HF 4210

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/18/2024 03:54pm

A bill for an act
relating to health; establishing safety requirements for hospitals and violence
intervention teams; requiring hospitals to have a secure online portal for reporting
of violence incidents and threats of violence; requiring de-escalation training for
all hospital health care workers; requiring a report; amending Minnesota Statutes
2022, section 144.55, by adding a subdivision; Minnesota Statutes 2023
Supplement, section 144.566, subdivisions 10, 15, by adding subdivisions;
proposing coding for new law in Minnesota Statutes, chapter 144.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2022, section 144.55, is amended by adding a subdivision
to read:

new text begin Subd. 3c. new text end

new text begin Standards for emergency rooms. new text end

new text begin A hospital must maintain a log of every
patient who leaves its emergency department after checking in but before receiving care.
The patient log must document the reason the patient left, if known, and the length of time
the patient waited before leaving or, if the length of time the patient waited is unknown, the
length of time between the time the patient checked in and the time the hospital determined
the patient left without receiving care. The patient log required under this subdivision must
be made available to the commissioner of health immediately upon request. A copy of the
patient log with all personally identifiable information removed, or summary data of the
information in the patient log, must be made available to union representatives within 30
days of a request.
new text end

Sec. 2.

Minnesota Statutes 2023 Supplement, section 144.566, subdivision 10, is amended
to read:

Subd. 10.

new text begin Safety new text end training required.

A hospital must provide training to all health care
workers employed or contracted with the hospital on safety during acts of violence. Each
health care worker must receive safety training during the health care worker's orientation
and before the health care worker completes a shift independently, and annually thereafter.
Training must, at a minimum, include:

(1) safety guidelines for response to deleted text begin and de-escalation of deleted text end an act of violence;

(2) ways to identify potentially violent or abusive situations, including aggression and
violence predicting factors;

(3) the hospital's preparedness and incident response action plans for acts of violence,
including how the health care worker may report concerns about workplace violence within
each hospital's reporting structure without fear of reprisal, how the hospital will address
workplace violence incidents, and how the health care worker can participate in reviewing
and revising the plan; and

(4) any resources available to health care workers for coping with incidents of violence,
including but not limited to critical incident stress debriefing or employee assistance
programs.

Sec. 3.

Minnesota Statutes 2023 Supplement, section 144.566, is amended by adding a
subdivision to read:

new text begin Subd. 10a. new text end

new text begin De-escalation training required. new text end

new text begin (a) Except as provided in paragraph (d),
a hospital must provide de-escalation training to all health care workers employed or under
contract with the hospital. For health care workers employed or under contract with the
hospital as of July 1, 2024, the hospital must provide de-escalation training by June 30,
2025. For health care workers whose employment or contract with the hospital begins after
July 1, 2024, the hospital must provide de-escalation training upon hire. The de-escalation
training must, at a minimum, include four hours of training covering the following topics:
new text end

new text begin (1) understanding violence in health care settings and violence-induced stress among
health care workers;
new text end

new text begin (2) recognizing escalating aggression and techniques for de-escalating aggression and
violence, including behavioral and logistical strategies;
new text end

new text begin (3) managing post-traumatic stress disorder;
new text end

new text begin (4) minimizing potentially violent situations through effective patient communication;
new text end

new text begin (5) effective whole-person and whole-family interventions;
new text end

new text begin (6) trauma-informed care;
new text end

new text begin (7) implicit bias and antiracism; and
new text end

new text begin (8) verbal and nonverbal communication techniques that diffuse tension and reduce
emotional intensity.
new text end

new text begin (b) A hospital may create its own training course or may use an existing training course
that meets the criteria in paragraphs (a) and (c). A hospital is encouraged to use resources
that utilize peer-reviewed, evidence-based standards. A hospital must update its training
annually to reflect best practices.
new text end

new text begin (c) Except as provided in paragraph (d), after the initial training, a hospital must provide
at least two hours of de-escalation training updates annually to all health care workers
employed or under contract with the hospital.
new text end

new text begin (d) Health care workers who work remotely at least 95 percent of the time and do not
interact with patients are exempt from the de-escalation training required under paragraphs
(a) and (c).
new text end

Sec. 4.

Minnesota Statutes 2023 Supplement, section 144.566, subdivision 15, is amended
to read:

Subd. 15.

Legislative report required.

(a) Beginning January 15, 2026, the commissioner
must compile the information new text begin submitted to the commissioner under subdivision 14 and the
commissioner's evaluation of hospitals' compliance with section 144.567 new text end into a single annual
report and submit the report to the chairs and ranking minority members of the legislative
committees with jurisdiction over health care by January 15 of each year.

