Spotlight on the Workplace Violence Bill: What is the right next step for Massachusetts?

Healthcare workers deserve workplaces that take violence seriously—not only after someone has been injured, but before an interaction reaches that point.

They deserve adequate staffing, useful training, responsive management, enforceable prevention plans, support following an injury, and institutions that learn from harmful encounters rather than simply recording them.

Patients and people receiving services also deserve safety. They deserve care that does not unnecessarily expose them to force, abuse, neglect, restraint, arrest, prosecution, or placement on a government-connected list of supposedly dangerous people.

Massachusetts lawmakers now have an opportunity to create legislation that protects both groups. Whether they will do that rests largely with the conference committee currently reconciling the House and Senate versions of H.4767/S.3184.

At a minimum: Choose the Senate version

If the conference committee limits itself largely to choosing between the two existing versions, it should adopt the Senate approach rather than the House provision allowing a knowing and intentional assault and battery on a healthcare worker that causes injury to be prosecuted as a felony. The House version would allow up to five years in state prison when the conduct causes bodily injury and up to ten years when it causes serious bodily injury.

As the previous articles in this series have discussed, increased penalties have not been shown to prevent violence against healthcare workers. The House proposal would expose more people to the lifelong consequences of felony prosecution—particularly people in psychiatric crisis, people with intellectual or developmental disabilities, Black and Brown people, unhoused people, and others already disproportionately subjected to policing.

The Senate version avoids that felony expansion. It also preserves several potentially valuable provisions, including employer prevention plans, incident reporting, paid leave and support for injured workers, protection against retaliation, and eligibility for consideration under the Commonwealth’s existing pretrial-diversion law.

If the choice is between the House and Senate approaches, the Senate version is clearly less harmful.

However, “less harmful” should not be confused with “good enough.”

The Senate version would still create new authority for police to make warrantless arrests for alleged misdemeanors in hospitals. After one year, that authority would automatically expand to the bill’s much broader definition of a healthcare facility—including certain group homes operated, funded, or overseen by the Department of Mental Health, Department of Developmental Services, or Department of Public Health.

Both versions also direct state agencies to develop recommendations for expanded information sharing involving healthcare, public-safety, and law-enforcement systems. The proposals focus in significant part on people with psychiatric or behavioral-health diagnoses and people with intellectual or developmental disabilities.

At a minimum, the conference committee should reject the House felony provision while preserving the Senate’s worker protections, prevention requirements, de-escalation language, and eligibility for consideration under pretrial diversion. It should also prevent the automatic expansion of warrantless-arrest authority into group homes.

That would prevent some of the most immediate damage. It would not, however, transform the proposal into the comprehensive prevention law Massachusetts needs.

If we really want to make a difference

If lawmakers genuinely want to reduce violence rather than simply increase the consequences imposed afterward, the final legislation requires more substantive changes.

Eliminate the interagency list and data-sharing proposal

Both versions direct state officials to develop recommendations for increased information sharing between healthcare facilities, public-safety agencies, and law enforcement. The House version goes especially far, directing officials to consider allowing healthcare facilities to access government reports on individuals and integrate that information into patients’ electronic health records.

The Senate language is somewhat less explicit, but it still directs health and public-safety agencies to develop data-sharing recommendations centered on “criminal justice-involved” people with psychiatric, behavioral-health, or intellectual and developmental disability diagnoses. Its report would also be submitted to the Joint Committee on Public Safety and Homeland Security.

Privacy safeguards do not resolve the central problem.

Government and healthcare institutions should not build an infrastructure for identifying, tracking, and circulating information about a disability-defined population as a public-safety concern. Whatever helpful purpose is offered—continuity of care, improved placement, advance warning—the system would allow police involvement, disability status, psychiatric information, healthcare records, and institutional judgments about dangerousness to follow a person from one setting to another.

The history of lists created by powerful institutions to identify supposedly dangerous, defective, disruptive, or undesirable people gives us little reason to believe that the risks can be solved through better management of the list.

This proposal should be removed entirely.

Remove the warrantless-arrest provision—and keep it out of group homes

The final bill should also eliminate the proposed expansion of warrantless-arrest authority. Existing law already allows alleged assaults to be investigated and prosecuted, and proponents have not demonstrated that bypassing the ordinary warrant process will prevent violence.

The Senate bill initially limits this new authority to hospitals, but after one year it automatically expands to all settings covered by the bill’s definition of a “health care facility.” That definition includes certain group homes overseen, operated, or funded by DMH, DDS, or DPH.

A group home is someone’s home. Receiving disability services or mental-health treatment should not subject a person to a special arrest rule inside the place where they live.

If lawmakers refuse to remove the provision completely, it should not apply:

• In group homes, residential programs, or other community-based disability-service settings.
• To someone undergoing a psychiatric, behavioral-health, or developmental-disability evaluation.
• To someone being transported, confined, examined, or treated involuntarily.
• When the alleged conduct occurred while the person was being restrained, secluded, searched, forcibly medicated, touched without consent, prevented from leaving, or subjected to another use of force.
• When disability-related behavior, communication differences, delirium, dementia, cognitive impairment, or an inability to understand what was happening materially contributed to the encounter.
• When there is no allegation of serious bodily injury or use of a dangerous weapon.

An allegation that someone struck a worker without context may sound straightforward. It becomes considerably less so when the person was being held down, forcibly undressed, injected, prevented from leaving, or attempting to breathe while several people restrained them. The criminal legal system is particularly poorly equipped to determine what happened in the immediate aftermath—especially when institutional reports reflect only employees’ perspectives.

