BILL ANALYSIS Ó
SB 1299
Page 1
Date of Hearing: June 17, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 1299 (Padilla) - As Amended: June 5, 2014
SENATE VOTE : 22-13
SUBJECT : Workplace violence prevention plans: hospitals.
SUMMARY : Requires the Division of Occupational Safety and
Health (Cal/OSHA) at the Department of Industrial Relations
(DIR), by July 1, 2016, 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 (WVPP) as part of its injury and illness
prevention plan to protect health care workers and other
facility personnel from aggressive and violent behavior.
Specifically, this bill :
1)Requires the standards adopted to include a requirement that
the WVPP be in effect at all times in all patient care units,
including inpatient and outpatient settings and clinics on the
hospital's license.
2)Requires the standards adopted 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 results in, or has a
high likelihood of resulting in, injury, psychological trauma,
or stress, regardless of whether the employee sustains an
injury, and an incident involving the use of a firearm or
other dangerous weapon, regardless of whether the employee
sustains an injury.
3)Requires the standards adopted to include a requirement that a
WVPP include, but not be limited to, all of the following:
a) Personnel education and training policies that require
all health care workers who provide direct care to patients
to, at least annually, receive education and training that
is designed to provide an opportunity for interactive
questions and answers with a person knowledgeable about the
WVPP. Requires the education and training to cover topics
that include, but are not limited to, how to recognize
potential for violence, how to report violent incidents to
SB 1299
Page 2
law enforcement, and resources available to employees for
coping with incidents of violence, including employee
assistance programs;
b) A system for responding to, and investigating violent
incidents and situations involving violence or the risk of
violence; and,
c) A system to, at least annually, assess and improve upon
factors that may contribute to, or help prevent workplace
violence, including, but not limited to:
i) Staffing patterns and patient classification
systems;
ii) Sufficiency of security systems and security
personnel availability;
iii) Job design, equipment and facilities; and,
iv) Security risks associated with specific units, areas
of the facility, specific shifts, and security in areas
surrounding the facility such as employee parking areas.
4)Requires all WVPPs be developed in conjunction with affected
employees, including their recognized collective bargaining
agents, if any.
5)Requires that all temporary personnel be oriented to the WVPP.
6)Requires WVPPs to include provisions prohibiting hospitals
from prohibiting 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.
7)Requires that hospitals document, and retain for 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.
8)Requires that a hospital report violent incidents to Cal/OSHA.
If the incident results in injury, involves a firearm or
other dangerous weapon, or presents an urgent or emergent
threat to the welfare, health, or safety of hospital
personnel, it must be reported within 24 hours, all other
incidents of violence within 72 hours.
SB 1299
Page 3
9)Requires Cal/OSHA to post a report on its Internet Website, by
January 1, 2017 and annually thereafter, in a manner that
protects patient and employee confidentiality, regarding
violent incidents at hospitals that includes, at a minimum,
the total number of reports, which hospitals filed reports,
the outcome of any related inspection or investigation, the
citations levied against a hospital based on a violent
incident, and recommendations on the prevention of violent
incidents at hospitals.
10)Exempts hospitals operated by the California Department of
State Hospitals, the California Department of Developmental
Services, or the California Department of Corrections and
Rehabilitation.
11)Specifies that the provisions of this bill do not limit the
authority of Cal/OSHA to adopt standards to protect employees
from workplace violence and that these provisions should not
be interpreted to preclude Cal/OSHA from adopting standards to
protect employees who work for hospitals exempted in 10)
above.
EXISTING LAW:
Health and Safety Code:
1)Establishes Department of Public Health (DPH), which among
other things, is responsible for licensing and inspecting
general acute care hospitals.
2)Requires hospitals 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.
3)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.
4)Requires a hospital, in developing the plan, to consult with
affected employees, including the recognized collective
bargaining agent, if any.
SB 1299
Page 4
5)Requires all hospital employees regularly assigned to the
emergency department receive security education and training,
as specified.
6)Requires any act of assault or battery, as defined in the
Penal Code, that results in injury or involves the use of a
firearm or other dangerous weapon, against any on-duty
hospital 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.
7)Establishes a structure under which 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, allows DPH to assess fines of up to $50,000 for the
first penalty, $75,000 for the second penalty, and $100,000
for the third and subsequent penalties.
Labor Code:
8)Establishes Cal/OSHA within 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.
9)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.
10)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
SB 1299
Page 5
involving a serious injury or illness, or death, the employer
is required to make an immediate report to Cal/OSHA by
telephone.
11)Specifies that every employer and every supervisor that has
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, $5,000 fine,
or both.
12)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, is subject to penalties of up to
one year in jail, $15,000 fine, or both for an individual, or
up to a $150,000 fine for a corporation or limited liability
company.
FISCAL EFFECT : According to the Senate Appropriations
Committee, DIR would incur costs of $375,000 in the first year
and $268,000 ongoing (Occupational Safety and Health Fund),
related to information technology costs for the internet-based
portal reporting requirement and additional rulemaking.
COMMENTS :
1)PURPOSE OF THIS BILL . 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 states that, 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. The author further contends that high rates of
violence against health care workers are not unique to
California and that at least 16 states have enacted laws aimed
at addressing workplace violence against health care workers.
The author concludes that 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)BACKGROUND . According to an April 2002 report from the
National Institute for Occupational Safety and Health (NIOSH),
which is part of the federal Centers for Disease Control and
SB 1299
Page 6
Prevention, data indicate that hospital workers are at high
risk for experiencing violence in the workplace. NIOSH stated
that several studies indicate that violence often takes place
during times of high activity and interaction with patients,
such as at meal times and during visiting hours and patient
transportation. Assaults may occur when service is denied,
when a patient is involuntarily admitted, or when a health
care worker attempts to set limits on eating, drinking, or
tobacco or alcohol use. According to the report, violence may
occur anywhere in the hospital, but it is most frequent in
psychiatric wards, emergency rooms, waiting rooms and
geriatric units. NIOSH recommends providing training for all
workers in recognizing and managing assaults, resolving
conflicts, and maintaining hazard awareness.