(b) This subdivision does not expire.

Sec. 5.

Minnesota Statutes 2023 Supplement, section 144.566, is amended by adding a
subdivision to read:

new text begin Subd. 18. new text end

new text begin Reports of acts or threats of violence. new text end

new text begin (a) When implementing the required
reporting procedures under subdivision 7, all hospitals must provide a secure online portal
through which health care workers can submit a report of a violent incident or threat of
violence that occurred in the hospital or on hospital grounds. Hospitals must retain all data
submitted through the online portal for a minimum of seven years from the date on which
the data were submitted.
new text end

new text begin (b) The data submitted through the online portal must be made available to appropriate
hospital personnel and upon request to the commissioner of health. A copy of data submitted
through the online portal with all personally identifiable information removed or, if requested,
summary data of the information submitted, must be made available to union representatives
within 30 days of a request.
new text end

new text begin (c) The online portal must include data fields allowing a health care worker to submit:
new text end

new text begin (1) the date, time, and location of the act of violence or threat of violence;
new text end

new text begin (2) the names and job titles of all health care workers known by the submitting health
care worker to have been victims of or witnesses to the act or threat of violence;
new text end

new text begin (3) the names and job titles of all health care workers known by the submitting health
care worker to have responded to the act or threat of violence;
new text end

new text begin (4) a classification of the person engaged in the violent act or threat of violence;
new text end

new text begin (5) a description of the act or threat of violence;
new text end

new text begin (6) a description of the incident response;
new text end

new text begin (7) the nature and extent of any injuries known by the submitting health care worker to
have been suffered by health care workers; and
new text end

new text begin (8) a description of the staffing levels at the time of the act or threat of violence and the
submitting health care worker's opinion concerning whether staffing levels contributed to
the incident.
new text end

Sec. 6.

new text begin [144.567] VIOLENCE INTERRUPTION INTERVENTION TEAMS.
new text end

new text begin Subdivision 1. new text end

new text begin Violence interruption intervention teams required. new text end

new text begin Except as provided
in subdivision 4, by July 1, 2025, all hospitals must establish and maintain at least one
violence interruption intervention team according to the requirements of this section. At
least one member of the violence interruption intervention team listed in subdivision 3 who
is a licensed medical professional and authorized to administer all medications that may be
required during a crisis intervention must be available on site at all times to respond promptly
to any crisis that may escalate to violence or is violent and that occurs in the hospital.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the following terms have the
meanings given.
new text end

new text begin (b) "Competency" means the ability of a health care worker to effectively demonstrate
a set of attributes, such as personal characteristics, professional attitude, values, knowledge,
and skills, and to fulfill the worker's professional responsibility through practice. A competent
person must possess these attributes, have the motivation and ability to use them, and
effectively use them to provide safe, effective, and professional care to patients.
new text end

new text begin (c) "Crisis intervention" means face-to-face, short-term intensive mental health services
initiated during a crisis where a patient's behavior may escalate to violence or is violent, to
help a patient cope with immediate stressors, identify and utilize available resources and
patient strengths, and begin to return to the patient's baseline level of functioning. Crisis
intervention does not include the use of violence, physical holds, mechanical restraints, or
chemical restraints to immobilize a patient unless the physical hold, mechanical restraint,
or chemical restraint is necessary to conduct a medical examination or treatment.
new text end

new text begin (d) "Hospital" means a general acute care hospital licensed under sections 144.50 to
144.58.
new text end

new text begin (e) "Licensed medical professional" means one of the following, licensed by the
profession's licensing board: (1) a doctor of medicine or osteopathy; (2) a registered nurse;
or (3) a practical nurse.
new text end

new text begin (f) "Licensed mental health professional" means a mental health professional who is
qualified according to section 245I.04, subdivision 2.
new text end

new text begin Subd. 3. new text end

new text begin Violence interruption intervention team. new text end

new text begin (a) Each violence interruption
intervention team must include at least four members, and all members must have completed
the training required under subdivision 11.
new text end

new text begin (b) Each violence interruption intervention team must include at least:
new text end

new text begin (1) three licensed medical professionals who have competency in providing psychiatric
care, of whom at least one must be a registered nurse and of whom at least one must be
either an additional registered nurse or a licensed practical nurse;
new text end

new text begin (2) one licensed mental health professional who has experience and competency in
responding to the needs of patients in mental health crisis; and
new text end