Problems in group homes require well-trained staff, adequate staffing, meaningful oversight, accessible complaint processes, crisis support, and accountability when providers fail residents or workers. They do not require transforming disability-service settings into extensions of the criminal legal system.

Require that current and former patients and advocacy groups have real and ongoing input

Neither version provides current or former patients, psychiatric survivors, people with intellectual or developmental disabilities, or independent advocacy organizations with a meaningful role in developing or implementing the legislation.

That omission is particularly striking in a proposal that would expand policing and information sharing in settings where these communities receive services.

People directly affected by the law should have legally required roles in developing regulations and training, designing incident-reporting standards, reviewing implementation and disparities, recommending corrective action, and participating in ongoing policy development. Their involvement should be substantial, compensated, and independent of healthcare employers, and include people with direct experience of involuntary treatment, force, psychiatric hospitalization, group homes, and criminalization within healthcare settings.

“Consultation” cannot mean inviting one patient representative into a room after the major decisions have already been made.

Count the whole encounter

Incident reports should document more than the final behavior attributed to a patient. They should include:

• Staffing and crowding at the time, delays in care, and unmet requests.
• Untreated pain, hunger, exhaustion, and sensory distress.
• Language, communication, disability, and sensory-access needs.
• Whether the person was being held involuntarily or attempting to leave.
• Searches, restrictions, threats, unwanted touching, forced medication, restraint, seclusion, or other force used before and during the incident.
• Whether de-escalation was attempted and what it actually consisted of.
• Allegations that workers harmed, threatened, neglected, humiliated, or provoked the patient.
• The perspectives of both workers and patients.
• Racial, disability, gender, and other disparities.
• Organizational changes that could prevent recurrence.

Violence does not begin at the moment a hospital starts counting.

Without information about what happened beforehand, Massachusetts will collect more reports without learning what actually produced—or could have prevented—the harm.

Require an independent evaluation

Neither version adequately requires Massachusetts to determine whether the legislation makes anyone safer.

A recent 50-state review found that Illinois was the only state whose healthcare workplace-violence law expressly mentioned evaluation of prevention programs. Even that requirement operates at the individual-provider level and does not appear to require an independent statewide assessment of whether the law reduced violence or caused unintended harm.

Massachusetts should go further. The final bill should establish an independent evaluation process, collect baseline information before implementation, and require regular public reporting afterward.

That evaluation should examine:

• Worker and patient injuries, lost work time, and allegations of abuse or neglect.
• Restraint, seclusion, forced medication, police calls, arrests, charges, convictions, and diversion outcomes.
• Staffing, crowding, wait times, and employee turnover.
• Outcomes by race, disability, gender, age, diagnosis, language, and facility type.
• Whether the law reduced harm or merely shifted more of it onto patients.
• Whether people arrested actually received promised support, and how prosecution affected housing, employment, immigration, family stability, and future access to healthcare.

The evaluators should have access to underlying data rather than summaries created exclusively by healthcare employers. Workers and current and former patients should be represented, but the process should not be controlled by hospital associations, law enforcement, or the agencies whose performance is being evaluated.

Any criminal-enforcement provisions should also contain a sunset date. If the Commonwealth cannot demonstrate that they improved safety without producing disproportionate harm, they should expire rather than become permanent through inertia.

Massachusetts does not need to invent prevention

Other states have already enacted stronger employer-focused prevention requirements. California’s healthcare workplace-violence regulation, for example, requires unit-specific written plans, active worker participation, assessment of environmental and staffing hazards, prompt correction of dangers, detailed incident documentation, recurring training, and annual review.

California’s approach is not perfect. Its patient-specific risk-assessment provisions could contribute to stigmatizing records or warnings, and Massachusetts should not reproduce that aspect. But its enforceable requirements involving staffing, working conditions, corrective action, employee participation, and annual review provide a much stronger model than relying primarily on arrests and punishment.

Massachusetts can adopt the strongest elements of that approach without creating patient-flagging systems or reinforcing the idea that psychiatric and disabled people are inherently dangerous.

What to tell the conference committee

The central message is simple:

Healthcare workers deserve genuine protection, but increasing punishment and police involvement after harm occurs is not a substitute for preventing it.

Ask the conference committee to:

1. Reject the House felony provision and preserve the Senate’s worker protections, prevention requirements, de-escalation language, and eligibility for consideration under pretrial diversion.
2. Remove the proposed interagency data-sharing and patient-list infrastructure.
3. Remove the warrantless-arrest expansion—or, at an absolute minimum, exclude group homes, disability-related conduct, psychiatric or disability evaluations, involuntary treatment, and encounters involving prior uses of force.
4. Require meaningful, compensated participation by current and former patients, psychiatric survivors, disabled people, and independent advocacy groups in training, implementation, evaluation, and policy development.
5. Require facilities to count the whole encounter and hold employers accountable for staffing, communication access, training, complaint systems, prevention planning, and corrective action.
6. Require independent evaluation, public reporting, disparity analysis, and sunset provisions.

We strongly encourage people to contact all six conference committee members and share their concerns, recommendations, and experiences.

Roots Up has provided a draft letter that readers can edit and personalize before sending it to the committee members. You can find that letter by clicking below.

Read more articles in this series…

Send a letter to the conference committee…

This article is a part of the Spotlight on the Workplace Violence bill.