[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.

       (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 training the 
     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--

       (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--

       (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 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

     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)

                          ____________________