Workplace violence killed

Deidre Silas, 36, an investigator for the Illinois Department of Children and Family Services (DCFS), was stabbed to death Tuesday while conducting a welfare check on children living in the home. Silas, a member of the American Federation of State, County and Municipal Employees (AFSCME), was the mother of two and had been with DCSF since August. Before that, she worked in behavioral health and for more than seven years with the Department of Juvenile Justice where she was a union steward.

AFSCME Council 31 President Roberta Lynch stated that “This tragedy is a stark reminder that frontline DCFS employees like Deidre do demanding, dangerous and essential jobs every day, often despite inadequate resources and tremendous stress. AFSCME will carefully study the facts of this incident as they emerge and press for any necessary changes to DCFS operations. One death in the line of service is too many.”

Unfortunately, there have been far too many “stark reminders.” The reminders need to become actions that will prevent these tragedies. This is the second time in four and a half years that a DCFS worker has been killed on the job. DCFS investigator Pamala Knight, 59, was brutally beaten to death in 2018 when she tried to take a child into protective custody.. Like Silas, Knight was alone when she was attacked.

I have been working on workplace violence issues since my first days at AFSCME in the early 1980’s where our members told horrifying stories of violent assaults.  One of earliest workplace violence fatalities I dealt with was the death of 37 year old Los Angeles County social worker Robbyn Panitch, who was fatally stabbed in the face and neck over 30 times by a client in her office. The client was known to have a violent temper and had been committed for an evaluation. But L.A. County, facing heavy budget cutbacks in 1989, started closing facilities, and released him days before the attack.  Her office had no emergency alarms or guards. Panitch was a member of AFSCME Local 2712.

At that point, health care and social service employers usually responding to workplace assaults by throwing up their hands and claiming it was “just part of the job” or even punishing injured workers for failure to keep clients under control. OSHA, in the 1980s, did not consider workplace violence an issue under the agency’s authority.  But Panitch’s death led to CalOSHA issuing the nation’s first violence-in-the-workplace guidelines that eventually became the basis for the federal OSHA’s guidelines that took the same approach to addressing workplace violence that health and safety officials took to address other hazards: Identify the risk factors then apply the hierarchy of controls: engineering controls like locked doors and communications devices, and administrative controls like training and adequate staffing.

These cases are also strikingly similar to the tragic 2012 death of 25-year-old Stephanie Nicole Ross. who was stabbed nine times, then left bleeding to death on a front lawn outside a Dade City, Florida home on Dec. 10, 2012, while visiting a client who had a history of mental illness and violent criminal behavior.

Workplace violence against social service workers and health care workers is common.

According to a 2016 Government Accountability Office (GAO) report entitled Workplace Safety and Health: Additional Efforts Needed to Help Protect Health Care Workers from Workplace Violence, workplace violence is a serious concern for 15 million health care workers in the United States. Federal injury data shows that the rates of workplace violence at health care facilities are high and rising. At state-run nursing and residential care facilities, the rates of serious injuries are higher than those in steel foundries, coal mines, hog farms or state prisons. The COVID-19 pandemic has made workplace violence in health care institutions even worse. The politics of COVID-19 and vaccinations, overcrowding, short staffing, as well as families’ inability to be with their dying loved ones have increased the frequency of violent assaults.

The COVID-19 pandemic has made workplace violence in health care institutions even worse. The politics of COVID-19 and vaccinations, overcrowding, short staffing, as well as families’ inability to be with their dying loved ones have increased the frequency of violent assaults.

According to the BLS, in 2020, hospital workers were nearly six times as likely to suffer a serious workplace violence injury than all other workers, while workers in psychiatric hospitals are at 41 times greater risk of workplace violence injuries compared with all other workers.  Individual and family social service workers are 3 times as likely to suffer as serious workplace injury than all other workers. BLS reports that over 15,000 health and social service workers had injuries so severe they lost workdays from injuries due to workplace violence in 2020, amounting to 76 percent of all workplace violence injuries across all industries. The total number of the most severe workplace violence injuries in the health care and social service industry, which are those requiring days away from work, has nearly doubled since 2011. In 2017, state government health care and social service workers were almost 9 times more likely to be injured by an assault than private sector health care workers.  And the opioid crisis has increased the number of at-risk child removals, which are always highly stressful — and potentially dangerous situations.

And workplace violence against this nation’s caregivers not only causes serious physical injuries and sometimes death, but it can also lead to post-traumatic stress disorder. Many workers are never able to return to their jobs, either due to severe physical injuries or ongoing mental trauma.

Workplace Violence is Predictable and Preventable

Employers and OSHA officials used to look at workplace violence as unpredictable and unpreventable. “You just never know when someone is going to go off.”

But you also never know exactly when a 12-foot deep unshored trench will collapse. But you know what risk factors make it more likely to collapse. Workplace violence is no different.

Employers and OSHA officials used to look at workplace violence as unpredictable and unpreventable. “You just never know when someone is going to go off.” But you also never know exactly when a 12-foot deep unshored trench will collapse. But you know what risk factors make it more likely to collapse. Workplace violence is no different.

Most assaults on health care and social service workers come from patients, clients, residents (or family members accompanying them). While no specific diagnosis or type of patient predicts specific incidents of future violence, there are risk factors that can be studied to determine the likelihood of assaults. For example, studies consistently demonstrate that inpatient and acute psychiatric services, geriatric long-term care settings, high volume urban emergency departments, and residential and day social services present the highest risks. A prior history of violent behavior will also raise the likelihood that a patient or client will behave violently. Working alone is another major risk factor.  Clients, patients and residents who are in pain, or who are facing devastating prognoses, long waiting times, unfamiliar surroundings, altered mental status associated with dementia, delirium or mind-and mood-altering medications and drugs, and disease progression can experience agitation and violent behaviors.

