Security

The law requires all licensed general acute-care hospitals, acute psychiatric hospitals and specialty hospitals to conduct a security and safety assessment at least annually. The law also requires hospitals to use the assessment to develop a security plan with measures to protect personnel, patients and visitors from aggressive or violent behavior. The security and safety assessment must examine trends of aggressive or violent behavior at the facility. Hospitals must 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 must not be limited to, security considerations relating to all of the following:

• Physical layout.
• Staffing. 
• Security personnel availability.
• Policy and training related to appropriate responses to violent acts.
• Efforts to cooperate with local law enforcement regarding violent acts in the facility.

In developing this plan, hospitals are required to consider guidelines or standards on violence in health care facilities issued by the California Department of Public Health, the Division of Occupational Safety and Health, and the federal Occupational Safety and Health Administration. As part of the security plan, hospitals are required to adopt security policies including, but not limited to, personnel training policies designed to protect personnel, patients and visitors from aggressive or violent behavior. In developing the plan and assessment, hospitals are required to consult with affected employees, including the recognized collective bargaining agent or agents, if any, and members of the hospital medical staff. This consultation may occur through hospital committees. The hospital committee responsible for developing the security plan is required to be familiar with all of the following:

• Role of security in hospital operations. 
• Hospital organization. 
• Protective measures, including alarms and access control. 
• Handling of disturbed patients, visitors and employees. 
• Identification of aggressive and violent predicting factors. 
• Hospital safety and emergency preparedness. 
• Rudiments of documenting and reporting crimes, including, by way of example, not disturbing a crime scene.

Hospitals are required to have sufficient personnel to provide security pursuant to the security plan developed. Persons regularly assigned to provide security in a hospital setting are required to be trained regarding the role of security in hospital operations, including the identification of aggressive and violent predicting factors and management of violent disturbances.

Any act of assault, which results in injury or involves the use of a firearm or other dangerous weapon, against any on-duty hospital personnel are required to be reported to the local law enforcement agency within 72 hours of the incident (defined in Section 240 of the Penal Code, or battery, as defined in Section 242 of the Penal Code). Any other act of assault, against any on-duty hospital personnel, may be reported to the local law enforcement agency within 72 hours of the incident. No health facility or employee of a health facility who reports a known or suspected instance of assault or battery pursuant to this section shall be civilly or criminally liable for any report required by this section (as defined in Section 240 of the Penal Code, or battery, as defined in Section 242 of the Penal Code). Any individual knowingly interfering with or obstructing the lawful reporting process may be guilty of a misdemeanor.

All hospital employees, as well as other health care workers such as physicians and nurse practitioners, regularly assigned to the emergency department are required to receive education as provided for in the security plan developed relating to the following topics:

• General safety measures.
• Personal safety measures.
• Assault cycle.
• Aggression and violence predicting factors.
• Obtaining patient history from a patient with violent behavior.
• Characteristics of aggressive and violent patients and victims.
• Verbal and physical maneuvers to diffuse and avoid violent behavior.
• Strategies to avoid physical harm.
• Restraining techniques.
• Appropriate use of medications as chemical restraints.
• Any resources available to employees for coping with incidents of violence, including, by way of example, critical incident stress debriefing or employee assistance programs.
• Temporary personnel are also required to be oriented to the security plan.

Hospitals are encouraged to review Health and Safety Code Sections 1257.7 and 1257.8 to ensure compliance with this mandate.