BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                 UNFINISHED BUSINESS


          Bill No:  SB 1299
          Author:   Padilla (D)
          Amended:  6/5/14
          Vote:     21

           
           SENATE LABOR & INDUSTRIAL RELATIONS COMMITTEE  :  4-1, 4/24/14
          AYES:  Hueso, Leno, Padilla, Mitchell
          NOES:  Wyland

           SENATE HEALTH COMMITTEE  :  5-1, 4/30/14
          AYES:  Hernandez, De León, DeSaulnier, Evans, Monning
          NOES:  Morrell
          NO VOTE RECORDED:  Beall, Nielsen, Wolk

           SENATE APPROPRIATIONS COMMITTEE  :  5-2, 5/23/14
          AYES:  De León, Hill, Lara, Padilla, Steinberg
          NOES:  Walters, Gaines

           SENATE FLOOR  :  22-13, 5/29/14
          AYES:  Beall, Block, Corbett, De León, DeSaulnier, Evans,  
            Galgiani, Hancock, Hernandez, Hill, Hueso, Jackson, Lara,  
            Leno, Lieu, Liu, Mitchell, Padilla, Pavley, Steinberg, Torres,  
            Wolk
          NOES:  Anderson, Berryhill, Cannella, Correa, Fuller, Gaines,  
            Huff, Knight, Morrell, Nielsen, Vidak, Walters, Wyland
          NO VOTE RECORDED:  Calderon, Monning, Roth, Wright, Yee

           ASSEMBLY FLOOR  :  54-21, 8/20/14 - See last page for vote


           SUBJECT  :    Workplace violence prevention plans:  hospitals

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           SOURCE  :     California Nurses Association


           DIGEST  :    This bill requires the Occupational Safety and Health  
          Administration Standards Board (OSHA), no later than July 1,  
          2016, to adopt standards 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.

           Assembly Amendments  stipulate that the OSHA authority is not  
          limited to adopt standards to protect employees from workplace  
          violence as specified; stipulate OSHA shall not be precluded  
          from adopting standards that require an employee covered, as  
          specified, or any employers, to adopt a workplace violence  
          prevention plan that includes element or requirements additional  
          to, broader in scope, as specified; change the date from no  
          later than July 1, 2015, to not later than July 1, 2016, for  
          OSHA to adopt standards developed by the Division of  
          Occupational Safety and Health (DOSH); and make technical  
          changes.

           ANALYSIS  :    Existing law provides a framework for the  
          protection of the occupational safety and health of employees  
          through OSHA, in the Department of Industrial Relations.  The  
          California Occupational Safety and Health Act of 1973,  
          establishes certain safety and other responsibilities of  
          employers and employees necessary to render the employment safe.  


          Under existing law, California employers are required to  
          establish, implement and maintain an effective written,  
          industry-specific Illness and Injury Prevention Program (IIPP)  
          that contains certain mandatory provisions as part of an effort  
          to reduce workplace injuries.  The IIPP shall include, among  
          other things, the employer's:

           1. System for identifying and evaluating workplace hazards,  
             including scheduled periodic inspections.

           2. Methods and procedures for correcting unsafe or unhealthy  
             conditions and work practices in a timely manner.


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           3. Training program designed to provide instruction with  
             respect to hazards specific to each employee's job  
             assignment.

           4. 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.  

          Existing law requires every employer to file a complete report  
          with OSHA of every occupational injury or occupational illness  
          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 OSHA by telephone.  Failure to file this  
          report as required deems an employer guilty of a misdemeanor  
          punishable by up to six months in a county jail and/or a $5,000  
          fine. 

          Existing law, under 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.  Additionally, existing law  
          requires hospitals to include in the plan:

           1. Specified security considerations, including those relating  
             to staffing, security personnel availability, education and  
             training related to appropriate responses to violent acts.

           2. Efforts to cooperate with local law enforcement when  
             incidents occur. 

           3. A consultation process with affected employees, including  
             the recognized collective bargaining agent, if any.

           4. A report to local law enforcement within 72 hours, any act  
             of assault or battery, as defined, which results in injury or  
             involves the use of a firearm or other dangerous weapon  
             against any on-duty hospital personnel.  

          Existing law establishes a structure under which the Department  
          of Public Health (DPH) is permitted to assess administrative  

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          fines to hospitals for violation of any of their licensing laws  
          and regulations.  

          This bill enacts various requirements related to workplace  
          violence prevention plans for hospitals. Specifically, this  
          bill: 

          1.Requires OSHA, 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: 

                           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.  


                           An incident involving the use of a firearm or  
                    other dangerous weapon, regardless of whether the  
                    employee sustains an injury. 

