HB0399ham001 94TH GENERAL ASSEMBLY

Health Care Availability and Access Committee

Filed: 3/1/2005

09400HB0399ham001 LRB094 05629 DRJ 42684 a

AMENDMENT TO HOUSE BILL 399

AMENDMENT NO. ______. Amend House Bill 399 by replacing everything after the enacting clause with the following:

"Section 1. Short title. This Act may be cited as the Health Care Workplace Violence Prevention Act.

Section 5. Findings. The General Assembly finds as follows:

(1) Violence is an escalating problem in many health care workplaces in this State and across the nation.

(2) The actual incidence of workplace violence in health care workplaces, in particular, is likely to be greater than documented because of failure to report such incidents or failure to maintain records of incidents that are reported.

(3) Patients, visitors, and health care employees should be assured a reasonably safe and secure environment in a health care workplace.

(4) Many health care workplaces have undertaken efforts to ensure that patients, visitors, and employees are safe from violence, but additional personnel training and appropriate safeguards may be needed to prevent workplace violence and minimize the risk and dangers affecting people in connection with the delivery of health care.

Section 10. Definitions. In this Act:

"Abuse" means any physical injury, sexual abuse, or mental injury inflicted on a patient, employee, or visitor at a health care workplace other than by accidental means.

"Department" means the Department of Labor.

"Director" means the Director of Labor.

"Employee" means any individual who is employed on a full-time, part-time, or contractual basis by a health care workplace.

"Health care workplace" means any of the following:

(1) A public or private hospital licensed under the Hospital Licensing Act or a hospital organized under the University of Illinois Hospital Act.

(2) A mental health facility or developmental disability facility as defined in the Mental Health and Developmental Disabilities Code.

"Imminent danger" means a preliminary determination of immediate, threatened, or impending risk of physical injury as determined by the employee.

"Responsible agency" means the State agency that (i) licenses, certifies, registers, or otherwise regulates or exercises jurisdiction over a health care workplace or a health care workplace's activities or (ii) contracts with a health care workplace for the delivery of health care services.

"Violence" or "violent act" means any act by a person that causes abuse of another person.

Section 15. Workplace violence plan.

(a) By July 1, 2006, every health care workplace must adopt and implement a plan to reasonably prevent and protect employees from violence at that setting. The plan must address security considerations related to the following items, as appropriate to the particular workplace, based on the hazards identified in the assessment required under subsection (b):

(1) The physical attributes of the health care workplace.

(2) Staffing, including security staffing.

(3) Personnel policies.

(4) First aid and emergency procedures.

(5) The reporting of violent acts.

(6) Employee education and training.

(b) Before adopting the plan required under subsection (a), a health care workplace must conduct a security and safety assessment to identify existing or potential hazards for violence and determine the appropriate preventive action to be taken. The assessment must include, but need not be limited to, a measure of the frequency of, and an identification of the causes for and consequences of, violent acts at the workplace during at least the preceding 5 years or for the years for which records are available for assessments involving home health agencies or hospice programs.

(c) In adopting the plan required by subsection (a), a health care workplace may consider any guidelines on violence in the workplace or in health care workplaces issued by the Department of Public Health, the Department of Human Services, the Department of Labor, the federal Occupational Safety and Health Administration, Medicare, and health care workplace accrediting organizations.

(d) It is the intent of the General Assembly that any violence protection and prevention plan developed under this Act be appropriate to the setting in which it is to be implemented. To that end, the General Assembly recognizes that not all health care services are provided in a facility or other formal setting, such as a hospital. Many health care services are provided in other, less formal settings. The General Assembly finds that it may inappropriate and impractical for all health care workplaces to address workplace violence in the same manner. When enforcing this Act, the Department shall allow a health care workplace sufficient flexibility in recognition of the unique circumstances in which the health care workplace may deliver services.

(e) Promptly after adopting a plan under subsection (a), a health care workplace must file a copy of its plan with the Department. The Department shall then forward a copy of the plan to the appropriate responsible agency.