new text begin (3) any additional health care staff necessary to ensure the care needs can be met of a
patient whose behavior may escalate to violence or is violent.
new text end

new text begin (c) Health care staff who are not members of the violence interruption intervention team:
new text end

new text begin (1) are not permitted to perform crisis interventions unless the team asks for assistance;
and
new text end

new text begin (2) may support the violence interruption intervention team during a crisis.
new text end

new text begin (d) When scheduled to serve on the violence interruption intervention team, hospitals
must not assign team members any duties or tasks that would prevent the team member
from promptly responding to a crisis where behavior may escalate to violence or is violent
and immediately participating in an intervention until the resolution of the crisis.
new text end

new text begin (e) A hospital must treat a response by violence interruption intervention team members
as a supplemental emergency service and must not regard the presence of team members
on a unit as a replacement for health care staff who would otherwise be assigned to the unit
to provide care for the patient who is experiencing a crisis and whose behavior may escalate
to violence or is violent, or any other patient on the unit.
new text end

new text begin Subd. 4. new text end

new text begin Critical access hospitals. new text end

new text begin A critical access hospital that does not have a
behavioral health unit or mental health unit is not required to have a violence interruption
intervention team that meets the requirements of subdivision 3, provided the critical access
hospital has a staff person available at all times who:
new text end

new text begin (1) is a licensed medical professional;
new text end

new text begin (2) is authorized to administer all medications that may be required during a crisis
intervention;
new text end

new text begin (3) completed the trainings required under subdivision 11 and section 144.566,
subdivision 10a; and
new text end

new text begin (4) is able to provide crisis intervention as a violence interruption intervention team
would.
new text end

new text begin Subd. 5. new text end

new text begin Violence interruption intervention. new text end

new text begin (a) Hospital staff must seek assistance
from the violence interruption intervention team when hospital staff believe that a patient
is experiencing a crisis where the patient's behavior may escalate to violence or is violent
or that a patient is at imminent risk of such a crisis. Hospital staff may also seek assistance
from the violence interruption intervention team when another person in the hospital or on
the hospital grounds is experiencing a crisis where the person's behavior may escalate to
violence or is violent, or is at imminent risk of such a crisis.
new text end

new text begin (b) A member of the violence interruption intervention team must respond promptly and
in person to all requests for assistance from the team.
new text end

new text begin (c) For each crisis intervention, one violence interruption intervention team member
must be designated the team lead. The team lead must determine what intervention method
is most appropriate and promptly organize an intervention plan.
new text end

new text begin Subd. 6. new text end

new text begin Violence interruption intervention follow-up; violence interruption
intervention team responsibilities. new text end

new text begin After a crisis intervention, the violence interruption
intervention team must conduct an informal debriefing to determine if: (1) policies and
procedures were followed prior to and during the intervention; (2) the best outcome for the
patient was achieved; and (3) improvement to the intervention process is needed to better
serve the needs of patients experiencing a crisis where the patient's behavior may escalate
to violence or is violent. The violence interruption intervention team may make
recommendations to the hospital administration for improving crisis interventions in the
future.
new text end

new text begin Subd. 7. new text end

new text begin Violence interruption intervention follow-up; care team responsibilities. new text end

new text begin (a)
After a crisis intervention, the care team of the patient who experienced the crisis must
review the patient's care plan and implement an updated person-centered care plan to
minimize the chances of a recurrence of a crisis where the patient's behavior may escalate
to violence or is violent. When preparing the updated care plan, the care team must consult
the patient's physician to determine if the patient's treatment plan needs to be adjusted.
new text end

new text begin (b) The patient's updated care plan must:
new text end

new text begin (1) address in observable and measurable terms where, when, and with whom the crisis
occurred and determine if adjustments to the patient's care, care team, or environment are
necessary to minimize known antecedents and triggers of the patient's prior crises where
the patient's behavior was violent or was at risk of escalating to violence;
new text end

new text begin (2) include what interventions and strategies were previously implemented to prevent
the patient from experiencing a crisis where the patient's behavior may escalate to violence
or is violent and the efficacy of those interventions and strategies;
new text end

new text begin (3) provide recommendations on the best de-escalation strategies for the patient; and
new text end

new text begin (4) set a staffing level and patient status observation schedule for the patient to ensure
the care plan is followed and the patient's needs are met in a timely manner.
new text end

new text begin (c) The care team must evaluate the patient's care plan at least weekly to ensure the care
plan continues to be appropriate for the patient.
new text end

new text begin (d) The care team of the patient who experienced the crisis must ensure all care plans
are appropriately transferred if the patient's care is transferred to other health care staff or
to a different unit or facility.
new text end

