Workplace Violence Prevention for Health Care and Social Service Workers Act

Floor Speech

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Ms. FOXX. Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, I thank my colleague for yielding.

Madam Speaker, I rise today in opposition to H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act.

Ensuring workplace safety for all American workers, especially our Nation's caregivers, is an issue of the utmost importance and is deserving of a serious and thorough solution. I agree with my colleague; we all appreciate what healthcare workers have done. I do every day, but particularly since we have had COVID.

H.R. 1195 purports to take a responsible approach to the issue of workplace violence, but legislation that results in a rushed and overly prescriptive rule that omits important input from stakeholders and experts, while driving up compliance costs for already struggling industries, is far from a sensible solution. Yet, that is what we are asked to consider today.

Workers in the healthcare and social services industries are at an increased risk of workplace violence, with the Bureau of Labor Statistics finding they are five times more likely to experience violence in the workplace than workers in other industries.

While the threat is real, the response the Democrats are proposing to address the situation, to further their own partisan agenda, is not grounded in reality.

Workplace violence is already a well-recognized hazard by employers and employees in the healthcare and social services industries. According to a 2018 American Hospital Association survey, 97 percent of respondents indicated they already have workplace violence policies in place.

In addition, the Occupational Safety and Health Administration, OSHA, is already enforcing workplace violence prevention measures, issuing citations to employers who fail to provide safe workplaces during both the Obama and Trump administrations.

The agency is also working on a rule through the standard OSHA rulemaking process and has announced plans to initiate a Small Business Regulatory Enforcement Fairness Act panel, a key part of the rulemaking process that allows the agency to gather valuable feedback from small businesses before a regulation is written.

H.R. 1195 is particularly ill-timed and ill-advised as it forces OSHA to issue an interim final rule on workplace violence within 1 year, which will significantly strain healthcare facilities that are heroically working on the front lines, responding to a once-in-a- century pandemic.

The CBO recently estimated the cost of this bill to private entities would be at least $1.8 billion in the first 2 years that the rushed OSHA rule is in effect and $750 million annually after that. The cost to public facilities will be at least $100 million in the first 2 years and $55 million annually after that.

Financially struggling healthcare facilities, such as rural hospitals that are already at risk of closure, cannot afford a rushed and costly government-imposed mandate from Washington bureaucrats.

The House is considering H.R. 1195 at a time when the Biden administration is also considering a burdensome, overreaching emergency temporary standard, ETS, on COVID-19. Though OSHA is weeks behind in deciding whether to issue the ETS, handing down two expensive, punitive Federal mandates on an already burdened healthcare industry could be the straw that breaks the camel's back.

There may be a time and place where a workplace violence regulation is appropriate, but now is certainly not it.

While I cannot support H.R. 1195, I want to be clear. The safety of our Nation's healthcare and social service workers is not a partisan issue. Republicans offered a workable solution at a recent committee markup and were willing to negotiate with our colleagues across the aisle on a compromise, one that requires OSHA to analyze a rule properly, heed appropriate and necessary input from stakeholders, and launch an educational campaign on workplace violence prevention.

Yet, here we are, considering another Democrat bill being pushed through with no Republican input.

Healthcare workers are familiar with the Hippocratic oath: ``First, do no harm.'' In its rush to judgment, H.R. 1195 does great harm. By short-circuiting the public input process and prescribing a specific result from the beginning, this bill will not achieve what it aims to accomplish.

Our healthcare workers and caregivers deserve an evidence-based and effective solution that protects them in the workplace. H.R. 1195 fails to deliver this result.

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Ms. FOXX. Madam Speaker, I yield myself such time as I may consume.

H.R. 1195 does not allow for a solid, well-researched foundation for a national workplace violence prevention standard. Input from experts and stakeholders is vital as OSHA undertakes rulemaking on this issue.

In February 2019, the Centers for Disease Control and Prevention, CDC, published its research agenda for healthcare and social assistance. The research agenda identifies the information and actions most urgently needed to improve safety in the industry.

The CDC identified the following concerns regarding the current state of research on the issue of healthcare workplace violence:

Many existing studies have evaluated workplace violence risk factors and prevention measures, but most lack the comprehensive, facility- and work area-specific perspective that is needed to effectively prevent workplace violence. Additionally, many of these studies examine the effects of training programs, showing little impact on workplace violence incident and injury rates.

