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---
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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
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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
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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
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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:
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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
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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
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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
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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
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