BILL ANALYSIS Ó
SB 1299
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Date of Hearing: June 11, 2014
ASSEMBLY COMMITTEE ON LABOR AND EMPLOYMENT
Roger Hernández, Chair
SB 1299 (Padilla) - As Amended: June 5, 2014
SENATE VOTE : 22-13
SUBJECT : Workplace violence prevention plans.
SUMMARY : Enacts various requirements related to workplace
violence prevention plans for hospitals. Specifically, this
bill :
1)Requires the OSHA Standards Board, no later than July 1, 2016,
to adopt standards that require specified hospitals to adopt a
workplace violence prevention plan as a part of their injury
and illness prevention plans to protect health care workers
and other facility personnel from aggressive and violent
behavior.
2)Specifies that this bill does not apply to a hospital operated
by the State Department of State Hospitals, the State
Department of Developmental Services, or the Department of
Corrections and Rehabilitation.
3)Specifies that the standards shall include all of the
following:
a) 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.
b) A definition of workplace violence that includes, but is
not limited to, both of the following:
i) 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.
ii) An incident involving the use of a firearm or other
dangerous weapon, regardless of whether the employee
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sustains an injury.
c) A requirement that a workplace violence prevention plan
include, but not be limited to, all of the following:
i) Personnel education and training policies that
require all health care workers who provide direct care
to patients to, at least annually, receive specified
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.
ii) A system for responding to, and investigating
violent incidents and situations involving violence or
the risk of violence.
iii) A system to, at least annually, assess and improve
upon factors that may contribute to, or help prevent
workplace violence, as specified.
d) A requirement that all workplace violence prevention
plans be developed in conjunction with affected employees,
including their recognized collective bargaining agents, if
any.
e) A requirement that all temporary personnel to be
oriented to the workplace violence prevention plan.
f) 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.
g) A requirement 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.
h) A requirement that a hospital report violent incidents
to the division. If the incident results in injury,
involves the use of a firearm or other dangerous weapon, or
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presents an urgent or emergent threat to the welfare,
health, or safety of hospital personnel, the hospital shall
report the incident to the Division of Occupational Safety
and Health (DOSH) within 24 hours. All other incidents of
violence shall be reported to DOSH within 72 hours.
4)Requires DOSH, by January 1, 2017, and annually thereafter, in
a manner that protects patient and employee confidentiality,
to post a report on its Internet Web site containing
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, the citations levied
against a hospital based on a violent incident, and
recommendations of DOSH on the prevention of violent incidents
at hospitals.
5)Specifies that this bill does not limit the authority of the
Standards Board to adopt standards to protect employees from
workplace violence and shall not be interpreted to preclude it
from adopting standards that require other employers,
including those exempted from this bill, to adopt plans to
protect employees from workplace violence.
6)Specifies that this bill shall not be interpreted to preclude
the Standards Board from adopting standards that require an
employer covered by this bill, or any other employers, to
adopt a workplace violence prevention plan that includes
elements or requirements additional to, or broader in scope,
than those described in this bill.
EXISTING LAW under the 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. (Health and Safety Code
§1257.7). Existing law also establishes a mechanism 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.
FISCAL EFFECT : According to the Senate Appropriations
Committee, the Department of Industrial Relations (DIR) would
incur costs of $375,000 in the first year and $268,000 ongoing
related to information technology costs and additional
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rulemaking.
COMMENTS : This bill would require the OSHA Standards Board, no
later than July 1, 2015, to adopt standards developed by DOSH
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.
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:
Surveillance of workplace violence events is
uncoordinated and inefficient.
Nursing staff within emergency departments were often
unsatisfied with their interactions with security
personnel.
Although all hospitals trained the majority of personnel
in emergency and psychiatric units, no hospitals trained
all employees regularly stationed in the unit.
Employee training programs rarely included review of
violence trends within their specific hospital.
OSHA logs and employers' reports did not provide
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detailed information about the circumstances of a violent
event, which could limit prevention efforts.
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 OSHA Standards
Board, no later than July 1, 2015, to adopt standards developed
by the DOSH 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.
Current Petitions Before the OSHA Standards Board
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 OSHA 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
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 OSHA Standards Board must consider all petitions and issue a
decision within six months. Petitions are referred to DOSH for
an evaluation (Labor Code §147) and the OSHA Standards Board's
staff also prepares an independent evaluation of the petition.
ARGUMENTS IN SUPPORT :
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
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assault or violent act by another person than the average worker
in all other major industries combined. In 2007, nearly 60
percent 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, CNA, these findings are consistent
with 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. These concerns, 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 and policies that ensure the safety
and security of its workers.
The author and proponents believe that by requiring the OSHA
Standards Board 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.
ARGUMENTS IN OPPOSITION :
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) DOSH already has jurisdiction to
investigate, remedy and enforce situations involving workplace
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violence, and (3) the sponsor of this bill, the California
Nurses Association, has initiated the regulatory process with
the OSHA Standards Board. Additionally, they argue that the
California 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 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.
Finally, opponents believe that this bill is duplicative of
current efforts already underway at the OSHA Standards Board,
where two petitions have been filed requesting that regulations
be developed pertaining to workplace violence in healthcare.
PRIOR RELATED LEGISLATION :
SB 718 (Yee) of 2013 would have directed all hospitals, as part
of their required injury and illness prevention programs, 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 contain a requirement that
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DOSH develop standards and that the OSHA Standards Board adopt
those standards by a prescribed date. SB 718 was placed on the
inactive file on the Assembly Floor.
AB 30 (Hayashi) of 2011 was similar to this bill, but proposed
to expand on existing Health and Safety Code provisions
requiring hospitals to develop a security plan. AB 30 was held
in the Assembly Appropriations Committee.
AB 1083 (John A. Pérez), Chapter 506, Statutes of 2009, required
hospital security and safety assessments to be conducted not
less than annually, and required 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.
REGISTERED SUPPORT / OPPOSITION :
Support
American Nurses Association/California
California Industrial Hygiene Council
California Nurses Association (sponsor)
Consumer Attorneys of California
Laborers' International Union of North America Locals 777 and
792
Opposition
Association of California Healthcare Districts
California Hospital Association
Analysis Prepared by : Ben Ebbink / L. & E. / (916) 319-2091
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