The California Division of Occupational Safety and Health, better known as “Cal/OSHA,” recently proposed sweeping regulations addressing workplace violence in health care settings. These far-reaching regulations cover health care workers in a broad range of health care settings, such as outpatient medical offices and clinics, home health care and home-based hospice, emergency medical services, mobile clinics and dispensing operations, drug treatment programs, medical outreach services, and other off-site operations, including retail outlets that provide health care services. Cal/OSHA, known for developing demanding workplace safety regulations, drafted the proposed regulations to implement the Healthcare Workplace Violence Prevention Act (SB 1299), signed by Governor Jerry Brown in 2014. The comment period on the proposed regulations closed on December 17, 2015, but the final regulations have not yet been filed with the Secretary of State.

Meanwhile, there has been a flurry of activity by the federal Occupational Safety and Health Administration (“OSHA”) regarding workplace violence in health care settings. In the past several months OSHA has published a massive overhaul of its Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers and added a page on its website providing more substantial guidance to aid employers and employees in preventing and responding to workplace violence in health care. The agency has not gone so far as proposing a regulation applicable to workplace violence in health care settings. Although OSHA has issued a number of citations to health care employers with allegedly inadequate workplace violence prevention programs, the agency has used its catch-all provision, the General Duty Clause, when issuing these citations.

All health care employers—regardless of location—should pay careful attention to Cal/OSHA’s proposed regulations as OSHA may refer to them for additional guidance if the agency promulgates federal regulations regarding workplace violence in health care settings.

Overview of the Cal/OSHA Regulations

The proposed regulations broadly define workplace violence as “any act of violence or threat of violence that occurs at the work site” and require employers to “establish, implement and maintain an effective workplace violence prevention plan (Plan) that is in effect at all times in every unit, service, and operation.” The Plan contains a demanding list of requirements, including:

• maintaining sufficient staff (including security personnel) who can keep order in the facility and respond to workplace violence incidents in a timely manner;

• removing or controlling furnishings and other objects that may be used as improvised weapons;

• installing an alarm system (or other effective means) by which employees can summon security and other personnel to respond to an actual or potential workplace violence emergency;

• establishing a response plan for actual or potential workplace violence emergencies that includes obtaining help from facility security or law enforcement agencies, as appropriate; and

• configuring facility spaces so that employee access to doors and alarm systems cannot be impeded.

The proposed regulations mandate that employers provide effective training to all employees, including temporary employees, working in the facility, unit, service, or operation. The training must be provided initially to all employees. Employees performing patient contact activities—and those employees’ supervisors—must be provided refresher training at least annually.

What Does All This Mean for Health Care Employers?

While these regulations are applicable only to health care employers in California, health care employers in all states should strongly consider incorporating the concepts of the proposed Cal/OSHA regulations as well as guidance provided by OSHA for creating effective workplace violence prevention programs in health care settings. The generally positive reception to the Cal/OSHA proposed regulations from health care providers could put pressure on OSHA to develop federal regulations incorporating similar standards.

Even if OSHA does not implement workplace violence prevention regulations, health care employers regulated by OSHA will continue to face liability under the General Duty Clause if their workplace violence prevention programs are deemed inadequate to ensure employee safety.