New Labor Code section 6401.8 requires state government, no later than July 1, 2016, to adopt required standards for acute general care and acute psychiatric hospitals plans to prevent workplace violence.

The new statute is from Senate Bill (SB) 1299, approved by Governor Brown September 29, 2014. According to Senator Alex Padilla, the bill’s sponsor, “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 … In 2007, nearly 60% of all nonfatal assaults and violent acts 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.”

The two April 20, 2014 stabbings of nurses in separate UCLA hospitals, Olive View and Harbor, likely gave further impetus to the bill.

Section 6401.8 directs Occupational Safety and Health Standards Board published rules on each affected hospital’s adoption of a workplace violence prevention plan “to protect health care workers and other facility personnel from aggressive and violent behavior.” Those standards are to include among other things:

• Plan Must Cover All Staff: A requirement that the 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”
• Workplace Violence Definition: A minimum definition of “workplace violence” that includes 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 any incident involving the use of a firearm or other dangerous weapon (emphasis supplied).
• Training: Required violence prevention, procedure and reporting training for all staff, including provision of “critical incident stress debriefing or employee assistance programs”
• Response: Incident response and investigation protocols
• Documentation: Required hospital documentation of all violent incidents, to be retained for five years; and
• Reporting: Required hospital reporting to the state of all violent incidents. The report will be required within 24 hours if the incident resulted in injury, involved a firearm or other dangerous weapon or “presents an urgent or emergent threat to the welfare, health, or safety of hospital personnel.”

Web Posting Requirement: Section 6401.8 also requires Division of Occupational Safety and Health (DOSH or Cal OSHA), beginning January 1, 2017, to annually post a report on its Internet Web site containing information regarding violent incidents at hospitals. The Cal OSHA report is to include:

• the total number of reports from covered hospitals
• which specific hospitals filed them
• the outcome of any related inspection or investigation
• the citations levied against a hospital based on a violent incident; and
• recommendations of the division on the prevention of violent incidents at hospitals

The New Law’s Shortcomings: While the new law commendably emphasizes the importance of building adequate security for workers and will make public the statewide extent of incidents in covered facilities for the first time, it presumes the rate and severity violent attacks will continue. There is no direction to determine the actual sources of such violence in order to address reduction or elimination of these perils altogether.

Section 6401.8 also lacks any initiative to address the prospect of violence from co-workers or from intruders in covered facilities. It also specifically exempts required regulation of state-run hospitals altogether, including psychiatric and prison facilities, arguably the sites of the greatest levels of violent attacks against health care personnel.

Tim Bowles
December 31, 2014