(f) A health care workplace must review its plan at least once every 3 years and must report each such review to the Department, together with any changes to the plan adopted by the health care workplace. If a health care workplace does not adopt any changes to its plan in response to such a review, it must report that fact to the Department. A health care workplace must promptly report to the Department all changes to the health care workplace's plan, regardless of whether those changes were adopted in response to a periodic review required under this subsection. The Department shall then forward a copy of the review report and changes, if any, to the appropriate responsible agency.

(g) A health care workplace that is required to submit written documentation of active safety and violence prevention plans to comply with national accreditation standards shall be deemed to be in compliance with subsections (a), (b), (c), and (f) of this Section when the health care workplace forwards a copy of that documentation to the Department.

Section 20. Violence prevention training. By July 1, 2007, and on a regular basis thereafter, as set forth in the plan adopted under Section 15, a health care workplace must provide violence prevention training to all its affected employees as determined by the plan. For temporary employees, training must take into account unique circumstances. A health care workplace also shall provide periodic follow-up training for its employees as appropriate. The training may vary by the plan and may include, but need not be limited to, classes, videotapes, brochures, verbal training, or other verbal or written training that is determined to be appropriate under the plan. The training must address the following topics, as appropriate to the particular health care workplace and to the duties and responsibilities of the particular employee being trained, based on the hazards identified in the assessment required under Section 15:

(1) General safety procedures.

(2) Personal safety procedures.

(3) The violence escalation cycle.

(4) Violence-predicting factors.

(5) Obtaining patient history from a patient with a history of violent behavior.

(6) Verbal and physical techniques to de-escalate and minimize violent behavior.

(7) Strategies to avoid physical harm.

(8) Restraining techniques.

(9) Appropriate use of medications to reduce violent behavior.

(10) Documenting and reporting incidents of violence.

(11) The process whereby employees affected by a violent act may debrief.

(12) Any resources available to employees for coping with violence.

(13) The workplace violence prevention plan adopted under Section 15.

Section 25. Record of violent acts; reporting of violent acts.

(a) Beginning no later than July 1, 2006, every health care workplace must keep a record of any violent act against an employee, a patient, or a visitor occurring at the workplace. At a minimum, the record must include the following:

(1) The health care workplace's name and address.

(2) The date, time, and specific location at the health care workplace where the violent act occurred.

(3) The name, job title, department or ward assignment, and staff identification or other identifier of the victim, if the victim was an employee.

(4) A description of the person against whom the violent act was committed as one of the following:

(A) A patient.

(B) A visitor.

(C) An employee.

(D) Other.

(5) A description of the person committing the violent act as one of the following:

(A) A patient.

(B) A visitor.

(C) An employee.

(D) Other.

(6) A description of the type of abuse as one of the following:

(A) A verbal or physical threat that presents imminent danger to an employee.

(B) A physical assault with mild soreness, surface abrasions, scratches, or small bruises.

(C) A physical assault with major soreness, cuts, or large bruises.

(D) A physical assault with severe lacerations, a bone fracture, or a head injury.

(E) A physical assault with loss of limb or death.

(7) An identification of any body part injured.

(8) A description of any weapon used.

(9) The number of employees in the vicinity of the violent act when it occurred.

(10) A description of actions taken by employees and the health care workplace in response to the violent act.

(b) A health care workplace must immediately report the occurrence of a violent act to the Department and to the appropriate law enforcement agency. The Department shall promptly forward a copy of the report of a violent act to the appropriate responsible agency. In addition, in the case of a report of a violent act occurring at a State-operated mental health or developmental disability facility under the jurisdiction of the Department of Human Services, the Department shall promptly forward a copy of the report to the Department of State Police and to the Inspector General appointed under Section 6.2 of the Abused and Neglected Long Term Care Facility Residents Reporting Act. The Department of State Police shall investigate any report indicating a possible murder, rape, or other felony.

The health care workplace must also make each report of a violent act in writing within 24 hours after the occurrence of a violent act.

(c) The Department or other appropriate responsible agency shall initiate an investigation of each report of a violent act. A report of a violent act that indicates that a patient's life or safety is in imminent danger must be investigated within 24 hours after the Department or other responsible agency receives the report. The Department or other responsible agency may delegate to a law enforcement agency or other public agency the duty to perform an investigation under this subsection. Nothing in this Section diminishes the duty of law enforcement officers to respond to and investigate incidents of possible criminal conduct.

