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Congressman Courtney’s Remarks at the House Education & Labor Committee Markup of H.R. 1309, the Workplace Violence Prevention for Health Care and Social Service Workers Act

June 11, 2019
Press Release
"This is a momentous step in a years-long process to address the serious problem of violence against the caregivers, medical professionals, and social workers who are enduring frightening rates of violent attacks while they are healing, caring for, and consoling patients all across America [...] "

Thank you, Chairman Scott for convening today’s mark up and Chairwoman Adams for taking urgent action on this issue in the Workforce Protections Subcommittee early in the 116th Congress.

This is a momentous step in a years-long process to address the serious problem of violence against the caregivers, medical professionals, and social workers who are enduring frightening rates of violent attacks while they are healing, caring for, and consoling patients all across America. 

Every person who has worked in a hospital, a psychiatric aide, a social worker, or emergency responder knows how serious and pervasive this problem is, and how it affects their ability to do their jobs. The primary source of this violence comes in the form of assaults: kicking, hitting, spitting, verbal threats from patients, residents, and clients, or those who accompany them.  It affects worker’s sense of safety at work, contributes to burnout, high workers’ compensation costs, stress, and traumatizes the patients and other staff who witness these events.

As the CEO of the Cleveland Clinic, Tom Mihaljevic said recently at his State of the Clinic address, workplace violence is “an epidemic” for health care workers. and called it “a fundamental problem in U.S. healthcare that very few people speak about… In 2018, Cleveland Clinic confiscated an incredible 30,000 weapons from patients and visitors in Northeast Ohio.

Close to home for me was an incident that occurred to Helene Andrews, a registered nurse from Danbury Connecticut who was assaulted multiple times during her career. Shortly before she retired, she was thrown to the floor by a patient and her pelvis was shattered.

In 2013, this committee started oversight of this problem, and requested a report from the GAO to determine how pervasive this violence is, and what strategies are at our disposal to reverse the trend. The report, which was completed in 2016 found that workers in health care facilities experience substantially higher rates of nonfatal injury due to violence in the workplace compared to workers overall. The graph on the screen shows how appalling this disparity is.

These events should not be part of the job. They should not be a daily, weekly, or monthly occurrence. But unfortunately, the data shows us otherwise. Between 2006 and 2017, there was a 70% increase in violent incidents that occurred in health care and social service workplaces that resulted in employees being away from work.

According to the Bureau of Labor Statistics, health care and social service workers are nearly five times more likely to suffer a serious injury from workplace violence than workers in other settings. Up to 30% of hospital workers report being assaulted at work. For employees in psychiatric hospitals that number is drastically higher. Nearly 50% of emergency room physicians have been physically assaulted at work, and 80% report that this violence effects patient care.

Despite these alarming statistics, we know that violence against this workforce is grossly underreported. Many medical professionals are discouraged from reporting incidents, fear further stigmatizing patients, or just think it’s “part of the job”.

We also know that these incidents are preventable. Since 1996 OSHA has published voluntary guidelines that recommend commonsense preventive measures that employers can take to reduce the risk and severity of violent incidents.  These were last updated in 2015.

While these guidelines are an excellent resource, the fact that we continue to see a growth in violence means that voluntary actions alone are not enough.

In order to ensure that the OSHA Guidelines are adopted and implemented, we need to provide OSHA with an enforceable standard.

That’s why in 2016, after receiving the GAO’s report, 5 members of the House and Senate asked that OSHA begin rulemaking on a standard to protect health care and social service workers from violence. In January 2017, Obama’s OSHA announced they would initiate the rulemaking process, a move that signaled to millions of health care employees that government would be on their side helping to provide a safer workplace.

However, since then OSHA has sputtered and stalled. Later in 2017 OSHA removed the issue from its active regulatory agenda, then in 2018 placed it back on.  They have twice delayed even the smallest step forward in rulemaking: convening a panel of affected small businesses. It is clear that the Administration is not making this a priority. The bill before us will.

Very simply, the standard required by the legislation would require that covered employers, such as hospitals and psychiatric treatment facilities, develop a Workplace Violence Prevention Plan that is tailored to the specific conditions and hazards present at each workplace.

I’d like to emphasize that this standard is far from “one size fits all” and instead explicitly requires that the violence prevention plans be “tailored to the specific conditions and hazards for each facility.”

Each employer would be responsible for assessing and identifying the risks that their employees face, and take measures to mitigate those risks. This includes work practice controls, such as sharing information with caregivers on a patient or client’s history of violence, training on de-escalation techniques, and ensuring workers are not isolated when dealing with a high risk patient. Other measures include engineering controls such as weapons detectors, securing furniture, improving lighting, and sufficient security alarms.

Many of these interventions are outlined by the Joint Commission, the body that accredits hospitals.

While we will never eliminate all risk, or stop every violent attack, research on the measures in this legislation have been shown to substantially mitigate risk of serious injury from workplace  violence.

The Amendment in the Nature of a Substitute will make two main changes to H.R. 1309.

  • When there are multiple employers operating in a facility, it requires procedures for determining which employer or employers are responsible for implementing and complying with the provisions of the standard. This change was made at the request of healthcare employer groups to keep the chain of command in a multi-employer setting clear and distinct.
  • Secondly, flexibility is provided in the provision of annual training.  After initial training, employers can use live video-conference in cases when in-person training is not practicable. This change acknowledges that many employees covered by this bill, especially social service workers, do not routinely visit one centralized workplace. Once again, this change was made at the request of health care employers who were seeking to improve a bill that will protect their workers.

I would like to thank the many researchers, professional and medical societies, union representatives and individual workers who contributed to this legislation.

And thank you to Mr. John Brady, a Registered Nurse and Vice President of AFT Connecticut who has worked tirelessly on this issue who is here today. This bill is certainly better thanks to all of your input.

I urge a yes vote on the Amendment in a Nature of a Substitute.

I yield back.