workplace violence
Photo by Earl Dotter.

Although I am frequently critical of OSHA under the Trump administration, never let it be said that I have failed to praise the agency when they do something good.

On August 11, OSHA announced that on June 29, the agency had issued a $207,690 failure to abate citation and fine against UHS of Westwood Pembroke, Inc. – doing business as Lowell Treatment Center —  in Massachusetts for workplace violence-related violations found while conducting a follow-up inspection. (OSHA even issued a press release, but that’s a different story.)  The Lowell Treatment Center is a 41-bed psychiatric hospital that offers inpatient hospitalization and partial hospitalization for adolescents and adults.  The facility has around 130 employees.

The hope is that this is a pretty big deal for a couple of reasons.

  • This is by far the largest workplace violence-related citation that OSHA has ever issued and should send a strong message to the health care industry. Normally, in workplace violence cases, OSHA issues a single serious violation for less than $10,000.  This one was so large because the hospital had failed to comply with multiple terms of a formal settlement agreement that OSHA had reached with the facility to resolve violations identified in a 2015 inspection which resulted in a $7,000 penalty for workplace violence hazards.  (The agency does not take kindly to employers who violate formal settlement agreements. The largest case in OSHA’s history was an $87 million penalty against BP issued in 2009 after the company violated the terms of its settlement agreement following the 2005 explosion at its Texas City refinery that killed 15 workers.)
  • This is hopefully an indication that OSHA does not plan to back away from aggressive pursuit of workplace violence citations when workers are at risk of assaults by patients.  This would be particularly reassuring after OSHA backed down on a citation against Bergen Regional Medical Center last June.

OSHA says that it opened a follow-up inspection at the hospital last January, after the hospital failed to provide documentation to show that it had implemented a workplace violence program, and the agency’s Andover Area Office also received a complaint alleging that employees were still at risk.

OSHA referenced three incidents that showed that UHS was not complying with the settlement:  In one case, a case manager was punched repeatedly and scratched by a patient, resulting in a scratched cornea, black eye, blurred vision, head injury, and contusions and bruises to the body. In another case,  an aggressive patient kneed an employee in the stomach while being escorted and bruised the employee’s abdomen. And a Nursing Supervisor was assaulted by a patient in the Adolescent Unit resulting in  in a concussion requiring the employee to lose at least 15 days away from work. Other cases involved “punching, grabbing, charging at, etc., resulting in bruises to the face, hands, arms, back and shoulders; back, neck, and hip injury; face swelling, and breaking of eye glasses causing a black eye.”

OSHA found that the hospital had not implemented a written Workplace Violence Prevention Program that identified risk factors such as available means of egress, items that could be used as weapons, presence of secured and/or locked rooms or units, and spaces that could pose the risk of entrapment. The hospital also failed to have a process for investigation and debriefing after each act of workplace violence, failed to ensure staff involvement and solicit input from its staff in all aspects of its Workplace Violence Prevention Program. The hospital had no system of determining the behavioral history of new or transferred patients. And the hospital had failed to implement a training program to ensure all staff are aware of the Workplace Violence Prevention Program, as well as training on effective methods for responding during a workplace violence incident, to recognize patients who are exhibiting aggressive behavior, and on techniques for timely deescalating the behavior and what protective measures to take in cases where deescalation failed. Finally, the hospital failed to maintain sufficient numbers of communication devices such as two-way radios, walkie-talkies, duress/panic alarms, or other similar devices in working order.

And UHS of Westwood Pembroke, Inc. is no mom and pop establishment. In fact, OSHA describes it as “one of the nation’s largest health-care management companies. Through its subsidiaries, UHS operates 350 behavioral health facilities, acute care hospitals, ambulatory centers, and freestanding emergency departments throughout the U.S., the United Kingdom, Puerto Rico, and the U.S. Virgin Islands.”

What’s Next?

Meanwhile, the nation’s eyes are focused on whether OSHA will move forward on its workplace violence standard.  OSHA began rulemaking last year by putting workplace violence on the regulatory agenda, conducting a stakeholder meeting in January 2017 and launching a request for information (RFI). In addition,  OSHA’s Assistant Secretary David Michaels stated at that stakeholder meeting that OSHA had officially accepted the union petitions and would move forward with a standard to protect health care and social service workers.  The Government Accountability Office recently sent a letter to OSHA asking the agency about its progress on a workplace violence standard.

Under normal circumstances, OSHA should be ready to launch the small business review (SBREFA) process soon, but given this administration’s hostility toward regulatory protections for workers (including the Executive Order requiring two worker protections to be removed for every one added), it’s unclear when — or if — that will happen.

Resource: Check out OSHA’s webpage on Workplace Violence.

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