BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: SB 1299 AUTHOR: Padilla AMENDED: March 25, 2014 HEARING DATE: April 30, 2014 CONSULTANT: Marchand SUBJECT : Workplace violence prevention plans. SUMMARY : Requires the Division of Occupational Safety and Health in the Department of Industrial Relations to adopt standards that require a general acute care hospital, acute psychiatric hospital, or a special hospital, as defined, to adopt a workplace violence prevention plan as a part of its injury and illness prevention plan to protect health care workers and other facility personnel from aggressive and violent behavior. Existing law: 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, defined in the Penal Code, which results in injury or involves the use of a firearm or other dangerous weapon, against any on-duty hospital Continued--- SB 1299 | Page 2 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, DPH may assess fines of up to $75,000 for the first penalty, $100,000 for the second penalty, and $125,000 for the third and subsequent penalties. Labor Code 7.Establishes the Division of Occupational Safety and Health (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. 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 SB 1299 | Page 3 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, are 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 liability company. This bill: 1.Requires the Occupational Safety and Health Standards Board (Standards Board), no later than July 1, 2015, to adopt standards developed by Cal/OSHA that require a general acute care hospital, acute psychiatric hospital, or a special hospital, as defined, to adopt a workplace violence prevention plan as a part of its injury and illness prevention plan to protect health care workers and other facility personnel from aggressive and violent behavior. 2.Requires the adopted standards on workplace violence prevention plans to include a requirement that the workplace violence prevention plan be in effect at all times in all patient care units, including inpatient and outpatient settings and clinics on the hospital's license. 3.Requires the adopted standards to include a definition of workplace violence that includes, but is not limited to, the use of physical force against a hospital employee by a patient or a person accompanying a patient that has a high likelihood of resulting in injury, psychological trauma, or stress, and an incident involving the use of a firearm or other dangerous weapon, regardless of whether the employee sustains an injury. 4.Requires the adopted standards for workplace violence prevention plans to include, but not be limited to, all of the following: a. Personnel education and training policies that require health care workers who provide direct care to patients to receive annual education and training that is designed to provide an opportunity for interactive questions and answers with a person knowledgeable about the workplace violence prevention plan, and that SB 1299 | Page 4 covers topics such as how to recognize the potential for violence, how to report violent incidents to law enforcement, and any resources available to employees for coping with incidents of violence, as specified; b. A system for responding to, and investigating, violent incidents and situations involving violence or the risk of violence; and, c. A system to annually assess and improve upon factors that may contribute to, or help prevent, workplace violence, including staffing patterns and patient classification systems that contribute to the risk of violence, sufficiency of security systems, and job design, equipment and facilities. 5.Requires that all workplace violence prevention plans be developed in conjunction with affected employees, including their recognized collective bargaining agents, if any. 6.Requires that all temporary personnel be oriented to the workplace violence prevention plan. 7.Requires workplace violence prevention plans to include provisions prohibiting hospitals from disallowing an employee from, or 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. 8.Requires that hospitals document, and retain for a period of five years, a written record of any violent incident against a hospital employee, regardless of whether the employee sustains an injury, and regardless of whether the report is made by the employee who is the subject of the violent incident or any other employee. 9.Requires hospitals to report violent incidents to Cal/OSHA within 24 hours if the incident results in injury, involves the use of a firearm or other dangerous weapon, or presents an urgent or emergent threat to the health or safety of hospital personnel. Requires all other violent incidents to be reported to Cal/OSHA within 72 hours. 10.Requires Cal/OSHA, by January 1, 2017, and annually thereafter, to post a report on its Internet Web site, in a manner that protects confidentiality, information regarding violent incidents at hospitals, including the total number of SB 1299 | Page 5 reports, which specific hospitals filed reports, the outcome of any related inspection or investigation, the citations levied against a hospital based on a violent incident, and recommendations of Cal/OSHA on the prevention of violent incidents at hospitals. FISCAL EFFECT : This bill has not been analyzed by a fiscal committee. COMMENTS : 1.Author's statement. 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. According to the U.S. Bureau of Labor Statistics, 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. According to the "Evaluation of Safety and Security Programs to Reduce Violence in Health Care Settings," a 2007 report commissioned by the National Institute for Occupational Safety and Health (NIOSH), health care workers have long been recognized as having a high risk of work-related assault, and nurses are at particularly high risk, with the highest rate of victimization among occupations in the health care industry. High rates of violence against health care workers are not unique to California. At least 16 states have enacted laws aimed at addressing workplace violence against health care workers. It is important that Cal/OSHA adopt standards requiring hospitals to establish workplace violence prevention plans to protect health care workers and other facility personnel from aggressive and violent behavior. 