BILL ANALYSIS �
AB 2399
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Date of Hearing: April 18, 2012
ASSEMBLY COMMITTEE ON LABOR AND EMPLOYMENT
Sandre Swanson, Chair
AB 2399 (Allen) - As Amended: April 9, 2012
SUBJECT : Injury and illness prevention plans (IIPP) for state
mental health hospitals.
SUMMARY : Requires that each state hospital under the purview
of the Department of Mental Health (DMH), take the following
measures to prevent patient on staff assaults in the work place:
(a) update its an injury and illness prevention plan (IIPP)
every two years, (b) establish an injury and illness prevention
committee that makes recommendations to revise the IIPP, and (c)
establish an incident reporting system, as specified.
EXISTING LAW :
1)Authorizes the DMH to regulate the conduct and management of
all state hospitals and psychiatric facilities. (Cal. Welf. &
Inst. Code � 4000 et seq.) DMH has jurisdiction over the
following five state hospitals, all of which have in-patient
psychiatric facilities: Atascadero State Hospital, Coalinga
State Hospital, Metropolitan State Hospital, Napa State
Hospital, and Patton State Hospital. (Cal.Welf. & Inst.Code �
4100.) DMH also separately operates two psychiatric
correctional facilities in Salinas Valley and Vacaville.
2)States that every California employer must establish,
implement and maintain a written copy of its IIPP. (8 CCR �
3203.) Under DOSH's model plan, each IIPP must address the
following eight elements: responsibility, compliance,
communication, hazard assessment, accident exposure and
investigation, hazard correction, training and instruction,
and record keeping.
FISCAL EFFECT : Unknown
COMMENTS :
Current IIPP requirements in California
Under �2303 of California's Code of Regulations, an employer
must at minimum have a written IIPP that meets the following
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eight essential elements:
1)Identifies the person with the authority and responsibility
for implementing the IIPP
2)Includes a system for ensuring that employees comply with safe
and healthy work practices.
3)Includes a system for communicating with employees in a form
readily understandable by all affected employees on matters
relating to occupational safety and health, including
provisions designed to encourage employees to inform the
employer of hazards at the worksite without fear of reprisal.
Compliance under this provision could include the employer
conducting meetings, in person trainings, posting written
communications, or establish a system of anonymous
notification.
4) Schedules periodic inspections to identify unsafe conditions
and work practices. Inspections shall be made to identify and
evaluate hazards:
a) When the program is first established
b) When s new substances, processes or equipment are
introduced to the workplace that could represent a safety
hazard,
c) When an employer is made aware of a new or a
previously unrecognized hazard.
1)Includes a procedure to investigate injuries or illnesses in
the workplace.
2)Includes methods or procedures for correcting unsafe or
unhealthy conditions in a timely manner.
3)Provides training and instruction:
a) When the program is first established.
b) To all new employees.
c) To employees given new jobs for which training has
not been received previously.
d) When new substances, processes or equipment is
introduced to the workplace.
e) When the employer is made aware of a previously
unknown hazard.
f) To supervisors to familiarize themselves with
hazards that employees under their direction may be
exposed to.
1)Records in writing all the steps and actions taken to
establish, implement, and revise the IIPP.
Rise in Forensic Population among California's State Mental
Health Hospitals
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The Select committee on State Hospital Safety has found that
there has generally been a steady rise in the number of violent
incidents at California's psychiatric facilities, a significant
number of which represent patient on staff aggression. A study
conducted by the University of California, Davis and the Napa
State Hospital showed that in 2012 there were over 8,300
incidents in the five state hospitals where an aggressor was
identified. Out of these incidents, there were over 5,100
injuries reported, over 1,000 of which were staff injuries
including 1 death. These numbers amount to 23 aggressive acts
per day, 18 victims per day, 14 injuries per day and 3 staff
injuries per day.
In October 2010, the Los Angeles Times highlighted the tragic
death of an employee and a brutal beating of another employee
only six weeks later at the Napa State Hospital. The
combination of these incidences has highlighted the inherent
dangers for patients and staff at California's state hospitals.