(d) A health care workplace must annually forward a copy of each such record of a violent act to the Department of Labor, which in turn shall forward a copy to the appropriate responsible agency.

(e) A health care workplace must keep each record of a violent act for at least 5 years following the occurrence of the violent act. During that time, the record must be available for inspection by the Department or by the appropriate responsible agency, upon request and subject to client confidentiality. The Department and each responsible agency must also make the record available to the General Assembly upon request, so long as the release of the record to the General Assembly does not violate client confidentiality.

Section 30. Assistance in complying with Act. A health care workplace that needs assistance in complying with this Act may contact the federal Department of Labor or the Illinois Department of Labor for assistance. The Illinois departments of Labor, Human Services, and Public Health shall collaborate with representatives of health care workplaces to develop technical assistance and training seminars on developing and implementing a workplace violence plan as required under Section 15. Those departments shall coordinate their assistance to health care workplaces.

Section 35. Noncompliance with Act; order to comply; civil penalty.

(a) If the Director determines that a health care workplace has violated this Act or the rules implementing this Act, the Director shall issue an order directing the health care workplace to comply with the Act or rules.

(b) If a health care workplace fails to comply with an order of the Director issued under subsection (a), the Director may impose a civil penalty against the health care workplace in an amount set by rule. The Director may impose a civil penalty under this subsection only after the Director provides the following to the health care workplace:

(1) Written notice of the alleged failure to comply with the Director's order.

(2) Written notice of the health care workplace's right to request an administrative hearing on the question of the alleged failure to comply.

(3) An opportunity to present evidence, orally or in writing or both, on the question of the alleged failure to comply before an impartial hearing examiner appointed by the Director.

(4) A written decision from the Director, based on the evidence introduced at the hearing and the hearing examiner's recommendations, finding that the health care workplace failed to comply with the Director's order and imposing the civil penalty.

The Attorney General may bring an action in the circuit court to enforce the collection of a civil penalty imposed under this subsection.

(c) The penalties authorized by this Section are in addition to any other penalties authorized by law, including administrative action with respect to a health care workplace's license, certification, or registration by a regulatory agency.

Section 40. Rules. The Department shall adopt rules to implement this Act.

Section 45. Hospitals; when deemed in compliance. Notwithstanding any other provision of this Act, a hospital licensed under the Hospital Licensing Act or organized under the University of Illinois Hospital Act shall be deemed to be in compliance with this Act if the hospital:

(1) has a written plan to manage the safety of patients, staff, and visitors that is consistent with the requirements of a national accreditation organization and submits a copy of that plan to the Department of Public Health; and

(2) completes reports of incidents of violence to patients, staff, and visitors that are available for review by the Department of Public Health.

Section 900. The Illinois State Auditing Act is amended by changing Section 3-2 as follows:

(30 ILCS 5/3-2) (from Ch. 15, par. 303-2)

Sec. 3-2. Mandatory and directed post audits. The Auditor General shall conduct a financial audit, a compliance audit, or other attestation engagement, as is appropriate to the agency's operations under generally accepted government auditing standards, of each State agency except the Auditor General or his office at least once during every biennium, except as is otherwise provided in regulations adopted under Section 3-8. The general direction and supervision of the financial audit program may be delegated only to an individual who is a Certified Public Accountant and a payroll employee of the Office of the Auditor General. In the conduct of financial audits, compliance audits, and other attestation engagements, the Auditor General may inquire into and report upon matters properly within the scope of a performance audit, provided that such inquiry shall be limited to matters arising during the ordinary course of the financial audit.

In any year the Auditor General shall conduct any special audits as may be necessary to form an opinion on the financial statements of this State, as prepared by the Comptroller, and to certify that this presentation is in accordance with generally accepted accounting principles for government.