We should heed the words of caution from CDC regarding our current knowledge base, and we should make sure OSHA receives input from all perspectives, including smaller healthcare providers, before it enacts a national standard.

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Ms. FOXX. Madam Speaker, I yield myself such time as I may consume.

As we have discussed today, workplace violence is a very real and persistent issue for healthcare and social service workers.

The Democrat title of H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act, presupposes that the rushed, overly prescriptive, and complex Federal regulation required by this bill will somehow prevent workplace violence.

However, a true solution to violence in the workplace will not be in the form of a Federal regulation. Rather, a broader, bipartisan approach is needed to address the root causes of this serious and complicated issue.

According to the American Hospital Association, increases in assaults in healthcare facilities are being driven, in part, by growing numbers of behavioral healthcare patients being treated in emergency departments and other acute-care settings.

The opioid and drug abuse epidemic is another major contributing factor to workplace violence, as healthcare workers are often tasked with treating patients that may be under the influence of potent drugs or experiencing their painful side effects.

Unfortunately, H.R. 1195 does nothing to address these realities.

Ultimately, an OSHA workplace violence regulation that is written under the standard rulemaking process will be much more informed and effective because it will require evidence-based input related to behavioral health and opioid abuse that are responsible for many workplace violence incidents.

But as I said earlier, we need to roll up our sleeves and develop a comprehensive, bipartisan response to address the root causes of this serious and complicated issue.

Again, I urge my colleagues to oppose H.R. 1195, and I reserve the balance of my time.

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Ms. FOXX. Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, the American Hospital Association, AHA, is opposed to H.R. 1195.

In a letter to Education and Labor Committee members prior to the committee markup last month, AHA stated: ``However, because hospitals have already implemented specifically tailored policies and programs to address workplace violence, we do not believe that the OSHA standards required by H.R. 1195 are warranted, nor do we support an expedited approach that would deny the public the opportunity to review and comment on proposed regulations.''

Further, AHA explained:

The prohibitive costs that the mandates in H.R. 1195 would impose on America's hospitals, particularly on those that provide care in rural and underserved areas, could strain scarce resources and jeopardize patient care.

These mandates would burden healthcare providers that are struggling to maintain services during the most deadly public health emergency in 100 years.

Madam Speaker, I include in the Record the letter from the American Hospital Association. American Hospital Association, Washington, DC, March 23, 2021. Hon. Joe Courtney, House of Representatives, Washington, DC.

Dear Representative Courtney: On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, and our clinician partners--including more than 270,000 affiliated physicians, 2 million nurses and other caregivers--and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) writes regarding the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1195).

Your bill would direct the Secretary of Labor to issue--on an expedited timetable--and Occupational Safety and Health Administration (OSHA) standard requiring employers in health care and social services to develop and implement a comprehensive workplace violence prevention plan. America's hospitals and health systems are committed to a culture of safety for every worker, patient and family member who enters our facilities. However, because hospitals have already implemented specifically tailored policies and programs to address workplace violence, we do not believe that the OSHA standards required by H.R. 1195 are warranted, nor do we support an expedited approach that would deny the public the opportunity to review and comment on proposed regulations.

Further, the prohibitive costs that the mandates in your bill would impose on America's hospitals, particularly on those that provide care in rural and underserved areas, could strain scarce resources and jeopardize patient care. These mandates would burden health care providers that are struggling to maintain services during the most deadly public health emergency in 100 years. For these reasons, we must oppose H.R. 1195 and urge the Committee on Education and Labor not to report it favorably.

H.R. 1195 Would Impose Burdensome Unfunded Mandates and Prohibitive Costs on Hospitals

According to the Congressional Budget Office's (CBO) estimate of your bill in 2019, in the first two years in which the OSHA final rule would be in effect, the cost to private entities would be at least $2.7 billion and at least $1.3 billion each year thereafter.

