BILL NUMBER: AB 508
FILED WITH SECRETARY OF STATE OCTOBER 8, 1993
APPROVED BY GOVERNOR OCTOBER 8, 1993
PASSED THE SENATE AUGUST 31, 1993
PASSED THE ASSEMBLY MAY 27, 1993
AMENDED IN ASSEMBLY APRIL 22, 1993
AMENDED IN ASSEMBLY APRIL 15, 1993
INTRODUCED BY Assembly Member Speier
(Principal Senate coauthor: Senator Killea)
(Coauthor: Senator Watson)
FEBRUARY 18, 1993
An act to add Sections 1257.7 and 1257.8 to the Health and
Safety Code, and to amend Section 14083 of the Welfare and
Institutions Code, relating to health facilities.
LEGISLATIVE COUNSEL’S DIGEST
AB 508, Speier. Hospital security.
Existing law prohibits operation of a health facility, as
defined, without a license. Existing law requires that
hospitals or other health facilities offering maternity services
establish written policies to promote the protection of babies,
and the reduction of baby thefts.
This bill would require all hospital employees regularly
assigned to the emergency department to receive training and
education relating to various security topics, including, but
not limited to, general safety measures, aggression and violence
predicting factors, and verbal and physical maneuvers to
diffuse or avoid violent behavior, by January 1, 1995, and on a
continuing basis thereafter as provided for in the security plan
of the hospital. The bill would require prescribed medical and
other staff to receive the same security training or training
determined sufficient pursuant to the security plan of the
This bill would require by July 1, 1995, all general acute
care, acute psychiatric, and special hospitals to conduct a
security and safety assessment and to develop a security plan.
This bill would require reporting of any act of assault or
battery, as defined, against any on-duty hospital personnel to
the local enforcement agency within 72 hours, and would make any
individual knowingly interfering with or obstructing the
reporting process guilty of a misdemeanor, thereby imposing a
state-mandated local program. Since violation of health
facility licensing standards and willful violation of the
regulations adopted for these facilities is a misdemeanor, this
bill would impose a state-mandated local program by changing the
definition of a crime.
Existing law, the Medi-Cal Act, requires the California
Medical Assistance Commission to negotiate rates, terms, and
conditions for, or to call bids for, exclusive contracts with
hospitals for inpatient services to be rendered to medical
beneficiaries. Existing law specifies various factors to be
considered by the negotiator in negotiating these contracts,
including, but not limited to, beneficiary access, ability to
render services efficiently and economically, and protection
against fraud and abuse.
This bill would, in addition, require that the negotiator
consider the ability of the contracting hospital to provide a
secure environment for the provision of health care services, as
The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated
by the state. Statutory provisions establish procedures for
making that reimbursement.
This bill would provide that no reimbursement is required by
this act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
(a) Violence is an escalating problem in hospital emergency
departments throughout California and the nation.
(b) The emergency department is particularly vulnerable to
violence because of its accessibility to all members of the
public. The emergency department is open 24 hours a day, seven
days a week, to anyone desiring care.
(c) During the past few years in California, deaths to nurses
and other health care workers occurred in emergency rooms,
psychiatric hospitals, and community mental health clinics.
(d) Actual incidence of the problem in all types of health
care facilities is greater than documented because of failure to
report or failure to maintain records of incidents that are
(e) A 1991 national survey of emergency room nurses found
that two-thirds reported at least one assault during their
careers, and over a third had been assaulted at least once
during the previous year.
(f) A 1992 survey of California hospitals reported that
nearly 60 percent of hospitals in Fresno, Los Angeles,
Sacramento, San Diego, and San Francisco reported injuries to
staff, visitors, or patients. Over 40 percent of the incidents
involved the use of a gun.
(g) Patients and emergency personnel should be assured of
access to health care in a safe environment. Personnel training
and appropriate safety controls should be implemented to
minimize the risks and dangers affecting all people in emergency
(h) Many hospitals have undertaken numerous efforts to assure
that patients and workers are safe from violence. These
efforts will be enhanced by the enactment of this act.
SEC. 2. Section 1257.7 is added to the Health and Safety Code,
1257.7. (a) By July 1, 1995, all hospitals licensed pursuant
to subdivisions (a), (b), and (f) of Section 1250 shall conduct
a security and safety assessment and, using the assessment,
develop a security plan with measures to protect personnel,
patients, and visitors from aggressive or violent behavior. The
security and safety assessment shall examine trends of
aggressive or violent behavior at the facility. These hospitals
shall track incidents of aggressive or violent behavior as part
of the quality assessment and improvement program and for the
purposes of developing a security plan to deter and manage
further aggressive or violent acts of a similar nature. The
plan may include, but shall not be limited to, security
considerations relating to all of the following:
(1) Physical layout.
(3) Security personnel availability.
(4) Policy and training related to appropriate responses to
In developing this plan, the hospital shall consider any
guidelines or standards on violence in health care facilities
issued by the state department, the Division of Occupational
Safety and Health, and the federal Occupational Safety and
Health Administration. As part of the security plan, a hospital
shall adopt security policies including, but not limited to,
personnel training policies designed to protect personnel,
patients, and visitors from aggressive or violent behavior.
(b) The individual or members of a hospital committee
responsible for developing the security plan shall be familiar
with all of the following:
(1) The role of security in hospital operations.