2.Report on violence in hospitals. According to the aforementioned 2007 report from NIOSH, data indicate that hospital workers are at high risk for experiencing violence in the workplace. 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 that suggested potential for improved protection and/or improved efficiency. Among others, these were some of the areas identified for needed improvement: SB 1299 | Page 6 a. Surveillance of workplace violence events is uncoordinated and inefficient; b. Nursing staff within emergency departments were often unsatisfied with their interactions with security personnel; c. Although all hospitals trained the majority of personnel in emergency and psychiatric units, no hospitals trained all employees regularly stationed in the unit; d. Employee training programs rarely included review of violence trends within their specific hospital; e. Cal/OSHA logs and employers' reports did not provide detailed information about the circumstances of a violent event, which could limit prevention efforts; and, f. 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. 1.Pending petitions before Cal/OSHA. The 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), which is sponsoring this bill, 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 the Health and Safety Code and the Labor Code, a specific, enforceable standard for workplace violence prevention is needed to protect health care 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 SB 1299 | Page 7 decision within six (6) months. Petitions are referred to Cal/OSHA for an evaluation and the Board's staff also prepares an independent evaluation of the petition. 2.Double referral. This bill was heard in the Senate Committee on Labor and Industrial Relations on April 24, 2014. It passed with a 4-1 vote. 3.Prior legislation. SB 718 (Yee) of 2013, similar to this bill, required all hospitals, as part of the injury prevention program required of all employers and enforced by Cal/OSHA, to adopt a workplace violence prevention plan designed to protect health care workers and others from aggressive or violent behavior. SB 718 was placed on the Assembly Inactive File. AB 30 (Hayashi) of 2011 was also 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 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), Chapter 936, Statutes of 1993, required hospitals to conduct security assessments, develop security plans, and have sufficient personnel to provide security. AB 508 also required hospitals to report any act of assault against on-duty personnel to a local law enforcement agency within a specified time frame. 4.Support. This bill is sponsored by CNA, which states that violence in health care settings has been an area of concern for some time, as the risk of workplace violence is a serious occupational hazard for registered nurses and other health care workers. CNA states that concerns over workplace violence reached a fever pitch near the end of October 2010, when a registered nurse at Contra Costa County's correctional SB 1299 | Page 8 facility was violently assaulted by an inmate while attempting to provide care, and died from her injuries. CNA states that the standards that this bill requires Cal/OSHA to adopt will improve the safety and security of registered nurses and healthcare workers throughout the state. This bill is also supported by the Consumer Attorneys of California (CAC), which states that according to the Bureau of Labor Statistics, health care and social assistance workers experience the most assaults on the job, accounting for almost 60 percent of violent assaults in the workplace. CAC states that ensuring the safety of healthcare workers from workplace injuries is important not only to workers themselves, but to the patients they serve, and that this bill will strengthen patient safety in California by protecting health care workers from aggressive and violent behavior. The California Industrial Hygiene Council states in support that the healthcare industry is the fastest-growing industry in the United States and it is also one of the most dangerous places to work. This bill provides reasonable provisions to improve the safety and security of healthcare workers throughout the state. 5.Opposition. The California Hospital Association (CHA) states in opposition that this bill is unnecessary as current law requires hospitals to adopt and implement a comprehensive workplace violence prevention plan, and that Cal/OSHA already has jurisdiction to investigate, remedy and enforce situations involving workplace violence. CHA states that the training requirements in this bill duplicate existing law and also unreasonably expand the scope. According to CHA, existing law already requires hospitals to provide annual training for staff in the emergency department 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 just those in high risk areas, which is a significant unfunded mandate. CHA also notes that this bill is unnecessary as two petitions were recently filed with the Cal/OSHA Standards Board requesting that it develop regulations pertaining to workplace violence in healthcare, including one petition by the sponsor of this bill. Finally, CHA states 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. According to SB 1299 | Page 9 CHA, the decision about when to call law enforcement is inextricably intertwined with patient care decisions, and that it is not unreasonable to expect employees to use a chain of command to ensure that the proper resource is used. This bill is also opposed by the Association of California Healthcare Districts, which states that this bill is duplicative and unnecessary. SUPPORT AND OPPOSITION : Support: California Nurses Association (sponsor) California Industrial Hygiene Council Consumer Attorneys of California LIUNA Locals 777 & 792 Oppose: Association of California Healthcare Districts California Hospital Association --END--