Congressional Record, Volume 167 Issue 66 (Friday, April 16, 2021)

[Congressional Record Volume 167, Number 66 (Friday, April 16, 2021)]
[House]
[Pages H1849-H1872]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

WORKPLACE VIOLENCE PREVENTION FOR HEALTH CARE AND SOCIAL SERVICE
WORKERS ACT

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.
The SPEAKER pro tempore (Mrs. Demings). Pursuant to House Resolution
303, the amendment in the nature of a substitute recommended by the
Committee on Education and Labor, printed in the bill, is adopted and
the bill, as amended, is considered read.
The text of the bill, as amended, is as follows:

H.R. 1195

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Workplace Violence
Prevention for Health Care and Social Service Workers Act''.

SEC. 2. TABLE OF CONTENTS.

The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

TITLE I--WORKPLACE VIOLENCE PREVENTION STANDARD

Sec. 101. Workplace violence prevention standard.
Sec. 102. Scope and application.
Sec. 103. Requirements for workplace violence prevention standard.
Sec. 104. Rules of construction.
Sec. 105. Other definitions.

TITLE II--AMENDMENTS TO THE SOCIAL SECURITY ACT

Sec. 201. Application of the workplace violence prevention standard to
certain facilities receiving Medicare funds.

TITLE I--WORKPLACE VIOLENCE PREVENTION STANDARD

SEC. 101. WORKPLACE VIOLENCE PREVENTION STANDARD.

(a) Interim Final Standard.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Labor shall issue an
interim final standard on workplace violence prevention--
(A) to require certain employers in the health care and
social service sectors, and certain employers in sectors that
conduct activities similar to the activities in the health
care and social service sectors, to develop and implement a
comprehensive workplace violence prevention plan and carry
out other activities or requirements described in section 103
to protect health care workers, social service workers, and
other personnel from workplace violence; and
(B) that shall, at a minimum, be based on the Guidelines
for Preventing Workplace Violence for Healthcare and Social
Service Workers published by the Occupational Safety and
Health Administration of the Department of Labor in 2015 and
adhere to the requirements of this title.
(2) Inapplicable provisions of law and executive order.--
The following provisions of law and Executive orders shall
not apply to the issuance of the interim final standard under
this subsection:
(A) The requirements applicable to occupational safety and
health standards under section 6(b) of the Occupational
Safety and Health Act of 1970 (29 U.S.C. 655(b)).
(B) The requirements of chapters 5 and 6 of title 5, United
States Code.
(C) Subchapter I of chapter 35 of title 44, United States
Code (commonly referred to as the ``Paperwork Reduction
Act'').
(D) Executive Order 12866 (58 Fed. Reg. 51735; relating to
regulatory planning and review), as amended.
(3) Notice and comment.--Notwithstanding paragraph (2)(B),
the Secretary shall, prior to issuing the interim final
standard under this subsection, provide notice in the Federal
Register of the interim final standard and a 30-day period
for public comment.
(4) Effective date of interim standard.--The interim final
standard shall--
(A) take effect on a date that is not later than 30 days
after issuance, except that such interim final standard may
include a reasonable phase-in period for the implementation
of required engineering controls that take effect after such
date;
(B) be enforced in the same manner and to the same extent
as any standard promulgated under section 6(b) of the
Occupational Safety and Health Act of 1970 (29 U.S.C.
655(b)); and
(C) be in effect until the final standard described in
subsection (b) becomes effective and enforceable.
(5) Failure to promulgate.--If an interim final standard
described in paragraph (1) is not issued not later than 1
year of the date of enactment of this Act, the provisions of
this title shall be in effect and enforced in the same manner
and to the same extent as any standard promulgated under
section 6(b) of the Occupational Safety and Health Act (29
U.S.C. 655(b)) until such provisions are superseded in whole
by an interim final standard issued by the Secretary that
meets the requirements of paragraph (1).
(b) Final Standard.--
(1) Proposed standard.--Not later than 2 years after the
date of enactment of this Act, the Secretary of Labor shall,
pursuant to section

[[Page H1850]]

6 of the Occupational Safety and Health Act (29 U.S.C. 655),
promulgate a proposed standard on workplace violence
prevention--
(A) for the purposes described in subsection (a)(1)(A); and
(B) that shall include, at a minimum, requirements
contained in the interim final standard promulgated under
subsection (a).
(2) Final standard.--Not later than 42 months after the
date of enactment of this Act, the Secretary shall issue a
final standard on such proposed standard that shall--
(A) provide no less protection than any workplace violence
standard adopted by a State plan that has been approved by
the Secretary under section 18 of the Occupational Safety and
Health Act of 1970 (29 U.S.C. 667), provided the Secretary
finds that the final standard is feasible on the basis of the
best available evidence; and
(B) be effective and enforceable in the same manner and to
the same extent as any standard promulgated under section
6(b) of the Occupational Safety and Health Act of 1970 (29
U.S.C. 655(b)).

SEC. 102. SCOPE AND APPLICATION.

In this title:
(1) Covered facility.--
(A) In general.--The term ``covered facility'' includes the
following:
(i) Any hospital, including any specialty hospital, in-
patient or outpatient setting, or clinic operating within a
hospital license, or any setting that provides outpatient
services.
(ii) Any residential treatment facility, including any
nursing home, skilled nursing facility, hospice facility, and
long-term care facility.
(iii) Any non-residential treatment or service setting.
(iv) Any medical treatment or social service setting or
clinic at a correctional or detention facility.
(v) Any community care setting, including a community-based
residential facility, group home, and mental health clinic.
(vi) Any psychiatric treatment facility.
(vii) Any drug abuse or substance use disorder treatment
center.
(viii) Any independent freestanding emergency centers.
(ix) Any facility described in clauses (i) through (viii)
operated by a Federal Government agency and required to
comply with occupational safety and health standards pursuant
to section 1960 of title 29, Code of Federal Regulations (as
such section is in effect on the date of enactment of this
Act).
(x) Any other facility the Secretary determines should be
covered under the standards promulgated under section 101.
(B) Exclusion.--The term ``covered facility'' does not
include an office of a physician, dentist, podiatrist, or any
other health practitioner that is not physically located
within a covered facility described in clauses (i) through
(x) of subparagraph (A).
(2) Covered services.--
(A) In general.--The term ``covered service'' includes the
following services and operations:
(i) Any services and operations provided in any field work
setting, including home health care, home-based hospice, and
home-based social work.
(ii) Any emergency services and transport, including such
services provided by firefighters and emergency responders.
(iii) Any services described in clauses (i) and (ii)
performed by a Federal Government agency and required to
comply with occupational safety and health standards pursuant
to section 1960 of title 29, Code of Federal Regulations (as
such section is in effect on the date of enactment of this
Act).
(iv) Any other services and operations the Secretary
determines should be covered under the standards promulgated
under section 101.
(B) Exclusion.--The term ``covered service'' does not
include child day care services.
(3) Covered employer.--
(A) In general.--The term ``covered employer'' includes a
person (including a contractor, subcontractor, a temporary
service firm, or an employee leasing entity) that employs an
individual to work at a covered facility or to perform
covered services.
(B) Exclusion.--The term ``covered employer'' does not
include an individual who privately employs, in the
individual's residence, a person to perform covered services
for the individual or a family member of the individual.
(4) Covered employee.--The term ``covered employee''
includes an individual employed by a covered employer to work
at a covered facility or to perform covered services.

SEC. 103. REQUIREMENTS FOR WORKPLACE VIOLENCE PREVENTION
STANDARD.

Each standard described in section 101 shall include, at a
minimum, the following requirements:
(1) Workplace violence prevention plan.--Not later than 6
months after the date of promulgation of the interim final
standard under section 101(a), a covered employer shall
develop, implement, and maintain an effective written
workplace violence prevention plan (in this section referred
to as the ``Plan'') for covered employees at each covered
facility and for covered employees performing a covered
service on behalf of such employer, which meets the
following:
(A) Plan development.--Each Plan shall--
(i) be developed and implemented with the meaningful
participation of direct care employees, other employees, and
employee representatives, for all aspects of the Plan;
(ii) 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; and
(iii) be suitable for the size, complexity, and type of
operations at the covered facility or for the covered
service, and remain in effect at all times.
(B) Plan content.--Each Plan shall include procedures and
methods for the following:
(i) Identification of the individual and the individual's
position responsible for implementation of the Plan.
(ii) With respect to each work area and unit at the covered
facility or while covered employees are performing the
covered service, risk assessment and identification of
workplace violence risks and hazards to employees exposed to
such risks and hazards (including environmental risk factors
and patient-specific risk factors), which shall be--

(I) informed by past violent incidents specific to such
covered facility or such covered service; and
(II) conducted with, at a minimum--

(aa) direct care employees;
(bb) where applicable, the representatives of such
employees; and
(cc) the employer.
(iii) Hazard prevention, engineering controls, or work
practice controls to correct hazards, in a timely manner,
applying industrial hygiene principles of the hierarchy of
controls, which--

(I) may include security and alarm systems, adequate exit
routes, monitoring systems, barrier protection, established
areas for patients and clients, lighting, entry procedures,
staffing and working in teams, and systems to identify and
flag clients with a history of violence; and
(II) shall ensure that employers correct, in a timely
manner, hazards identified in any violent incident
investigation described in paragraph (2) and any annual
report described in paragraph (5).

(iv) Reporting, incident response, and post-incident
investigation procedures, including procedures--

(I) for employees to report workplace violence risks,
hazards, and incidents;
(II) for employers to respond to reports of workplace
violence;
(III) for employers to perform a post-incident
investigation and debriefing of all reports of workplace
violence with the participation of employees and their
representatives;
(IV) to provide medical care or first aid to affected
employees; and
(V) to provide employees with information about available
trauma and related counseling.

(I) ensuring the coordination of risk assessment efforts,
Plan development, and implementation of the Plan with other
employers who have employees who work at the covered facility
or who are performing the covered service; and
(II) determining which covered employer or covered
employers shall be responsible for implementing and complying
with the provisions of the standard applicable to the working
conditions over which such employers have control.

(viii) Procedures for conducting the annual evaluation
under paragraph (6).
(C) Availability of plan.--Each Plan shall be made
available at all times to the covered employees who are
covered under such Plan.
(2) Violent incident investigation.--
(A) In general.--As soon as practicable after a workplace
violence incident, risk, or hazard of which a covered
employer has knowledge, the employer shall conduct an
investigation of such incident, risk, or hazard under which
the employer shall--
(i) review the circumstances of the incident, risk, or
hazard, and whether any controls or measures implemented
pursuant to the Plan of the employer were effective; and
(ii) solicit input from involved employees, their
representatives, and supervisors about the cause of the
incident, risk, or hazard, and whether further corrective
measures (including system-level factors) could have
prevented the incident, risk, or hazard.
(B) Documentation.--A covered employer shall document the
findings, recommendations, and corrective measures taken for
each investigation conducted under this paragraph.
(3) Training and education.--With respect to the covered
employees covered under a Plan of a covered employer, the
employer shall provide training and education to such
employees who may be exposed to workplace violence hazards
and risks, which meet the following requirements:
(A) Annual training and education shall include information
on the Plan, including identified workplace violence hazards,
work practice control measures, reporting procedures, record
keeping requirements, response procedures, anti-retaliation
policies, and employee rights.
(B) Additional hazard recognition training shall be
provided for supervisors and managers to ensure they--
(i) can recognize high-risk situations; and
(ii) do not assign employees to situations that predictably
compromise the safety of such employees.
(C) Additional training shall be provided for each such
covered employee whose job circumstances have changed, within
a reasonable timeframe after such change.
(D) Applicable training shall be provided under this
paragraph for each new covered employee prior to the
employee's job assignment.
(E) All training shall provide such employees opportunities
to ask questions, give feedback on training, and request
additional instruction, clarification, or other followup.

[[Page H1851]]

(F) All training shall be provided in-person and by an
individual with knowledge of workplace violence prevention
and of the Plan, except that any annual training described in
subparagraph (A) provided to an employee after the first year
such training is provided to such employee may be conducted
by live video if in-person training is impracticable.
(G) All training shall be appropriate in content and
vocabulary to the language, educational level, and literacy
of such covered employees.
(4) Recordkeeping and access to plan records.--
(A) In general.--Each covered employer shall--
(i) maintain for not less than 5 years--

(I) records related to each Plan of the employer, including
workplace violence risk and hazard assessments, and
identification, evaluation, correction, and training
procedures;
(II) a violent incident log described in subparagraph (B)
for recording all workplace violence incidents; and
(III) records of all incident investigations as required
under paragraph (2)(B); and

(ii)(I) make such records and logs available, upon request,
to covered employees and their representatives for
examination and copying in accordance with section 1910.1020
of title 29, Code of Federal Regulations (as such section is
in effect on the date of enactment of this Act), and in a
manner consistent with HIPAA privacy regulations (defined in
section 1180(b)(3) of the Social Security Act (42 U.S.C.
1320d-9(b)(3))) and part 2 of title 42, Code of Federal
Regulations (as such part is in effect on the date of
enactment of this Act); and
(II) ensure that any such records and logs that may be
copied, transmitted electronically, or otherwise removed from
the employer's control for purposes of this clause omit any
element of personal identifying information sufficient to
allow identification of any patient, resident, client, or
other individual alleged to have committed a violent incident
(including the individual's name, address, electronic mail
address, telephone number, or social security number, or
other information that, alone or in combination with other
publicly available information, reveals such individual's
identity).
(B) Violent incident log description.--Each violent
incident log shall--
(i) be maintained by a covered employer for each covered
facility controlled by the employer and for each covered
service being performed by a covered employee on behalf of
such employer;
(ii) be based on a template developed by the Secretary not
later than 1 year after the date of enactment of this Act;
(iii) include, at a minimum, a description of--

(I) the violent incident (including environmental risk
factors present at the time of the incident);
(II) the date, time, and location of the incident, and the
names and job titles of involved employees;
(III) the nature and extent of injuries to covered
employees;
(IV) a classification of the perpetrator who committed the
violence, including whether the perpetrator was--

(aa) a patient, client, resident, or customer of a covered
employer;
(bb) a family or friend of a patient, client, resident, or
customer of a covered employer;
(cc) a stranger;
(dd) a coworker, supervisor, or manager of a covered
employee;
(ee) a partner, spouse, parent, or relative of a covered
employee; or
(ff) any other appropriate classification;

(V) the type of violent incident (such as type 1 violence,
type 2 violence, type 3 violence, or type 4 violence); and
(VI) how the incident was abated;

(iv) not later than 7 days after the employer learns of
such incident, contain a record of each violent incident,
which is updated to ensure completeness of such record;
(v) be maintained for not less than 5 years; and
(vi) in the case of a violent incident involving a privacy
concern case, protect the identity of employees in a manner
consistent with section 1904.29(b) of title 29, Code of
Federal Regulations (as such section is in effect on the date
of enactment of this Act).
(C) Annual summary.--
(i) Covered employers.--Each covered employer shall prepare
and submit to the Secretary an annual summary of each violent
incident log for the preceding calendar year that shall--

(I) with respect to each covered facility, and each covered
service, for which such a log has been maintained, include--

(aa) the total number of violent incidents;
(bb) the number of recordable injuries related to such
incidents; and
(cc) the total number of hours worked by the covered
employees for such preceding year;

(II) be completed on a form provided by the Secretary;
(III) be posted for 3 months beginning February 1 of each
year in a manner consistent with the requirements of section
1904 of title 29, Code of Federal Regulations (as such
section is in effect on the date of enactment of this Act),
relating to the posting of summaries of injury and illness
logs;
(IV) be located in a conspicuous place or places where
notices to employees are customarily posted; and
(V) not be altered, defaced, or covered by other material.

(ii) Secretary.--Not later than 1 year after the
promulgation of the interim final standard under section
101(a), the Secretary shall make available a platform for the
electronic submission of annual summaries required under this
subparagraph.
(5) Annual report.--
(A) Report to secretary.--Not later than February 15 of
each year, each covered employer shall report to the
Secretary, on a form provided by the Secretary, the
frequency, quantity, and severity of workplace violence, and
any incident response and post-incident investigation
(including abatement measures) for the incidents set forth in
the annual summary of the violent incident log described in
paragraph (4)(C). The contents of the report of the Secretary
to Congress shall not disclose any confidential information.
(B) Report to congress.--Not later than 6 months after
February 15 of each year, the Secretary shall submit to
Congress a summary of the reports received under subparagraph
(A).
(6) Annual evaluation.--Each covered employer shall conduct
an annual written evaluation, conducted with the full, active
participation of covered employees and employee
representatives, of--
(A) the implementation and effectiveness of the Plan,
including a review of the violent incident log; and
(B) compliance with training required by each standard
described in section 101, and specified in the Plan.
(7) Plan updates.--Each covered employer shall incorporate
changes to the Plan, in a manner consistent with paragraph
(1)(A)(i) and based on findings from the most recent annual
evaluation conducted under paragraph (6), as appropriate.
(8) Anti-retaliation.--
(A) Policy.--Each covered employer shall adopt a policy
prohibiting any person (including an agent of the employer)
from the discrimination or retaliation described in
subparagraph (B).
(B) Prohibition.--No covered employer shall discriminate or
retaliate against any employee for--
(i) reporting a workplace violence incident, threat, or
concern to, or seeking assistance or intervention with
respect to such incident, threat, or concern from, the
employer, law enforcement, local emergency services, or a
local, State, or Federal government agency; or
(ii) exercising any other rights under this paragraph.
(C) Enforcement.--This paragraph shall be enforced in the
same manner and to the same extent as any standard
promulgated under section 6(b) of the Occupational Safety and
Health Act (29 U.S.C. 655(b)).