CBO concluded that ``substantial personnel and capital costs would be imposed by the requirements for training, investigation, engineering, and infrastructure changes.'' Such costs are unsustainable. A recent report by Kaufman-Hall forecasts that total hospital revenue in 2021 could be down between $53 billion and $122 billion from pre-pandemic levels. In addition to lost revenue, hospitals must absorb increases in many expenses due to COVID-19. These losses come on top of the historic financial crisis that hit the hospital field last year, with an AHA report estimating total losses for the nation's hospitals and health systems to be at least $323 billion through 2020. HOSPITALS ALREADY STRIVE TO PREVENT VIOLENCE IN THE WORKPLACE

Hospitals and health systems depend on compassionate, skilled, trained, and dedicated men and women to support and carry out their core mission of caring for people. As a result, they view the safety and well-being of employees as a top priority and take seriously their responsibilities to ensure a safe workplace free of all forms of violence-- whether such violence results from encounters between staff and patients and/or their families, staff-to-staff aggression and harassment, or the intrusion of community conditions and community violence into the workplace. Hospitals are focused on violence prevention within their facilities and in the communities they serve.

To support hospitals' efforts, the AHA has implemented a cross-association effort to develop tools and resources to highlight and share with the field numerous programs and resources to combat violence within the hospital and the community. We have encouraged OSHA to support hospitals' efforts by sponsoring research to identify best practices for various workplace settings and circumstances and widely disseminating information about these proven best practices to the health care field.

Hospitals have established organization-wide initiatives to address workplace violence. As the most recent Hospital Security Survey conducted in 2018 by AHA's Society for Healthcare Engineering and Health Facilities Management reveals, workplace violence policies are in place for 97% of respondent facilities and 95% have active-shooter policies. Further, nearly three-quarters of hospitals responding (72%) conduct security risk assessments at least annually, with almost half using a combination of in-house and outside security experts to conduct these assessments. Moreover, in response to the increasing challenges of maintaining secure environments, a majority of hospitals are using aggressive management training as a proactive way to prevent the occurrence of security incidents and to be better prepared to respond effectively when incidents arise.

A majority of hospitals, working in tandem with security officers and front-line staff, have adopted programs to train all clinical staff to de-escalate security situations before they erupt. Hospitals have created these programs in-house and tailored them to their particular needs. For example, Boston Medical Center (BMC), a 500-bed, 41-building hospital located close to a county jail, a homeless shelter and a methadone clinic, developed its own de-escalation program. BMC's training focuses on verbal de-escalation and physical restraint skills. All frontline staff-unit clerk nurses, intensive care unit staff, social workers, etc.,--along with security staff receive ongoing training at BMC. Scenario training uses videos that re-enact possible active-shooter security incidents; these BMC videos are available for other hospitals to access as training tools. Another example is that of Atrium Health, which has created its in-house training program. Staff members certified in workplace violence prevention train other staff members, including home health workers, using a multi-tiered program.

As the association representing hospitals and health systems nationwide, the AHA is committed to helping our members prevent and reduce violence. We have established a specific initiative focused on combatting violence in all its forms. A critical component of this initiative includes developing tools and resources to highlight and share with the hospital field programs, initiatives and other efforts to help combat violence at hospital facilities as well as in the communities served by the hospital. We have developed a dedicated webpage to share information and resources that address everything from conducting a risk assessment to emergency response best practices, and we encourage all hospitals to use these resources to expand and strengthen their own violence prevention efforts.

On the website, hospitals can find the Healthcare Facility Workplace Violence Risk Assessment Tool developed by the AHA's American Society for Healthcare Risk Management to offer practical guidance for those charged with overseeing hospital security and facilities management. Also on the website is Guiding Principles for Mitigating Violence in the Workplace, a resource created jointly by the American Organization for Nursing Leadership (an AHA-affiliated organization) and the Emergency Nurses Association. The resource outlines guiding principles and priorities to systematically reduce lateral as well as patient and family violence in the workplace. In addition, an article from Health Facilities Management encourages and guides health care organizations in consulting with security personnel during design of new facilities to incorporate workplace safety considerations as a fundamental component of these construction projects. FEDERAL POLICYMAKERS SHOULD Focus ON DISSEMINATION OF BEST PRACTICES TO THE FIELD AND SUPPORT INCREASED FUNDING FOR BEHAVIORAL HEALTH CARE

Hospitals' efforts to curb workplace violence would be bolstered by robust federal initiatives that would disseminate health care and social assistance sectors best practices that have demonstrated effectiveness in violence prevention. Federal support of research to identify the effectiveness of best practices for different workplace settings and circumstances and disseminating information about such best practices would do more to advance and promote workplace safety than the adoption of a ``one-size- fits-all'' standard for compliance and enforcement. The establishment of a uniform workplace violence standard for the field may lead to organizations using a narrowly focused and thereby less effective compliance strategy in addressing the problem of workplace violence.

