Workplace Violence Prevention for Health Care and Social Service Workers Act

Floor Speech

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Mr. COURTNEY. Madam Speaker, as the designee of the chairman of the Committee on Education and Labor, pursuant to House Resolution 303, I call up the bill (H.R. 1195) to direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan, and for other purposes, and ask for its immediate consideration.

The Clerk read the title of the bill.

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Mr. COURTNEY. Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, if there is one lesson that all Americans have learned in the last year from the shared experience of the COVID pandemic, it is that our Nation's healthcare workers have truly been heroic, putting their lives and health at risk, treating and caring for millions of patients suffering from a scary deadly disease. I am sure that every Member in this Chamber at some point has tweeted, issued statements, held up signs thanking nurses, EMTs, doctors, and many other caregivers for their amazing work.

But as all those brave workers can attest, there is a second colliding epidemic that they continue to face, namely, frightening levels of violence at rates that far exceed those faced by any other sector in our economy.

The Bureau of Labor Statistics, which has studied this alarming phenomenon, found that 73 percent of all violent incidents that happen in American workplaces happen to healthcare and social assistance employees. Year after year, BLS tallies tens of thousands of violent incidents which could be prevented by the standard required by today's legislation.

Today, we have the power right here in this Chamber to prevent this wave of violence by passing H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act.

The primary source of this violence comes in the form of assaults: kicking, hitting, spitting, even the use of firearms and other weapons from patients and those who accompany them.

H.R. 1195 would require an enforceable workplace violence prevention standard within 42 months after enactment at about 200,000 healthcare centers, not small doctors' offices or clinics. The standard would require that covered employers develop a workplace violence prevention plan that is tailored to the specific conditions and hazards present at each workplace, not a one-size-fits-all mandate.

Since 1996, OSHA has published voluntary guidelines that recommended many commonsense measures that employers can take to reduce the risk and severity of violent incidents. These guidelines are an excellent resource, but the fact that we continue to see an alarming growth in violence means that relying on ad hoc, voluntary adoption is failing to protect our healthcare heroes. We need an enforceable standard.

Over the last 5 years, in the last two administrations, despite verbal support for an enforceable OSHA rule, nothing has moved in the rulemaking process. History shows that with no deadlines in statute, OSHA takes 15 to 20 years to issue a standard.

Indeed, in the last administration, despite giving lip service for 3 years that they were creating a new rule, not one administrative step was actually taken to protect healthcare and social assistance workers.

I want to be very clear. Right now, over at that agency, this issue is dead in the water.

Every year we fail to address this situation, we are condemning thousands of nurses, doctors, aides, EMTs, and social workers to suffer preventable injuries, sometimes fatal, on the job.

That is why a huge coalition of healthcare workers from the American College of Emergency Physicians, National Nurses United, American Nurses Association, EMTs, and many more have come together, begging Congress to enact this bill.

No more delays. It is time that Congress puts a clock on this issue so that we can get the preventative measures in place nationwide that we know will save lives.

Madam Speaker, I want to thank the chair of the committee, Mr. Scott, for his great support on this measure, as well as Chair Adams, the Subcommittee on Workforce Protections chair, as well as my Republican colleagues, because there actually is some agreement on the basics on this issue.

Lastly, I want to thank our outstanding, stellar staff: Richard Miller; Jordan Barab, who is leaving us shortly, at the end of the month, for his incredible institutional knowledge and work; and Maria Costigan, from my office.

Committee on Energy and Commerce, House of Representatives, Washington, DC, March 26, 2021. Hon. Bobby Scott, Chairman, Committee on Education and Labor, Washington, DC.

Dear Chairman Scott: I write concerning H.R. 1195, the ``Workplace Violence Prevention for Health Care and Social Service Workers Act,'' which was additionally referred to the Committee on Energy and Commerce.

In recognition of the desire to expedite consideration of H.R. 1195, the Committee on Energy and Commerce agrees to waive formal consideration of the bill as to provisions that fall within the rule X jurisdiction of the Committee on Energy and Commerce. The Committee takes this action with the mutual understanding that we do not waive any jurisdiction over the subject matter contained in this or similar legislation, and that the Committee will be appropriately consulted and involved as this bill or similar legislation moves forward so that we may address any remaining issues within our jurisdiction. I also request that you support my request to name members of the Committee on Energy and Commerce to any conference committee to consider such provisions.

