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States lead the way on mitigating workplace violence in health care settings


Legislative and regulatory efforts to address the persistent problem of workplace violence in the health care and social services sector are gaining some traction at both the federal and state levels, experts say.

Twenty-seven employees in the health care and social assistance sectors died as a result of homicide in their workplaces in 2017, according to the U.S. Bureau of Labor Statistics.

“I think it’s a problem that a lot of employers just aren’t equipped to deal with,” said Paul Vescio, senior risk consultant at Aon PLC in Pittsburgh. “For one reason or another, they’re not dedicating the time and the resources and the talent to put prevention programs in place.”

The U.S. House of Representatives Committee on Education and Labor adopted H.R. 1309, the Workplace Violence Prevention for Health Care and Social Service Workers Act, on June 11 to require the U.S. Occupational Safety and Health Administration to promulgate a standard to prevent workplace violence in the health care and social services industry. The bill, which would require employers in the sector to develop and implement a workplace violence prevention plan, passed out of committee on a 26-18 vote, with 24 Democrats and two Republicans voting to move it forward.

“This federal standard is what is necessary to resolve the problem because of the patchwork nature of OSHA enforcement,” said Michelle Mahon, a registered nurse and national nursing practice representative with National Nurses United based in Cleveland.

Meanwhile, three states recently adopted legislation relating to the creation or enhancement of workplace violence prevention programs for health care workers, and more than a half dozen more introduced legislation in 2019 aimed at making hospitals and other health care facilities safer for their workers.

On June 12, Nevada Gov. Steve Sisolak signed A.B. 348, which requires certain medical facilities to develop and carry out a plan for the prevention of workplace violence and report incidents to the state’s Division of Industrial Relations.

In Oregon, S.B. 823, signed by Gov. Kate Brown on June 11, amended a previously passed workplace violence safety law to now require all health care employers to conduct comprehensive security and safety evaluations using state or nationally recognized workplace violence protection toolkits to identify factors that may expose employees to violence by June 30, 2021. The state passed its first health care workplace violence prevention legislation in 2009. The amended law also requires health care employers to evaluate their safety program every two years and maintain a record of assaults for at least five years from the date of the incident.

Washington state’s H.B. 1931, signed into law on May 21, also amends previous health care violence legislation to include similar record-keeping and evaluation requirements. The law mandates that health care facilities identify security risks within certain units, offer training on de-escalation techniques and define expected processes and expected interventions when a violent act occurs and requires additional record keeping for violent acts, including a description of the perpetrator, the act itself and the employees in the vicinity.

“States now have stepped in to fill that void because federal OSHA has not promulgated a standard to address it,” Mr. Vescio said. “If anything does happen with OSHA, they will probably borrow heavily from the states that have already developed a requirement.”

But some state-level efforts have faltered this year. Massachusetts, Missouri, Texas and West Virginia introduced legislation regarding the development of workplace violence prevention programs to protect health care workers, but all four stalled in committee this spring. California, Minnesota, New York and Pennsylvania, which all passed workplace violence in health care bills in the past few years, proposed amendments to their laws that varied from creating a violence prevention database and mandatory assault reporting to increasing criminal penalties for assaults and defining mandatory aspects of violence prevention programs, but none passed before adjournment.

Vague wording in much of the legislation passed or proposed at the state level could be problematic, said Michael Taylor, shareholder at Greenberg Traurig LLP in McLean, Virginia. Without specifics as to what is required of a health care organization with regard to creating a workplace violence safety program, a safety inspector may take the position that though such a program is in place, it doesn’t comply with cited state standards, he said.

“That’s why more specific wording as to what’s required would be helpful for the regulated industry as opposed to (an act) for stopping workplace violence,” he said. “A lot of this is poorly worded, and to me that’s a recipe for OSHA citations.”

OSHA has used the Occupational Safety and Health Act’s general duty clause to cite employers when no specific standards exist for certain workplace hazards.

“In particular we’ve seen (general duty clause citations) in skilled nursing environments where you will have a lot of issues with regards to Alzheimer’s and dementia patients lashing out,” Mr. Vescio said. “There’s no malice. There’s no intent. But it’s still physical violence directed towards an employee. The way OSHA looks at that is, ‘Hey, it’s Alzheimer’s and dementia, you’re the experts, it’s reasonable to assume that there could be an assault so you should be better prepared for that,’ and they will cite employers for not putting reasonable controls in place.”

The Occupational Safety and Health Review Commission affirmed a citation issued against a social services employer in a closely watched case in March, but the commissioners urged OSHA to promulgate a standard that addresses workplace violence in the industry.

“The benefit of the standard is that it’s explicitly stated,” Ms. Mahon said. “The most important part is that it’s a preventive standard.”

The federal legislation would specifically require that all workplace violence prevention plans “be developed and implemented with the meaningful participation of direct care employees,” the bill stated.

This is an important requirement because the caregivers themselves are in the best position to know exactly what hazards exist in these health care facilities in general and in patients’ rooms in particular, including objects such as coffee pots, chairs and oxygen tanks, Ms. Mahon said.

“Pretty much anything can become a weapon,” she said. “These are things that direct caregivers see as potential threats, but somebody who is not in that environment of care may not recognize these things.”





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