SEC. 104. RULES OF CONSTRUCTION.

Notwithstanding section 18 of the Occupational Safety and
Health Act of 1970 (29 U.S.C. 667)--
(1) nothing in this title shall be construed to curtail or
limit authority of the Secretary under any other provision of
the law;
(2) the rights, privileges, or remedies of covered
employees shall be in addition to the rights, privileges, or
remedies provided under any Federal or State law, or any
collective bargaining agreement; and
(3) nothing in this Act shall be construed to limit or
prevent health care workers, social service workers, and
other personnel from reporting violent incidents to
appropriate law enforcement.

SEC. 105. OTHER DEFINITIONS.

In this title:
(1) Workplace violence.--
(A) In general.--The term ``workplace violence'' means any
act of violence or threat of violence, without regard to
intent, that occurs at a covered facility or while a covered
employee performs a covered service.
(B) Exclusions.--The term ``workplace violence'' does not
include lawful acts of self-defense or lawful acts of defense
of others.
(C) Inclusions.--The term ``workplace violence'' includes--
(i) the threat or use of physical force against a covered
employee that results in or has a high likelihood of
resulting in injury, psychological trauma, or stress, without
regard to whether the covered employee sustains an injury,
psychological trauma, or stress; and
(ii) an incident involving the threat or use of a firearm
or a dangerous weapon, including the use of common objects as
weapons, without regard to whether the employee sustains an
injury, psychological trauma, or stress.
(2) Type 1 violence.--The term ``type 1 violence''--
(A) means workplace violence directed at a covered employee
at a covered facility or while performing a covered service
by an individual who has no legitimate business at the
covered facility or with respect to such covered service; and
(B) includes violent acts by any individual who enters the
covered facility or worksite where a covered service is being
performed with the intent to commit a crime.
(3) Type 2 violence.--The term ``type 2 violence'' means
workplace violence directed at a covered employee by
customers, clients, patients, students, inmates, or any
individual for whom a covered facility provides services or
for whom the employee performs covered services.
(4) Type 3 violence.--The term ``type 3 violence'' means
workplace violence directed at a covered employee by a
present or former employee, supervisor, or manager.
(5) Type 4 violence.--The term ``type 4 violence'' means
workplace violence directed at a covered employee by an
individual who is not an employee, but has or is known to
have had a personal relationship with such employee, or with
a customer, client, patient, student, inmate, or any
individual for whom a covered facility provides services or
for whom the employee performs covered services.
(6) Threat of violence.--The term ``threat of violence''
means a statement or conduct that--
(A) causes an individual to fear for such individual's
safety because there is a reasonable

[[Page H1852]]

possibility the individual might be physically injured; and
(B) serves no legitimate purpose.
(7) Alarm.--The term ``alarm'' means a mechanical,
electrical, or electronic device that does not rely upon an
employee's vocalization in order to alert others.
(8) Dangerous weapon.--The term ``dangerous weapon'' means
an instrument capable of inflicting death or serious bodily
injury, without regard to whether such instrument was
designed for that purpose.
(9) Engineering controls.--
(A) In general.--The term ``engineering controls'' means an
aspect of the built space or a device that removes a hazard
from the workplace or creates a barrier between a covered
employee and the hazard.
(B) Inclusions.--For purposes of reducing workplace
violence hazards, the term ``engineering controls'' includes
electronic access controls to employee occupied areas, weapon
detectors (installed or handheld), enclosed workstations with
shatter-resistant glass, deep service counters, separate
rooms or areas for high-risk patients, locks on doors,
removing access to or securing items that could be used as
weapons, furniture affixed to the floor, opaque glass in
patient rooms (which protects privacy, but allows the health
care provider to see where the patient is before entering the
room), closed-circuit television monitoring and video
recording, sight-aids, and personal alarm devices.
(10) Environmental risk factors.--
(A) In general.--The term ``environmental risk factors''
means factors in the covered facility or area in which a
covered service is performed that may contribute to the
likelihood or severity of a workplace violence incident.
(B) Clarification.--Environmental risk factors may be
associated with the specific task being performed or the work
area, such as working in an isolated area, poor illumination
or blocked visibility, and lack of physical barriers between
individuals and persons at risk of committing workplace
violence.
(11) Patient-specific risk factors.--The term ``patient-
specific risk factors'' means factors specific to a patient
that may increase the likelihood or severity of a workplace
violence incident, including--
(A) a patient's treatment and medication status, and
history of violence and use of drugs or alcohol; and
(B) any conditions or disease processes of the patient that
may cause the patient to experience confusion or
disorientation, be non-responsive to instruction, behave
unpredictably, or engage in disruptive, threatening, or
violent behavior.
(12) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(13) Work practice controls.--
(A) In general.--The term ``work practice controls'' means
procedures and rules that are used to effectively reduce
workplace violence hazards.
(B) Inclusions.--The term ``work practice controls''
includes--
(i) assigning and placing sufficient numbers of staff to
reduce patient-specific type 2 violence hazards;
(ii) provision of dedicated and available safety personnel
such as security guards;
(iii) employee training on workplace violence prevention
methods and techniques to de-escalate and minimize violent
behavior; and
(iv) employee training on procedures for response in the
event of a workplace violence incident and for post-incident
response.

TITLE II--AMENDMENTS TO THE SOCIAL SECURITY ACT

SEC. 201. APPLICATION OF THE WORKPLACE VIOLENCE PREVENTION
STANDARD TO CERTAIN FACILITIES RECEIVING
MEDICARE FUNDS.

(a) In General.--Section 1866 of the Social Security Act
(42 U.S.C. 1395cc) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (X), by striking ``and'' at the end;
(B) in subparagraph (Y), by striking the period at the end
and inserting ``; and''; and
(C) by inserting after subparagraph (Y) the following new
subparagraph:
``(Z) in the case of hospitals that are not otherwise
subject to the Occupational Safety and Health Act of 1970 (or
a State occupational safety and health plan that is approved
under 18(b) of such Act) and skilled nursing facilities that
are not otherwise subject to such Act (or such a State
occupational safety and health plan), to comply with the
Workplace Violence Prevention Standard (as promulgated under
section 101 of the Workplace Violence Prevention for Health
Care and Social Service Workers Act).''; and
(2) in subsection (b)(4)--
(A) in subparagraph (A), by inserting ``and a hospital or
skilled nursing facility that fails to comply with the
requirement of subsection (a)(1)(Z) (relating to the
Workplace Violence Prevention Standard)'' after ``Bloodborne
Pathogens standard)''; and
(B) in subparagraph (B)--
(i) by striking ``(a)(1)(U)'' and inserting ``(a)(1)(V)'';
and
(ii) by inserting ``(or, in the case of a failure to comply
with the requirement of subsection (a)(1)(Z), for a violation
of the Workplace Violence Prevention standard referred to in
such subsection by a hospital or skilled nursing facility, as
applicable, that is subject to the provisions of such Act)''
before the period at the end.
(b) Effective Date.--The amendments made by subsection (a)
shall apply beginning on the date that is 1 year after the
date of issuance of the interim final standard on workplace
violence prevention required under section 101.

The SPEAKER pro tempore. The bill, as amended, shall be debatable for
1 hour equally divided and controlled by the chair and ranking minority
member on the Committee on Education and Labor.
The gentleman from Connecticut (Mr. Courtney) and the gentlewoman
from North Carolina (Ms. Foxx) each will control 30 minutes.
The Chair recognizes the gentleman from Connecticut.

general leave

Mr. COURTNEY. Madam Speaker, I ask unanimous consent that all Members
have 5 legislative days in which to revise and extend their remarks and
include extraneous material on H.R. 1195, the Workplace Violence
Prevention for Health Care and Social Service Workers Act.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Connecticut?
There was no objection.
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.

[[Page H1853]]

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.
Madam Speaker, I reserve the balance of my time.
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.

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.
Madam Speaker, I reserve the balance of my time.
Mr. COURTNEY. Madam Speaker, I yield myself such time as I may
consume. Very briefly, again, I appreciate that Ms. Foxx acknowledges
the severity of this issue, and I think that is important. But I would
note, if anyone checks with the House Clerk's office, we actually have
a solid number of Republican cosponsors on this bill. I want to make
that clear, for the record, and I appreciate their support as well.
Madam Speaker, I yield 2\1/2\ minutes to the gentleman from Virginia
(Mr. Scott), the chair of the Committee on Education and Labor and an
outstanding staunch supporter of this legislation.

[[Page H1854]]

{time} 0930

Mr. SCOTT of Virginia. Madam Speaker, I thank the gentleman for
yielding.
Madam Speaker, I rise in support of H.R. 1195, the Workplace Violence
Prevention for Health Care and Social Service Workers Act.
Over the past year, we have voiced exceptional praise for healthcare
and social service workers, who have risked their lives to care for
ourselves and our loved ones. Yet, for too long, we have failed to
address the high and growing rates of workplace violence for these
workers, who are regularly beaten, kicked, punched, and sometimes even
killed on the job.
In 2018, healthcare workers accounted for nearly three out of four of
all nonfatal workplace injuries and illnesses caused by violence. Let
me repeat that. In 2018, healthcare workers alone accounted for nearly
three out of four of all nonfatal workplace injuries and illnesses
caused by violence.
Many of these incidents are foreseeable and can be prevented by sound
workplace violence prevention plans. They work, and when they are
implemented, they can reduce workers' compensation claims.
Yet the Occupational Safety and Health Administration, or OSHA, still
has no enforceable workplace standard that requires healthcare and
social service employers to implement violence prevention programs. We
have tried voluntary guidance for the past 25 years, yet still too many
employers choose not to follow the best evidence on what is well
understood to be authoritative guidance issued by OSHA.
To make matters worse, without action from Congress, protections for
healthcare workers and social service workers are nowhere in sight.
OSHA typically takes 7 to 20 years to issue a new standard. The recent
beryllium standard that was adopted a couple of years ago was in the
works for over 17 years.
We cannot ask healthcare and social service workers to wait any
longer, particularly during this global pandemic when Congress has the
ability to ensure that OSHA can act as quickly as possible to protect
workers' lives.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. COURTNEY. Madam Speaker, I yield an additional 30 seconds to the
gentleman from Virginia.
Mr. SCOTT of Virginia. Madam Speaker, to that end, H.R. 1195 directs
OSHA to issue an interim final standard within 1 year and a final
standard within 42 months, requiring healthcare and social service
employers to develop and implement a workplace violence prevention
plan. It protects workers from retaliation for reporting assaults to
their employers or government authorities. It also protects the
employees of healthcare facilities run by State, county, or local
governments in the 24 States that are not covered by either Federal
OSHA or a State-run OSHA plan.
Madam Speaker, I commend the gentleman from Connecticut (Mr.
Courtney) for his leadership, and I urge my colleagues to join us in
voting for this legislation.
Ms. FOXX. Madam Speaker, I yield 2 minutes to gentleman from
Pennsylvania (Mr. Keller).
Mr. KELLER. Madam Speaker, my 25 years in private industry taught me
many lessons. One which resonates with me today is that sweeping
industry mandates with no input from those who will be impacted don't
work. No one knows better what the workforce needs to be successful
than the workforce itself.
It seems to me that my colleagues across the aisle have yet to learn
this lesson and are rushing and pushing H.R. 1195, a bill that would
institute a rushed, sweeping initiative that ignores the data and, more
importantly, ignores the people it will effect.
Though H.R. 1195 is founded under the premise of finding solutions
for workplace violence--especially for our healthcare workers and
social service workers, who are most susceptible--this bill clearly
misses the mark.
In tandem, the Occupational Safety and Health Administration also
recognizes the risks that our healthcare and social service workers
face in the workplace. However, this rulemaking process should and must
account for the important views of impacted stakeholders.
There is not a more notable red flag to H.R. 1195 than the fact that
the American Hospital Association came out to oppose it because it
would institute additional restrictions to already struggling rural
hospitals across the country. To ensure long-lasting policy that can
address the complex problem of workplace violence, it is imperative we
develop a solution that seeks input from stakeholders and employers
that goes through the normal rulemaking process.
Our healthcare and social service workers have given so much during
this pandemic, and we owe them a debt of gratitude for their work.
Moreover, we owe them policy that will improve workplace safety without
making it harder for them to do their jobs. We owe it to them to seek
their input.
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.
Ms. ADAMS. Madam Speaker, I thank the gentleman from Connecticut for
all his great work on this bill.
Madam Speaker, I rise in support of H.R. 1195.
As chair of the Committee on Education and Labor's Workforce
Protections Subcommittee, I work every day to ensure that all workers
are treated with dignity and respect because workers deserve nothing
less. Our labor laws must be held to that same principle.
Unfortunately, our healthcare and social service workers face
disproportionately high rates of violence on the job. We must do
something to address that, and the Workplace Violence Prevention for
Health Care and Social Service Workers Act does just that.
This critical piece of legislation requires that OSHA issue a
workplace violence protection standard for employers in these sectors
in order to actively prevent, address, and track workplace violence
incidents.
We have always relied heavily on the selflessness of healthcare and
social service workers, and that truth has been even clearer during the
COVID pandemic. We must ensure their well-being just as they work
tirelessly every day to ensure ours.
Madam Speaker, I urge support of H.R. 1195.
The SPEAKER pro tempore. The time of the gentlewoman has expired.
Mr. COURTNEY. Madam Speaker, I yield an additional 15 seconds to the
gentlewoman from North Carolina.
Ms. ADAMS. Madam Speaker, I include in the Record letters from the
American Society of Safety Professionals, who actively support this
bill.

American Society of

Safety Professionals,

March 25, 2021.
To: Contacts, Stakeholders and Participants Workplace
Prevention Legislation [HR 1195]
From: Joseph Weiss, ASSP External Affairs
Comments of the American Society of Safety Professionals
(ASSP)--The Workplace Violence Prevention for Health Care
and Social Service Workers Act (HR 1309 & S 851)--
Confirming ASSP's Position on HR 1195.
Greetings: The attached statement and comments were
originally submitted by the American Society of Safety
Professionals (ASSP) in support of The Workplace Violence
Prevention for Health Care and Social Service Workers Act (HR
1309 & S 851) in April 2019.
We understand this legislation has been reintroduced as HR
1195. Our comments in the April 2019 statement remain current
and reflect our position on HR 1195.
ASSP stands ready to assist with initiatives and endeavors
to help move occupational safety and health forward. Please
contact us if you have any questions regarding our support of
HR 1195.
Thank you for your attention to this matter.
Cordially,
Joseph Weiss,
ASSP External Affairs.

[[Page H1855]]

____
American Society of

Safety Professionals,

April 22, 2019.
Comments of the American Society of Safety Professionals
(ASSP)--The Workplace Violence Prevention for Health Care
and Social Service Workers Act (HR 1309 & S 851).

