California’s Division of Occupational Safety and Health (“Cal/OSHA”) has made the Golden State the first in the nation to propose standards specifically aimed at protecting health care workers against workplace violence.

According to the U.S. Bureau of Labor Statistics, the rate of injuries and illnesses from violence in the health care industry is more than three times greater than that for all private industries. Supporters of California’s proposed standards argue that these statistics indicate workplace violence is a serious occupational hazard for health care workers, warranting the need for hospitals and other healthcare facilities to develop and implement a workplace violence prevention plan.

The federal Occupational Safety and Health Administration provides guidance and training materials to combat workplace violence in the healthcare industry, but it has no specific regulations in place. Instead, it relies on the General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health Act of 1970, to cite employers for hazards involving workplace violence.

In California, as a result of petitions to the Occupational Safety and Health Standards Board by two health care worker unions, and subsequent advisory committee meetings held by the Cal/OSHA, the state passed legislation in September 2014, requiring that standards be issued to address Workplace Violence Prevention in Health Care. The Board recently released the proposed standards to the public for comment. A public hearing on the proposal is scheduled for December 17, 2015. The new standards must be adopted by July 1, 2016.

In the proposed standards, workplace violence “is defined as any act of violence or threat of violence that occurs at the work site,” including “the threat or use of physical force against an employee that results in, or has a high likelihood of resulting in injury, psychological trauma,” or an “incident involving the threat or use of a firearm or other dangerous weapon.” In all instances, under the proposed standards, it is immaterial whether the employee sustains an injury. The definition encompasses four types of violent encounters, whether committed by: (1) someone with “no legitimate business;” (2) a person who is the beneficiary of the services provided; (3) a current or past employee; or (4) someone who “has a personal relationship with an employee.”

The proposed regulations apply to hospitals and other health care facilities, such as outpatient medical offices and clinics; home health care and home-based hospice; paramedic and emergency medical services; field operations (e.g., mobile clinics); drug treatment programs; and, ancillary health care operations.

The cornerstones of the proposed regulations address:

  1. Establishing a workplace violence prevention plan that includes active employee involvement;
  2. Identifying and evaluating environmental risk factors, such as employees working in isolated locations, poor illumination or blocked visibility, lack of physical barriers and escape routes, obstacles and impediments to accessing alarm systems and storage of high-value items, currency or pharmaceuticals;
  3. Identifying and evaluating patient-specific workplace violence risk factors by utilizing assessment tools, decision trees, or algorithms;
  4. Correcting hazards related to workplace violence in a timely manner and implementing corrective measures, such as: providing line of sight or other communication in all areas in which patients may be present; configuring spaces so that employees have access to doors and alarms; removing or fastening furnishings and other objects so they cannot be used as weapons; creating a security plan for prevention of the transport of unauthorized firearms and other weapons in the facility; maintaining sufficient staffing; and maintaining an alarm system;
  5. Providing specific training and education to all health care workers who provide direct care to patients at least annually;
  6. Setting up a system to respond to and investigate violent incidents and situations or the risk of violent incidents and situations;
  7. Assessing annually the program and making improvements to help prevent workplace violence; and
  8. Making and retaining records for five years of any violent incident against a hospital employee, regardless of whether an injury was sustained.

The proposed regulations also require that a covered healthcare facility report violent incidents to Cal/OSHA. 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 healthcare facility must report the incident to Cal/OSHA within 24 hours. All other incidents of violence must be reported to Cal/OSHA within 72 hours.

Starting in 2017, Cal/OSHA will post a report on its website containing information regarding the total number of workplace violence reports and which specific healthcare facilities filed reports, the outcome of any related inspection or investigation, the citations levied against a facility based on a violent incident and any recommendations by Cal/OSHA on the prevention of violent incidents.