New Law Presents Major Challenges to Healthcare Facilities

The Violence Prevention in Healthcare Facilities Act was signed by Governor Corzine in January with relatively little fanfare. Nonetheless, it is a sweeping overhaul of the way New Jersey healthcare providers must tackle the challenge of workplace violence.

The law provides that all healthcare facilities licensed or run by the state (including hospitals and nursing homes) must establish a violence prevention committee divided between management and workers. Those facilities have until June 2009 to meet requirements related to violence risk assessment, violence prevention training, post-incident response and more. Those failing to meet the requirements face relatively small financial penalties – $2,500 for first offenses and $5,000 for subsequent offenses. Still, the act has teeth because it gives the state the power to revoke or suspend providers’ licenses.

Once the facility’s violence prevention committee is formed, the first step toward compliance is to develop a “detailed, written violence prevention plan.” That means performing and documenting an annual risk assessment of the facility that considers physical layout, lighting, restrictions on entry, surrounding crime rate, alarm systems, and identifies those individuals in the facility “who may pose a risk of violence.” A thorough review of past violent incidents – recorded in logs required by the U.S. Occupational Safety and Health Administration (OSHA) and in workers compensation records – must be conducted as well.

Once the risk assessment is done, the facility must implement specific measures to reduce the risk of violence. Depending on layout and location, these could include installing metal detectors at entrances, fastening furniture to the floors, using panic buttons, surveillance cameras and card-key access systems, and providing security escorts and parking lot shuttle services. Besides taking site-specific precautions to reduce violence, the law requires all providers to conduct annual violence prevention training sessions, to set up trained teams to respond to violent disturbances, and to keep detailed records of all incidents.

The law, however, may actually increase the risk of violence-related litigation faced by those providers. For example, an incident which occurs at a facility that has failed to develop the required written prevention plan will undoubtedly be used in a subsequent lawsuit as strong evidence that the facility was negligent and, thus, liable for hefty damages. On the other hand, providers who comply with the law by installing 24-hour surveillance cameras may be vulnerable to a lawsuit grounded on privacy rights. The same is true for providers who meet the law’s requirements of keeping records of violent acts and giving employees access to those records. The risk of defamation and other tort lawsuits by those listed as violent actors appears substantial.

Fortunately, providers are not entirely on their own as they seek to comply. As written, the law hews closely to OSHA’s Guidelines for Preventing Workplace Violence for Health Care Workers, which provides invaluable guidance on developing an effective prevention program.