Hon. Alma Adams,
House of Representatives: Committee on Education and Labor,
Chair, Subcommittee on Workforce Protections, U.S.
Congresswoman for the 12th District, Washington, DC.
Hon. Bradley Byrne,
U.S. Congressman for the 1st District, House of
Representative: Subcommittee on Workforce Protections,
Washington, DC.
Hon. Joe Courtney,
U.S. Congressman for the 2nd District,
Washington, DC.
The American Society of Safety Professionals (ASSP) is
pleased to submit the following comments to the House
Education and Labor Committee and the Senate Health Education
Labor and Pensions Committee in support of HR 1309 and S.
851, legislation to help protect workers in the healthcare
and social service sectors from the threat of workplace
violence.
ASSP notes that this legislation has already secured nearly
60 co-sponsors in the House of Representatives and 8
cosponsors in the U.S. Senate. Because we believe that safety
is a nonpartisan issue and that all of us benefit from the
services the workers in these sectors deliver, we encourage
bipartisan support of the legislation and additional public
hearings on this critical issue.
ASSP is the oldest society of safety professionals in the
world. Founded in 1911, ASSP represents more than 38,000
dedicated occupation safety and health (OSH) professionals.
Our members are experts in managing workplace safety and
health issues in every industry, in every state and across
the globe. ASSP is also the Secretariat for various voluntary
consensus standards related to best practices in occupational
safety and health management and training.
In late October 2018, ASSP hosted the Women's Workplace
Safety Summit, and workplace violence involving women was one
of three focus topics of the event. Workplace violence has a
disproportionate impact on women and is the leading cause of
fatalities for workers who are women. ASSP's Women in Safety
Excellence (WISE) Common Interest Group is also deeply
engaged on the issue of workplace violence prevention.
ASSP commends your committees for addressing this issue
through legislation that directs the Secretary of Labor to
issue an OSH standard that requires covered employers within
the healthcare and social service industries to develop and
implement a comprehensive workplace violence prevention plan.
If enacted, the legislation would ensure that enforceable and
effective workplace violence prevention programs would be
required within two years of enactment.
The Occupational Safety and Health Administration (OSHA)
commenced a rulemaking by initiating a request for
information (RFI) in December 2016: OSHA Request for
Information Concerning Prevention of Workplace Violence in
Healthcare and Social Assistance, OSHA Docket 2016-0014,
Regulatory Information Number (RIN) 1218-AD 08. The comment
period closed April 6, 2017. No further action has occurred
since that date, despite workplace violence becoming an ever-
more recognized hazard in the U.S.
ASSP submitted comments to OSHA on that RFI (at the time,
the organization's name was American Society of Safety
Engineers), and those comments are attached to this
submission, along with an article from our ``HealthBeat''
publication, Preventing Workplace Violence, A Systematic &
Systemic Approach, which was also submitted to the OSHA
docket. We ask that these materials be formally included in
the record on this legislation.
OSHA's November 2018 regulatory agenda included
``Prevention of Workplace Violence in Health Care and Social
Assistance'' as a future item with a small business panel
(pursuant to the Small Business Regulatory Enforcement
Fairness Act) slated for March 2019. However, that date is
now past with no action indicated any time in the foreseeable
future. The next regulatory agenda will reveal whether any
further action is anticipated by the agency within the next
12 months to move toward promulgation of a workplace violence
standard.
Barring any movement from the agency in this regard, it is
appropriate for Congress--in its oversight role--to signal to
OSHA that this is a priority rulemaking area, and for your
committees to take the lead on helping to fill the gaps in
protections for the many vulnerable workers in this highrisk
area.
Currently, OSHA can take enforcement actions against
employers under its General Duty Clause (GDC) [Section
5(a)(1) of the Occupational Safety and Health Act of 1970]
and can issue penalties of up to $132,598 per willful or
repeated violation. However, OSHA has the burden of providing
that the cited employer was aware of a recognized hazard,
that employees were actually exposed to the hazard within the
previous six months and that there is a feasible method of
abatement.
GDC citations are often difficult for the agency to
sustain, they cannot trigger criminal prosecution even in the
case of a fatality, and there is no coverage for third-party
workers such as contractors or temporary staffers. This is
one exception to OSHA's multiemployer worksite enforcement
policy. In 2015, OSHA issued ``Guidelines for Preventing
Workplace Violence for Healthcare and Social Service
Workers,'' but the guidance did not go through formal
rulemaking so it is advisory and not enforceable at the
present time.
Another problem with using the GDC as the main enforcement
tool to address workplace violence issues is simply that it
is reactive in virtually every situation. While OSHA
investigates fatalities and cases with severe injuries that
must be reported by law, it is virtually unheard of for OSHA
to investigate an employer concerning workplace violence
prevention before a tragic incident occurs, unless triggered
by a publicized ``near miss'' or due to an employee hazard
complaint.
While the federal Occupational Safety and Health Review
Commission recently affirmed a GDC workplace violence
violation issued against Integra Health Management (March 4,
2019, OSHRC), the action was taken only after the death of a
healthcare worker at the hands of a patient, and the ultimate
OSHA civil penalty was $7,000. The case is still subject to
appeal in the U.S. Court of Appeals and amici curiae in the
case include the U.S. Chamber of Commerce (opposing the
enforcement action) and the AFL-CIO (in support of the OSHA
citation). ASSP is not a party to this action.
A Government Accountability Office study reported that
there were 730,000 cases of healthcare workplace assaults
over the
5-year span from 2009 through 2013. The Bureau of Labor
Statistics reports that healthcare and social service sector
employees suffered 69 percent of all workplace violence
injuries caused by persons in 2016 and are nearly 5 times as
likely to suffer a workplace violence injury than workers
overall.
The healthcare and social service industries experience the
highest rates, with workplace violence injury rates for this
sector at 8.2 per 10,000 full-time workers, more than four
times higher than the overall private sector incidence rate
for such injuries. This is simply unacceptable when
interventions are available to mitigate risk. As noted in
ASSP's 2016 comments to OSHA, we believe that a workplace
violence prevention standard is feasible and that there are
measures that employers can use to reduce a significant risk
of material harm.
Finally, ASSP observes that many of the at-risk workers in
the healthcare and social service sectors are employed in the
public sector, by state or local government facilities or
agencies. Currently, they have no protections under the
federal Occupational Safety and Health Act. The states that
operate their own OSHA agencies must cover their public
sector workers (and several state governmental agencies in
federal OSHA states also cover the safety of their public
sector workers), but most workers go without OSHA protection.
We urge you to consider including public sector coverage of
healthcare and social service workers in this legislation to
the extent possible.

Conclusion

ASSP condemns all forms of violence in the workplace and is
particularly concerned with the rise of injuries associated
with violence in the healthcare and social service industry
sectors, targeted by the pending federal legislation. ASSP
supports congressional efforts to eliminate workplace
violence and encourages OSHA to continue with its rulemaking
to promulgate an enforceable and effective standard,
accompanied by comprehensive education and outreach.
Thank you for consideration of ASSP's comments. We look
forward to working with Congress in a proactive manner to
address the critical issues affecting the health and safety
of all Americans in the workplace.
Respectfully Submitted,
Rixio Medina, CSP, CPP,
2018-19 ASSP President.

Ms. FOXX. Madam Speaker, I yield 2 minutes to the gentleman from
Georgia (Mr. Allen).
Mr. ALLEN. Madam Speaker, I rise in opposition to H.R. 1195.
Madam Speaker, our healthcare and social service workers deserve
tremendous praise for their work over the past year, as they have faced
unprecedented challenges during the COVID-19 pandemic. They also
deserve protections, as they face a significant risk of workplace
violence.
This complex issue deserves an evidence-based solution, not a rushed
and costly top-down government mandate.
Unfortunately, H.R. 1195 would prevent workers and stakeholders from
giving meaningful input based on experience regarding how to address
this highly technical issue. It forces the Occupational Safety and
Health Administration, or OSHA, to issue an interim final workplace
violence prevention rule within 1 year, significantly impacting the
healthcare industry as they remain on the front lines of combating this
pandemic.
I have heard firsthand from our healthcare facilities--especially our
rural hospitals--that the pandemic has caused serious financial
struggles, and many are already at risk of closure.
The CBO estimates that the rushed rule will cost private entities at
least $1.8 billion in the first 2 years that the

[[Page H1856]]

rule is in effect and $750 million annually after that. For public
facilities, it will cost at least $100 million in the first 2 years and
$55 million after that.
The last thing our healthcare facilities need right now is another
costly top-down mandate from Washington.
Our Founders envisioned a government by the people. I am always
amazed that the intellectuals in this town know more about solving
problems than the great people on the front lines. My colleagues are
approaching this issue the wrong way. We must address this from the
bottom up by empowering healthcare workers, hospital leadership, the
scientific community, and the public to have a say in the development
of a new comprehensive standard.
That is why I oppose this bill today and I urge my colleagues to
ensure our healthcare workers and caregivers are protected in the
workplace by allowing them to give their input directly.
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.
Madam Speaker, I yield 1 minute to the gentlewoman from Oregon (Ms.
Bonamici), who is the chair of the Subcommittee on Civil Rights and
Human Services.
Ms. BONAMICI. Madam Speaker, I rise in support of the Workplace
Violence Prevention for Health Care and Social Service Workers Act.
The coronavirus pandemic has exposed the increasingly harsh workplace
conditions that nurses, doctors, social workers, and other healthcare
workers have endured to keep our communities going. But even before the
pandemic, healthcare and social service workers faced a
disproportionate risk of on-the-job violence and injuries.
A few year ago, two workers in Oregon were tragically wounded in a
workplace stabbing at an organization that provides essential services
to youth who are facing addiction, homelessness, and behavioral health
issues. Following the incident, Oregon AFSCME members organized to
improve working conditions that were compromising the quality of
services for vulnerable clients and the safety of the employees.
Workers across the country, like the workers at Outside In, in
Portland, need an evidence-based workplace violence prevention plan
tailored to the needs of the vulnerable populations they serve. Today,
we have a chance to support their safety and well-being in the
workplace.
Madam Speaker, I include in the Record a letter in support of the
legislation from the Emergency Nurses Association.

Emergency Nurses Association,

February 23, 2021.
Hon. Joe Courtney,
House of Representatives,
Washington, DC.
Dear Representative Courtney: On behalf of the Emergency
Nurses Association (ENA) and our more than 52,000 members, I
am writing to express our support for H.R. 1195, the
Workplace Violence Prevention for Health Care and Social
Service Workers Act of 2021. This important and timely
legislation will ensure that health care and social service
employers undertake steps to protect their employees and
patients from violence in the workplace.
As you know, workplace violence against health care
workers, including emergency nurses, has become a national
crisis. According to the Occupational Safety and Health
Administration (OSHA), workers in the health care sector
accounted for only 20% of workplace injuries yet comprised
approximately 50% of all victims of workplace assault. The
same study found that between 2002 and 2013, serious
incidents of workplace violence were four times more common
for workers in the health care sector versus all workers in
the U.S.
Unfortunately, assaults and batteries directed at workers
occur at especially high rates in emergency departments
(EDs), which are open 24 hours a day, seven days a week and
are required under the Emergency Medical Treatment and Labor
Act (EMTALA) to stabilize and treat all patients. Often,
health care professionals in the ED interact with members of
the public when emotions run high and their behavior can
sometimes become violent. Research has found that emergency
nurses and other personnel in the ED experience a violent
event about once every two months. Further, a 2011 study
reported that one-third of emergency nurses had considered
leaving the profession due to workplace violence.
The Workplace Violence Prevention for Health Care and
Social Service Workers Act will ensure that health care
employers, including hospitals, take specific steps to
prevent workplace violence and ensure the safety of patients
and workers. This bill will require health care and social
service employers to develop and implement a comprehensive
violence prevention plan which must include procedures to
identify and respond to risks that make workplaces vulnerable
to violent incidents. In addition, the legislation will help
ensure that employees are appropriately trained in mitigating
hazards.
Emergency nurses are disproportionately victims of assaults
in the workplace. We would like to thank you for introducing
this important legislation and your leadership on this
critical issue.
Sincerely,

Ron Kraus, MSN, RN, EMT,

CEN, ACNS-BC, TCRN,
2021 ENA President.

Ms. BONAMICI. Madam Speaker, I thank Congressman Courtney for his
leadership on this bill, and I urge my colleagues to support it.
Ms. FOXX. Madam Speaker, I yield 3 minutes to the gentleman from
Virginia (Mr. Good).
Mr. GOOD of Virginia. Madam Speaker, memo to my friends across the
aisle: violence, including workplace violence, is already illegal; and
it should always be prosecuted, regardless of whether it happens in the
name of Antifa or BLM, or even if it is directed at those police
officers working to keep us safe.
Again, violence in the workplace is already illegal, and you
certainly won't decrease it, Madam Speaker, with calls to defund or
even eliminate law enforcement and correctional facilities.
Talk about increasing workplace violence, Madam Speaker, and you
wonder why more Americans are purchasing firearms to protect themselves
with the anarchy you seem to be promoting.
Speaking of law enforcement, do we actually want to protect police
from workplace violence, too?
Or do we want to continue to increase it with a dishonest narrative
that makes it more difficult for them to do their jobs and keep us all
safe?
But here we find ourselves again today with our daily portion of
proposed unnecessary workplace regulations intended to punish law-
abiding American employers, making their lives more costly and more
difficult.
Specific to those who would be most negatively impacted by this bill,
in a 2018 American Hospital Association survey, 97 percent reported
that they already have workplace violence prevention policies in place.
In addition, OSHA, of course, is already enforcing workplace violence
prevention policies.
So why are we trying to saddle employers with new regulations
estimated by the CBO to cost private entities at least $1.8 billion--
that is $1,800 million, for my friends across the aisle--in just the
first 2 years of mandated implementation, and then $750 million
annually going forward?
Where does this money come from for these unnecessary mandates?
From consumers in higher prices. You might call this hidden tax
increases. This is how all regulations are paid for, unless they
actually force the organization to go out of business because they
can't deal with the cost.
The CBO estimates that the cost to public healthcare facilities will
be $100 million in the first 2 years. The last thing that financially
struggling rural hospitals, like those in my district, need are more
unfunded mandates from Washington.
While we seem to be far off course today, Congress, in the past, has
actually passed statutes that make regulations more accountable,
requiring that bureaucrats give public notice regarding new rules and
mandates, and solicit feedback before implementation.
But, today, House Democrats want to make it easier for OSHA to issue
one-size-fits-all regulations without having to receive any feedback
from the public.
Article I of the Constitution mandates that Congress make our Federal
laws, not Federal agencies and their unelected bureaucrats.
Congress should make the regulatory process more accountable to the
taxpayer. That is why I introduced a bill called Article I Regulatory
Budget Act that would require agencies to account for the cost of
regulation.
The SPEAKER pro tempore. The time of the gentleman has expired.
Ms. FOXX. Madam Speaker, I yield an additional 15 seconds to the
gentleman from Virginia.
Mr. GOOD of Virginia. In that spirit, Madam Speaker, I thank Ranking
Member Foxx for her leadership on regulatory reform with her Unfunded

[[Page H1857]]

Mandates Accountability and Transparency Act. I am proud to stand with
her as we try to shrink the size of the Federal Government and its
negative impact on those we represent. So I oppose this bill.

{time} 0945

Mr. COURTNEY. Madam Speaker, I yield 1 minute to the gentleman from
Indiana (Mr. Mrvan), an outstanding new member of the Committee on
Education and Labor.
Mr. MRVAN. Madam Speaker, I thank Mr. Courtney for the time.
First, I include in the Record this letter of support for H.R. 1195,
the Workplace Violence Prevention for Health Care and Social Service
Workers Act, written by Thomas Conway, the International President for
the United Steelworkers.

United Steelworkers,

March 24, 2021.
Re United Steelworkers supports H.R. 1195, the Workplace
Violence Prevention for Health Care and Social Service
Workers Act.

House of Representatives,
Washington, DC.
Dear Representative: On behalf of the 850,000 members of
the United Steelworkers (USW), I am urging you to support the
Workplace Violence Prevention for Health Care and Social
Service Workers Act (H.R. 1195).
Even before the COVID-19 pandemic, workplace violence in
health care and social service settings was a growing and
ever-present threat to workers. While helping patients fight
against the virus, these workers, who repeatedly put their
lives on the line to ensure the health and wellbeing of
others, have had to face a continued rash of assaults and
violent attacks.
According to data from the Department of Labor, healthcare
employees are four times more likely to experience workplace
violence than others in the private sector. And those in a
hospital setting are nearly six times as likely as other
workers to be the victim of an intentional injury. It is
clear that these essential workers need protection against
violence on the job. They need an enforceable OSHA standard
to prevent workplace violence and ensure the safe working
environment that they all deserve.
H.R. 1195 would compel OSHA to issue a workplace violence
prevention standard that requires health care and social
services employers to develop and implement comprehensive
plans to protect workers from violence in the workplace. The
requirements are based on existing guidelines and
recommendations from OSHA, the National Institute for
Occupational Safety and Health (NIOSH), industry
associations, and state measures and ensure that there are
workplace-specific plans in place to protect workers.
Violent, serious, and life-altering incidents should never
be part of the job. In order to begin curbing this epidemic
of preventable workplace violence, our health care and social
service workers need an enforceable OSHA standard that
addresses violence in the workplace in a comprehensive
manner.
Our union urges you to support the Workplace Violence
Prevention for Health Care and Social Service Workers Act
(H.R. 1195).
Sincerely,
Thomas Conway,
International President.