Simultaneously with the biennial compliance audit of the Department of Human Services, the Auditor General shall conduct a program audit of each facility under the jurisdiction of that Department that is described in Section 4 of the Mental Health and Developmental Disabilities Administrative Act. The program audit shall include an examination of the records of each facility concerning (i) reports of suspected abuse or neglect of any patient or resident of the facility and (ii) reports of suspected abuse of facility staff by patients or residents. The Auditor General shall report the findings of the program audit to the Governor and the General Assembly, including findings concerning patterns or trends relating to (i) abuse or neglect of facility patients and residents or (ii) abuse of facility staff. However, for any year for which the Inspector General submits a report to the Governor and General Assembly as required under Section 6.7 of the Abused and Neglected Long Term Care Facility Residents Reporting Act, the Auditor General need not conduct the program audit otherwise required under this paragraph.

The Auditor General shall conduct a performance audit of a State agency when so directed by the Commission, or by either house of the General Assembly, in a resolution identifying the subject, parties and scope. Such a directing resolution may:

(a) require the Auditor General to examine and report upon specific management efficiencies or cost effectiveness proposals specified therein;

(b) in the case of a program audit, set forth specific program objectives, responsibilities or duties or may specify the program performance standards or program evaluation standards to be the basis of the program audit;

(c) be directed at particular procedures or functions established by statute, by administrative regulation or by precedent; and

(d) require the Auditor General to examine and report upon specific proposals relating to state programs specified in the resolution.

The Commission may by resolution clarify, further direct, or limit the scope of any audit directed by a resolution of the House or Senate, provided that any such action by the Commission must be consistent with the terms of the directing resolution.

(Source: P.A. 93-630, eff. 12-23-03.)

Section 905. The Community Living Facilities Licensing Act is amended by changing Section 11 as follows:

(210 ILCS 35/11) (from Ch. 111 1/2, par. 4191)

Sec. 11. Grounds for denial or revocation of a license. The Department may deny or begin proceedings to revoke a license if the applicant or licensee has been convicted of a felony or 2 or more misdemeanors involving moral turpitude, as shown by a certified copy of the court of conviction; if the Department determines after investigation that such person has not been sufficiently rehabilitated to warrant the public trust; or upon other satisfactory evidence that the moral character of the applicant or licensee is not reputable. In addition, the Department may deny or begin proceedings to revoke a license at any time if the licensee:

(1) Submits false information either on Department licensure forms or during an inspection;

(2) Refuses to allow an inspection to occur;

(3) Violates this Act or rules and regulations promulgated under this Act;

(4) Violates the rights of its residents;

(5) Fails to submit or implement a plan of correction within the specified time period.

The Department also may begin proceedings to revoke a license if the Department determines that a licensee (i) has failed to file a workplace violence prevention plan, or a review of such a plan or changes made to such a plan, as required under the Health Care Workplace Violence Prevention Act or (ii) has failed to report a violent act as required under that Act.

(Source: P.A. 82-567.)

Section 915. The Hospital Licensing Act is amended by changing Section 7 as follows:

(210 ILCS 85/7) (from Ch. 111 1/2, par. 148)

Sec. 7. (a) The Director after notice and opportunity for hearing to the applicant or licensee may deny, suspend, or revoke a permit to establish a hospital or deny, suspend, or revoke a license to open, conduct, operate, and maintain a hospital in any case in which he finds that there has been a substantial failure (i) to comply with the provisions of this Act or the Hospital Report Card Act or the standards, rules, and regulations established by virtue of either of those Acts or (ii) to file a workplace violence prevention plan, or a review of such a plan or changes made to such a plan, as required under the Health Care Workplace Violence Prevention Act or to report a violent act as required under that Act.

(b) Such notice shall be effected by registered mail or by personal service setting forth the particular reasons for the proposed action and fixing a date, not less than 15 days from the date of such mailing or service, at which time the applicant or licensee shall be given an opportunity for a hearing. Such hearing shall be conducted by the Director or by an employee of the Department designated in writing by the Director as Hearing Officer to conduct the hearing. On the basis of any such hearing, or upon default of the applicant or licensee, the Director shall make a determination specifying his findings and conclusions. In case of a denial to an applicant of a permit to establish a hospital, such determination shall specify the subsection of Section 6 under which the permit was denied and shall contain findings of fact forming the basis of such denial. A copy of such determination shall be sent by registered mail or served personally upon the applicant or licensee. The decision denying, suspending, or revoking a permit or a license shall become final 35 days after it is so mailed or served, unless the applicant or licensee, within such 35 day period, petitions for review pursuant to Section 13.