Finally, I would appreciate the inclusion of this letter in the report on the bill and into the Congressional Record during floor consideration of H.R. 1195. Sincerely, Frank Pallone, Jr., Chairman. ____ Committee on Education and Labor, House of Representatives, Washington, DC, March 26, 2021. Hon. Frank Pallone, Jr., Chairman, House Committee on Energy and Commerce, Washington, DC.

Dear Chairman Pallone: In reference to your letter of March 26, 2021, I write to confirm our mutual understanding regarding H.R. 1195, the ``Workplace Violence Prevention for Health Care and Social Service Workers Act.''

I appreciate the Committee on Energy and Commerce's waiver of consideration of H.R. 1195 as specified in your letter. I acknowledge that the waiver was granted only to expedite floor consideration of H.R. 1195 and does not in any way waive or diminish the Committee on Energy and Commerce's jurisdictional interests over this or similar legislation.

I would be pleased to include our exchange of letters on this matter in the committee report for H.R. 1195 and in the Congressional Record during floor consideration of the bill to memorialize our joint understanding.

Again, thank you for your assistance with these matters. Very truly yours, Robert C. ``Bobby'' Scott, Chairman.

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Mr. COURTNEY. Madam Speaker, I would just note that the bill language explicitly protects a comment period for all stakeholders, including hospitals and every other institution affected by it.

Madam Speaker, I yield 1 minute to the gentlewoman from North Carolina (Ms. Adams), who is the chairwoman of the Subcommittee on Workforce Protections and a staunch advocate for this bill.

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Mr. COURTNEY. Just to be clear, Madam Speaker, that CBO score is not per facility. That score is spread out over 200,000 healthcare centers. If you do the math, it is actually $9,000 per year per facility.

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Mr. COURTNEY. Madam Speaker, I yield myself such time as I may consume.

First of all, I just want to compliment Ms. Foxx about her very thoughtful remarks about what is driving this crisis out there for healthcare workers. There is no question that behavioral health and the heroin and opioid addiction--and we heard this from witnesses who testified before our committee.

But I would respectfully suggest that the people who are actually out there on the front lines, the EMTs--their association has endorsed this bill--and the American College of Emergency Room Physicians--they are the ones right there taking in these very sort of high-risk, intense cases--have issued a letter of support for H.R. 1195 because they realize that what this bill will, in fact, create, is a safer system for better communication, better lighting, not leaving people alone with patients, who have been identified as high-risk.

Really, all you have to do is talk to any ER doc. They will tell you it is tough out there, and we need to change. We need to have systems in place to better protect them.

Madam Speaker, I include in the Record a letter of support from the American College of Emergency Physicians. American College of Emergency Physicians, March 23, 2021. Hon. Joe Courtney, Washington, DC.

Dear Representative Courtney: On behalf of the American College of Emergency Physicians (ACEP) and our 40,000 members, thank you for introducing for H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act. ACEP appreciates your leadership to help establish procedures to ensure that emergency physicians, health care workers, social workers, and patients, are protected from violence in the workplace, and we urge Congress to swiftly consider and pass this important legislation.

Violence in the emergency department is a serious and growing concern, causing significant stress to emergency department staff and to patients who seek treatment in the emergency department (ED). According to a survey conducted by ACEP in 2018, nearly half of emergency physicians polled reported being physically assaulted, with more than 60 percent of those occurring within the past year. Nearly 7 in 10 emergency physicians say ED violence has increased within the past 5 years. Beyond the immediate physical impacts, the risk of violence increases the difficulty of recruiting and retaining qualified health care professionals and contributes to greater levels of physician burnout. Most importantly, patients with medical emergencies deserve high-quality care in a place free of physical dangers from other patients or individuals, and care from staff that is not distracted by individuals with behavioral or substance-induced violent behavior.

There are many factors contributing to the increase in ED and hospital violence, and like you, we recognize there is no one-size-fits-all solution. Employers and hospitals should develop workplace violence prevention and response procedures that address the needs of their particular facilities, staff, contractors, and communities, as those needs and resources may vary significantly.

