BILL ANALYSIS Ó SB 1299 Page 1 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 SB 1299 Page 2 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 SB 1299 Page 3 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 SB 1299 Page 4 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 SB 1299 Page 5 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 SB 1299 Page 6 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 SB 1299 Page 7 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 SB 1299 Page 8 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 SB 1299 Page 9