A January 2007 report sponsored by NIOSH, "Evaluation of
Safety and Security Programs to Reduce Violence in Health Care
Settings," found that Cal/OSHA logs and employers' reports do
not provide detailed information about the circumstances of
the violent event, which could limit prevention efforts. For
example, the specific location of the event was unknown in
over 70% of all events and the activity at the time of the
event was unspecific in over 40% of all events.
A 2013 Journal of Safety Research article, "Perpetrator,
worker and workplace characteristics associated with patient
and visitor perpetrated violence on hospital workers: A review
of the literature and existing occupational injury data,"
found that non-fatal type II violence experienced by hospital
workers (patient/visitor-on-worker violence) is not well
described. Approximately 484 physical assaults were
identified in the data, however, only few details about events
were captured, while non-physical events were not captured.
The researchers concluded that the literature lacked rigorous
methods for examining incidence and circumstances surrounding
events or rates of events over time. The reports required by
this bill could help provide more data on the incidence of
violence in California hospitals.
The California Occupational Safety and Health Standards Board
(Board) is the only agency in the State authorized to adopt
occupational safety and health standards or orders. The Board
is required to hold open public meetings at least monthly and
to permit any person to address the Board on any matters of
occupational safety or health or to propose new or revised
standards. Petitions for standard changes are evaluated by
SB 1299
Page 7
Cal/OSHA and the Board reports its decision no later than six
months following receipt of a petition. The California Nurses
Association (CNA) and SEIU Local 121/RN/SEIU Nurse Alliance of
California have submitted petitions to the Board seeking the
creation of workplace violence prevention standards for
healthcare workers. Both petitions were filed in February of
this year, and a decision from the Board was anticipated in
August, however the Board's analyses are complete and the
proposed decision, scheduled to be heard at a June 19th
hearing in Sacramento, indicates that both petitions will be
granted. The proposed petition decision concludes that DIR
should be asked to convene an advisory committee to discuss
the necessity of rulemaking regarding violence directed at
healthcare workers and if DIR determines that necessity
exists, the advisory committee should then seek to develop a
consensus regarding the scope and provisions of a rulemaking
proposal it deem appropriate. Both CNA and SEIU Local
121/RN/SEIU Nurse Alliance would be invited to participate, as
would other stakeholders, including employers. DIR will also
be asked to update various guidelines they have developed on
the issue of workplace safety.
3)SUPPORT . CNA is the sponsor of this bill and writes that
countless acts of assault, battery, and aggression that
routinely take place in health care settings demonstrate a
frightening trend of increasing violence faced by health care
workers in California and throughout the country. CNA states
that concerns over workplace violence reached a fever pitch
near the end of October 2010 when a registered nurse (RN) at
contra Costa County's Martinez correctional facility was
violently assaulted by an inmate and tragically died three
days later. CNA concludes that this bill puts forth
reasonable provisions that will improve the safety and
security of RNs and health care workers throughout the state.
SEIU California also supports this bill, stating that a
specific enforceable standard for workplace violence
prevention is needed to protect healthcare workers from harm
and this bill is an important effort toward that goal.
4)OPPOSITION . The California Hospital Association and the
Association of California Healthcare Districts both have an
oppose unless amended position, writing that the bill is
inconsistent with existing law requiring hospitals to adopt a
safety and security plan, and that it unreasonably usurps the
Cal/OSHA stakeholder process for developing regulations, which
SB 1299
Page 8
is currently under way. They request the bill be amended to
ensure that any regulations issued by Cal/OSHA be consistent
with current law to ensure that hospitals are not subjected to
inconsistent and possibly contradictory requirements.
5)PREVIOUS LEGISLATION .
a) SB 718 (Yee) of 2013, similar to this bill, would have
required all hospitals, as part of the injury prevention
program required of all employers and enforced by Cal/OSHA,
to adopt a WVPP designed to protect health care workers and
others from aggressive or violent behavior. SB 718 was
placed on the Assembly Inactive File.
b) AB 2399 (Allen), Chapter 751, Statutes of 2012, requires
each of the five state hospitals under the jurisdiction of
the Department of State Hospitals to update its injury and
illness prevention plan (IIPP) at least once a year,
establish an IIPP committee to provide recommendations for
updates to the plan, and develop an incident reporting
procedure for assaults on employees.
c) AB 30 (Hayashi) of 2011 was 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 similar
provision in the Labor Code. AB 30 was held in Assembly
Appropriations Committee.
d) AB 1083 (John A. Pérez), 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
requires 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.
e) AB 508 (Speier), Chapter 936, Statutes of 1993, the
California Hospital Safety and Security Act, requires
hospitals to conduct security assessments, develop security
plans, and have sufficient personnel to provide security.
Requires hospitals to report any act of assault against
on-duty personnel to a local law enforcement agency within
a specified time frame.
SB 1299
Page 9
6)DOUBLE REFERRAL . This bill has been double referred. It
passed the Assembly Committee on Labor and Employment with a
vote of 5-1 on June 11, 2014.
REGISTERED SUPPORT / OPPOSITION :
Support
California Nurses Association (sponsor)
American Nurses Association\California
Association of California Healthcare Districts
California Industrial Hygiene Council
Consumer Attorneys of California
LIUNA Locals 777 & 792
SEIU California
Opposition
California Hospital Association (unless amended)
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097