To this end, ACEP asks that Congress also take into consideration how emergency departments are staffed to ensure that the important provisions of this legislation are implemented in the most appropriate manner. As you are aware, emergency physicians may be employed in an ED in a variety of ways, whether directly employed through the hospital in an academic setting, or contracted as a member of a small democratic practice or a larger, national physician group. Given that emergency physicians and these groups do not control the resources of an individual facility that they staff, it would be neither practical nor effective to require contracted groups themselves to be responsible for implementing, tracking and reporting of violent incidents. ACEP believes that emergency physicians that contract with hospitals or facilities should not be held responsible for situations or hazards outside of their direct control; however, they can and should serve an integral role in developing effective violence prevention strategies. We appreciate your efforts to date to provide additional clarity on what a ``covered employer'' is ultimately responsible for, and ask Congress to ensure that any new federal requirements do not create any unintentional or undue burdens for entities that do not control the health care workplace.

Once again, thank you for your leadership on this important issue. ACEP looks forward to working with you to ensure patients, health care workers, and all others in the emergency department (ED) are prepared for and protected against violent acts occurring in the department. Sincerely, Mark Rosenberg, DO, MBA, FACEP, ACEP President.

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Mr. COURTNEY. Madam Speaker, I include in the Record a letter of support from AFT, which is a union that represents hundreds of thousands of frontline workers, including nurses, across the country in support of H.R. 1195. AFT, March 23, 2021. House of Representatives, Committee on Education and Labor, Washington, DC.

Dear Representative: On behalf of the 1.7 million members of the American Federation of Teachers, including nearly 200,000 healthcare professionals, I thank Chairman Bobby Scott for bringing H.R.1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act, before the committee, and I urge you to vote in support of Congressman Joe Courtney's crucial legislation.

This bipartisan bill is straightforward and needed, requiring employers to develop violence prevention plans and establishing whistleblower protections so that healthcare and social service workers don't fear retaliation for speaking out against what they see in the workplace.

This is not an abstract issue for me. I hear from AFT healthcare members about violence all the time: a nurse choked to the point of unconsciousness, a nurse stabbed, members who have suffered bone fractures and brain injuries from being thrown against walls and floors. Subcommittee Chairwoman Alma Adams held an important hearing on workplace violence last Congress, where an AFT member shared the following:

He then spun around on his back and kicked his leg high into the air striking me in the neck, hitting with such force to my throat that my head snapped backward; I heard this ``bang'' and ``pop,'' and all the air just rushed out of me. . . . Since June 2015, I have been diagnosed with moderate to severe post-traumatic stress disorder, moderate anxiety, insomnia, depressive disorder and social phobia related to this incident. . . . I LOVED being a nurse. I have a huge problem still calling myself a nurse. I do not know what to call myself now. There is a deep loss when you used to make a difference in the lives of people, in your true calling and with passion. Now, that space is filled with extreme sadness and fear. . . . I lost my career.

Violence is not just ``part of the job.'' No one should face violence, intimidation or fear for their safety while working to heal others and save lives. Sadly, healthcare and social service workers are nearly five times more likely to be assaulted while on the job than the rest of our workforce. The costs of this violence are high: in injury rates, in professionals being driven from doing the work they love, and in workers' compensation claims and staff shortages.

Our nurses, health techs, social service workers and other health professionals need more than nightly applause; they need enforceable federal protections to keep them safe from the epidemic of workplace violence and other serious hazards they face at work. These are the people who take care of us when we need them, who have devoted their careers to looking after the aging, the sick and the injured, but are forced to beg Congress for basic workplace rights.

I urge you to support the nurses, social workers and other healthcare professionals in your district by voting for committee approval of the Workplace Violence Prevention for Health Care and Social Service Workers Act. Sincerely, Randi Weingarten, President.

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Mr. COURTNEY. Madam Speaker, really quick, on page 11 of the bill it specifically states that the plans proposed to be adopted by OSHA would ``be tailored and specific to conditions and hazards for the covered facility or the covered service, including patient-specific risk factors and risk factors specific to each work area or unit.'' That is not one size fits all.

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Mr. COURTNEY. Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, just to clarify, the April 9 CBO report that came out, which, again, cited the numbers which were cited accurately by the opposition, is a number that is spread out over 200,000 facilities across the country.

If you do the math, we are talking about $9,000 per facility per year. Ask yourself whether or not that figure, weighing the balance of what we are trying to protect here, which is people's health and lives, is worth it.