Mr. MRVAN. Madam Speaker, I appreciate that we are taking action
today to support and defend these frontline workers, our healthcare and
social workers, who selflessly have chosen their professions in order
to serve others, and who, at the same time, experience rates of
violence 12 times higher than other workers.
The United Steelworkers letter just inserted into the Record
importantly noted that violent, serious, and life-altering incidents
should never be a part of the job, and that in order to begin curbing
this epidemic of workplace violence, our healthcare and social service
workers need an enforceable OSHA standard that addresses violence in
the workplace in a comprehensive manner.
There is a difference between punishment and safety, and I urge my
colleagues to join me in supporting this critically important
legislation for these invaluable workers.
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.
Madam Speaker, I reserve the balance of my time.
Mr. COURTNEY. Madam Speaker, I yield 2 minutes to the gentlewoman
from Michigan (Ms. Stevens), an outstanding member of the Committee on
Education and Labor who worked very diligently to protect the comment
process called for in this bill.
Ms. STEVENS. Madam Speaker, as I rise in support of the Workplace
Violence Prevention for Health Care and Social Service Workers Act, I
pose the question: Where were you, Madam Speaker, at 2 a.m. last night
when a gunman stormed into a FedEx facility in Indianapolis killing
eight colleagues who did not have a workplace safety plan because their
phones were in their lockers, unable to text their loved ones that they
were alive?
This is what we are asking our colleagues on the other side of the
Chamber this morning as we debate this very important legislation.
Because when you refuse to change the laws to enact gun safety in this
country, when you refuse to enact a bill that will allow for workplace
safety prevention plans to be put into place, you are simply accepting
the status quo of the perpetuation of violence in our workplaces.
We are at a moment of crisis in this country when it pertains to gun
violence. We have the testimonies of the doctors and the nurses. This
has been extremely well-vetted.
Madam Speaker, I include in the Record a letter from National Nurses
United in support of this legislation.

National Nurses United,

February 23, 2021.
Dear Representative: On behalf of the 170,000 registered
nurses represented by National Nurses United, we write to
urge you to cosponsor the Workplace Violence Prevention for
Health Care and Social Service Workers Act, introduced by
Representative Joe Courtney.
Across the country, registered nurses and other health care
workers are put at risk every day when providing quality care
for patients in need. Over the course of the past year, the
dangerous working conditions in our nation's hospitals and
health care facilities have been exposed due the Covid-19
pandemic. But these hazardous working conditions pre-date
Covid-19.
The danger of violence in the workplace has become its own
epidemic in our nation's health care and social service
workplaces. In 2019, nurses reported more than three times
the rate of injuries due to workplace violence than workers
overall. Nurses report being punched, kicked, bitten, beaten,
and threatened with violence as they provide care to others--
and far too many have experienced stabbings and shootings.
Violence on the job has increased for nurses during the
Covid-19 pandemic. According to a recent survey conducted by
National Nurses United, twenty percent of nurses report
facing increased workplace violence on the job over the
course of the pandemic, which they attribute to decreasing
staffing levels, changes in the patient population, and
visitor restrictions.
There are practical steps that healthcare and social
service employers can take to fulfill their obligations to
protect their employees from these serious occupational
hazards. We know that violence can be prevented through the
development and implementation of plans that are tailored to
specific patient care units and facilities. These plans must
assess and address the range of risks for violence--from the
sufficiency of staffing and security systems to environmental
and patient-specific risk factors.
The Workplace Violence Prevention for Health Care and
Social Service Workers Act mandates that the Occupational
Safety and Health Administration promulgate a workplace
violence prevention standard that would require healthcare
and social service employers to develop and enforce plans to
protect their employees from violence on the job. To ensure
that workplace violence prevention plans are effective,
workers (including nurses, other direct care employees, and
security personnel) must be involved throughout all stages of
plan development, implementation, and review, which go hand-
in-hand with the standard's comprehensive training
requirements. The enforceable occupational health and safety
standard established in this legislation is necessary to
create and maintain protections against workplace violence
that our members, other

[[Page H1858]]

workers in healthcare and social settings, and, importantly,
our patients deserve.
Last Congress, the Workplace Violence Prevention for Health
Care and Social Service Workers Act was passed in the House
of Representatives with bipartisan support. As nurses and
other health care and social service workers continue to put
their lives at risk to do their jobs, it is imperative that
Congress pass this legislation and ensure it is signed into
law.
Sincerely,
Bonnie Castillo, RN,
Executive Director, National Nurses United.
Zenei Cortez, RN,
President, National Nurses United.
Deborah Burger, RN,
President, National Nurses United.
Jean Ross, RN,
President, National Nurses United.

Ms. STEVENS. Workplaces need violence protection. Vote to pass H.R.
1195.
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.
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.

Mr. COURTNEY. Madam Speaker, I yield 1 minute to the gentleman from
Texas (Mr. Green), another outstanding supporter of this legislation.
Mr. GREEN of Texas. Madam Speaker, whatever employers are doing in
the main is not enough. Workplace violence is the third leading cause
of job death. Whatever they are doing is not enough.
Twenty percent of registered nurses in one survey reported an
increase in workplace violence. Whatever they are doing is not enough.
It is not unreasonable to ask people to have a plan to protect
employees. It is not unreasonable to ask them to enforce that plan. And
it is not unreasonable to provide cover for those who report these
workplace violence incidents in the form of protection from retaliation
from reporting. It is just not enough.
Ms. FOXX. Madam Speaker, I reserve the balance of my time.
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

[[Page H1859]]

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.

Mr. COURTNEY. Madam Speaker, I yield 1 minute to the gentleman from
Rhode Island (Mr. Cicilline), my neighbor and good friend.
Mr. CICILLINE. Madam Speaker, our Nation owes a great debt to the
healthcare and social service workers fighting on the frontlines of the
COVID-19 pandemic. These essential workers treat the ill, administer
vaccines, care for the elderly, and respond to emergencies across the
country. Their efforts are critical to our Nation's response to the
pandemic.
Yet, Congress has abdicated its responsibility to protect these
essential workers from violence in the workplace. These workers are
almost five times as likely to experience a serious injury from
workplace violence than workers in other sectors.
That is why I am proud to cosponsor H.R. 1195. I want to acknowledge
the principled, compassionate, committed and effective leadership of
Congressman Courtney for shepherding this bill to the floor.
This legislation would direct OSHA to quickly issue an interim final
standard mandating healthcare and social service employers implement
workplace prevention plans.
This is not a partisan issue. I hope we can all agree that everyone
deserves to feel safe at work. I urge my colleagues to vote ``yes.''
Madam Speaker, I include in the Record a letter from the American
Public Health Association in support of the legislation.

American Public

Health Association,

Washington, DC, March 23, 2021.
House Committee on Education and Labor,
Washington, DC.
Dear Representative: On behalf of the American Public
Health Association, a diverse community of public health
professionals that champions the health of all people and
communities, I write in strong support of H.R. 1195, the
Workplace Violence Prevention for Health Care and Social
Services Workers Act. This important bipartisan legislation
would require the Occupational Safety and Health
Administration to develop a workplace violence prevention
standard to protect workers who are at the greatest risk from
violence on the job.
Workplace violence is a serious problem that has increased
substantially in the last decade. Every day, nurses,
psychiatric aides, social workers and other caretakers are
assaulted on the job. The Bureau of Labor Statistics reports
that in 2019 health care and social service workers
experienced the highest rate of workplace violence injuries
at 14.7 per 10,000 workers, compared to a national average of
4.4 for all workers. In the same year, psychiatric hospitals
had a recorded rate of serious injury due to workplace
violence at 152.4 per 10,000 workers. Since 2010, the rate of
serious workplace violence injuries has increased by 52% in
health care and social assistance jobs. Health care and
social service workers are at greatest risk because they are
on the frontlines of patient and client care, often working
with high-risk populations who need specialized care and
attention. This type of violence has a significant and long-
lasting impact on individual workers and on the public's
health.
Assaults and other violence experienced by health care and
social assistance workers is a preventable problem that
requires a public health approach. This legislation would
require employers who operate health care facilities, mental
health clinics, emergency services and home care to develop a
workplace violence prevention plan. These plans have shown to
be effective and the tools for preventing violence in these
workplaces are available, such as emergency response alarms,
improved lighting and safe staffing levels.
We strongly urge your support for this important
legislation which is a critical step in protecting our
caregivers from work-related violence.
Sincerely,
Georges C. Benjamin, MD,
Executive Director.

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.

[[Page H1860]]

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.

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.
I reserve the balance of my time.
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.
Madam Speaker, I yield 2 minutes to the gentlewoman from Texas (Ms.
Garcia), a Member who can really bring a very powerful personal
experience to this issue.

{time} 1000

Ms. GARCIA of Texas. Madam Speaker, I am here today to express my
support for this very important piece of legislation. This is simple;
it is much needed; and it is just a commonsense bill.
For my friends across the aisle who think that this is some
intellectual exercise, that we are trying to find some mandate, or that
we need to listen to the front lines, well, I am here to tell you what
happens on the front lines.
It was not yesterday; it was when I was a geriatric social worker. We
had

[[Page H1861]]

received a report of a street child taking care of a senior, and there
was concern about the senior and the street child.
I went to the door to make an assessment. I knocked on the door, and
I was greeted by a Saturday night special right in my face, as a social
worker just trying to do my job. She kept saying: ``You ain't gonna
take my baby. You ain't gonna take my baby.'' I was scared, scared, and
scared, never having had a gun to my face.
Madam Speaker, I am sure you know what I am talking about because you
have probably had similar experiences.
I was a social worker just trying to make an assessment to see if
this senior needed help at home. I had nothing to do with trying to
take her child away, but she confused me for a child welfare worker.
This is what can happen. It has happened to me. It happens today. As
Representative Stevens pointed out, it happened at 2 a.m. this morning,
not to a social worker but to a FedEx worker. We must do something to
make sure that we can protect workers and that we end workplace
violence.
This is a small step. It is not an intellectual exercise. It is real.
I am speaking personally, and I am here to stand with social workers
across America to make sure that we do everything we can to make their
workplace safe and that everyone is protected.
Ms. FOXX. Madam Speaker, I reserve the balance of my time.
Mr. COURTNEY. Madam Speaker, I yield 1 minute to the gentlewoman from
Illinois (Ms. Schakowsky).
Ms. SCHAKOWSKY. Madam Speaker, workplace violence has reached
epidemic levels and is the third greatest cause of job death right now.
Nurses, medical assistants, emergency responders, and social workers
face some of the greatest threats, suffering more than 72 percent of
all workplace assaults. Women suffer two out of every three serious
workplace violence incidents.
This is unacceptable. We need to protect workers and require
employers to put in place effective workplace violence prevention
plans. It is simple. Make a plan.
We need to protect our healthcare and social service workers who have
done so much for us during the pandemic to care for us. Now, we need to
care for them.
We need H.R. 1195 now. Let's come together and get it done.
Madam Speaker, I include in the Record an editorial column from
Bonnie Castillo and a letter from the AFL-CIO.

[From The Hill, Apr. 9, 2021]

We Can't Afford to Lose One More Nurse--Passing Workplace Violence
Prevention Bill Would Help

(By Bonnie Castillo, Opinion Contributor)

``My children were very distraught to see their mom with a
black eye,'' said Luciana Herr, a registered nurse in the
inpatient psychiatry unit at Abbott Northwest Hospital in
Minneapolis, Minn. Herr entered a hospital room in early
March to find a patient hitting and biting her co-worker.
With no security or other staff around, she tried to help and
was punched in the face twice and kicked several times. It
was the second time she had been assaulted in just a few
months.
Tragically, Herr's story is all too common. According to
the Bureau of Labor Statistics, health care and social
service workers have a five times greater likelihood of
experiencing a workplace violence-related injury than workers
overall. This extremely high rate of violence is
unacceptable, a fact driven home by the pandemic. We cannot
let nurses and other health care workers go one more day
fighting for optimal COVID protections while also wondering
whether they will be assaulted at work.
That's why National Nurses United (NNU), the largest union
of registered nurses in the United States, is fighting to get
a critical bill across the finish line. The Workplace
Violence Prevention for Health Care and Social Service
Workers Act (H.R. 1195) would mandate that federal OSHA hold
health care and social service employers accountable for
developing and implementing a comprehensive workplace
violence prevention plan, publicly reporting incidents of
violence, and not retaliating against workers who report
violence.
The legislation passed the U.S. House in the 116th Congress
and was reintroduced this session by U.S. Rep. Joe Courtney
(D-Conn.). It will come up for a floor vote soon in the
House, and nurses across the country urge congressmembers to
vote yes.
Planning to prevent violence means everything because once
violence happens, it's already too late. This truth really
hit home when our beloved NNU member Cynthia Palomata, a
registered nurse in California, was killed by her patient in
2010. Countless nurses across the country are attacked
physically and verbally each year, and the violence may be
growing. A November 2020 National Nurses United survey of
15,000 registered nurses across the country found that 20
percent of respondents reported an increase in workplace
violence during the pandemic.
It's important to remember that when nurses aren't safe,
patients, visitors, and family members are also not safe.
Violence can harm anyone in the vicinity.
According to Herr, staffing at an optimal level, adding
security, and making sure patients are assessed and placed
where they are best served are examples of actions her
employer could take to curb violence before it happens. But
there is no federal mandate for health care and social
service employers to have a comprehensive, unit-specific
prevention plan. This bill will establish one. In our profit-
driven health care system, employers will never invest in
prevention unless they are held accountable.
``All I got was an `I am sorry that happened to you,' ''
said Melanie Autrey, a general surgery registered nurse at
Mission Hospital in Asheville, N.C., who--along with her co-
worker--was attacked in January by a patient with dementia.
``It made me feel like I was not safe working here. It made
me feel like `What does it take?' ''
In Autrey's case, simple things may have helped, like the
hospital investing in ``sitters,'' staff who can watch over
patients in need of supervision and notice changes in
behavior before a patient grows violent. There are so many
clear actions that health care employers can take to prevent
violence from happening and to ensure nurses can focus on
caring for patients, not on wondering whether they will be
hurt or killed on the job. But if we don't hold profit-driven
employers accountable, they will never change.
As of early April, more than 3,570 registered nurses and
other health care workers have already died of COVID-19. We
can't afford to lose one more--not to the virus, not to
violence, not to preventable causes. Congress must pass the
Workplace Violence Prevention for Health Care and Social
Service Workers Act without delay.
____

AFL-CIO,

Washington, DC, April 13, 2021.
Dear Representative: I am writing on behalf of the AFL-CIO
to urge you to vote for the Workplace Violence Prevention for
Health Care and Social Services Workers Act (H.R. 1195) when
it is brought to the floor this week. This bill would direct
the Occupational Safety and Health Administration (OSHA) to
issue a federal workplace violence prevention standard to
protect workers in health care and social services from
injury and death. We also urge you to oppose Keller #6.
Workplace violence is a serious and growing safety and
health problem that has reached epidemic levels. Workplace
violence is the third leading cause of job death, and results
in more than 30,000 serious lost-time injuries each year.
Nurses, medical assistants, emergency responders and social
workers face some of the greatest threats, suffering more
than 72% of all workplace assaults. Women workers
particularly are at risk, suffering two out of every three
serious workplace violence injuries.
An OSHA standard under H.R. 1195 would protect these
workers by requiring employers in the health care and social
service sectors to develop and implement a workplace violence
prevention plan, tailored to specific workplaces and worker
populations. As part of the plan, employers would be required
to work with employees to identify and correct hazards,
develop systems for reporting threats of violence and
injuries, provide training for workers and management and
protect workers from retaliation for reporting workplace
violence incidents. Common sense prevention measures include
alarm devices, lighting, security, and surveillance and
monitoring systems to reduce the risk of violent assaults and
injuries.
The requirements for a workplace violence prevention plan
are based upon existing recommendations from OSHA, NIOSH and
professional associations, and scientific studies have found
these guidelines to significantly reduce the incidence of
workplace violence. Similar measures have been adopted in a
number of states and implemented by some employers.
Currently, however, there is no federal OSHA workplace
standard, which would ensure these measures are in place. The
majority of healthcare and social service workers lack
effective protection and remain at serious risk while OSHA
has been slow to act.
The AFL-CIO opposes Keller # 6, the Amendment in the Nature
of a Substitute, as it will continue to delay protections for
workers and will weaken the underlying protections of H.R.
1195. Working people need protection from workplace violence
now, and should not have to wait seven years or more, the
average time it takes for OSHA to issue a safety and health
standard. It has been over four years since OSHA issued a
Request for Information on workplace violence. Since this
initial step, the agency has not taken additional action.
In recognition of the urgency to protect these workers from
dangerous assaults, we support the underlying bill, which
requires OSHA to develop an interim standard within one year
and a final standard within 42 months. OSHA issued its first
guidance to employers on protecting health care and social
service workers from workplace violence

[[Page H1862]]

25 years ago in 1996. These frontline workers cannot wait any
longer; their lives are in danger.
The underlying bill has broad support from health care
professionals, safety and health professionals and healthcare
unions including the National Association of Social Workers,
American Public Health Association, American Industrial
Hygiene Association and American Society of Safety
Professionals. Also, this important legislation passed the
House during the 116th Congress with 251 votes and continues
to have strong bipartisan support.
We urge you to support H.R. 1195 to help protect health
care and social service workers from the growing threat of
workplace violence and unnecessary injury and death. We also
urge you to oppose any Motion to Recommit, which would have
the effect of killing the bill.
Sincerely,

William Samuel,

Director, Government Affairs.

