The Oregon Senate is considering a bill that would impose new and expanded workplace violence prevention, response, and reporting obligations upon hospitals, ambulatory surgery centers, home health agencies, and home hospice programs. Supporters of SB 537 argue that the proposed legislation is necessary to combat a growing epidemic of workplace violence in health care. They point to United States Bureau of Labor Statistics indicating that workers in the health care and social assistance sector are five times more likely to be sidelined by injuries resulting from workplace violence than workers in other U.S. industry sectors.[1]^,[2] Indeed, the health care sector accounts for nearly as many serious violent injuries as all other industries combined–and it is well-known that many more assaults and threats go unreported.[3] Some employees do not report workplace violence because they feel “it’s part of the job.”[4]

Opponents of the bill agree that workplace violence is a festering problem in health care. But they question whether SB 537 is the right solution at the right time. The Hospital Association of Oregon, for example, lamented in testimony that: “The bill comes at a moment when Oregon hospitals—nearly half of which are operating at a loss—are stretching limited health care dollars to care for communities and navigate the implementation of a landmark hospital staffing law.”[5]

What the bill requires

If passed in its current form, SB 537 would require health care employers to complete six high-level tasks. Specifically, they would have to:

• • Conduct periodic security and safety assessments to identify existing or potential threats of workplace violence;
  • Implement comprehensive workplace violence prevention and protection programs informed by the findings from their assessments;
  • Provide annual workplace violence prevention and protection training to their employees, volunteers, and contracted security personnel;
  • Submit detailed, annual workplace violence reports to the Oregon Health Authority;
  • Post signage informing the public of what types of workplace violence are considered criminal offenses; and
  • Implement flagging systems to alert providers and staff to potential threats of violence or disruptive behavior.

Fulfilling each of these obligations will generate a cascade of additional duties and responsibilities for health care employers. For example, SB 537 requires that employers spell out in policy who is authorized to initiate a warning flag, when posting of such a flag is warranted, and what should be done (and what cannot be done) in response to such a flag. It follows that health care employers must train their providers and staff not only to become adept at properly using the flagging technology in their electronic medical records systems, but also to avoid overreactions when they see flags in patient charts.

The bill has other, low-cost and common-sense requirements. It allows health care workers to disclose only their first names on ID badges; it requires hospitals to install bullet-resistant barriers at their emergency room intake windows; and it obligates home health care providers to collect information at intake about any health or safety risks that workers might encounter while providing services in a client’s home.

Would the bill improve safety?

Health care workers’ safety is often in direct tension with patient rights. Employers could dramatically improve staff safety by turning away patients with known violent tendencies, allowing the liberal use of patient restraints, or minimizing patient visitation rights. But these types of measures are anathema to patient autonomy, dignity, and bodily integrity. They may also be illegal.[6] Generally, restraints and seclusion may be used only to ensure the immediate physical safety of the patient and staff, and only after less restrictive interventions have proven ineffective. Medicare certification and reimbursement are contingent on health care employer policies respecting the Patient Bill of Rights. Although the health care employer’s annual assessment in SB 537 must contain an analysis of the “root causes” of workplace violence, some question whether additional tracking, reporting, and planning sufficiently address this fundamental tension.

It is important to note that SB 537 is not the Oregon legislature’s first foray into the workplace violence arena. The bill expands on a 2007 law requiring hospitals and ambulatory surgical centers to implement strategies to protect health care employees from assault in the workplace. Unfortunately, existing law has failed to stem the tide of violence, leaving Oregon as the state with the nation’s 7th highest annualized incident rate of nonfatal cases of workplace violence requiring days away from work, job restriction, or transfer.[7] (Query whether this is due to other states lacking robust reporting obligations.[8])

Yes—but at what cost?

The Oregon Legislative Fiscal Office has estimated the state’s cost of implementing SB 537 during the 2025-2027 biennium to be about $2.3 million. This amount is the aggregate compensation of the eight additional OHA staff members needed to oversee compliance with the bill.[9] But health care employers’ cost of implementing SB 537 is bound to dwarf this amount. This fact begs a critical question: Can Oregon’s health care employers afford to implement robust workplace violence programs at a time when many of them are failing to break even, and all of them are facing the prospect of substantial Medicaid cuts?[10]

There is evidence to suggest that workplace violence programs can more than pay for themselves in the forms of reduced absenteeism, improved morale, and other tangible and intangible benefits.[11] In addition, many health care employers regard protecting and promoting provider and staff health as among their top priorities. But the financial and other challenges facing Oregon’s health care industry right now are truly daunting. If shouldering the upfront cost of a new workplace violence prevention and protection program means cutting essential services, laying off staff, or postponing needed capital improvements, then neither Oregon’s health care workers nor their patients will benefit. After all, a health care provider cannot provide a safe workplace to its employees—or a safe care environment to its patients—if it cannot afford to keep its doors open.

This article summarizes aspects of the law and opinions that are solely those of the authors. This article does not constitute legal advice. For legal advice regarding your situation, you should contact an attorney.

[1] See https://www.bls.gov/iif/factsheets/workplace-violence-2021-2022.htm#:~:text=Health%20care%20and%20social%20assistance%20experienced%20the%20highest%20counts%20and%20annualized%20incidence%20rates%20for%20workplace%20violence%20of%20any%20private%20industry%20sector%20over%20the%20two%2Dyear%20period%20from%202021%2D2022

[2] See ONA at https://www.oregonrn.org/page/WPV#:~:text=Far%20too%20many%20healthcare%20workers,unsafe%20and%20unsupported%20at%20work.

[3]https://www.osha.gov/hospitals/workplace-violence#:~:text=healthcare%20accounts%20for%20nearly%20as%20many%20serious%20violent%20injuries%20as%20all%20other%20industries%20combined

[4] https://olis.oregonlegislature.gov/liz/2025R1/Downloads/PublicTestimonyDocument/160416

[5] See OHA at https://olis.oregonlegislature.gov/liz/2025R1/Downloads/PublicTestimonyDocument/197385

[6] SB 537 expressly prohibits providers from denying admission to, withholding care from, or otherwise punishing patients who have been flagged in the electronic health record as posing safety risks. The bill can also be interpreted as limiting a provider’s right to redirect a patient with known, violent tendencies from a remote and unprotected clinic site to a centralized hospital emergency room that is continuously monitored by trained security guards.

[7] https://www.bls.gov/iif/factsheets/workplace-violence-2021-2022-chart4-data.htm

[8] In 2004, the federal Occupational Safety and Health Administration established a guidelines for “framework for thinking about the challenges of workplace violence prevention,” concerning worksite analysis, hazard prevention and control, safety training, and recordkeeping and program evaluation. https://wwwn.cdc.gov/WPVHC/Nurses/Course/Slide/Unit5_5. The guidelines are not enforceable, however, and OSHA rarely penalizes health care employers for failing to provide a workplace free from recognized hazards that are likely to cause serious physical harm leading to an incidence of workplace violence. A federal bill with many of the same tracking and reporting obligations as SB 537 stalled out in the U.S. Senate in 2021. https://www.congress.gov/bill/117th-congress/house-bill/1195/all-actions.

[9] https://olis.oregonlegislature.gov/liz/2025R1/Downloads/MeasureAnalysisDocument/91545

[10] See, e.g., https://www.opb.org/article/2025/05/15/how-proposed-medicaid-cuts-could-impact-health-care-in-oregon/

[11] See, e.g., https://www.irmi.com/articles/expert-commentary/a-workplace-violence-prevention-program-an-investment-with-a-great-yield