I think most people would apply common sense to that and realize that it is not going to drive healthcare costs through the roof. In fact, it is going to protect workers and protect them from absenteeism. It is going to protect these institutions from high workers' compensation costs. It is just common sense.

Madam Speaker, I yield 2 minutes to the gentlewoman from Michigan (Ms. Tlaib).

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Mr. COURTNEY. Madam Speaker, I yield myself the balance of my time.

Here is the good news. When we started this journey on this legislation back in 2013, a number of us requested a GAO report because we had heard anecdotal evidence about the fact that healthcare workers were experiencing this really disturbing level of violence that was something that people had really never seen before.

GAO took 3 years, very methodically, as only they do. They are the gold standard, in terms of research. They brought in all the studies and all the evaluations. They verified, sadly, all the statistics that we have talked about here on the floor today. Seventy-three percent of incidents happen in these two sectors. The fact is that they not only verified that, but they showed that those numbers are actually underreported.

What is happening out there is because we don't have any system that people can turn to when they are experiencing this kind of unacceptable behavior. They basically are in a situation where, most of the time, they just are saying suck it up, shake it off, that is part of the job, just move on, don't spend any time on that.

In fact, what GAO told us is that the numbers that we are seeing in other sorts of reports underreport what is going on out there.

We took that report, and we crafted legislation. We really did accommodate some of the issues that we have heard talked about on the floor here today, about ensuring that there is going to be an adequate comment period for all stakeholders. We want that. We understand that the hospital association, just like the emergency room doctors, just like the nurses, should all have their opportunity to weigh in, in terms of what is a viable, workable standard.

But what we don't need is to have OSHA just sort of lapse into its notorious dysfunctional delays in terms of developing a workforce standard.

Mr. Scott ticked off, again, some of the most recent examples: 2017 beryllium took 18 years, silica dust took 17 years.

Again, when the last administration came to the committee, they said, ``We are going to start the process. We are going to begin a docket in terms of getting a rulemaking.''

And then the first scheduled date was delayed, and then the second scheduled date was delayed again, and on and on and on. Right now, today, as we stand here in this Chamber, there is nothing scheduled.

When you really boil it down, where I think the disagreement exists-- and I am happy to acknowledge that, but I think it is a meaningful distinction--is that we are going to put this agency on the clock. We are telling them that, you know, you can follow the procedures, take the comment, but we are not going to sit back and allow this unacceptable trend to continue unaddressed.

That agency was created back in the Nixon administration to protect America's workers, and as the branch of government that created them, we want them to develop a standard in a reasonable amount of time.

Madam Speaker, this is not unprecedented. Congresses, in the past, have done this. During the last pandemic, during AIDS, we saw a blood- borne pathogen that was just totally sweeping hospitals and healthcare institutions all across the country, and we intervened and put a clock on OSHA to develop a blood-borne pathogen workforce standard.

That is why, today, when you go to the hospitals, people are wearing gloves and using disposable needles. All that stuff that we take for granted now, that was OSHA. Actually, it was Congress who told OSHA to develop that standard. So we are in a situation here today in 2021 where, again, we are seeing something out there.

I thank Ms. Foxx because she is not in denial, that is for sure. She really thoughtfully talked about what is driving some of this, but the fact is now it is time to act. I thank some of the Republican Members who came forward because it is hard right now, but they came forward and cosponsored this bill.

I hope, Madam Speaker, that the shared experience of the last year that this country went through is something people will think about when they vote later today and support this legislation.

Madam Speaker, I yield back the balance of my time.

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Mr. COURTNEY. Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, I rise in support of the amendments en bloc.

These five amendments will: one, direct OSHA to prioritize providing technical assistance and advice to employers to promote compliance during the first year; two, clarify that nothing in this act will limit existing protections against domestic violence, stalking, or sexual violence; three, clarify that employers can consult experts when developing their workplace violence prevention plans; four, provide additional training to workers who interact with survivors of torture, trafficking, and domestic violence; and, five, adds Alzheimer's and memory care facilities as facilities covered by this legislation.

These amendments make meaningful improvements to the bill, and I urge a ``yes'' vote on the amendments en bloc.

Madam Speaker, I yield 1 minute to the gentleman from New York (Mr. Jones).