new text begin Subd. 8. new text end

new text begin Violence interruption intervention follow-up; hospital responsibilities. new text end

new text begin After
a crisis intervention, the hospital administration must:
new text end

new text begin (1) provide options for affected staff to leave their shift and return to work when they
are fit to do so;
new text end

new text begin (2) ensure the patient's electronic health record is modified to display a conspicuous
notice alerting members of the patient's care team that the patient recently experienced a
crisis requiring a response from the violence interruption intervention team, and ensure that
this notice is removed from the patient's electronic health record once seven days elapse
without the patient experiencing such a crisis;
new text end

new text begin (3) contact affected staff to provide support and referrals to employee assistance plans,
mental health programs, and other available resources;
new text end

new text begin (4) conduct a thorough investigation of the circumstances precipitating the crisis,
including staffing levels at the time of the crisis, and documenting direct care staff concerns
about staffing levels;
new text end

new text begin (5) provide recommendations to the workplace violence prevention action plan team
under section 144.566 for remedial action and remedies around staffing levels;
new text end

new text begin (6) review incidents, staffing levels, and documentation to ensure crisis prevention
strategies are implemented and added to the workplace violence prevention action plan
under section 144.566;
new text end

new text begin (7) submit a violence incident report to the workplace violence prevention action plan
team under section 144.566; and
new text end

new text begin (8) submit to the workplace violence prevention action plan team any recommendations
for improving crisis interventions in the future that the violence interruption intervention
team may have submitted to the hospital administration under subdivision 6.
new text end

new text begin Subd. 9. new text end

new text begin Required violence interruption intervention policies. new text end

new text begin All hospitals must
adopt and implement policies governing a violence interruption intervention team's response
when hospital staff believe a patient is experiencing a crisis where the patient's behavior
may escalate to violence or is violent or believe a patient is at imminent risk of such a crisis.
The violence interruption intervention policies must include the names or job titles of the
hospital staff responsible for implementing the violence interruption intervention policies.
The violence interruption intervention policies must include procedures for:
new text end

new text begin (1) creating a violence interruption intervention team that meets the requirements of
subdivision 3;
new text end

new text begin (2) identifying and assessing a patient's condition to determine the need for response or
intervention by a violence interruption intervention team member;
new text end

new text begin (3) ambulance personnel to request that a violence interruption intervention team be
available to assist when the ambulance arrives at the hospital;
new text end

new text begin (4) training all hospital staff to seek assistance from the violence interruption intervention
team when appropriate or to call emergency services;
new text end

new text begin (5) training of violence interruption intervention team members that meet the requirements
of subdivision 11;
new text end

new text begin (6) ensuring at least one member of the violence interruption intervention team listed in
subdivision 3, who is a licensed medical professional and authorized to administer all
medications that may be required during a crisis intervention, is available on site at all times
to respond promptly to any crisis that occurs in the hospital where a patient's behavior may
escalate to violence or is violent, including a requirement that a violence interruption
intervention team member is not considered available if the team member has been assigned
any duties or tasks that would prevent the team member from promptly responding to a
crisis and immediately participating in an intervention until the resolution of the crisis;
new text end

new text begin (7) a violence interruption intervention team's timely response to a request for assistance;
new text end

new text begin (8) evaluating a patient experiencing a crisis where the patient's behavior may escalate
to violence or is violent, for substance use treatment and counseling and to provide guidance
on that treatment and counseling;
new text end

new text begin (9) ensuring the provision of linguistically and culturally competent behavioral health
crisis intervention services to patients;
new text end

new text begin (10) reporting concerns by hospital staff regarding the availability of violence interruption
intervention team members and concerns regarding the availability, condition, storage, and
maintenance of equipment; and
new text end

new text begin (11) coordinating implementation of the requirements of this section with the workplace
violence prevention plan adopted by a hospital under section 144.566, including methods
of reporting and investigating any incidents of workplace violence that result from a patient's
crisis.
new text end

new text begin Subd. 10. new text end

new text begin Required safety procedures. new text end

new text begin All hospitals must adopt and implement safety
procedures for situations in which the risk posed by a crisis where a patient's behavior may
escalate to violence or is violent exceeds the ability of the violence interruption intervention
team to safely intervene. The safety procedures must be created by the violence interruption
intervention team with input from direct patient care staff. The safety procedures must
include:
new text end

new text begin (1) mechanisms to provide appropriate intervention when health care staff are concerned
about confronting a suspected perpetrator of abuse or concerned for their own safety, such
as when a person is wielding a deadly weapon;
new text end