Workplace violence prevention plans that requires risk assessment, implementation of controls, training, recordkeeping, and program evaluation have been shown to reduce the probability of workplace violence. For field workers, knowing the history of your clients, having the ability to work in teams or even have law enforcement accompaniment are measures that can reduce their risk.  Field workers need an easy and reliable way to summon help, and where appropriate, GPS tracking systems or other means to keep track of workers’ location. They should also have pre-visit assessments, specific log-in and log-out procedures and training on emergency procedures, how to de-escalate a situation and how to defend yourself.

Finally, any change of procedure in a health care institution or affecting field work should be analyzed for its effect on increasing worker risk.  “Management of Change” procedures are common in other industries, such as chemical plants, and should be used in health care as well.

What is to be done?

At the time of Robbyn Panitch’s death, California and other states were deinstitutionalizing mental health patients and disinvesting in mental health care in the United States. People who needed close supervision because of mental health disorders or drug problems were being thrown out onto the street without adequate care or placed in community homes that didn’t always have the capacity or expertise to address their problems. Some with histories of violence or drug problems ended up in acute care hospitals or on the streets, where social workers attempted to address their problems.  Patients and family members in emergency rooms were facing longer lines and more wait times to receive dwindling services from fewer staff. Cutting costs and increasing profits in long-term care facilities meant that elderly patients lacked the care they needed. Employers routinely dismissed these violent attacks as random, unpredictable events that were “just part of the job.”

Although AFSCME and other health care unions pressed the issue – mostly futilely –with the federal Occupational Safety and Health Administration (OSHA) and state health departments, progress in the United States has been hard and slow. In the 1980s and early 1990s, most health care administrators as well as federal OSHA leadership refused to consider workplace violence an appropriate issue that the an agency that dealt primarily with falls, machine guarding and chemical issues could – or should — address. The only solution they saw at that point was to increase staffing levels, a management prerogative that OSHA was loath to interfere with. Meanwhile, state health departments pleaded poverty and rejected the notion that a worker’s right to a safe workplace should compete with a patient’s right to not be restrained, physically or pharmaceutically.

In the 1980s and early 1990s, most health care administrators as well as federal OSHA leadership refused to consider workplace violence an appropriate issue that the an agency that dealt primarily with falls, machine guarding and chemical issues could – or should — address.

Finally, in the 1990’s, OSHA’s mindset began to change.  In 1992, the US Department of Labor (DOL) Solicitors Office issued an opinion finding that violence could be considered a hazard covered by OSHA’s general duty clause, a general requirement that employers provide a safe workplace. Following the issuance of the CalOSHA workplace violence guidelines, federal OSHA issued its first Guidelines for Workplace Violence in Health Care and Social Services in 1996 and updated those guidelines in 2015.

OSHA also began enforcing workplace violence hazards in the late 1990s, but lacking a standard, the agency was forced to use only the General Duty Clause (GDC) which requires employers to provide a safe workplace. The problem with using the GDC is that it is legally burdensome and faces repeated legal attack by employers who want to categorize workplace violence as a random, unpreventable act rather than a recognized hazard that can be prevented or mitigated. GDC citations are frequently challenged in court. By comparison, an OSHA standard delineates mandatory compliance elements. Because of the legal burdens associated with use of the GDC, only a small number of OSHA inspections regarding workplace violence result in citations. In fact, from 1991 through October 2014, OSHA issued 18 general duty clause citations to health care employers for failing to address workplace violence.  In addition,  the GDC is generally used only after a worker has been injured or killed; in all 18 of the cases where OSHA issued citations, health care workers had been injured or killed by patients, clients, or residents.

Ten states—California, Connecticut, Illinois, Maine, Maryland, Nevada, New Jersey, New York, Oregon, and Washington—have some form of laws or regulations covering workplace violence in health care. In Fall 2016, federal OSHA finally started work on a workplace violence standard. The Trump administration, which kept the workplace violence standard on OSHA’s regulatory agenda, failed to move the standard past the first major regulatory step — the small business review panel. And one year into the Biden administration, OSHA has yet to move forward on workplace violence. Focused on the COVID-19 pandemic, and increasingly underfunded, OSHA’s standard setting process seems to be grinding to halt on issues aside from addressing COVID-10 related workplace hazards.

Absent an OSHA standard, labor unions representing health care and social service workers must insist that their management adhere to the OSHA’s guidance. Workplace violence prevention programs should be written into their contracts.

Absent an OSHA standard, labor unions representing health care and social service workers must insist that their management adhere to the OSHA’s guidance. Workplace violence prevention programs should be written into their contracts. 

Congress to the Rescue?

To the rescue came the House of Representatives, where the Committee on Education and Labor held a hearing in 2019 and passed bills in the 116th and 117th Congress, with bipartisan majorities, that would require OSHA to issue a workplace violence interim standard in one year, and a permanent standard in 42 months. Unfortunately, there has been no action in the Senate.  Absent Congressional action that allows OSHA to move more quickly on a workplace violence standard, it is not unlikely that another decade will pass before OSHA issues a standard.

How many more social service and health care workers will die over that time? How many will be so injured that they are never able to return to work?

 

More on workplace violence here and here.

One thought on “Another Social Worker Killed: When will it end?”
  1. If OSHA enacts the suggested regulations, will it apply to the Caseworkers, since they are usually public employees? Lets follow the case workers that respond to domestic violence and see how many are injured and killed. Case workers will be involved in violence, they will call the police to respond and another well meaning but not thought out progressive plan will lead to lives lost. I can see you blaming the republicans for the progressive democrats plans in the near future.

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