Ms. FOXX. Madam Speaker, may I inquire as to how much time is
remaining.
The SPEAKER pro tempore. The gentlewoman from North Carolina has
11\3/4\ minutes remaining. The gentleman from Connecticut has 11\1/4\
minutes remaining.
Ms. FOXX. Madam Speaker, I reserve the balance of my time.
Mr. COURTNEY. Madam Speaker, I yield 1 minute to the gentlewoman from
Minnesota (Ms. Craig).
Ms. CRAIG. Madam Speaker, just over 2 months ago, a man walked into
an Allina Health clinic in Buffalo, Minnesota, and opened fire, killing
one employee and injuring four others.
On that tragic day, nurses, doctors, social workers, and others were
reportedly targeted because of their professions.
Tragically, this senseless and horrific act of violence is
representative of a broader trend in our society. Today, members of the
healthcare workforce are five times as likely to suffer a workplace
injury than Americans in other professions.
Madam Speaker, what in the hell are we doing in Congress if we are
not going to stand up and do anything for our healthcare heroes and
those workers?
My colleagues who vote against this bill are ignoring the pleas of
the EMTs, the emergency workers, and all of those folks who have been
on the front lines of this healthcare pandemic.
The SPEAKER pro tempore. The time of the gentlewoman has expired.
Mr. COURTNEY. Madam Speaker, I yield an additional 15 seconds to the
gentlewoman from Minnesota.
Ms. CRAIG. Madam Speaker, it is our responsibility to step forward
and help protect our workers. It is beyond the pale to put our heads in
the sand, as Members of Congress, and say there is nothing that we can
do. What the hell are we doing here if we do that?
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.
Madam Speaker, I reserve the balance of my time.
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).
Ms. TLAIB. Madam Speaker, everyone should feel safe at work, and they
should be safe at work.
I want to give testimony about Kenya, who is a 49-year-old certified
nursing assistant. I want to bring her words here in the Congress to
understand what we are trying to do, who we are trying to protect.
She said: ``You don't know if you are going to take the virus home to
your family or not. I have two children, 16 and 18, and a 1-year-old
grandbaby that I worry about all the time.
``I have a designated place where I take my uniform off and my shoes
off to keep my family safe. I come in, go directly to the basement,
where I already have a change of clothes, strip all my clothes off, put
all of my clothes directly into the washing machine.
``Then there is my mom. I am her only child now, so that is a big
scare because who is going to take care of her?
``It is very scary for my family. They don't want me to go back to
work. But I have to go to work because I have to be able to take care
of my family, and I tell them that my residents need me.''
These are the human stories behind the fact that people right now are
asking us, the United States Congress, to pass legislation that is long
overdue to protect workers in some of the most high-stress, least-
appreciated positions in our communities.
These workers are on the front lines, day in and day out, serving
vulnerable groups and facing rates of workplace violence at five times
the rate of workers in other communities.
She is expressing in here just the stress of it and, on top of that,
workplace violence.
Madam Speaker, I include in the Record a letter of support from SEIU
on behalf of the over 1 million healthcare and social service workers
across our country.

Service Employees

International Union,

Washington, DC, March 25, 2021.
Dear Representative: On behalf of the over 1 million
healthcare and social services workers of the Service
Employees International Union and the 80,000 nurses of the
National Nurse Alliance of SEIU Healthcare whom have been on
the frontlines of the COVID-19 pandemic, I urge you to
support H.R. 1195, the Workplace Violence Prevention for
Health Care and Social Service Workers Act.
Nurses are on the front lines of care, and workplace
violence against healthcare workers, especially nurses, is an
enormous and underreported problem. Almost three quarters of
workplace violence injuries are suffered by healthcare and
social service workers and these workers are nearly 5 times
more likely to experience violence on the job than any other
worker in the US. As nurses, we know that threats and
violence are a major impediment to the essential care we
provide.
H.R. 1195 would direct the Occupational Safety and Health
Administration (OSHA) to issue a federal workplace violence
standard. This specific standard would require employers in
health care and social service assistance sectors to develop
and implement a plan to protect workers from workplace
violence.
The legislation requires that employer prevention plans be
tailored to a specific workplace and employee population.
This is important to overcome the very dangerous

[[Page H1863]]

myth that workplace violence is part of the job, essentially
random or unpredictable, and therefore, not preventable.
Workplace violence, in both health care and social service
assistance settings, has clear patterns and identifiable
risks. Research has found that evidence-based practices, when
implemented consistently, can significantly reduce incidents
of workplace violence.
We cannot expect nurses, who spend more time with patients
than any other health care providers and have been at the
forefront of providing care during the pandemic, to be able
to deliver the high-quality care we were trained to provide
under threat of violence and assault. A safe and violence-
free workplace is essential to good patient outcomes and an
exceptional healthcare system.
Essential workers have put their lives on the line
throughout the pandemic and now elected leaders must meet
their demands to be respected, protected and paid. We ask
that you support H.R. 1195 and send a clear message that
message that Congress will not ignore the harm and suffering
caused to health care, behavioral health and social
assistance workers by workplace violence.
Sincerely,
Martha Baker, RN,
President SEIU 1991, Chair, National Nurse Alliance of SEIU
Healthcare.

Ms. TLAIB. These are protections that should have long been in place
and enforced. I urge my colleagues to support this legislation.
When passed and signed into law, I urge OSHA to immediately work to
issue the standards necessary to protect these workers.
The SPEAKER pro tempore. The time of the gentlewoman has expired.
Mr. COURTNEY. Madam Speaker, I yield an additional 30 seconds to the
gentlewoman from Michigan.
Ms. TLAIB. Madam Speaker, I gave that story of Kenya, who lives in
Livonia, Michigan, because, on top of all of that, she was dealing with
the number of protections that were lacking in the workplace.
Again, these are people who take care of our loved ones, take care of
our sick, take care of those who are mentally ill, who need assistance,
whose family members are not equipped for what they are trying to do.
The least we can do, especially during this pandemic, is to offer them
more protection and safety in the workplace.
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.
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.

{time} 1015

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.
Ms. JACKSON LEE. Madam Speaker, as senior member of the Committees on
the Judiciary, on Homeland Security, and on the Budget, I rise in
strong support of H.R. 1195, the ``Workplace Violence Prevention for
Health Care and Social Service Workers Act,'' which would establish
within one year an Occupational Safety and Health Administration
(``OSHA'') interim workplace standard requiring health care and social
service providers to implement workplace violence prevention plans, and
which would establish a permanent OSHA standard within 42 months.
Currently, there is no OSHA standard that requires employers to
implement violence prevention plans that would help reduce workplace
violence injuries among health care and social service workers.
The lack of an enforceable standard means that OSHA, the federal
agency created to protect workers' safety, has few meaningful tools to
protect health care workers from the threat of workplace violence.
The Government Accountability Office has estimated, conservatively,
that it takes OSHA at least 7 years to issue a standard.
Seven years; Our healthcare workers have worked too hard and
sacrificed too much for them to wait a minimum of seven more years
before measures are in place to secure their basic physical safety.
H.R. 1195 would provide health and social service workers the
protection they deserve by:

[[Page H1864]]

Compelling OSHA to issue an interim final standard in one year and a
final standard within 42 months requiring employers within the health
care and social service sectors to develop and implement a workplace
violence prevention plan.
Identifying risks, specify solutions, and require training,
reporting, and incident investigations. It would also provide
protections from retaliation for reporting violent incidents.
Protecting health care and social service workers in the public
sector in the 24 states not covered by OSHA protections.
Our nation's caregivers--including nurses, social workers, and many
others who dedicate their lives to caring for those in need--suffer
workplace violence injuries at far higher rates than any other
profession.
While the previous administration relegated the OSHA standard
protecting healthcare and social workers to the back burner, making no
progress for 4 years, we will not do the same.
Study after study has confirmed that healthcare workers are not
adequately protected in the workplace.
In 2014, OSHA reported that there are nearly as many serious violent
injuries in healthcare as there are in all other industries combined.
In 2018, the U.S. Bureau of Labor Statistics (BLS) reported that the
rate of violence against health care workers increased more than 60
percent between 2011 and 2018.
Just last year, the BLS 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 this problem has been exacerbated by the influx of patients and
stressors during the COVID-19 pandemic--according to National Nurses
United, 20 percent of registered nurses across the U.S. reported
increased workplace violence due to the pandemic.
This is not a new problem; this is an old problem that has found
fertile ground to grow during the COVID-19 pandemic due to an influx of
patients and increasing demands on our healthcare workers.
In my home state of Texas, over 50 percent of nurses in Texas have
reported being subject to workplace violence during the course of their
career.
A 2016 study by the Texas State Health Services found that in any
given year:
6 percent of Texas nurses experience sexual harassment;
12 percent of Texas nurses experience physical violence;
Nearly half of all Texas nurses experience verbal abuse.
The injuries healthcare workers take from workplace violence are not
only physical; victims of workplace violence often suffer mental trauma
that they will carry with them for the rest of their lives.
One example is Bridgette Jenkins, a nurse for 20 years in Houston and
professor at Houston Baptist University's School of Nursing, who will
not work in a psychiatric ward because 19 years ago a psychiatric
patient hit her so hard that half her face became swollen and doctors
encouraged her to get an x-ray to ensure her jaw wasn't broken.
Another is Norma Broadhurst, who testified before the Texas House of
Representatives that she experienced a ``traumatic amputation'' of her
right ring finger due to an intoxicated spring break patient biting off
her finger.
Workplace violence against healthcare workers is so ubiquitous that
more than a third of Texas nurses surveyed who did not report a recent
violent incident said they did so because it was ``an accepted/expected
part of the job'' or because they did ``not expect anything to
change.''
One stark example of this is Kimberly Curtin, a nurse for nearly 28
years in Houston, who was punched in the side of the head by a patient
as a young nurse.
Her colleague who witnessed the attack said to her, ``Welcome to
ER.''
As of 2019, according to the Texas Health and Human Services
Commission, Harris County has 4,303 registered physicians and 45,946
registered nurses.
That is over 50,000 individuals in my district that have been on the
front lines of the fight against the pandemic, where in addition to
facing a historically deadly virus they have been spit on, cursed out,
sexually harassed, and physically assaulted.
I cannot stand by while knowing that these people I represent, who
give so much to others, who have a personal and professional obligation
to ``do no harm,'' and who have a steadfast focus on helping patients,
must remain constantly vigilant at their place of work due to potential
threats to their physical safety.
Madam Speaker, throughout this deadly COVID-19 pandemic, we have
called our healthcare workers heroes, and we have lauded them for being
the front line defense against this deadly violence.
But words are only the first step towards action, and action is what
is needed here today.
Although it is not enough, the very least we can do to repay their
sacrifice and heroism is make sure healthcare workers everywhere are
secure against violence from within their workplace.
I urge all members to join me in voting to pass H.R. 1195, the
``Workplace Violence Prevention for Health Care and Social Service
Workers Act,'' to reduce workplace violence injuries among health care
and social service workers.

[The Texas Tribune, Feb. 9, 2021]

Half of Texas' Nurses Experience Workplace Violence. A Texas Lawmaker
Says It's Time To Protect Them.

(By Shannon Najmabadi and Neelam Bohra)

Steven D. Powell is a nurse with Texas Medical Center in
Houston. Powell said violent patients have left him covered
in bruises, but he more regularly faces verbal assaults.
Credit: Shelby Tauber for The Texas Tribune
State Rep. Donna Howard was working as an intensive care
unit nurse in the 1970s when a patient pulled an intravenous
drip out of his arm and walked toward her. She rushed to help
him--but didn't see the metal urinal he was clutching behind
his back until it was too late. He smacked her in the jaw
with it, knocking her across the room. ``I was briefly
stunned by the hit,'' said Howard, then working at the
Brackenridge hospital in Austin. ``But I continued working.''
For decades, health care workers have faced rampant
violence in the workplace. Now praised as heroes of the
pandemic, those front-line medical workers have been
routinely scratched, bitten or verbally abused by patients.
Well over half of Texas' nurses reported being subject to
workplace violence in their career, according to a 2016 state
study.
Nationwide, the rate of violence for health care workers
increased more than 60% between 2011 and 2018, and the
Occupational Safety and Health Administration has found the
rate of serious violent incidents in health care is more than
four times greater than for those in other industries.
``It is presumed to be a part of the job,'' Howard, D-
Austin, said of the violence. ``That's not OK.''
There are no federal laws that specifically target violence
in nurses' workplaces. OSHA does not require health care
facilities to have violence prevention plans, though states
like California and Washington have passed laws to do so.
Howard has filed similar legislation in Texas that if passed
this year, would place Texas in a vanguard of states that
have backed similar protections for nurses.
It would require health care providers to create committees
to prevent workplace violence and to offer medical treatment
and other services after a violent incident. It would also
bar facilities from penalizing nurses who report abuse.
``They are there to take care of us. And I think we have a
responsibility to take care of them,'' Howard said, adding
that this year especially, lawmakers have a moral obligation
to take care of health care workers who have been risking
their lives throughout the pandemic.
State lawmakers have for years heard examples of the
violence nurses face.
Rep. Stephanie Klick, R-Fort Worth, who has worked as a
nurse, said in a committee hearing that her wrist was broken
by an elderly patient and that she had to have surgery to
repair it.
Cindy Zolnierek, head of the Texas Nurses Association, said
a patient tried to punch her in the face on her first day as
a graduate nurse. She quickly stepped back to avoid being
struck.
And in 2013, an emergency room nurse named Norma Broadhurst
told a panel of lawmakers she'd had a ``traumatic
amputation'' of her right ring finger after it was bitten off
by an ``intoxicated spring break patient'' who she was trying
to help.
``I will never have my finger back to wear the ring my
grandmother gave me,'' she said. ``Is this going to interfere
with my wanting to help the next patient? . . . I am right-
handed, everything I do involves this hand.''
That year, the Legislature strengthened the penalties for
assaulting emergency room workers, putting the offense on par
with harming first responders. Lawmakers later signed off on
creating a grant program to find creative ways to lower the
number of verbal and physical attacks against nurses. Those
efforts have been focused on training, trying to quickly
identify patients at high risk of lashing out, or raising
public awareness about the rate of violence, Zolnierek said.
Nurse advocates say that a proactive approach is essential
to stop assaults before they happen and leave health care
workers and patients traumatized by the experience.
``Many members of the general public, they're like, 'Are
you kidding me? People assault nurses?' They don't understand
that it's a problem,'' Zolnierek said.
In Texas, more than a third of nurses surveyed for a 2016
report who did not report a recent violent incident said it
was because it was ``anaccepted/ expected part of the job''
or because they did ``not expect anything to change.'' About
a quarter of nurses--and nearly a third of those in
freestanding emergency centers--said their employer was not
at all or only ``slightly effective'' at managing workplace
violence.
It's not just nurses. Respiratory therapists, dietary aides
and other health care workers all face violence. Nearly half
of emergency physicians have reported being physically
assaulted at work.