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Mr. COURTNEY. Madam Speaker, I again want to clarify for the record that Congress in the past has required interim standards in situations where there have been real acute problems in America's workforce. We did it for workers who were working in hazardous waste and hazardous disposal sites, and we did it for workers who were exposed to lead.

So, again, there is precedent for this. This is not having an interim standard where there is an urgent need to have some action for just a program standard for workers out there. We have done it in the past. And I think we have certainly heard enough from the other side that they acknowledge the severity of the problem and the incredible people that would benefit from having a standard out there that we should apply the interim rule in this case, which would take place a year from enactment and then the final standard 3\1/2\ years from enactment.

I want to be clear. When we drafted the bill, we put in language that requires a notice and comment section for both the interim standard and the final standard. Nobody is being foreclosed in terms of having an opportunity to weigh in.

Since 1996, OSHA has had voluntary recommendations and guidelines for workplace safety in healthcare settings. This thing has been knocking around for 25 years, and that is no secret here. We are not starting from a blank sheet of paper.

So, again, all the stakeholders know what some of the strategies are that could be employed to protect workers better, and what we are doing in the baseline of the bill is basically saying we are not going to sit back and let the dysfunctional history of OSHA dominate and really expose people needlessly to workplace violence.

Again, Mr. Scott went through the sad history over OSHA: 18 years for beryllium; 17 years for silica dust; 16 or 17 years for working in enclosed construction site spaces. OSHA is just notorious in terms of going slow, and, in fact, the last administration, which did try to convene the Small Business panel, postponed it five separate times, and today there is nothing scheduled. I mean, zero.

So, again, I appreciate the fact that the other side acknowledges the seriousness of the problem. Again, I think the bill acts on that by actually putting a clock on OSHA to move forward.

I will close by saying that the administration has weighed in, who actually is the executive branch that has control of OSHA, and, again, they submitted a letter titled: ``Statement of Administration Policy'' on April 13 supporting this bill, and specifically the 1-year interim standard and the 42-month final standard timeline that is in the bill. I include that letter in the Record, Madam Speaker. Statement of Administration Policy

H.R. 1195--Workplace Violence Prevention for Health Care and Social

Service Workers Act--Rep. Courtney, D-CT, and 145 cosponsors The Administration strongly supports passage of H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act. This bipartisan legislation will lead to the development of Federal standards to ensure that health care and social service employers develop and implement plans to protect their staff, prevent and improve the response to workplace violence, and address existing barriers to reporting.

Even before the COVID-19 pandemic, incidents of violence against health care and social service workers have been on the rise. A 2016 Government Accountability Office study reported that rates of violence against health care workers are up to 12 times higher than rates for the overall workforce. In 2018, the Bureau of Labor Statistics reported that health care and social service workers were nearly five times as likely to suffer a serious workplace violence injury than workers in other sectors, and that healthcare workers accounted for 73 percent of such injuries. In 2017, state government health care and social service workers were almost nine times more likely to be injured by an assault than private-sector health care workers. Front line employees in these settings interact with a range of patients, clients, and their families, often with little training or direction for how to handle interactions that may become violent. Workplace violence often causes both physical and emotional harm. Victims of these incidents often suffer post-traumatic stress that undermines their ability to continue their employment in that sector. This burdens a stretched health care workforce that has been severely impacted by the COVID- 19 pandemic. There is currently no Occupational Safety and Health Administration (OSHA) standard that requires employers to implement violence prevention plans that would help reduce workplace violence injuries among health care and social service workers.

Under the Workplace Violence Prevention for Health Care and Social Service Workers Act, OSHA must issue an interim final standard in one year and a final standard within 42 months requiring employers in the health care and social service sectors to develop and implement a workplace violence prevention plan. Under such a standard, employers would need to ensure that health care and social service workers are directly involved in the development, implementation, and assessment of these plans. This will include identifying risks, specifying solutions, and requiring training, reporting, and incident investigations. It would also provide protections from retaliation for reporting violent incidents. Additionally, this legislation will protect health care and social service workers in the public sector in 24 states where those employees are not covered by OSHA protections.

The Administration commends the bipartisan support for the Workplace Violence Prevention for Health Care and Social Service Workers Act and urges swift passage of this legislation.

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