BILL ANALYSIS Ó
Senate Committee on Labor and Industrial Relations
Senator Ben Hueso, Chair
Date of Hearing: April 24, 2014 2013-2014 Regular
Session
Consultant: Alma Perez-Schwab Fiscal:Yes
Urgency: No
Bill No: SB 1299
Author: Padilla
As Introduced/Amended: March 25, 2014
SUBJECT
Workplace violence prevention plans
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 annually educate and
train all health care workers who provide direct care to
patients on how to respond to workplace violence incidents?
Should the Division of Occupational Safety and Health (Cal/OSHA)
be required to annually post a report on its web site containing
information regarding violent incidents at hospitals, including
any citations levied against the hospitals?
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. Failure to file this report as required deems an
employer guilty of a misdemeanor punishable by up to six months
in a county jail and/or a $5,000 fine. (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
with measures to protect personnel, patients, and visitors from
aggressive or violent behavior. Additionally, existing law
requires hospitals to include in the plan:
(Health and Safety Code §1257.7)
Specified security considerations, including those
relating to staffing, security personnel availability,
education and training related to appropriate responses to
violent acts.
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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, any act
of assault or battery, as defined, which results in injury
or involves the use of a firearm or other dangerous weapon
against any on-duty hospital personnel.
Existing law 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.
This Bill would require the Occupational Safety and Health
Standards Board, no later than July 1, 2015, to adopt standards
developed by Cal/OSHA that require specified hospitals to adopt
a workplace violence prevention plan as part of their injury and
illness prevention plan to protect health care workers and other
facility personnel from aggressive and violent behavior.
Specifically, this bill would require that the standards adopted
include provisions requiring:
1. A definition of workplace violence, as specified;
2. A workplace violence prevention plan that includes , but
not be limited to, the following:
a. Personnel education and training policies, to
be conducted at least annually, that require all
health care workers who provide direct care to
patients to learn how to recognize potential for
violence, how to seek assistance and report violent
incidents to law enforcement, and information on
resources available for coping with incidents of
violence.
b. A system for responding to, and investigating
violent incidents and situations.
c. A system to, at least annually, assess and
improve upon factors that may contribute to, or help
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prevent, workplace violence including, but not limited
to:
i. Staffing;
ii. Sufficiency of security systems,
including security personnel availability;
iii. Job design, equipment and
facilities;
iv. Security risks associated with
specific units, areas of the facility with
uncontrolled access, late-night or early morning
shifts, and employee security in areas
surrounding the facility.
3. That workplace violence prevention plans be in effect at
all times in all patient care units;
4. That all workplace violence prevention plans be
developed in conjunction with affected employees, including
their recognized collective bargaining agents, if any;
5. That all temporary personnel be oriented to the plan;
6. Provisions prohibiting hospitals from disallowing an
employee from (or taking punitive or retaliatory action
against) seeking assistance and intervention from local
emergency services or law enforcement when a violent
incident occurs;
7. A requirement that hospitals document, and retain for a
5-year period, a written record of any violent incident
against an employee;
8. Hospital to report violent incidents to Cal/OSHA
1)within 24 hours if it resulted in injury due to the use
of a firearm or other dangerous weapon or if the incident
presents an urgent/emergent threat or, 2)within 72 hours
for all other incidents of violence; and
9. By January 1, 2017, and annually thereafter, Cal/OSHA
must post a report on its web site containing information
regarding violent incidents at hospitals, including any
reports filed and the citations levied against the hospital
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for any violent incidents.
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
and morbidity. 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.
A 2007 report, "Evaluation of Safety and Security Programs to
Reduce Violence in Health Care Settings," commissioned by the
National Institute of Occupational and Environmental Health,
found that health care workers have a high risk of
work-related assault, and nurses are at particularly high
risk, with the highest rate of victimization among occupations
in the healthcare industry. The majority of hospitals, they
found, had ongoing workplace violence training programs and
all had implemented some type of prevention efforts, usually
in the form of security equipment. However, the report also
found some consistent areas which suggested potential for
improved protection and/or improved efficiency. Among others,
these were some of the areas identified for needed
improvement:
1. Surveillance of workplace violence events is
uncoordinated and inefficient;
2. Nursing staff within emergency departments were
often unsatisfied with their interactions with security
personnel;
3. Although all hospitals trained the majority of
personnel in emergency and psychiatric units, no
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hospitals trained all employees regularly stationed in
the unit;
4. Employee training programs rarely included review of
violence trends within their specific hospital;
5. OSHA logs and employers' reports did not provide
detailed information about the circumstances of a violent
event, which could limit prevention efforts; and
6. Few hospitals had effective systems to communicate
about the presence of violent patients, hospital security
equipment systems were uncoordinated and insufficient to
protect the unit, and security programs and training were
often less complete in psychiatric units than in
emergency departments.
In order to address the problem of workplace violence, the
author has introduced this bill to require the Occupational
Safety and Health Standards Board, no later than July 1, 2015,
to adopt standards developed by the Division of Occupational
Safety and Health (Cal/OSHA) that require specified hospitals
to develop a workplace violence prevention plan to protect
health care workers and other facility personnel from
aggressive and violent behavior.