[[Page H1865]]

Dr. Theresa Tran, an assistant professor of emergency
medicine at the Baylor College of Medicine, said violence is
an ``unfortunate commonality'' in emergency rooms everywhere
and something workers there have to always be ``vigilant''
about.
An OSHA webpage says people who work in hospitals, nursing
homes and other health care facilities face ``significant
risks'' of violence, in part because they may work closely
with people who have a history of violence or are under the
influence of drugs. A state report said nurses have the
``highest risk'' among health professionals because of how
often they interact with patients.
Zolnierek said nurses may be viewed as ``non threatening''
and may be vulnerable to being struck because they work in
close proximity to patients. There can also be outdated sex-
based stereotypes of nurses--about 88% of whom are women--as
being passive or doctors' ``handmaids,'' said Zolnierek,
though both male and female nurses experience sexual
harassment from patients.
Daniel Funtong, a nurse who works in North Texas, said
older patients sometimes react poorly to pain medication, in
some cases threatening nurses with knives or spoons that are
served with meals.
``I don't think they understand the magnitude, because
after going through . . . trauma or injury and then the
recovery process, and sometimes that brain doesn't function
as normal,'' Funtong said.
A variety of factors can spark aggression or a violent
outburst from patients. The presence of needles can trigger
violence, and patients who want to leave the hospital or who
are frustrated with waiting could be more prone to erupt,
according to researchers who analyzed a year of incident
reports at a hospital system in the midwest.
In other cases, patients' family members have lashed out if
they think the health care worker isn't doing enough to care
for their loved one.
Nurses and physicians ``constantly'' feel threatened by
patients and family members, Funtong said, and have been
trained to identify crisis-type situations and alert building
security if needed. He wishes police would work closely with
health care facilities' private security to more promptly
intervene with violent patients.
Registered nurse Steven Powell said violent patients have
left him covered in bruises, but he more regularly faces
verbal assaults. Recently, a patient called him a racial
slur--an occurrence that's not uncommon for nurses, according
to experts.
``When you look at the workforce for nurses, it's a very
diverse landscape,'' he said. ``The violence that they can
experience from a verbal nature, threats due to their
culture--they may keep it to themselves or not respond in the
same manner that everyone would, having a plan like this that
encourages reporting.''
Powell, who also works as a traveling nurse, said health
care facilities he worked at in the Houston and Dallas areas
were unprepared for the pandemic--and that lack of readiness
extends to how they plan for violence.
``Not all facilities are taking the steps necessary to
protect their staff,'' Powell said.
Some 82% of Texas nurses report being verbally abused,
which can include yelling, swearing and the use of hurtful
words, according to the 2016 state report. Nearly half also
reported physical violence like being hit, slapped or choked.
The threat of violence or abuse can take a heavy toll,
leaving health care workers with injuries, psychological
trauma or decreased morale. Nurseswho face violence may trust
their employers or coworkers less, become more guarded when
treating patients or even leave the profession--while Texas
faces a shortage of nurses.
``One abusive patient can negate 25 lovely patients, and it
just hurts you on so many levels, more than just the
physical,'' said Mary Ball, a registered nurse at Parkland
Health & Hospital System. Ball said a co-worker was recently
bitten by a patient who drew blood, and that the hospital
doesn't provide enough information to staff or the public
about safety issues.
Ball, who is still in therapy after being robbed at
gunpoint in an employee parking lot almost two years ago,
said she wishes more armed officers were present in and
outside the hospital and said that restraints should be more
frequently used to protect them from potentially violent
patients.
A Parkland spokesperson said the hospital ``puts out a
great deal of information about safety and discusses these
matters regularly in our system-wide town halls, which is
open to all employees.'' Police officers are also present to
protect patients and employees.
The Dallas-based hospital has used other initiatives to try
to reduce workplace violence. It created a free course a few
years ago to raise awareness about the prevalence of
workplace violence and to teach employees and nursing
students how to protect themselves. It also purchased
wearable alarm systems for employees that can emit a piercing
noise if they need help and are not near a panic button, said
Karen Garvey, Parkland's vice president of safety and
clinical risk management.
Ball said the wearable alarm wouldn't have helped her when
she was being robbed.
Workplace violence is thought to be vastly underreported
among health care workers, in part because of a professional
obligation to ``do no harm,'' and a steadfast focus on
helping patients, even those who hurt them, according to
experts. Some health care workers who experience violence may
not want to blame or shame violent patients who are ill or
affected by medication. Others may be reluctant to report
violence because they view it as part of their job, fear
retaliation from their employer or are deterred by the time
and administrative hassle of going through the process,
experts say.
They may think, ```Nothing ever happens when I report so
why should I bother?''' said Judy Arnetz, a professor at
Michigan State University who for decades has studied
workplace violence in the health care sector. Some health
care workers may also sympathize with the patient and think
they ``didn't mean to hurt me, that patient . . . suffers
from dementia or was under the influence,'' she said.
Though awareness about workplace violence has grown,
there's still a dearth of information about how frequently it
erupts and affects health care workers, largely because of a
lack of reporting, said Arnetz, one of the researchers who
analyzed incidents at the Midwestern hospital system.
Health care workers and experts have said hospitals can add
more security guards or metal detectors and instill a culture
of violence prevention to help deter workplace violence. They
should also better understand where violence is occurring and
why. Violent outbursts have been reported more frequently in
emergency rooms or psychiatric facilities, where people may
be anxious, stressed, in pain or under other kinds of
psychological strain, experts have said. But it can still
happen in other health care settings, and workers there may
be less prepared to deal with the violence.
Tran, the emergency room physician, said health care
workers' role in stabilizing patients and trying to find
physical or mental issues that they cari address can add a
complicated layer to the violence.
``I think health care workers, especially physicians and
nurses in the ER, tolerate violence more than other
industries because we see ourselves in a position where we're
supposed to help patients and look past any aggressions on
ourselves,'' she said.

The SPEAKER pro tempore. All time for debate has expired.
Each further amendment printed in part C of House Report 117-15 not
earlier considered as part of amendments en bloc pursuant to section 6
of House Resolution 303, shall be considered only in the order printed
in the report, may be offered only by a Member designated in the
report, shall be considered as read, shall be debatable for the time
specified in the report equally divided and controlled by the proponent
and an opponent, may be withdrawn by the proponent at any time before
the question is put thereon, shall not be subject to amendment, and
shall not be subject to a demand for division of the question.
It shall be in order at any time for the chair of the Committee on
Education and Labor or his designee to offer amendments en bloc
consisting of further amendments printed in part C of House Report 117-
15 not earlier disposed of. Amendments en bloc shall be considered as
read, shall be debatable for 20 minutes equally divided and controlled
by the chair and ranking minority member of the Committee on Education
and Labor or their respective designees, shall not be subject to
amendment, and shall not be subject to a demand for division of the
question.

amendments en bloc offered by mr. courtney of connecticut

Mr. COURTNEY. Madam Speaker, as the designee of the chairman of the
Education and Labor Committee, and pursuant to section 6 of House
Resolution 303, I rise to offer amendments en bloc.
The SPEAKER pro tempore. The Clerk will designate the amendments en
bloc.
Amendments en bloc consisting of amendment Nos. 1, 2, 3, 4, and 6,
printed in part C of House Report 117-15, offered by Mr. Courtney of
Connecticut:

Amendment No. 1 Offered by Mr. Brown of Maryland

On page 17, after line 21, insert the following:
(D) Additional training shall be provided for each such
covered employee whose job circumstances require working with
victims of torture, trafficking, or domestic violence.
Beginning on page 17, line 22, and ending on page 18, line
13, redesignate subparagraphs (D) through (G) as
subparagraphs (E) through (H).

Amendment No. 2 Offered by Mr. Cohen of Tennessee

Page 8, line 3, strike ``and'' and insert ``Alzheimer's and
memory care facility, and''

Amendment No. 3 Offered by Mr. Delgado of New York

Page 4, line 6, strike ``and''.
Page 4, line 12, strike the period and insert ``; and''.
Page 4, after line 12, insert the following:
(C) that provides for a period determined appropriate by
the Secretary, not to exceed 1 year, during which the
Secretary shall

[[Page H1866]]

prioritize technical assistance and advice consistent with
section 21(d) of the Occupational Safety and Health Act of
1970 (29 U.S.C. 670(d)) to employers subject to the standard
with respect to compliance with the standard.

Amendment No. 4 Offered by Mr. Jones of New York

Page 11, line 18, strike ``shall''.
Page 11, line 19, insert ``shall'' before ``be''.
Page 11, line 23, insert ``shall'' before ``be''.
Page 12, line 2, strike ``and'' at the end.
Page 12, line 3, insert ``shall'' before ``be''.
Page 12, line 6, strike the period at the end and insert
``; and''.
Page 12, after line 6, insert the following:
(iv) may be in consultation with stakeholders or experts
who specialize in workplace violence prevention, emergency
response, or other related areas of expertise for all
relevant aspects of the Plan.

Amendment No. 6 Offered by Ms. Ocasio-Cortez of New York

Page 26, line 25, strike ``and''.
Page 27, line 4, strike the period and insert ``; and''.
Page 27, after line 4, insert the following:
(4) nothing in this Act shall be construed to limit or
diminish any protections in relevant Federal, State, or local
law related to--
(A) domestic violence;
(B) stalking;
(C) dating violence; and
(D) sexual assault.
The SPEAKER pro tempore. Pursuant to House Resolution 303, the
gentleman from Connecticut (Mr. Courtney) and the gentlewoman from
North Carolina (Ms. Foxx) each will control 10 minutes.
The Chair recognizes the gentleman from Connecticut.
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).
Mr. JONES. Madam Speaker, my amendment makes a simple change that
would help improve the development of workplace violence prevention
plans required under H.R. 1195, the Workplace Violence Prevention for
Health Care and Social Service Workers Act.
As you know, our Nation's nurses, social workers, and other
caregivers suffer from workplace violence injuries at far higher rates
than any other profession. In fact, these workers are nearly five times
as likely to suffer a serious workplace violence injury than workers in
other sectors, according to the Bureau of Labor Statistics.
The underlying legislation would require employers within these
sectors to develop and implement a workplace violence prevention plan
to reduce the incidence of injuries and create safer working conditions
for their workers.
In order to ensure that covered employers in the healthcare and
social service industries develop thoughtful and comprehensive
workplace violence prevention plans, my amendment clarifies that
employers are able to outreach to experts and specialists who lead in
the issue of workplace violence.
Healthcare and social service workers have unique needs and face many
difficult challenges in the workplace.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. COURTNEY. Madam Speaker, I yield an additional 15 seconds to the
gentleman from New York.
Mr. JONES. Madam Speaker, I include in the Record a letter of support
for H.R. 1195 from the CEO of AIHA, Mr. Sloan.

AIHA.

Support for H.R. 1195, Workplace Violence Prevention for Health Care
and Social Service Workers Act

Rep. Robert C. ``Bobby'' Scott,
Chair, Education and Labor Committee,
House of Representatives.
Rep. Virginia Foxx,
Ranking Member, Education and Labor Committee, House of
Representatives.
Dear Chairman Scott, Ranking Member Foxx, and Members of
the Committee: On behalf of AIHA, which represents scientists
and professionals committed to preserving and ensuring
occupational and environmental health and safety in the
workplace and community, I urge you to quickly approve H.R.
1195, the Workplace Violence Prevention for Health Care and
Social Service Workers Act.
AIHA supports this bipartisan bill, which has 120
cosponsors and would address workplace violence in health
care and social service settings. Violence in these
industries remains a leading cause of traumatic workplace
injury and death in the US. The bill would help solve this
problem by requiring covered employers to develop and
implement comprehensive workplace violence prevention plans
that are tailored to meet their individual needs.
AIHA looks forward to our continued work together on
workplace violence and other occupational and environmental
health and safety issues.
Sincerely,

Lawrence D. Sloan,

Chief Executive Officer,
AIHA.
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.

[[Page H1867]]

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 I reserve the balance of my time.
Mr. COURTNEY. Madam Speaker, I yield 2\1/2\ minutes to the gentleman
from Tennessee (Mr. Cohen).
Mr. COHEN. Madam Speaker, I appreciate Mr. Courtney for yielding to
me, and I appreciate him for bringing this bill. He has a long history
of now 15 years of looking out for workers, laborers, and their fair
place in our country, and I thank him for that.
Over the past 13 months, our healthcare and social service workers
have gone over and beyond in their efforts to keep us healthy and free
during this COVID-19 pandemic. This bill, the Workplace Violence
Prevention for Health Care and Social Service Workers Act, is one way
Congress can help keep them healthy and look out for their safety.
This amendment is a simple one. It simply says that Alzheimer's and
memory care facilities are added to the type of residential treatment
facilities covered by this bill. Alzheimer's and memory care facilities
are sometimes overlooked in the definition and should not be.
With our aging population, Alzheimer's and dementia is growing in
prevalence. In the United States, more than 5.5 million people now are
living with Alzheimer's. The number is expected to increase to 14
million people by 2060. Alzheimer's is the sixth leading cause of death
in our country, but third among senior citizens, behind only cancer and
heart disease. This increase in Alzheimer's diagnoses means more
healthcare workers and social workers will be needed to help patients
and their families to try to manage this disease and cope with the
effects.
This bill doesn't only help the workers, but it helps the victims of
these diseases that put them in the institutions by making it more
likely that people will want to go into those professions and not fear
for their health.
As anyone who has or had a loved one with Alzheimer's knows that
Alzheimer's patients can become aggressive for many reasons. Sometimes
it is just the inability to grasp a subject or to remember something or
they are hungry or whatever, and they get violent.

{time} 1030

That is the reason oftentimes they are put into long-term facilities
caring for Alzheimer's patients, and that is going to continue to grow.
They have these outbursts of aggression. Healthcare professionals and
social service workers need to be protected similar to their colleagues
that work in residential treatment facilities.
I appreciate your consideration. I appreciate this amendment being
put in the en bloc. Hopefully, we pass it and pass the bill and we look
out for healthcare workers and the people who are the beneficiaries of
their work. And they will need more and more service providers as the
years go on.
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.
Mr. COURTNEY. Madam Speaker, again, I support the en bloc as stated
earlier, and I yield back the balance of my time.
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.
The SPEAKER pro tempore. Pursuant to House Resolution 303, the
previous question is ordered on the amendments en bloc printed in part
C of House Report 117-15 offered by the gentleman from Connecticut (Mr.
Courtney).
The question is on the amendments en bloc.
The en bloc amendments were agreed to.
A motion to reconsider was laid on the table.

Amendment No. 5 Offered by Mr. Keller

The SPEAKER pro tempore. It is now in order to consider amendment No.
5 printed in part C of House Report 117-15.
Mr. KELLER. Madam Speaker, I have an amendment at the desk.
The SPEAKER pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:

Strike all after the enacting clause and insert the
following:

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Workplace Violence
Prevention for Health Care and Social Service Workers Act''.

SEC. 2. TABLE OF CONTENTS.

The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

TITLE I--WORKPLACE VIOLENCE PREVENTION STANDARD

Sec. 101. Final standard.
Sec. 102. Scope and application.
Sec. 103. Requirements for workplace violence prevention standard.
Sec. 104. Rules of construction.
Sec. 105. Other definitions.

TITLE II--AMENDMENTS TO THE SOCIAL SECURITY ACT

Sec. 201. Application of the workplace violence prevention standard to
certain facilities receiving Medicare funds.

TITLE I--WORKPLACE VIOLENCE PREVENTION STANDARD

SEC. 101. FINAL STANDARD.

(a) In General.--The Secretary of Labor shall promulgate a
final standard on workplace violence prevention--
(1) to require certain employers in the healthcare and
social service sectors, and certain employers in sectors that
conduct activities similar to the activities in the
healthcare and social service sectors, to develop and
implement a comprehensive workplace violence prevention plan
to protect health care workers, social service workers, and
other personnel from workplace violence; and
(2) that may be based on the Guidelines for Preventing
Workplace Violence for Healthcare and Social Service Workers
published by the Occupational Safety and Health
Administration of the Department of Labor in 2015 and adhere
to the requirements of this title.
(b) Effective Date of Standard.--The final standard shall--
(1) take effect on a date that is not later than 60 days
after promulgation, except that such final standard may
include a reasonable phase-in period for the implementation
of required engineering controls that take effect after such
date; and
(2) be enforced in the same manner and to the same extent
as any standard promulgated under section 6(b) of the
Occupational Safety and Health Act of 1970 (29 U.S.C.
655(b)).
(c) Educational Outreach.--
(1) During rulemaking.--During the period beginning on the
date the Secretary commences rulemaking under this section
and

[[Page H1868]]

ending on the effective date of the final standard
promulgated under this section, the Secretary of Labor shall
engage in an educational campaign for covered employees and
covered employers regarding workplace violence prevention in
health care and social service industries on the materials of
the Occupational Safety and Health Administration on
workplace violence prevention for such industries.
(2) Requirements of final standard.--Beginning on the date
on which the final standard is promulgated under this
section, the Secretary shall engage in an educational
campaign for covered employees and covered employers on the
requirements of such final standard.

SEC. 102. SCOPE AND APPLICATION.

In this title:
(1) Covered facility.--
(A) In general.--The term ``covered facility'' means a
facility with respect to which the Secretary determines that
requirements of the final standard promulgated under section
101(a) would be reasonably necessary or appropriate, and
which may include the following:
(i) Any hospital, including any specialty hospital.
(ii) Any residential treatment facility, including any
nursing home, skilled nursing facility, hospice facility, and
long-term care facility.
(iii) Any medical treatment or social service setting or
clinic at a correctional or detention facility.
(iv) Any community-based residential facility, group home,
and mental health clinic.
(v) Any psychiatric treatment facility.
(vi) Any drug abuse or substance use disorder treatment
center.
(vii) Any independent freestanding emergency centers.
(viii) Any facility described in subparagraphs (A) through
(G) operated by a Federal Government agency and required to
comply with occupational safety and health standards pursuant
to section 1960 of title 29, Code of Federal Regulations (as
such section is in effect on the date of enactment of this
Act).
(B) Exclusion.--The term ``covered facility'' does not
include an office of a physician, dentist, podiatrist, or any
other health practitioner that is not physically located
within a covered facility described in subparagraphs (A)
through (H) of paragraph (1).
(2) Covered services.--The term ``covered service''--
(A) includes--
(i) any services and operations provided in home health
care, home-based hospice, and home-based social work;
(ii) any emergency medical services and transport,
including such services when provided by firefighters and
emergency responders;
(iii) any services described in clauses (i) and (ii)
performed by a Federal Government agency and required to
comply with occupational safety and health standards pursuant
to section 1960 of title 29, Code of Federal Regulations (as
such section is in effect on the date of enactment of this
Act); and
(iv) any other services and operations the Secretary
determines should be covered under the standards promulgated
under section 101; and
(B) does not include child day care services.
(3) Covered employer.--
(A) In general.--The term ``covered employer'' includes a
person (including a contractor, subcontractor, or a temporary
service firm) that employs an individual to work at a covered
facility or to perform covered services.
(B) Exclusion.--The term ``covered employer'' does not
include an individual who privately employs a person to
perform covered services for the individual or a friend or
family member of the individual.
(4) Covered employee.--The term ``covered employee''
includes an individual employed by a covered employer to work
at a covered facility or to perform covered services.