(c) The procedure governing hearings authorized by this Section shall be in accordance with rules promulgated by the Department and approved by the Hospital Licensing Board. A full and complete record shall be kept of all proceedings, including the notice of hearing, complaint, and all other documents in the nature of pleadings, written motions filed in the proceedings, and the report and orders of the Director and Hearing Officer. All testimony shall be reported but need not be transcribed unless the decision is appealed pursuant to Section 13. A copy or copies of the transcript may be obtained by any interested party on payment of the cost of preparing such copy or copies.

(d) The Director or Hearing Officer shall upon his own motion, or on the written request of any party to the proceeding, issue subpoenas requiring the attendance and the giving of testimony by witnesses, and subpoenas duces tecum requiring the production of books, papers, records, or memoranda. All subpoenas and subpoenas duces tecum issued under the terms of this Act may be served by any person of full age. The fees of witnesses for attendance and travel shall be the same as the fees of witnesses before the Circuit Court of this State, such fees to be paid when the witness is excused from further attendance. When the witness is subpoenaed at the instance of the Director, or Hearing Officer, such fees shall be paid in the same manner as other expenses of the Department, and when the witness is subpoenaed at the instance of any other party to any such proceeding the Department may require that the cost of service of the subpoena or subpoena duces tecum and the fee of the witness be borne by the party at whose instance the witness is summoned. In such case, the Department in its discretion, may require a deposit to cover the cost of such service and witness fees. A subpoena or subpoena duces tecum issued as aforesaid shall be served in the same manner as a subpoena issued out of a court.

(e) Any Circuit Court of this State upon the application of the Director, or upon the application of any other party to the proceeding, may, in its discretion, compel the attendance of witnesses, the production of books, papers, records, or memoranda and the giving of testimony before the Director or Hearing Officer conducting an investigation or holding a hearing authorized by this Act, by an attachment for contempt, or otherwise, in the same manner as production of evidence may be compelled before the court.

(f) The Director or Hearing Officer, or any party in an investigation or hearing before the Department, may cause the depositions of witnesses within the State to be taken in the manner prescribed by law for like depositions in civil actions in courts of this State, and to that end compel the attendance of witnesses and the production of books, papers, records, or memoranda.

(Source: P.A. 93-563, eff. 1-1-04.)

Section 920. The Community-Integrated Living Arrangements Licensure and Certification Act is amended by changing Section 6 as follows:

(210 ILCS 135/6) (from Ch. 91 1/2, par. 1706)

Sec. 6. (a) The Department shall deny an application for a license, or revoke or refuse to renew the license of a community mental health or developmental services agency, or refuse to issue a license to the holder of a temporary permit, if the Department determines that the applicant, agency or permit holder has not complied with a provision of this Act, the Mental Health and Developmental Disabilities Code, or applicable Department rules and regulations. Specific grounds for denial or revocation of a license, or refusal to renew a license or to issue a license to the holder of a temporary permit, shall include but not be limited to:

(1) Submission of false information either on Department licensure forms or during an inspection;

(2) Refusal to allow an inspection to occur;

(3) Violation of this Act or rules and regulations promulgated under this Act;

(4) Violation of the rights of a recipient; or

(5) Failure to submit or implement a plan of correction within the specified time period; or

(6) Failure (i) to file a workplace violence prevention plan, or a review of such a plan or changes made to such a plan, as required under the Health Care Workplace Violence Prevention Act or (ii) to report a violent act as required under that Act.

(b) If the Department determines that the operation of a community mental health or developmental services agency or one or more of the programs or placements certified by the agency under this Act jeopardizes the health, safety or welfare of the recipients served by the agency, the Department may immediately revoke the agency's license and may direct the agency to withdraw recipients from any such program or placement.

(Source: P.A. 85-1250.)

Section 999. Effective date. This Act takes effect upon becoming law.".