We note evidence suggesting that increases in assaults in the health care workplace are being driven, in part, by growing numbers of behavioral health care patients reporting to and being treated in emergency departments and other settings in acute care, general hospitals. Another security challenge is the opioid epidemic, which continues to affect communities nationwide.

Integrating mental health, substance use disorder, and primary care services has proven to produce the best outcomes and to be the most effective approach to caring for people with multiple health care needs. But at the same time, funding for behavioral health treatment for such patients is being stripped, and it can be difficult for health care organizations to find the financial, staffing, and other resources needed to fully address issues associated with caring for them.

For these reasons, we believe there are productive actions Congress can take to help stem workplace violence in hospitals and health systems. We urge Congress to significantly increase funding for expanded and improved delivery of behavioral health care, and to support the hospital field's efforts to secure necessary funds to share best practices and approaches, expand educational programs, and make other investments in safety. We must address the root causes of the negative workplace safety issues that have arisen as a result of continued underfunding of treatment and service delivery for growing numbers of behavioral health care and opioid-dependent patients in emergency departments and other acute care hospital settings.

We believe that these approaches would help mitigate workplace violence and aid hospitals and health systems in further addressing these incidents through policies and strategies that are best suited to their needs and the needs of the communities they serve. We stand ready to work with you to explore an appropriate congressional response that would improve hospitals' ability to address workplace violence. Sincerely, Thomas P. Nickels, Executive Vice President.

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Ms. FOXX. Madam Speaker, we are hearing from the people who are on the front lines, and we have said we want to protect the people on the front lines. Well, let's listen to the people on the front lines.
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Ms. FOXX. Madam Speaker, may I inquire as to how much time is remaining.
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Ms. FOXX. Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, we grieve for anyone who is killed violently in this country under any circumstances. Again, that is not a partisan issue.

Madam Speaker, the healthcare industry is currently in the midst of responding to a once-in-a-century pandemic and has rightly prioritized significant resources to caring for patients and keeping its employees safe from COVID-19.

Forcing OSHA to issue an interim final standard on workplace violence within 1 year, as H.R. 1195 requires, will have a devastating impact on the healthcare industry during the COVID-19 pandemic.

The last thing our healthcare providers need during this unprecedented public health crisis is more costly mandates from Washington that will strain resources and personnel and jeopardize patient care.

Moreover, the Biden administration is expected to soon impose new employer mandates in the form of an OSHA emergency temporary standard for COVID-19 and, eventually, a permanent infectious disease rule, which will have a significant impact on the healthcare industry.

At a time when healthcare facilities are experiencing massive revenue losses and have invested significant resources into responding to COVID-19, the issuance of two new regulations from Washington, potentially within months of each other, will be devastating.

Our Nation's healthcare providers have responded admirably to the pandemic and are doing heroic work to keep Americans safe and healthy. The House should reject this ill-timed and ill-advised legislation that will inhibit work and burden the healthcare industry at exactly the wrong time.

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Ms. FOXX. Madam Speaker, I yield myself the balance of my time.

Madam Speaker, overbearing regulations burden workers and stifle the economy. Preventing workplace violence in healthcare and social service settings is crucial, and we should get this done by allowing OSHA to issue standards through the normal rulemaking process, which brings all experts and parties, including small businesses, to the table.

Short-circuiting the process and rushing to a conclusion eliminates valuable technical and scientific input and will lead to unintended consequences, which could have a detrimental impact on workplace safety outcomes.

A bipartisan solution was possible here, but once again, Democrats have kicked it to the curb. I urge a ``no'' vote on H.R. 1195, and I yield back the balance of my time.

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Ms. FOXX. Madam Speaker, I yield myself such time as I may consume.