SEC. 103. REQUIREMENTS FOR WORKPLACE VIOLENCE PREVENTION
STANDARD.

Each standard described in section 101 may include the
following requirements:
(1) Workplace violence prevention plan.--Not later than 6
months after the date of promulgation of the final standard
under section 101(a), a covered employer shall develop,
implement, and maintain a written workplace violence
prevention plan for covered employees at each covered
facility and for covered employees performing a covered
service on behalf of such employer, which meets the
following:
(A) Plan development.--Each Plan shall--
(i) subject to subparagraph (D), be developed and
implemented with the meaningful participation of direct care
employees and, where applicable, employee representatives,
for all aspects of the Plan;
(ii) be applicable 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; and
(iii) be suitable for the size, complexity, and type of
operations at the covered facility or for the covered
service, and remain in effect at all times.
(B) Plan content.--Each Plan shall include procedures and
methods for the following:
(i) Identification of each individual or the job title of
each individual responsible for implementation of the Plan.
(ii) With respect to each work area and unit at the covered
facility or while covered employees are performing the
covered service, risk assessment and identification of
workplace violence risks and hazards to employees exposed to
such risks and hazards (including environmental risk factors
and patient-specific risk factors), which may be--

(I) informed by past violent incidents specific to such
covered facility or such covered service; and
(II) conducted with--

(aa) representative direct care employees;
(bb) where applicable, the representatives of such
employees; and
(cc) the employer.
(iii) Hazard prevention, engineering controls, or work
practice controls to correct, in a timely manner, hazards
that the employer creates or controls which--

(I) may include security and alarm systems, adequate exit
routes, monitoring systems, barrier protection, established
areas for patients and clients, lighting, entry procedures,
staffing and working in teams, and systems to identify and
flag clients with a history of violence; and
(II) shall ensure that employers correct, in a timely
manner, hazards identified in the annual report described in
paragraph (5) that the employer creates or controls.

(iv) Reporting, incident response, and post-incident
investigation procedures, including procedures--

(I) for employees to report to the employer workplace
violence risks, hazards, and incidents;
(II) for employers to respond to reports of workplace
violence;
(III) for employers to perform a post-incident
investigation and debriefing of all reports of workplace
violence with the participation of employees and their
representatives; and
(IV) to provide medical care or first aid to affected
employees.

(v) Procedures for emergency response, including procedures
for threats of mass casualties and procedures for incidents
involving a firearm or a dangerous weapon.
(vi) Procedures for communicating with and educating of
covered employees on workplace violence hazards, threats, and
work practice controls, the employer's plan, and procedures
for confronting, responding to, and reporting workplace
violence threats, incidents, and concerns, and employee
rights.
(vii) Procedures for ensuring the coordination of risk
assessment efforts, Plan development, and implementation of
the Plan with other employers who have employees who work at
the covered facility or who are performing the covered
service.
(viii) Procedures for conducting the annual evaluation
under paragraph (6).
(C) Availability of plan.--Each Plan shall be made
available at all times to the covered employees who are
covered under such Plan.
(D) Clarification.--The requirement under subparagraph
(A)(i) shall not be construed to require that all direct care
employees and employee representatives participate in the
development and implementation of the Plan.
(2) Violent incident investigation.--
(A) In general.--As soon as practicable after a workplace
violence incident, of which a covered employer has knowledge,
the employer shall conduct an investigation of such incident,
under which the employer shall--
(i) review the circumstances of the incident and whether
any controls or measures implemented pursuant to the Plan of
the employer were effective; and
(ii) solicit input from involved employees, their
representatives, and supervisors, about the cause of the
incident, and whether further corrective measures (including
system-level factors) could have prevented the incident,
risk, or hazard.
(B) Documentation.--A covered employer shall document the
findings, recommendations, and corrective measures taken for
each investigation conducted under this paragraph.
(3) Education.--With respect to the covered employees
covered under a Plan of a covered employer, the employer
shall provide education to such employees who may be exposed
to workplace violence hazards and risks, which meet the
following requirements:
(A) Annual education includes information on the Plan,
including identified workplace violence hazards, work
practice control measures, reporting procedures, record
keeping requirements, response procedures, and employee
rights.
(B) Additional hazard recognition education for supervisors
and managers to ensure they can recognize high-risk
situations and do not assign employees to situations that
predictably compromise their safety.
(C) Additional education for each such covered employee
whose job circumstances has changed, within a reasonable
timeframe after such change.
(D) Applicable new employee education prior to employee's
job assignment.
(E) All education provides such employees opportunities to
ask questions, give feedback on such education, and request
additional instruction, clarification, or other followup.
(F) All education is provided in-person or online and by an
individual with knowledge of workplace violence prevention
and of the Plan.
(G) All education is appropriate in content and vocabulary
to the language, educational level, and literacy of such
covered employees.

[[Page H1869]]

(4) Recordkeeping and access to plan records.--
(A) In general.--Each covered employer shall--
(i) maintain at all times records related to each Plan of
the employer, including workplace violence risk and hazard
assessments, and identification, evaluation, correction, and
education procedures;
(ii) maintain for a minimum of 5 years--

(I) a violent incident log described in subparagraph (B)
for recording all workplace violence incidents; and
(II) records of all incident investigations as required
under paragraph (2)(B); and

(iii) make such records and logs available, upon request,
to covered employees and their representatives for
examination and copying in accordance with section 1910.1020
of title 29, Code of Federal Regulations (as such section is
in effect on the date of enactment of this Act), and in a
manner consistent with HIPAA privacy regulations (defined in
section 1180(b)(3) of the Social Security Act (42 U.S.C.
1320d-9(b)(3))) and part 2 of title 42, Code of Federal
Regulations (as such part is in effect on the date of
enactment of this part), and ensure that any such records and
logs removed from the employer's control for purposes of this
clause omit any element of personal identifying information
sufficient to allow identification of any patient, resident,
client, or other individual alleged to have committed a
violent incident (including the person's name, address,
electronic mail address, telephone number, or social security
number, or other information that, alone or in combination
with other publicly available information, reveals such
person's identity).
(B) Violent incident log description.--Each violent
incident log--
(i) shall be maintained by a covered employer for each
covered facility controlled by the employer and for each
covered service being performed by a covered employee on
behalf of such employer;
(ii) may be based on a template developed by the Secretary
not later than 1 year after the date of promulgation of the
standards under section 101(a);
(iii) may include a description of--

(I) the violent incident (including environmental risk
factors present at the time of the incident);
(II) the date, time, and location of the incident, names
and job titles of involved employees;
(III) the nature and extent of injuries to covered
employees;
(IV) a classification of the perpetrator who committed the
violence, including whether the perpetrator was--

(V) the type of violent incident (such as type 1 violence,
type 2 violence, type 3 violence, or type 4 violence); and
(VI) how the incident was addressed;

(iv) not later than 7 days, depending on the availability
or condition of the witness, after the employer learns of
such incident, shall contain a record of each violent
incident, which is updated to ensure completeness of such
record;
(v) shall be maintained for not less than 5 years; and
(vi) in the case of a violent incident involving a privacy
concern case as defined in section 1904.29(b)(7) of title 29,
Code of Federal Regulations (as such section is in effect on
the date of enactment of this Act), shall protect the
identity of employees in a manner consistent with that
section.
(C) Annual summary.--Each covered employer shall prepare an
annual summary of each violent incident log for the preceding
calendar year that shall--
(i) with respect to each covered facility, and each covered
service, for which such a log has been maintained, include
the total number of violent incidents, the number of
recordable injuries related to such incidents, and the total
number of hours worked by the covered employees for such
preceding year;
(ii) be completed on a form provided by the Secretary;
(iii) be posted for three months beginning February 1 of
each year in a manner consistent with the requirements of
section 1904 of title 29, Code of Federal Regulations (as
such section is in effect on the date of enactment of this
Act), relating to the posting of summaries of injury and
illness logs;
(iv) be located in a conspicuous place or places where
notices to employees are customarily posted; and
(v) not be altered, defaced, or covered by other material
by the employer.
(5) Annual evaluation.--Each covered employer shall conduct
an annual written evaluation, conducted with the full, active
participation of covered employees and employee
representatives, of--
(A) the implementation and effectiveness of the Plan,
including a review of the violent incident log; and
(B) compliance with education required by each standard
described in section 101, and specified in the Plan.
(6) Anti-retaliation.--
(A) Policy.--Each covered employer shall adopt a policy
prohibiting any person (including an agent of the employer)
from discriminating or retaliating against any employee for
reporting, or seeking assistance or intervention from, a
workplace violence incident, threat, or concern to the
employer, law enforcement, local emergency services, or a
government agency, or participating in an incident
investigation.
(B) Enforcement.--Each violation of the policy shall be
enforced in the same manner and to the same extent as a
violation of section 11(c) of the Occupational Safety and
Health Act (29 U.S.C. 660(c)) is enforced.

SEC. 104. RULES OF CONSTRUCTION.

Notwithstanding section 18 of the Occupational Safety and
Health Act of 1970 (29 U.S.C. 667)--
(1) nothing in this title shall be construed to curtail or
limit authority of the Secretary under any other provision of
the law;
(2) the rights, privileges, or remedies of covered
employees shall be in addition to the rights, privileges, or
remedies provided under any Federal or State law, or any
collective bargaining agreement; and
(3) nothing in this Act shall be construed to limit or
prevent health care workers, social service workers, or other
personnel from reporting violent incidents to appropriate law
enforcement.

SEC. 105. OTHER DEFINITIONS.

In this title:
(1) Workplace violence.--
(A) In general.--The term ``workplace violence'' means any
act of violence or threat of violence, that occurs at a
covered facility or while a covered employee performs a
covered service.
(B) Exclusions.--The term ``workplace violence'' does not
include lawful acts of self-defense or lawful acts of defense
of others.
(C) Inclusions.--The term ``workplace violence'' includes
an incident involving the threat or use of a firearm or a
dangerous weapon, including the use of common objects as
weapons, without regard to whether the employee sustains an
injury.
(2) Type 1 violence.--The term ``type 1 violence''--
(A) means workplace violence directed at a covered employee
at a covered facility or while performing a covered service
by an individual who has no legitimate business at the
covered facility or with respect to such covered service; and
(B) includes violent acts by any individual who enters the
covered facility or worksite where a covered service is being
performed with the intent to commit a crime.
(3) Type 2 violence.--The term ``type 2 violence'' means
workplace violence directed at a covered employee by
customers, clients, patients, students, inmates, or any
individual for whom a covered facility provides services or
for whom the employee performs covered services.
(4) Type 3 violence.--The term ``type 3 violence'' means
workplace violence directed at a covered employee by a
present or former employee, supervisor, or manager.
(5) Type 4 violence.--The term ``type 4 violence'' means
workplace violence directed at a covered employee by an
individual who is not an employee, but has or is known to
have had a personal relationship with such employee.
(6) Alarm.--The term ``alarm'' means a mechanical,
electrical, or electronic device that can alert others but
does not rely upon an employee's vocalization in order to
alert others.
(7) Engineering controls.--
(A) In general.--The term ``engineering controls'' means an
aspect of the built space or a device that removes or
minimizes a hazard from the workplace or creates a barrier
between a covered employee and the hazard.
(B) Inclusions.--For purposes of reducing workplace
violence hazards, the term ``engineering controls'' includes
electronic access controls to employee occupied areas, weapon
detectors (installed or handheld), enclosed workstations with
shatter-resistant glass, deep service counters, separate
rooms or areas for high-risk patients, locks on doors,
removing access to or securing items that could be used as
weapons, furniture affixed to the floor, opaque glass in
patient rooms (which protects privacy, but allows the health
care provider to see where the patient is before entering the
room), closed-circuit television monitoring and video
recording, sight-aids, and personal alarm devices.
(8) Environmental risk factors.--
(A) In general.--The term ``environmental risk factors''
means factors in the covered facility or area in which a
covered service is performed that may contribute to the
likelihood or severity of a workplace violence incident.
(B) Clarification.--Environmental risk factors may be
associated with the specific task being performed or the work
area, such as working in an isolated area, poor illumination
or blocked visibility, and lack of physical barriers between
individuals and persons at risk of committing workplace
violence.
(9) Patient-specific risk factors.--The term ``patient-
specific risk factors'' means factors specific to a patient
that may increase the likelihood or severity of a workplace
violence incident, including--
(A) a patient's psychiatric condition, treatment and
medication status, history of violence, and known or recorded
use of drugs or alcohol; and
(B) any conditions or disease processes of the patient that
may cause the patient to experience confusion or
disorientation, to be non-responsive to instruction, or to
behave unpredictably.

[[Page H1870]]

(10) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(11) Work practice controls.--
(A) In general.--The term ``work practice controls'' means
procedures and rules that are used to effectively reduce
workplace violence hazards.
(B) Inclusions.--The term ``work practice controls''
includes assigning and placing sufficient numbers of staff to
reduce patient-specific Type 2 workplace violence hazards,
provision of dedicated and available safety personnel such as
security guards, employee training on workplace violence
prevention method and techniques to de-escalate and minimize
violent behavior, and employee education on procedures for
response in the event of a workplace violence incident and
for post-incident response.

TITLE II--AMENDMENTS TO THE SOCIAL SECURITY ACT

SEC. 201. APPLICATION OF THE WORKPLACE VIOLENCE PREVENTION
STANDARD TO CERTAIN FACILITIES RECEIVING
MEDICARE FUNDS.

(a) In General.--Section 1866 of the Social Security Act
(42 U.S.C. 1395cc) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (X), by striking ``and'' at the end;
(B) in subparagraph (Y), by striking at the end the period
and inserting ``; and''; and
(C) by inserting after subparagraph (Y) the following new
subparagraph:
``(Z) in the case of hospitals that are not otherwise
subject to the Occupational Safety and Health Act of 1970 (or
a State occupational safety and health plan that is approved
under 18(b) of such Act) and skilled nursing facilities that
are not otherwise subject to such Act (or such a State
occupational safety and health plan), to comply with the
Workplace Violence Prevention Standard (as promulgated under
section 101 of the Workplace Violence Prevention for Health
Care and Social Service Workers Act).''; and
(2) in subsection (b)(4)--
(A) in subparagraph (A), by inserting ``and a hospital or
skilled nursing facility that fails to comply with the
requirement of subsection (a)(1)(Z) (relating to the
Workplace Violence Prevention Standard)'' after ``Bloodborne
Pathogens Standard)''; and
(B) in subparagraph (B)--
(i) by striking ``(a)(1)(U)'' and inserting ``(a)(1)(V)'';
and
(ii) by inserting ``(or, in the case of a failure to comply
with the requirement of subsection (a)(1)(Z), for a violation
of the Workplace Violence Prevention standard referred to in
such subsection by a hospital or skilled nursing facility, as
applicable, that is subject to the provisions of such Act)''
before the period at the end.
(b) Effective Date.--The amendments made by subsection (a)
shall apply beginning on the date that is 1 year after the
date of issuance of the final standard on workplace violence
prevention required under section 101.