new text begin (2) standards for determining when and how to inform all impacted health care staff of
potential life-threatening circumstances in the hospital; and
new text end

new text begin (3) standards for determining when to call security or law enforcement to respond to an
incident.
new text end

new text begin Subd. 11. new text end

new text begin Required training for violence interruption intervention team members. new text end

new text begin (a)
All hospitals must ensure that all members of a violence interruption intervention team
receive training and education on a continuing annual basis to ensure competency in existing
and new skills in psychiatric care, crisis intervention, substance use treatment services,
providing trauma-informed care, and ensuring access to linguistically and culturally
competent care.
new text end

new text begin (b) The training and education required under this subdivision must include opportunities
for interactive questions and answers between violence interruption intervention team
members and a person knowledgeable about the hospital's violence interruption intervention
policies.
new text end

new text begin (c) The training and education required under this subdivision must be conducted during
the normal working hours of the participating team member unless the team member receives
at least the normal hourly wage for any additional time spent in the training and education
sessions. Training must be conducted only when participating team members are not
scheduled to provide patient care.
new text end

new text begin Subd. 12. new text end

new text begin Violence interruption intervention program implementation
requirements. new text end

new text begin (a) All hospitals must designate as a violence interruption intervention
director a licensed medical professional who: (1) has experience and competence in
psychiatric services; (2) is either a registered nurse or a physician; and (3) is responsible
for the implementation of the requirements of this section.
new text end

new text begin (b) The violence interruption intervention director must ensure that the policies adopted
under subdivisions 9 and 10 are developed, implemented, and annually reviewed with
meaningful input and active involvement of the following hospital staff, including hospital
staff with a recognized collective bargaining agent or agents:
new text end

new text begin (1) registered nurses who provide emergency medical services;
new text end

new text begin (2) registered nurses who provide psychiatric nursing care or provide care in a psychiatric
unit, if any;
new text end

new text begin (3) psychiatrists and other physicians who provide inpatient psychiatric services or
provide care in a psychiatric unit, if any;
new text end

new text begin (4) ancillary health care staff who provide inpatient psychiatric services or provide care
in a psychiatric unit, including psychiatric technicians, if any;
new text end

new text begin (5) emergency medical technicians who serve the hospital;
new text end

new text begin (6) violence interruption intervention team members; and
new text end

new text begin (7) any other hospital staff required to be present in a patient care area who are reasonably
anticipated to require a response by a violence interruption intervention team.
new text end

new text begin (c) The violence interruption intervention director must ensure that the programs
implementing the training and education requirements under subdivisions 9 to 11 are
developed, implemented, and annually reviewed and revised with meaningful input and
active involvement of the hospital staff listed in paragraph (b), including the development
of curricula and training materials.
new text end

new text begin (d) The violence interruption intervention director must ensure that the hospital's violence
interruption intervention program is evaluated annually for effectiveness in providing timely
access to crisis intervention services and reducing rates of workplace violence. The violence
interruption intervention director must ensure that the program evaluation is conducted with
meaningful input and active involvement of the hospital staff listed in paragraph (b).
new text end

new text begin Subd. 13. new text end

new text begin Enforcement. new text end

new text begin (a) Notwithstanding section 144.55, the commissioner of health
shall inspect hospitals for compliance with this section according to the schedule in section
144.653, subdivision 2. The commissioner shall issue a correction order to the hospital if,
upon inspection, the commissioner finds that the hospital was not in compliance with this
section for three or more days. The correction order shall state the deficiency, cite the specific
rule violated, and specify the time allowed for correction.
new text end

new text begin (b) If, upon reinspection, the commissioner finds that the hospital has not corrected
deficiencies specified in the correction order, the commissioner shall issue a notice of
noncompliance with a correction order stating all deficiencies not corrected and the provisions
of section 144.653, subdivisions 6 to 9, apply.
new text end

new text begin Subd. 14. new text end

new text begin Limited immunity. new text end

new text begin (a) No individual employed to work in a hospital shall
be subject to civil or criminal liability for engaging in conduct in good faith compliance
with the hospital's procedures governing the hospital's violence interruption intervention
program.
new text end

new text begin (b) No licensed medical professional or licensed mental health professional employed
to work in a hospital shall be subject to professional disciplinary action, including censure,
suspension, loss of license, loss of privileges, loss of membership, or any other penalty for
engaging in conduct in good faith compliance with the hospital's procedures governing the
hospital's violence interruption intervention program.
new text end