BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1083
A
AUTHOR: John A. Perez
B
AMENDED: June 17, 2009
HEARING DATE: June 25, 2009
1
CONSULTANT:
0
Hansel/sh
8
3
SUBJECT
Health facilities: security plans
SUMMARY
Requires hospital security and safety assessments to be
conducted not less than annually, and requires hospital
security plans to be updated annually. Provides that
hospital security plans may additionally include efforts to
cooperate with local law enforcement regarding violent acts
at the facility. Requires hospitals to consult with
affected employees and members of the medical staff in
developing their security plans and assessments.
CHANGES TO EXISTING LAW
Existing law:
Requires all general acute care, acute psychiatric, and
special hospitals to conduct a security and safety
assessment and develop a security plan with measures to
protect personnel, patients, and visitors from aggressive
and violent behavior.
Requires the assessment to examine trends of aggressive or
violent behavior at the facility.
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 1083 (John A. Perez) Page
2
Requires hospitals to track incidents of aggressive or
violent behavior for purposes of developing a security
plan, which may include security considerations relating to
physical layout, staffing, security personnel availability,
and policy and training related to responses to violent
acts.
Requires hospitals, in developing the security plan, to
consider guidelines or standards issued by DPH, the
Division of Occupational Safety and Health, and the federal
Occupational Safety and Health Administration, and to adopt
policies including but not limited to, policies regarding
personnel training designed to protect personnel, patients,
and visitors from aggressive or violent behavior.
Requires the members of a hospital committee responsible
for developing the security plan to be familiar with
several things, including the role of security in hospital
operations, hospital organization, protective measures,
handling of disturbed patients, visitors, and employees,
and identification of aggressive and violent predictive
factors.
Requires a hospital to have sufficient personnel to provide
security pursuant to the plan.
Requires certain acts of assault, as defined, to be
reported to the local law enforcement agency within 72
hours.
Gives DPH authority to assess administrative penalties
against hospitals for licensing deficiencies, including up
to $100,000 for a deficiency that constitutes immediate
jeopardy to the health or safety of a patient, and up to
$25,000 for a deficiency that does not constitute immediate
jeopardy to the health or safety of a patient.
This bill:
Requires hospitals to conduct security and safety
assessments not less than annually and to annually update
their security plans.
Provides that security plans may additionally include
efforts to cooperate with local law enforcement regarding
STAFF ANALYSIS OF ASSEMBLY BILL 1083 (John A. Perez) Page
3
violent acts at the facility.
Requires hospitals, in developing their plans and
assessments, to consult with affected employees, including
the recognized collective bargaining agents and members of
the medical staff. Provides that the consultation may
occur through hospital committees.
FISCAL IMPACT
According to the Assembly Appropriations Committee analysis
of AB 1083, unknown annual costs, likely less than $50,000
to UC medical centers, to update safety assessments each
year and to increase employee access to safety plans.
BACKGROUND AND DISCUSSION
According to the author, AB 1083 will help ensure that
patients and workers do not become victims of violence, by
requiring hospitals to update their security assessments
and security plans annually, encouraging them to cooperate
with local law enforcement, and requiring them to consult
with their employees and medical staff.
The author notes that gang violence, mental health
problems, and other acts of aggression are endemic - and
hospital patients and employees all too often face real
risks: whether it is the nurse walking through parking lot
at midnight at the end of her shift, the emergency room
technician called on to assist with a violent patient, or
the families frightened by the potential for gang violence
following a loved one into the hospital.
Prevalence of violence in hospital settings
Recent data developed by the Bureau of Labor Statistics
(BLS) indicates that hospital workers are at high risk for
violence in the workplace. The BLS estimates that in a
typical year 2,637 nonfatal assaults are made on hospital
workers in this country, a rate of 8.3 assaults per 10,000
workers. This rate is much higher than the same rate for
all
STAFF ANALYSIS OF ASSEMBLY BILL 1083 (John A. Perez) Page
4
other private sector industries which is only two nonfatal
assaults per 10,000 workers. Nurses and aides with direct
patient contact are at higher risk for violence as are
emergency response personnel, hospital security officers,
and other providers.
Violence in health care work settings has been the focus of
several policy initiatives in California since the early
1990s. In 1990 a survey of emergency departments was
conducted by the California Emergency Nurses Association to
determine the magnitude of violence against emergency
nurses and the security practices in place at the time.
This survey precipitated the passage of SB 508 (Speier) in
1993, which required hospitals to conduct security
assessments and develop security plans by July 1, 1995. A
follow-up survey in 2002 found that security measures had
increased since passage of SB 508, but that substantial
gaps still exist. In 1993, Cal-OSHA issued guidelines for
safety and security of health care and community service
workers.
According to an evaluation of safety and security programs
that was completed in 2007, which looked at safety and
security in California and New Jersey hospitals, health
care workers, particularly those who work in emergency
departments and in psychiatric care units, have a high risk
of work-related assault. Among the factors that place such
workers at hightened risk are dealing with the public on
demand in a highly publicly accessible place and working
with potentially hostile clients.
The survey found that 93.1 percent of California hospitals
provided workplace violence training for emergency
department employees, and that 94.8 percent had written
policies regarding violence in the workplace, but found
that many emergency department employees in general acute
care and employees in psychiatric hospitals do not receive
training. The survey found wide variation in the specific
types of security measures in place in hospitals, but also
documented a decline in the rate of violent events in
emergency departments and in psychiatric care units after
the passage of SB 508. The survey also found that nurses,
medical technicians, and mental health workers were the
most frequently assaulted employees.
STAFF ANALYSIS OF ASSEMBLY BILL 1083 (John A. Perez) Page
5
Arguments in support
The Service Employees International Union (SEIU), the
sponsor of AB 1083, states that AB 1083 is a modest measure
that will address gaps in existing law by requiring
hospitals to annually review and update security and safety
assessment plans and to consult with their employees in the
development of the plans. SEIU states that violence and
aggression do not stop at the hospital door and the reality
is that doctors, nurses, hospital workers, and patients
face acts of aggression and violence on a daily basis.
SEIU states that while many hospitals undertake periodic
reviews of their plans, unfortunately, not all do.
Oppose unless amended
The California Emergency Nurses Association (CENA) states
that making the violence assessment available to any
employee or to the collective bargaining agent will
increase risk by highlighting a hospital's vulnerability to
acts of aggression or violence. CENA requests amendments
to provide that the assessment is only made available to
those who need to be involved in developing the plan and to
implement security measures, and to only require hospitals
to consult with individuals it deems necessary to assist
with the assessment and implementation of a security plan.
The latest set of amendments address some of the concerns
raised by CENA, but it is not clear if they remove their
opposition to the bill.
Previous legislation
SB 508 (Speier), Chapter 936, Statutes of 1993, requires
hospitals to conduct a security and safety assessment and
to develop a security plan. Requires hospitals to report
acts of assault or battery, as specified. Requires
hospital employees regularly assigned to the emergency
department to receive training and education related
security topics, as specified.
PRIOR ACTIONS
Assembly Floor: 76-0
Assembly Appropriations: 12-0
Assembly Health: 17-0
COMMENTS
STAFF ANALYSIS OF ASSEMBLY BILL 1083 (John A. Perez) Page
6
POSITIONS
Support: Service Employees International Union (Sponsor)
California Labor Federation
California Medical Association
Kaiser Permanente
Oppose: California Emergency Nurses Association (unless
amended)
-- END --