The SPEAKER pro tempore. Pursuant to House Resolution 303, the
gentleman from Pennsylvania (Mr. Keller) and a Member opposed each will
control 5 minutes.
The Chair recognizes the gentleman from Pennsylvania.
Mr. KELLER. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I rise today in support of this amendment, which I am
offering with my colleague, Representative Walberg.
Healthcare and social service workers face real safety risks in the
workplace. This issue demands our attention and thoughtful
consideration.
Unfortunately, H.R. 1195 will result in a rushed and flawed OSHA rule
that will not effectively address workplace violence. This bill is
excessively prescriptive and heavy-handed, prejudging and imposing a
regulation without allowing for necessary stakeholder input and expert
review.
Just as Members of Congress should be working together to develop
adequate solutions to these pressing issues, OSHA should be working
with and listening to industry experts and stakeholders closest to the
problem.
That is why this amendment requires OSHA to follow proper procedures
in their rulemaking process, including inviting meaningful stakeholder
participation, and responding to comments from the public.
The amendment also calls on OSHA to convene the already planned Small
Business Regulatory Enforcement Fairness Act panel before proceeding
with the rulemaking process.
This will ensure that small employers directly impacted by the rule
have the chance to speak on it, allowing for a more informed solution
that empowers workers and employers, not one that cripples them with
overbearing Federal mandates
This amendment would also require OSHA to conduct an educational
campaign on workplace violence prevention in healthcare and social
services industries.
This initiative would target the regulated community and raise
awareness of the issue while also increasing compliance with the
eventual final rule.
Finally, despite the heavy burdens placed on our healthcare system
responding to the pandemic, the Biden administration is considering a
job-killing emergency, temporary standard on COVID-19 that will further
bog down already overwhelmed businesses with sweeping and costly
mandates at the very time that vaccines are widely available and the
economy is recovering at a record pace.
As such, this amendment removes the unnecessary and problematic
requirement that OSHA issue an interim final standard on workplace
violence within 1 year, enabling these facilities to continue fighting
COVID-19 and allowing our entire economy to continue recovering from
economic peril.
We all agree that our frontline workers have shown incredible courage
in responding to this global health crisis and their efforts continue
to be an invaluable part of our Nation's recovery.
We owe it to these heroes to provide a solution that keeps them safe
at work without drowning employers in compliance costs or implementing
overbearing rules and rushed regulations from Washington that do not
take into account their meaningful input.
We owe these frontline workers the opportunity to have their say and
their input. This amendment does just that, and I urge my colleagues to
support it. Madam Speaker, I yield back the balance of my time.
Mr. COURTNEY. Madam Speaker, I rise in opposition to the amendment.
The SPEAKER pro tempore. The gentleman from Connecticut is recognized
for 5 minutes.
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

[[Page H1871]]

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.

Mr. COURTNEY. Madam Speaker, respectfully I rise in opposition and
recommend a ``no'' vote on Mr. Keller's amendment, and I yield back the
balance of my time.
The SPEAKER pro tempore. Pursuant to House Resolution 303, the
previous question is ordered on the amendment offered by the gentleman
from Pennsylvania (Mr. Keller).
The question is on the amendment.
The question was taken; and the Speaker pro tempore announced that
the noes appear to have it.
Mr. KELLER. Madam Speaker, on that I demand the yeas and nays.
The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution
8, the yeas and nays are ordered.
The vote was taken by electronic device, and there were--yeas 168,
nays 256, not voting 5, as follows:

[Roll No. 117]

YEAS--168

Aderholt
Allen
Amodei
Armstrong
Babin
Baird
Balderson
Banks
Barr
Bentz
Bergman
Bice (OK)
Bilirakis
Bishop (NC)
Bost
Brady
Buchanan
Bucshon
Burgess
Calvert
Carl
Carter (GA)
Carter (TX)
Chabot
Cheney
Cline
Cloud
Cole
Comer
Crawford
Crenshaw
Curtis
Davis, Rodney
DesJarlais
Diaz-Balart
Duncan
Dunn
Emmer
Estes
Fallon
Feenstra
Ferguson
Fischbach
Fitzgerald
Fleischmann
Foxx
Fulcher
Gallagher
Garbarino
Gimenez
Gonzales, Tony
Gonzalez (OH)
Granger
Graves (LA)
Graves (MO)
Griffith
Grothman
Guest
Guthrie
Hagedorn
Harris
Harshbarger
Hartzler
Hern
Herrera Beutler
Higgins (LA)
Hill
Hinson
Hollingsworth
Hudson
Huizenga
Issa
Jackson
Jacobs (NY)
Johnson (LA)
Johnson (OH)
Johnson (SD)
Jordan
Joyce (OH)
Joyce (PA)
Keller
Kelly (MS)
Kelly (PA)
Kim (CA)
Kinzinger
Kustoff
LaHood
LaMalfa
Lamborn
Latta
LaTurner
Lesko
Letlow
Long
Loudermilk
Lucas
Luetkemeyer
Malliotakis
Mann
McCarthy
McCaul
McClain
McHenry
McKinley
Meijer
Meuser
Miller (WV)
Miller-Meeks
Moolenaar
Mooney
Moore (AL)
Moore (UT)
Mullin
Murphy (NC)
Nehls
Newhouse
Norman
Nunes
Obernolte
Owens
Palazzo
Palmer
Pence
Pfluger
Reed
Reschenthaler
Rice (SC)
Rodgers (WA)
Rogers (AL)
Rogers (KY)
Rose
Rouzer
Rutherford
Salazar
Scalise
Schweikert
Scott, Austin
Sessions
Simpson
Smith (MO)
Smith (NE)
Smucker
Spartz
Steel
Stefanik
Steil
Steube
Stewart
Taylor
Tenney
Thompson (PA)
Timmons
Turner
Upton
Valadao
Van Duyne
Wagner
Walberg
Walorski
Waltz
Weber (TX)
Wenstrup
Williams (TX)
Wilson (SC)
Wittman
Womack
Young
Zeldin

NAYS--256

Adams
Aguilar
Allred
Arrington
Auchincloss
Axne
Bacon
Barragan
Bass
Beatty
Bera
Beyer
Biggs
Bishop (GA)
Blumenauer
Blunt Rochester
Boebert
Bonamici
Bourdeaux
Bowman
Boyle, Brendan F.
Brooks
Brown
Brownley
Buck
Budd
Burchett
Bush
Bustos
Butterfield
Cammack
Carbajal
Cardenas
Carson
Cartwright
Case
Casten
Castor (FL)
Castro (TX)
Chu
Cicilline
Clark (MA)
Clarke (NY)
Cleaver
Clyburn
Clyde
Cohen
Connolly
Correa
Costa
Courtney
Craig
Crist
Crow
Cuellar
Davids (KS)
Davidson
Davis, Danny K.
Dean
DeFazio
DeGette
DeLauro
DelBene
Delgado
Demings
DeSaulnier
Deutch
Dingell
Doggett
Donalds
Doyle, Michael F.
Escobar
Eshoo
Espaillat
Evans
Fitzpatrick
Fletcher
Fortenberry
Foster
Frankel, Lois
Gaetz
Gallego
Garamendi
Garcia (CA)
Garcia (IL)
Garcia (TX)
Gibbs
Gohmert
Golden
Gomez
Gonzalez, Vicente
Good (VA)
Gooden (TX)
Gosar
Gottheimer
Green (TN)
Green, Al (TX)
Greene (GA)
Grijalva
Harder (CA)
Hayes
Herrell
Hice (GA)
Higgins (NY)
Himes
Horsford
Houlahan
Hoyer
Huffman
Jackson Lee
Jacobs (CA)
Jayapal
Jeffries
Johnson (GA)
Johnson (TX)
Jones
Kahele
Kaptur
Katko
Keating
Kelly (IL)
Khanna
Kildee
Kilmer
Kim (NJ)
Kind
Kirkpatrick
Krishnamoorthi
Kuster
Lamb
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee (CA)
Lee (NV)
Leger Fernandez
Levin (CA)
Levin (MI)
Lieu
Lofgren
Lowenthal
Luria
Lynch
Mace
Malinowski
Maloney, Carolyn B.
Maloney, Sean
Manning
Massie
Mast
Matsui
McBath
McClintock
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Mfume
Miller (IL)
Moore (WI)
Morelle
Moulton
Mrvan
Murphy (FL)
Nadler
Napolitano
Neal
Neguse
Newman
Norcross
O'Halleran
Ocasio-Cortez
Omar
Pallone
Panetta
Pappas
Pascrell
Payne
Perlmutter
Perry
Peters
Phillips
Pingree
Pocan
Porter
Posey
Pressley
Price (NC)
Quigley
Raskin
Rice (NY)
Rosendale
Ross
Roy
Roybal-Allard
Ruiz
Ruppersberger
Rush
Ryan
Sanchez
Sarbanes
Scanlon
Schakowsky
Schiff
Schneider
Schrader
Schrier
Scott (VA)
Scott, David
Sewell
Sherman
Sherrill
Sires
Slotkin
Smith (NJ)
Smith (WA)
Soto
Spanberger
Speier
Stanton
Stauber
Stevens
Strickland
Suozzi
Swalwell
Takano
Thompson (CA)
Thompson (MS)
Tiffany
Titus
Tlaib
Tonko
Torres (CA)
Torres (NY)
Trahan
Trone
Underwood
Van Drew
Vargas
Veasey
Vela
Velazquez
Wasserman Schultz
Waters
Watson Coleman
Welch
Westerman
Wexton
Wild
Williams (GA)
Wilson (FL)
Yarmuth

NOT VOTING--5

Cawthorn
Cooper
Franklin, C. Scott
Stivers
Webster (FL)

{time} 1116

Messrs. KIND, WESTERMAN, DeSAULNIER, Mrs. TORRES of California,
Messrs. GIBBS, GOODEN of Texas, Ms. LEGER FERNANDEZ, Messrs. COSTA,
CLYDE, GOHMERT, and MAST changed their vote from ``yea'' to ``nay.''
Mr. OWENS, Ms. CHENEY, and Mr. BANKS changed their vote from ``nay''
to ``yea.''
So the amendment was rejected.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.

[[Page H1872]]

MEMBERS RECORDED PURSUANT TO HOUSE RESOLUTION 8, 117TH CONGRESS

Allred (Wexton)
Babin (Fallon)
Barragan (Beyer)
Buchanan (LaHood)
Cardenas (Gonzalez, Vicente)
Crenshaw (Fallon)
Gomez (Pressley)
Gottheimer (Panetta)
Graves (MO) (Wagner)
Greene (GA) (Gosar)
Grijalva (Garcia (IL))
Jayapal (Pocan)
Johnson (TX) (Jeffries)
Keating (Clark (MA))
Lawrence (Kildee)
Lawson (FL) (Evans)
Lieu (Beyer)
Lowenthal (Beyer)
McHenry (Banks)
Meng (Clark (MA))
Mfume (Wexton)
Moore (WI) (Beyer)
Moulton (Underwood)
Napolitano (Correa)
Neal (Lynch)
Nehls (Fallon)
Norcross (Pallone)
Omar (Pressley)
Payne (Pallone)
Porter (Wexton)
Rush (Underwood)
Sewell (DelBene)
Sires (Pallone)
Stefanik (Tenney)
Steube (Timmons)
Trahan (Lynch)
Walorski (Wagner)
Wasserman Schultz (Soto)
Watson Coleman (Pallone)
Wilson (FL) (Hayes)
Wilson (SC) (Timmons)
The SPEAKER pro tempore. The previous question is ordered on the
bill, as amended.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. SCOTT of Virginia. Madam Speaker, on that I demand the yeas and
nays.
The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution
8, the yeas and nays are ordered.
The vote was taken by electronic device, and there were--yeas 254,
nays 166, not voting 9, as follows:

[Roll No. 118]

YEAS--254

Adams
Aguilar
Allred
Auchincloss
Axne
Bacon
Barragan
Bass
Beatty
Bera
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Bost
Bourdeaux
Bowman
Boyle, Brendan F.
Brady
Brown
Brownley
Bucshon
Bush
Bustos
Butterfield
Carbajal
Cardenas
Carson
Cartwright
Case
Casten
Castor (FL)
Castro (TX)
Chu
Cicilline
Clark (MA)
Clarke (NY)
Cleaver
Clyburn
Cohen
Cole
Connolly
Cooper
Correa
Costa
Courtney
Craig
Crist
Crow
Cuellar
Davids (KS)
Davis, Danny K.
Davis, Rodney
Dean
DeFazio
DeGette
DeLauro
DelBene
Delgado
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Escobar
Eshoo
Espaillat
Evans
Fitzpatrick
Fletcher
Fortenberry
Foster
Frankel, Lois
Gallego
Garamendi
Garbarino
Garcia (CA)
Garcia (IL)
Garcia (TX)
Gimenez
Golden
Gomez
Gonzalez (OH)
Gonzalez, Vicente
Gottheimer
Graves (LA)
Green, Al (TX)
Griffith
Grijalva
Harder (CA)
Hartzler
Hayes
Herrera Beutler
Higgins (NY)
Himes
Horsford
Houlahan
Hoyer
Huffman
Jackson Lee
Jacobs (CA)
Jacobs (NY)
Jayapal
Jeffries
Johnson (GA)
Johnson (TX)
Jones
Joyce (OH)
Kahele
Kaptur
Katko
Keating
Kelly (IL)
Khanna
Kildee
Kilmer
Kim (CA)
Kim (NJ)
Kind
Kinzinger
Kirkpatrick
Krishnamoorthi
Kuster
Lamb
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee (CA)
Lee (NV)
Leger Fernandez
Lesko
Levin (CA)
Levin (MI)
Lieu
Lofgren
Lowenthal
Luria
Lynch
Malinowski
Malliotakis
Maloney, Carolyn B.
Maloney, Sean
Manning
Matsui
McBath
McCollum
McEachin
McGovern
McKinley
McNerney
Meeks
Meijer
Meng
Mfume
Moore (WI)
Morelle
Moulton
Murphy (FL)
Murphy (NC)
Nadler
Napolitano
Neal
Neguse
Newhouse
Newman
Norcross
O'Halleran
Ocasio-Cortez
Omar
Pallone
Panetta
Pappas
Pascrell
Payne
Perlmutter
Peters
Phillips
Pingree
Pocan
Porter
Pressley
Price (NC)
Quigley
Raskin
Reed
Rice (NY)
Rice (SC)
Rodgers (WA)
Ross
Roybal-Allard
Ruiz
Ruppersberger
Rush
Ryan
Salazar
Sanchez
Sarbanes
Scanlon
Schakowsky
Schiff
Schneider
Schrader
Schrier
Scott (VA)
Scott, David
Sewell
Sherman
Sherrill
Sires
Slotkin
Smith (NJ)
Smith (WA)
Soto
Spanberger
Speier
Stanton
Stauber
Stefanik
Stevens
Strickland
Suozzi
Swalwell
Takano
Thompson (CA)
Thompson (MS)
Titus
Tlaib
Tonko
Torres (CA)
Torres (NY)
Trahan
Trone
Underwood
Upton
Van Drew
Vargas
Veasey
Vela
Velazquez
Wasserman Schultz
Waters
Watson Coleman
Welch
Wexton
Wild
Williams (GA)
Wilson (FL)
Yarmuth
Young
Zeldin

NAYS--166

Aderholt
Allen
Amodei
Armstrong
Arrington
Babin
Baird
Balderson
Banks
Barr
Bentz
Bergman
Bice (OK)
Biggs
Bilirakis
Bishop (NC)
Brooks
Buchanan
Buck
Budd
Burchett
Calvert
Cammack
Carl
Carter (GA)
Carter (TX)
Chabot
Cheney
Cline
Cloud
Clyde
Comer
Crawford
Crenshaw
Curtis
Davidson
DesJarlais
Diaz-Balart
Donalds
Duncan
Dunn
Emmer
Estes
Fallon
Feenstra
Ferguson
Fischbach
Fitzgerald
Fleischmann
Foxx
Fulcher
Gaetz
Gallagher
Gibbs
Gohmert
Gonzales, Tony
Good (VA)
Gooden (TX)
Gosar
Granger
Graves (MO)
Green (TN)
Greene (GA)
Grothman
Guest
Guthrie
Hagedorn
Harris
Harshbarger
Hern
Herrell
Hice (GA)
Higgins (LA)
Hill
Hinson
Hollingsworth
Hudson
Issa
Jackson
Johnson (LA)
Johnson (OH)
Johnson (SD)
Jordan
Joyce (PA)
Keller
Kelly (MS)
Kelly (PA)
Kustoff
LaHood
LaMalfa
Lamborn
Latta
LaTurner
Letlow
Long
Loudermilk
Lucas
Luetkemeyer
Mace
Mann
Massie
Mast
McCarthy
McCaul
McClain
McClintock
McHenry
Meuser
Miller (WV)
Miller-Meeks
Moolenaar
Mooney
Moore (AL)
Moore (UT)
Mullin
Nehls
Norman
Nunes
Obernolte
Owens
Palazzo
Palmer
Pence
Perry
Pfluger
Posey
Reschenthaler
Rogers (AL)
Rogers (KY)
Rose
Rosendale
Rouzer
Roy
Rutherford
Scalise
Schweikert
Scott, Austin
Sessions
Simpson
Smith (MO)
Smith (NE)
Smucker
Spartz
Steel
Steil
Steube
Stewart
Taylor
Tenney
Thompson (PA)
Tiffany
Timmons
Turner
Valadao
Van Duyne
Wagner
Walberg
Walorski
Waltz
Weber (TX)
Wenstrup
Westerman
Williams (TX)
Wilson (SC)
Wittman
Womack

NOT VOTING--9

Boebert
Burgess
Cawthorn
Franklin, C. Scott
Huizenga
Miller (IL)
Mrvan
Stivers
Webster (FL)

{time} 1148

Mr. COMER changed his vote from ``yea'' to ``nay.''
Messrs. RICE of South Carolina and KIM of New Jersey changed their
vote from ``nay'' to ``yea.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Stated for:
Mr. MRVAN. Mr. Speaker, had I been present, I would have voted
``yea'' on rollcall No. 118.

Members Recorded Pursuant to House Resolution 8, 117th Congress

____________________