             A.   A requirement that a workplace violence prevention plan  
               include, but not be limited to, all of the following: 

                           Personnel education and training policies that  

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                    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. 

                           A system for responding to, and investigating,  
                    violent incidents and situations involving violence or  
                    the risk of violence. 

                           A system to, at least annually, assess and  
                    improve upon factors that may contribute to, or help  
                    prevent workplace violence, as specified. 

             A.   A requirement that all workplace violence prevention  
               plans be developed in conjunction with affected employees,  
               including their recognized collective bargaining agents, if  
               any. 

             B.   A requirement that all temporary personnel to be  
               oriented to the workplace violence prevention plan. 

             C.   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. 

             D.   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. 

             E.   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  
               presents an urgent or emergent threat to the welfare,  
               health, or safety of hospital personnel, the hospital shall  
               report the incident to DOSH within 24 hours. All other  
               incidents of violence shall be reported to DOSH within 72  
               hours. 

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          1.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. 

          2.Specifies that this bill does not limit the authority of the  
            OSHA 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. 

          3.Specifies that this bill shall not be interpreted to preclude  
            the OSHA 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. 

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

          According to the Assembly Appropriations Committee, this bill  
          will result in: 

           One-time costs to DOSH of $350,000 over two years, and ongoing  
            costs of approximately $180,000. 

           Cost pressure to the University of California's five medical  
            centers in the hundreds of thousands of dollars annually  
            associated with new training requirements of direct care  
            staff. 

           Cost pressure to the state and other purchaser of health care  
            by raising the total cost of hospital care by several million  
            dollars statewide annually, due to new security training  
            requirements of direct care staff not currently required to  

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            receive this training. 

           SUPPORT  :   (Verified  8/20/14)

          California Nurses Association (source)
          American Nurses Association/ California
          California Industrial Hygiene Council
          Consumer Attorneys of California
          Laborers' International Union of North America Locals 777 & 792
          SEIU - California
          United Nurses Associations of California/ Union of Health Care  
          Professionals

           OPPOSITION  :    (Verified  8/20/14)

          Association of California Healthcare Districts 
          California Hospital Association

           ARGUMENTS IN SUPPORT  :    According to the author's office,  
          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's  
          office 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  
          assault or violent act by another person than the average worker  
          in all other major industries combined.  In 2007, nearly 60% 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, the California Nurses Association  
          (CNA), these findings are consistent with plentiful 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. Concerns that,  
          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  

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          the safety and security of its workers. 

          The author's office and proponents believe that by requiring  
          Cal/OSHA to adopt standards addressing workplace violence in  
          hospitals, this bill puts forth reasonable provisions that  
          enhance safety and security protections for the healthcare labor  
          force.  Additionally, the author's office 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) existing law requires  
          hospitals to adopt and implement a comprehensive workplace  
          violence prevention plan; (2) Cal/OSHA already has jurisdiction  
          to investigate, remedy and enforce situations involving  
          workplace violence; and (3) the sponsor of this bill, the  
          California Nurses Association, has initiated the regulatory  
          process with Cal/OSHA. Additionally, they argue that DPH 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  
          requires 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  

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          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. 

          Lastly, opponents believe that this bill is duplicative of  
          current efforts already underway at the Cal/OSHA, where two  
          petitions have been filed requesting that regulations be  
          developed pertaining to workplace violence in healthcare.


           ASSEMBLY FLOOR  :  54-21, 8/20/14
          AYES:  Alejo, Ammiano, Bloom, Bocanegra, Bonilla, Bonta,  
            Bradford, Buchanan, Ian Calderon, Campos, Chau, Chesbro,  
            Cooley, Dababneh, Daly, Dickinson, Eggman, Fong, Fox, Frazier,  
            Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray, Hall, Roger  
            Hernández, Holden, Jones-Sawyer, Levine, Lowenthal, Medina,  
            Mullin, Muratsuchi, Nazarian, Pan, Perea, John A. Pérez, V.  
            Manuel Pérez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas,  
            Rodriguez, Salas, Skinner, Stone, Ting, Weber, Wieckowski,  
            Wilk, Williams, Atkins
          NOES:  Achadjian, Allen, Bigelow, Chávez, Conway, Dahle,  
            Donnelly, Beth Gaines, Hagman, Harkey, Jones, Linder, Logue,  
            Maienschein, Mansoor, Melendez, Nestande, Olsen, Patterson,  
            Wagner, Waldron
          NO VOTE RECORDED:  Brown, Gorell, Grove, Yamada, Vacancy


          PQ:AL:d:n  8/20/14   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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