2. Pending petitions before the Occupational Safety and Health
Standards Board :
The Occupational Safety and Health Standards Board (Standards
Board), within DIR, is tasked with the responsibility of
promoting, adopting, and maintaining reasonable and
enforceable standards that will ensure a safe and healthful
workplace for California workers. The Standards Board
considers petitions for new or revised regulations proposed by
any interested person concerning occupational safety and
health.
Earlier this year, two petitions, one from the California
Nurses Association (CNA) and another from SEIU Local 121RN/
SEIU Nurse Alliance of California, were submitted to the
Standards Board seeking the creation of workplace violence
prevention standards for healthcare workers. According to the
SEIU petition, "while California addresses workplace violence
prevention through Health and Safety Code and Labor Code, a
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specific, enforceable standard for workplace violence
prevention is needed to protect healthcare workers from harm."
In their petition, CNA stated that, "regardless of whether
workplace violence is addressed through the legislative or the
regulatory process, we believe that a strong framework for
workplace violence prevention requirements must be
established."
The Standards Board must consider all petitions and issue a
decision within six (6) months. Petitions are referred to
Cal/OSHA for an evaluation (Labor Code §147) and the Board's
staff also prepares an independent evaluation of the petition.
3. Proponent Arguments :
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 health care
workers. The author cites a finding from the U.S. Bureau of
Labor Statistics, which states that 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. In 2007, nearly 60% of all nonfatal assaults and
violent acts by persons occurred in the health care and social
assistance industry. The fatal injury rate between 2003 and
2007 was twice the average rate for workers in all industries
combined.
According to the sponsor, the California Nurses Association
(CNA), these findings are consistent with plentiful anecdotal
evidence from RNs and other health care workers throughout the
state who have expressed worry and frustration over inadequate
protections from violence in their workplace. Concerns that,
they argue, reached a fever pitch near the end of October
2010, when Cynthia Palomata, an RN at Contra Costa County's
Martinez correctional facility was violently assaulted and
killed by an inmate while attempting to provide him care. CNA
argues that her death has sparked a public outcry over the
safety of RNs and other health care workers, and called into
question the efforts of employers to have in place standards
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and policies that ensure the safety and security of its
workers.
The author and proponents believe that by requiring Cal/OSHA
to adopt standards addressing workplace violence in hospitals,
this bill would put forth reasonable provisions that would
enhance safety and security protections for the healthcare
labor force. Additionally, the author states that at least 16
states have enacted laws aimed at addressing workplace
violence against 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 assaults against health care workers.
4. Opponent Arguments :
According to opponents, California hospitals take very
seriously the duty of providing a safe, healthy environment
for patients as well as staff and argue that this bill is
simply unnecessary as 1) current law requires hospitals to
adopt and implement a comprehensive workplace violence
prevention plan; 2) Cal/OSHA already has jurisdiction to
investigate, remedy and enforce situations involving workplace
violence; and 3) the sponsor of this bill, the California
Nurses Association, has initiated the regulatory process with
Cal/OSHA. Additionally, they argue that the CA Department of
Public Health (CDPH) already reviews the adequacy of these
workplace violence prevention plans and evaluates compliance.
If problems are found, then hospitals would be subject to
administrative penalties.
According to opponents, the training requirements in this bill
duplicate existing law and unreasonably expand the scope.
Currently, hospitals are required to provide annual training
for staff in the emergency department (ED) as well as any high
risk areas as identified in the security assessment. This bill
would require training for all direct patient care employees
rather than only those in high risk areas, a provision that,
they argue, creates a significant unfunded mandate without any
evidence of a corresponding benefit and does not allow
hospitals the ability to allocate training resources
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appropriately.
Additionally, opponents argue that the prohibition on a
hospital's ability to direct employees to contact internal
security staff rather than local emergency services or law
enforcement is not in the best interest of employee safety or
patient care because contacting internal security can provide
the assistance and support needed in a timelier manner. They
also argue that some in some units, such as a psychiatric
unit, the presence of uniformed officers can be detrimental to
patient care. Thus, they argue, it is not unreasonable to
expect employees to use a chain of command to ensure that the
proper resource is used and if law enforcement is called in,
they know where to go and can partner with the hospital
security personnel.
Lastly, opponents believe that this bill is duplicative of
current efforts already underway at the Cal/OSHA Standards
Board, where two petitions have been filed requesting that
regulations be developed pertaining to workplace violence in
healthcare.
5. Double Referral :
This bill has been double referred and, if approved by this
committee, it will be sent to the Senate Health Committee for
a hearing.
6. Prior Legislation :
SB 718 (Yee) of 2013: Ordered to the inactive file on the
Assembly Floor
Similar to this bill, SB 718 would have directed 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, however, that bill did not
have the requirement that Cal/OSHA develop standards and that
the Standards Board adopt these by a prescribed date.
AB 30 (Hayashi) of 2011: Held in Assembly Appropriations
Committee
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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,
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
LIUNA Locals 777 & 792
OPPOSITION
Association of California Healthcare Districts
California Hospital Association
Hearing Date: April 24, 2014 SB 1299
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Senate Committee on Labor and Industrial Relations