House committee reviews H.259 to require hospital workplace-violence plans and reporting

The Vermont House Committee on Health Care heard a presentation on H.259 on a proposed set of requirements intended to prevent workplace violence at hospitals, including mandated hospital security plans, incident reporting, and changes to budgeting and certificate-of-need rules. Katie, legislative counsel to the committee, walked members through the bill’s text and said it would take effect July 1, 2025.

The bill matters, supporters told the committee, because workplace violence in health care is common and costly: Devin Green of the Vermont Association of Hospitals and Health Systems said high turnover linked to workplace violence drives substantial recruitment and training costs for hospitals, and that Vermont shows high rates of workplace‑violence injury days compared with other states.

H.259 would add a new section to Title 18 requiring hospitals licensed under the hospital‑licensure chapter to develop and implement a written security plan to prevent workplace violence and manage aggressive behavior. Katie, legislative counsel, said the bill mandates that each hospital create a security‑plan development team that must include direct‑care health care employees, the state’s attorney for the region (the district attorney), and relevant law‑enforcement representatives.

The bill requires a security risk assessment that addresses high‑risk areas including emergency departments and other patient care areas and that is informed by medical and nursing directors and supervisors of high‑risk units. The plan must consider patient volume, local crime rates and law‑enforcement response availability. The bill would allow health‑care employees who provide direct patient care to request an identification badge showing only a first name or a first name plus last initial.

Training is a central element: the security plan must set training requirements in areas the bill lists, including a culture of safety, response to presence or use of weapons, defensive tactics, de‑escalation techniques, appropriate physical restraint and seclusion, crisis intervention, trauma‑informed care, clinician well‑being practices, and law‑enforcement presence and intervention. Katie said the bill requires at least one hospital employee trained in de‑escalation to be present at all times in emergency departments and other patient care areas and calls for a trauma‑informed‑care liaison to support victims and coordinate with law enforcement.

H.259 would also require hospitals to adopt a workplace‑violence incident reporting system to document, track, analyze and evaluate incidents. The reporting system, the bill states, must at minimum track the number of reported incidents, the number of incidents reported to law enforcement and the number of individuals involved in reported incidents who were criminally charged. The bill creates a nondiscrimination and anti‑retaliation requirement for employees who report incidents or participate in investigations and requires conspicuous notice to patrons that threatening or aggressive behavior is not tolerated. The Agency of Human Services would be directed to collaborate with hospitals on incentives and funding to implement prevention programs.

The bill would add an explicit exception in the certificate‑of‑need (CON) section so expenditures necessary to implement an approved security plan would be excluded from CON review. It would also add a requirement that the Green Mountain Care Board consider and record costs associated with implementing a hospital’s security plan when hospitals file required budget information, and that budgets allocate sufficient funds to support plan operation and capital investments.

Committee members voiced several implementation concerns during the discussion. Multiple members urged clarity on which staff the bill intends to train in defensive tactics versus de‑escalation, with several lawmakers and nurses saying it would be inappropriate for bedside nurses to be relied on as the hospital’s defensive force. A committee member noted the importance of ensuring the word “appropriate” used in the bill not make nurses the default personnel expected to perform security functions; another member asked whether the security‑plan development team or an external reviewer would approve who is designated to receive each category of training.

Devin Green, the Vermont Association of Hospitals and Health Systems representative, said hospitals generally support the bill but cautioned about the practical burden of tracking whether an incident reported to law enforcement ultimately resulted in criminal charges, because charging decisions are outside hospital control. Green also urged flexibility on signage so that messaging does not create an adversarial dynamic between staff and patients.

Members discussed existing work under Act 24 (work the committee passed two years earlier) and previous statewide reporting efforts; witnesses said hospitals vary in the content and resources of their existing plans, and that H.259 aims to standardize elements of planning and to ensure funding is available. Committee members asked for witness testimony from hospital security leaders; Katie said she had invited the head of security at UVM Medical Center or a delegate to testify in later hearings.

No vote was taken on H.259 during the hearing. Committee discussion continued with multiple members expressing the bill’s goal to reduce threats to clinicians but also asking for tightened language on training, clearer definitions of which facilities and affiliated sites are covered, and practical guidance to avoid creating additional risk for clinical staff.

Next steps: the committee plans to hear witnesses and follow‑up testimony in subsequent hearings; no formal action on H.259 was recorded at the session.