers from health
and safety hazards on the job, is well-equipped to enforce the
provisions of this bill and address the issue of workplace
violence from the perspective of worker safety and injury
prevention. CNA also states that it should be noted that this
bill was carefully drafted so as not to conflict with any of
the provisions of the Health and Safety Code governing
hospital safety and security plans. Instead, this bill
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complements and augments the current provisions in the Health
and Safety Code. Hospitals appropriately complying with the
Health and Safety Code will have a head start in compliance
with this bill.
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.
The California Labor Federation writes in support of this bill
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
for patients.
The National Association of Social Workers - California
Chapter (NASW) supports the bill, writing, everyone is
entitled to a safe work environment. Due to the nature of the
work in hospitals, extra caution should be taken to ensure
safety and promote healing for patients. Violence experienced
by an employee can influence service delivery and should be
prevented whenever possible.
The Consumer Attorneys of California also supports the bill
because it will aid law enforcement agents in their
investigation and apprehension of dangerous individuals by
requiring hospitals to report any incident that results in
injury, involves the use of a firearm or other dangerous
weapon, or presents an urgent or emergent threat to the
welfare, health, or safety of hospital personnel, to Cal/OSHA
within 24, instead of 72 hours.
4)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
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assessment, and to annually update a security plan based on
the assessment. CHA states that the training requirements
duplicate existing law, and unreasonably expand the scope by
requiring training for all medical staff, rather than just for
emergency department staff and other departments identified in
the security plan. Because hospitals do not have unlimited
training dollars, the consequence would be that training in
high risk areas would be reduced in order to meet the new
requirement to train all direct patient care workers. 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.
The California Association of Joint Powers Authorities (CAJPA)
also opposes the bill because it would require duplicative
reporting and training mandates on public and private
hospitals. CAJPA is also concerned that failure to meet the
bill's extended record keeping mandates, and the new
time-sensitive reporting requirements beyond those already
required for occupational safety and workers' compensation
purposes will set public hospitals up for this bill's new
Labor Code fines, and that these new fines and penalties will
be levied on top of existing state Health and Safety Code
fines and penalties.
5)PREVIOUS LEGISLATION .
a) AB 2399 (Allen), Chapter 751, Statutes of 2012, requires
each of the five state hospitals under the jurisdiction of
the Department of State Hospitals to update its injury and
illness prevention plan (IIPP) at least once a year,
establish an IIPP committee to provide recommendations for
updates to the plan, and develop an incident reporting
procedure for assaults on employees.
b) 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 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.
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c) AB 1083 (John A. Pérez), 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 efforts to cooperate
with local law enforcement regarding violent acts at the
facility.
d) AB 508 (Speier), Chapter 936, Statutes of 1993, the
California Hospital Safety and Security Act, 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.
6)SUGGESTED AMENDMENT . In order to ease potential burdens on
DIR and ensure continuity in reporting, the Committee may want
to consider amending the bill to do the following:
Eliminate the requirement that Cal/OSHA provide a report to
the Legislature on violent incidents at hospitals, and
instead require Cal/OSHA to post the report on its Website
in a manner that protects patient and worker
confidentiality and DPH to post a link to the Cal/OSHA
report on its Website.
REGISTERED SUPPORT / OPPOSITION :
Support
California Nurses Association (sponsor)
California Labor Federation
Consumer Attorneys of California
Laborers' Locals 777 & 792
National Association of Social Workers - California Chapter
United Nurses Associations of California/Union of Health Care
Professionals
Opposition
California Association of Joint Powers Authorities
California Hospital Association
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Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097