The Select committee has found that the rise in violent
incidences at state hospitals is caused by a variety of factors
including the increasing forensic population at state hospitals,
insufficient staff levels, and lack of safety and infrastructure
to maintain the current levels of patient population. Today,
over 85% of the patients housed at the Napa State Hospital are
forensic patients, whereas fifteen years ago that number hovered
around 40% of hospital's patient population. This trend is
clear throughout all of California's state hospitals. As of
December 31, 2010, most of the 9,061 patients at the five state
hospitals were forensic commitments.
Lack of Regulations have led to increasing workplace hazards in
State Mental Health Hospitals
Under the authority of the Department of Industrial Relations
(DIR), the Division of Occupational Health and Safety (DOSH)
enforcement unit is tasked to impose citations and fines on
employers who violate the state's workplace safety laws.
(Cal.Labor Code � 6300 et seq.)
Over the last year, DOSH issued numerous citations and fines
amounting to over $200,000 to all five of the state's mental
health hospitals run by the DMH due to staff related injuries
related to patient assaults and other workplace related hazards.
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Most recently, in April 2012, California workplace safety
officials fined Coalinga State Hospital more than $20,000,
alleging in part that the psychiatric facility failed to keep
staff members safe from assault and has an inadequate employee
alarm system.<1>
Additionally, the Select Committee on State Hospital Safety
recently reviewed the existing IIPP for each state hospital,
including the mental hospitals, and verified that addressing
workplace hazards related to patient assaults is incomplete or
non-existent in each of the plans.
Cost saving benefits to the State
Enacting an IIPP is not only beneficial to employees and
patients of state hospitals, but there are also significant
financial benefits to the state. The Select Committee on State
Hospital Safety has found that since 2003, overtime expenditures
in the five state hospitals and the two state psychiatric
facilities went from $40 million to $101 million. Most of that
increase has been attributed to time missed due to worker
compensation claims which have increased with the increase in
forensic populations in these facilities. The UC Davis study
points out that at the Napa State Hospital for example, there
were 396 staff injuries in 2009 resulting in 278 workers'
compensation claims and 9,473 missed work days. In 2010, there
were 384 staff injuries resulting in 289 workers' compensation
claims and 10,724 missed work days. <2>
Federal Law
The Occupational Health and Safety Department (OSHA) identifies
certain private sector employers and federal agencies that
should have written injury and illness prevention plans in place
to protect employees from workplace related hazards. (29
U.S.C.A. � 657.) OSHA has identified the following key elements
that a model injury and illness prevention plan should address:
management leadership, worker participation, hazard
---------------------------
<1> Los Angeles Times, Coalinga State Hospital Fined more than
$20,000 over safety issues, April 5th, 2012.
http://latimesblogs.latimes.com/lanow/2012/04/calosha-fines-coali
nga-state-hospital-more-than-20000-over-safety-issues.html.
<2> Deparment of Mental Health Hospital Oversight and Monitoring
Branch, Statewide Aggression Analysis.
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identification, hazard prevention, and control, education and
training, and program evaluation and improvement. <3>
The National Institute for Occupational Safety and Health
(NIOSHA) has recognized that healthcare and social services
workers face a significant job-related violence as assaults
represent a serious safety and health hazard within these
industries. <4> The Bureau of Labor Statistics (BLS) reports
that there were 69 homicides in the health services from 1996 to
2000. BLS data also shows that in 2000, 48 % of all non-fatal
injuries from occupational assaults and violent acts occurred in
health care and social services. Most of these occurred in
hospitals, nursing and personal care facilities, and residential
care services.
Injury rates also reveal that health care and social service
workers are at high risk of the most violent assault at work.
In 2000, health service workers overall had an incidence rate of
9.3 for injuries resulting from assaults and violent acts. The
rate for social service workers was 15, and for nursing and
personal care facility workers, 25. This compares to an overall
private sector injury rate of two.
