Workers in California’s hospitals and doctors’ offices may be less likely to get hit, kicked, bitten or grabbed under workplace standards adopted by a state workplace safety board.

Regulators within the California Division of Occupational Safety and Health approved a rule last Thursday that would require hospitals and other employers of health professionals to develop violence prevention protocols and involve workers in the process. The standard now will be reviewed by the Office of Administrative Law, which proponents expect will approve the new rules. The earliest they could take effect would be January 2017.

“This is a landmark day for the entire country,” said Bonnie Castillo, a registered nurse who is director of health and safety for the California Nurses Association/National Nurses United, which represents 185,000 registered nurses across the U.S.

There are no federal rules specifically protecting workers from violence, but some states, including California, New York, Illinois and New Jersey require public employers to take preventive measures, according to the American Nurses Association.

The Cal/OSHA rules apply to private health care facilities in the state and are more robust than existing workplace protection rules, union officials say. Site-specific assessments will be done to identify violence risks, and the resulting plans to prevent injuries will address concerns identified by workers.

“California has now set the bar with the strongest workplace violence regulation in the nation,” wrote Castillo in a statement.

Two unions, the California Nurses Association and the Service Employees International Union, have been pushing for more comprehensive protections because of what they see as an alarming rate of health care workplace assaults, such as the 2010 strangling death of a nurse at a state-run psychiatric hospital in Napa.

“Unfortunately, [violence] is sort of a daily occurrence,” said Kathy Hughes, a registered nurse and spokesperson for the SEIU Nurse Alliance of California. She said her union formed a campaign and talked to hundreds of health care professionals, many of whom had accepted the idea that assaults happen at work. But “violence shouldn’t be part of the job,” said Hughes.

The California Nurses Association sponsored the 2014 bill that required the board to adopt the violence prevention rules this year.

National research shows that health care workers are at a “substantially higher” risk of workplace violence than the average worker. In 2013, for example, private-sector hospital workers were five times more likely to take time off from work because of an injury caused by violence than a typical private sector worker.

Workplace safety standards already exist in California, but the Cal/OSHA rules are specifically designed to prevent violence.

“It can’t be a cookie-cutter approach,” said Hughes, adding that emergency departments and pediatric care units pose different dangers to workers, so safety protocols can’t simply be a canned plan found on the Internet.

Both the California Nurses Association and SEIU say they hope the new California standards will become a national model.

Testimony at hearings leading up to the approval of the rules to prevent violence suggest that worker assaults vary in severity.

As a student nurse at a San Francisco hospital, Amy Erb remembered being kicked in the head by an agitated, confused patient with a traumatic brain injury.

Other health care workers told stories about patients throwing lamps, lifting caregivers up by their necks or stuffing dirt into the mouths of their colleagues.

Under the new rules, California employers wouldn’t be liable for every act of violence against a worker, such as a mass shooting, but they could be cited by Cal/OSHA for not following protocols, Hughes said. The standard applies to hospital-affiliated facilities and clinics, including home health care settings and drug treatment programs.

Hospitals and physicians were at the table when regulators hammered out the workplace rules. The California Hospital Association didn’t provide comment for this story, but it had been opposed to creating new standards when lawmakers looked at the issue in 2014. Hospitals also wanted “workplace violence” to be better defined.

The hospital trade association said several recent trends may contribute to violence at health care facilities. Cuts to mental health care services lead to more psychiatric patients in hospitals. The aging patient population may include more Alzheimer’s patients, some with aggressive tendencies. And hospitals caring for current or recently released prisoners face a higher risk of violence.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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Researchers have launched an innovative medical experiment that’s designed to provide quick answers while meeting the needs of patients, rather than drug companies.

Traditional studies can cost hundreds of millions of dollars, and can take many years. But patients with amyotrophic lateral sclerosis, or Lou Gehrig’s disease don’t have the time to wait. This progressive muscle-wasting disease is usually fatal within a few years.

Scientists in an active online patient community identified a potential treatment and have started to gather data from the participants virtually rather than requiring many in-person doctor’s visits.

How is that possible?