(2) Hospital organization.
(3) Protective measures, including alarms and access control.
(4) The handling of disturbed patients, visitors, and
(5) Identification of aggressive and violent predicting
(6) Hospital safety and emergency preparedness.
(7) The rudiments of documenting and reporting crimes,
including, by way of example, not disturbing a crime scene.
(c) The hospital shall have sufficient personnel to provide
security pursuant to the security plan developed pursuant to
subdivision (a). Persons regularly assigned to provide security
in a hospital setting shall be trained regarding the role of
security in hospital operations, including the identification of
aggressive and violent predicting factors, and management of
(d) Any act of assault, as defined in Section 240 of the
Penal Code, or battery, as defined in Section 242 of the Penal
Code, against any on-duty hospital personnel shall be reported
to the local law enforcement agency within 72 hours of the
incident. Any individual knowingly interfering with or
obstructing the reporting process shall be guilty of a
SEC. 3. Section 1257.8 is added to the Health and Safety Code,
1257.8. (a) All hospital employees regularly assigned to the
emergency department shall receive, by July 1, 1995, and
thereafter, on a continuing basis as provided for in the
security plan developed pursuant to Section 1257.7, security
education and training relating to the following topics:
(1) General safety measures.
(2) Personal safety measures.
(3) The assault cycle.
(4) Aggression and violence predicting factors.
(5) Obtaining patient history from a patient with violent
(6) Characteristics of aggressive and violent patients and
(7) Verbal and physical maneuvers to diffuse and avoid
(8) Strategies to avoid physical harm.
(9) Restraining techniques.
(10) Appropriate use of medications as chemical restraints.
(11) Any resources available to employees for coping with
incidents of violence, including, by way of example, critical
incident stress debriefing or employee assistance programs.
(b) As provided in the security plan developed pursuant to
Section 1257.7, members of the medical staff of each hospital
and all other practitioners, including, but not limited to,
nurse practitioners, physician assistants, and other personnel,
who are regularly assigned to the emergency department or other
departments identified in the security plan shall receive the
same training as that provided to hospital employees or, at a
minimum, training determined to be sufficient pursuant to the
(c) Temporary personnel shall be oriented as required
pursuant to the security plan. This section shall not be
construed to preempt state law or regulations generally
affecting temporary personnel in hospitals.
SEC. 4. Section 14083 of the Welfare and Institutions Code is
amended to read:
14083. The factors to be considered by the negotiator in
negotiating contracts under this article, or in drawing
specifications for competitive bidding, include, but are not
limited to, all of the following:
(a) Beneficiary access.
(b) Utilization controls.
(c) Ability to render quality services efficiently and
(d) Demonstrated ability to provide or arrange needed
(e) Protection against fraud and abuse.
(f) Any other factor which would reduce costs, promote
access, or enhance the quality of care.
(g) The capacity to provide a given tertiary service, such as
specialized children’s services, on a regional basis.
(h) Recognition of the variations in severity of illness and
complexity of care.
(i) Existing labor-management collective bargaining
(j) The situation of county hospitals and university medical
centers contracting with counties for provision of health care
to indigent persons entitled to care under Section 17000, which
are burdened to a greater extent than private hospitals with bad
debts, indirect costs, medical education programs, and capital
(k) The special circumstances of hospitals serving a
disproportionate number of Medi-Cal beneficiaries and patients
who are not covered by other third-party payers, including the
costs associated with assuring an adequate supply of registered
(l) The costs of providing complex emergency services,
including the costs of meeting and maintaining state and local
requirements for trauma center designation.
(m) The hospital does any of the following:
(1) Provides additional obstetrical beds.
(2) Contracts with one or more comprehensive perinatal
(3) Permits certified nurse midwives, subject to hospital
rules, and consistent with existing laws and regulations, to
admit patients to the health facility.
(4) Expands overall obstetrical services in the hospital.
(n) The special circumstances of hospitals whose Medi-Cal
inpatient utilization rate exceeds the mean Medicaid inpatient
utilization rate by at least one-half of one standard deviation.
(o) The ability and capacity of the contracting hospital in a
closed health facility planning area to provide health care
services to beneficiaries who are in life threatening or
emergency situations, but have been sufficiently stabilized at
another noncontracting facility in order to facilitate
transportation to the contracting hospital.
(p) The ability of the contracting hospital to provide a
secure environment for the provision of health care services.
In this regard, the negotiator shall consider additional
security measures that the contracting hospital may have taken
to provide a secure environment, including, but not limited to,
the use of detection equipment or procedures to detect lethal
weapons, the appropriate use of surveillance cameras, limiting
access of unauthorized personnel to the emergency department,
installation of bullet proof glass as appropriate in designated
areas, the use of emergency “panic” buttons to alert local law
enforcement agencies, and assigning full-time security personnel
to the emergency department.
SEC. 5. No reimbursement is required by this act pursuant to
Section 6 of Article XIIIB of the California Constitution
because the only costs which may be incurred by a local agency
or school district will be incurred because this act creates a
new crime or infraction, changes the definition of a crime or
infraction, changes the penalty for a crime or infraction, or
eliminates a crime or infraction. Notwithstanding Section 17580
of the Government Code, unless otherwise specified in this act,
the provisions of this act shall become operative on the same
date that the act takes effect pursuant to the California