This story was first published Friday, March 1, 2019, by MedPage Today.
By Shannon Firth, Washington Correspondent, MedPage Today
WASHINGTON -- House members discussed legislation aimed at protecting healthcare workers from violent patients during a hearing on Wednesday.
The purpose of Wednesday's hearing by the House Education and Labor Committee's Workforce Protections subcommittee was to examine the Workplace Violence Prevention for Health Care and Social Service Workers Act, recently re-introduced by Rep. Joe Courtney (D-Conn.)
Witnesses told of threats and injuries on the job. Some said the incidents ended their careers and shattered their health.
"My head snapped backwards, and I heard a bang and a pop and all of the air rushed out of me," said Patricia Moon-Updike, RN, of the Wisconsin Federation of Nurses and Health Professionals, recalling the moment in June 2015 when a large, agitated teenage boy kicked her in the throat.
At the time, Moon-Updike and the patient's assigned nurse had been trying to bring the teenager "screaming and thrashing" into a seclusion room. One of her colleagues called security and Moon-Updike believed that four guards were on their way -- one to hold each of the teenager's four limbs, as Moon-Updike noted in written testimony.
Only two arrived
Moon-Updike said she remembers holding her throat with both hands, knowing that if she let go her trachea would collapse and she would die. "I was praying to stay conscious," she said.
Her trachea was undamaged, but soon she started having nightmares and grew frightened of people and children being unpredictable. She was ultimately diagnosed with post-traumatic stress disorder, anxiety, depression, insomnia, and social phobia, and she could no longer work.
In her last position as a nurse she made $62,000 annually. She now makes $12,720 a year in Social Security Disability, after Medicare deductions, noted her written testimony.
"I loved being a nurse. I do not know what to call myself now," she said.
She said the hospital's procedures and policies to prevent violent attacks like the one she suffered were inadequate.
The Bureau of Labor Statistics found healthcare and social workers are nearly five times more likely to be seriously and violently injured at work compared with workers in other sectors, said subcommittee chairwoman Rep. Alma Adams (D-N.C.). However, such incidents are "predictable and preventable."
"OSHA [Occupational Safety and Health Administration] has not ignored this problem, but it currently lacks the tools to address it adequately," she said, stressing the need for congressional action.
Under the Obama administration, OSHA began rulemaking for workplace violence on OSHA's agenda, but the Trump administration put a freeze on any efforts to establish a national workplace violence prevention standard. Adams stressed that the agency is "years away" from proposing a standard.
"Where we are today isn't good enough," Adams said.
Courtney's bill would mandate that OSHA create a national standard requiring health care and social service employers to develop and execute comprehensive workplace violence prevention plans.
Adams explained that such a plan "would identify risks, specify both work practice and environmental controls, and require training, reporting and incident investigation."
It would also require employers to keep a log of violent incidents and prepare annual summaries. In addition, the bill would expand protections to public employees in the 24 states that are currently not covered by OSHA by forcing compliance from any healthcare institutions and social service agencies that receive Medicare funds.
Finally, the bill calls for OSHA to meet strict deadlines. The agency would be required to publish an interim final standard within 1 year of enactment and a final standard within 42 months of its enactment.
"These are not radical, impractical, infeasible or unaffordable requirements," said Adams.
She noted that the legislation mirrors much of what has already been recommended to the agency. "The difference is that these measures would, for the first time, be enforceable."
Moon-Updike supported the bill as does National Nurses United.
"As nurses who work at the bedside, our union has seen violence reach epidemic proportions in our hospitals and clinics, " said NNU co-president Jeans Ross, RN, in a press statement. "Employers failure to prevent violence not only harms nurses and other healthcare workers, but it harms our patients too."
Due Process versus Speed
Another witness at the hearing, attorney Manesh Rath, JD, who has represented industry in previous OSHA rulemaking, said Congress shouldn't rush the rulemaking.
While he agreed that employers have a role in mitigating risk of violence to healthcare and social workers, the reintroduced bill does not take the time to gather the appropriate evidence for its proposed solutions.
"The causes of workplace violence are far from understood and the remedy remains unclear," Rath said, citing a CDC report that stated more research is needed.
He also argued that the bill "would direct OSHA to adopt and implement an enforceable final rule without the well-accepted principle of administrative due process" required by Congress, and without time for input from affected stakeholders to be submitted and considered.
"Those are the cherished cornerstones in administrative law and have been so for 72 years."
But Jane Lipscomb, PhD, RN, an epidemiologist and professor of nursing and medicine at the University of Maryland, said enough is enough.
"If you think about the testimony that you heard today from Ms. Moon-Updike and you multiply that story by tens of thousands of healthcare workers all around the country ... you'll realize why we need this mechanism to encourage OSHA to make this a priority and promulgate an interim final standard and a final standard in the shortest amount of time possible."
In her written testimony, Lipscomb cited research from Wayne State University in Detroit that found a "data driven, worksite-based intervention, based on OSHA guidelines" decreased the risk of "patient-to-worker violence-related injuries" by 60% within months of implementation.
States including California, New York, New Jersey, Oregon, Washington, and Maryland have enacted workplace violence laws and they have gathered enough stakeholder comment to inform a national rule, she argued.
"Experts in healthcare safety and patient safety have all written documents that recommend pretty much the same measures that are described in this bill," Lipscomb testified. "So, I completely disagree that there hasn't been an opportunity for stakeholder input. In fact, I think there's a consensus in industry on what's needed."
“Where we are today isn't good enough.”
Rep. Alma Adams (D-N.C.)