The Department of Justice's (DOJ) National Crime Victimization
Survey for 1993 to 1999 lists average annual rates of non-fatal
violent crime by occupation. The average annual rate for
non-fatal violent crime for all occupations is 12.6 per 1,000
workers. The average annual rate for physicians is 16.2; for
nurses, 21.9; for mental health professionals, 68.2; and for
mental health custodial workers, 69. <5>
The reason for the increase risks posed to health care workers
stem from several factors which include:
� The prevalence of handguns and other weapons among
patients, their families or friends;
--------------------------
<3> http://www.osha.gov/dsg/topics/safetyhealth/index.html .
<4> OSHA Guidelines for Preventing Workplace Violence for
Healthcare and Social workers. OSHA 3148-01R 2004
<5> Note: The DOJ data do not compare directly to the BLS data
because DOJ presents violent incidents per 1,000 workers and BLS
displays injuries involving days away from work per 10,000
workers. Both sources, however, reveal the same high risk for
health care and social service workers.
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� The increasing use of hospitals by police and the
criminal justice system for criminal holds and the care of
acutely disturbed, violent individuals;
� The increasing number of acute and chronic mentally ill
patients being released from hospitals without follow-up
care (these patients have the right to refuse medicine and
can no longer be hospitalized involuntarily unless they
pose an immediate threat to themselves or others);
� The availability of drugs or money at hospitals, clinics
and pharmacies, making them likely robbery targets;
� Factors such as the unrestricted movement of the public
in clinics and hospitals and long waits in emergency or
clinic areas that lead to client frustration over an
inability to obtain needed services promptly;
� The increasing presence of gang members, drug or alcohol
abusers, trauma patients or distraught family members;
� Low staffing levels during times of increased activity
such as mealtimes, visiting times and when staff are
transporting patients; and
� Isolated work with clients during examinations or
treatment.
OSHA's current violence prevention guidelines are built on a
voluntary generic safety and health program management OSHA
published in 1989. These guidelines aim to reduce worker
exposure to conditions that lead to death or injury from
violence by implementing effective security devices and
administrative work practices, among other measures. Much like
AB 2399, OSHA's guidelines call for management and employee
involvement, a step-by-step worksite analysis to identify
potential hazards that could lead to workplace violence, and a
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comprehensive system to record and track incidences in the
workplace. The OSHA guidelines also include detailed guidelines
for healthcare employers to train their employees, record
keeping, training for security personnel, and immediate response
and investigation to violent incidences.
Other States
Thirty-four states have some type of program initiatives for
worker safety and health protection. The forms of the programs
vary greatly between different states. Some may be voluntary or
mandatory, comprehensive or partial, applicable to all employers
or only to a subset, and may be provided by the State
occupational safety and health agency or through the State's
workers' compensation system.
Thirty-four states have some type of program initiatives for
worker safety and health protection, but only Alabama,
California, Hawaii, Mississippi, Nebraska and Washington have
laws that require all employers to have an injury and illness
prevention plan. <6>
In January 2012, OSHA released a White Paper report that
summarizes several different studies conducted on the
effectiveness of various types of injury and illness plans
enacted by the states. <7> In one study, OSHA examined the
injury and illness prevention programs in eight states where the
state had either required a program or provided incentives or
requirements through its workers' compensation programs. The
success of these state programs was evident as data showed they
lowered injury and illness incidences anywhere between 9% to
more than 60%. In 2009, OSHA also examined fatality rates and
found that California, Hawaii and Washington, with their
mandatory injury and illness prevention program requirements
---------------------------
<6> http://www.osha.gov/dsg/topics/safetyhealth/states.html
<7> OSHA Injury and Illness Prevention Programs White Paper
Report, January 2012,
http://www.osha.gov/dsg/topics/safetyhealth/OSHAwhite-paper-janua
ry2012sm.pdf
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workplace fatality rates were as much as 31 % below the national
average.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Psychiatric Technicians
California Psychiatric Association (prior version)
California Psychological Association
California Statewide Law Enforcement Association
Opposition
None on file.
Analysis Prepared by : Meeti Sudame/Benjamin Ebbink / L. & E.
/ (916) 319-2091