In this case, doctors and patients alike got interested in an extraordinary ALS patient whose symptoms actually got better, which rarely occurs. He’d been taking a dietary supplement called lunasin, “and lo and behold six months later, [his] speech [was] back to normal, swallowing back to normal, doesn’t use his feeding tube, [and he was] significantly stronger as measured by his therapists,” said Richard Bedlack, a neurologist who runs the ALS clinic at Duke University.

Of course, it could just be a coincidence that the man who got better happened to be taking these supplements. To find out, Bedlack teamed up to run a study with Paul Wicks, a neuropsychologist and vice president for innovation at a web-based patient organization called PatientsLikeMe.

The study they came up with dispensed with many of the standard features of research that make it so expensive, time-consuming and often so hard to recruit patients:

• There’s no comparison group taking a placebo; instead the researchers match each patient with three to five people whose disease was on a similar course.
• The researchers could skip safety testing because the supplement is already on the market.
• Most important, they aren’t looking for subtle effects, like slower disease progression. That may be vital for a pharmaceutical company seeking approval for a new drug, but isn’t necessarily what patients want.

“I think what people are really looking for is to regain some function,” Wicks says. “So with limited time resources, limited patients available to take part in studies, perhaps we want to swing for the fences every now and then.”

Chances are the dietary supplement won’t help, but at least people will learn the outcome quickly and won’t waste their time and money if lunasin fails.

“If we find just one patient that has a reversal the size of the initial patient, that in itself is incredible, because these reversals are once in a generation,” Wicks said. He and Bedlack have identified just 24 patients, over many years, whose disease actually reversed course, at least temporarily.

The study recruited 50 volunteers at a record pace for ALS research, Bedlack said. That’s partly because it only requires three doctor visits. Those appointments are frequently challenging for people with this debilitating disease.

Most of the data are gathered virtually — patients post their own weekly assessments in a secure area of the PatientsLikeMe website.

Karen Lorne, a 58-year-old nurse practitioner from Chapel Hill, N.C., had cared for patients with ALS, so she knew about the inexorable nature of the disease. This spring, she noticed she could no longer hold medical instruments securely in her left hand, and her speech started to slur. She was diagnosed with ALS in July.

“I was pretty shocked that we know so little and that we have no idea how to fix it — because that’s what we do in medicine,” she says.

After considering her options, Lorne decided to sign up for the low-hassle trial with the supplement. She reports her own symptoms once a week, by typing them in on the PatientsLikeMe website. She can track her own progress, as well as that of the other patients in the study.

And it also serves as a support group. “You can type in, ‘I’m having a bad day,’ and somebody will give you a list of pointers to help you keep in the center, which is where you really want to live,” she said.

And the study doesn’t consume her precious days. She still can focus on her family and life’s daily pleasures.

“We try to live in the present and enjoy every moment as thoroughly as possible,” she says. “And actually, some of my friends who do not have the disease, seeing me having it has helped them shore up their lives and recognize what’s important.”

She is also helping advance knowledge about ALS, even if this trial doesn’t end up helping her.

Patients are a valuable resource, yet only 10 percent ever end up in a study.

“If this infrastructure works, in two years could you imagine 20 trials like this run in parallel?” Wicks asks. “You know, I have a question for the field: Why isn’t every patient in a study?”

One reason that’s not the case is that very ill patients are not likely to recover under any circumstances, so they don’t usually provide a lot of value in scientific studies, says Jeffrey Rothstein, a neurologist who runs ALS studies at the Johns Hopkins University School of Medicine. “That’s why almost no trial is open to all-comers,” as this one was, he says.

He agreed, though, that the study would show whether the supplement has a truly dramatic effect, which is the main purpose of the experiment. “The value of getting patients involved is fantastic,” he says.

If a virtual study like this identifies a promising lead, scientists could quickly pursue that through laboratory studies and more traditional studies with volunteers. Clearly that approach, of starting with animal studies and building on that knowledge, has been a huge disappointment so far with ALS.

And if the approach is successful, it could apply to other diseases as well.

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The White House released information Monday about rates and offerings for the 2017 Affordable Care Act Open Enrollment.

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