We all agree American workers should be kept out of harm's way on the job so they can safely and healthily return home to their families. These caregivers deserve protections, but H.R. 1195 is the wrong approach to address the important issue of workplace violence.

I am disappointed by the lack of effort to develop a workable bipartisan solution to combat workplace violence before this flawed legislation was rushed to the floor by Democrat leaders in Congress.

In fact, committee Democrats chose not to hold a legislative hearing focused on this bill. Unfortunately, the Democrat amendments only reinforce that H.R. 1195 is the wrong approach to addressing this important issue.

Representative Brown's amendment, while well-intentioned, ignores the fact that there are Federal agencies other than OSHA that would be better equipped to handle a regulatory requirement for the education of healthcare and social service workers who work with the victims of torture, trafficking, or domestic violence.

The question of whether employer education programs governed by OSHA, the Federal Government's workplace safety agency, are appropriate to address the objectives of this amendment should be thoroughly vetted and discussed during the rulemaking process before decisions impacting healthcare facilities and their patients are made. H.R. 1195 does not allow for this to occur.

Representative Cohen's amendment is also well-intentioned, but will unilaterally expand the reach of a flawed regulation to include numerous small facilities.

This is particularly problematic because H.R. 1195 precludes the opportunity for OSHA to conduct a Small Business Regulatory Enforcement and Fairness Act panel prior to a regulation being written, a key element in the process which considers the impact of proposed regulatory changes on small businesses. The implications of such a proposal should be carefully evaluated through the established OSHA rulemaking process before a decision is made regarding expansion to additional facilities.

With regard to Representative Delgado's amendment, I agree with his assessment that employers will need compliance assistance and technical help from OSHA in order to understand the complex and burdensome new rule mandated by this bill.

However, this amendment is little more than window dressing. While technical assistance is always welcome and appropriate for a rule of this complexity, this amendment places an arbitrary time limit that is woefully insufficient to cope with a rushed and flawed rule. Moreover, technical assistance after employers are subject to a rule in which they had no input is too little, too late.

Rather than amend a flawed bill by allowing the Department of Labor to help businesses after the fact, we should reject this bill and instead allow OSHA to pursue its established rulemaking process that provides ample opportunity for feedback from stakeholders and the public, which will ensure a better product and eliminate the need for this type of amendment.

Representative Jones' amendment puts the cart before the horse. Consultation with outside experts regarding compliance should occur while a regulation is being written by OSHA and before it is issued so the final product takes this expertise into account. This amendment simply adds yet another costly mandate on employers.

H.R. 1195, which requires OSHA to issue an interim final rule within 1 year, short-circuits the opportunity for the agency to hear from experts before a rushed rule is issued. This amendment is a feeble attempt to correct this critical flaw.

I believe, Madam Speaker, that every Member of this Chamber is committed to ensuring American workers are safe in the workplace. I appreciate Mr. Courtney's very kind comments about my concern for this personally, but I can say every Republican feels this way.

Our Nation's caregivers, who have been on the front lines of responding to the COVID-19 pandemic, are deserving of a responsible, workable, and thorough response to the serious issue of violence in the workplace. However, this legislation is a far cry from a sensible or workable solution.

H.R. 1195 is overly prescriptive and heavy-handed and takes the wrong approach, prejudging and imposing a rushed regulation without allowing for necessary stakeholder input. Unfortunately, the Democrat amendments do nothing to change this fact.

Madam Speaker, I urge my colleagues to oppose the Democrat amendments en bloc and the underlying bill, and

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Ms. FOXX. Madam Speaker, I believe I have the right to close, and I apologize for neglecting to say I oppose the amendment at the beginning.

I believe I have the right to close, therefore, I will reserve the balance of my time.

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Ms. FOXX. Madam Speaker, again, I want to thank Mr. Courtney for the comments he has made during this debate today. He has been a very kind colleague.

However, what we should be doing is more debating of some of the underlying issues that are creating this increased workplace violence, and we are not doing that as a Congress.

We need to be looking at why these things that are happening are happening. And I am sorry that we are not doing that. And I am sorry we are doing a rushed product here when we could be working together.

Madam Speaker, I urge my colleagues to vote ``no'' on the en bloc amendments and ``no'' on the underlying bill, and I yield back the balance of my time.

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