workplace violence

Workplace violence continues to kill and injure this country’s caregivers while the latest round of healthcare worker homicides has renewed calls for action to be taken to protect healthcare workers.

Two healthcare workers were shot and killed at Methodist Dallas Medical Center in Dallas Texas on Saturday. The shooter, who was shot and wounded, was out on parole for aggravated robbery. The two women, 43-year-old social worker Jacqueline Pokuaa and nurse Katie Flowers, 63, were shot and killed by a man who was there for the birth of his child, according to police and the hospital.

And on Saturday, June Onkundi, a nurse practitioner at the Freedom House Recovery Center clinic in Durham was fatally stabbed Tuesday by a patient at the clinic. Freedom House Recovery Center is a licensed outpatient facility under the North Carolina Department of Health and Human Services’ Division of Health Service Regulation

A former employee at Methodist revealed that

“there have been security concerns at the hospital for years, including not enough restrictions, and not enough oversight. ‘Like, we’ve said this. We’ve said this is going to happen. We always said it was going to happen.’ Since the shooting, Methodist has not held a press conference or even answered FOX 4’s specific questions about security protocols, even though its own police force is leading the investigation. “It feels very shady, it feels like there’s some sort of covering up of something that’s going on,” she said.

More upsetting is that, according to FOX4 News, although many active Methodist healthcare workers have reached out to the station with security concerns. “The thing is, none will interview for fear of losing their jobs.”

“The thing is, none will interview for fear of losing their jobs.”

These homicides come less than a year after Illinois Department of Family and Child Services social worker Deirdre Silas was brutally stabbed to death while conducting a welfare check on children living in a private home. A hospital worker was killed in June after he was kicked by a woman in June and last July, a nurse and paramedic were stabbed at Missouri hospital.

Meanwhile, an OSHA standard to protect healthcare and social service workers from workplace violence languishes.

An Epidemic of Workplace Violence Injuries

When healthcare and social service workers are killed on the job, there are big headlines, at least for a few days. But homicides are just the tip of the workplace violence iceberg.  Injuries caused by workplace assaults are at epidemic levels, but rarely receive any attention by the media.

Homicides are just the tip of the workplace violence iceberg.  Injuries caused by workplace assaults are at epidemic levels, but rarely receive any attention by the media.

A 2020 report from the House Committee on Education and labor noted that healthcare workers suffer high injury rates from workplace violence.

In 2019, hospital workers were nearly five times as likely to suffer a serious workplace violence injury than all other workers, while workers in psychiatric hospitals are at 34 times greater risk of workplace violence injuries compared with all other workers. BLS reports 20,870 health and social service workers had injuries so severe they lost workdays from injuries due to workplace violence in 2019, amounting to 70 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….Studies have found between 19-30 percent of hospital workers report being physically assaulted at work, and 70 percent of psychiatric hospital workers reported being assaulted during the past year.

Public employees, many of whom are not covered by OSHA, are at even higher risk.

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. Each year, nearly 7 percent of psychiatric aides employed in state and local government mental health facilities experienced violence-related injuries causing them to lose time from work. State psychiatric aides suffered an extraordinarily high rate of assault-related injuries in 2019—1,460.1 per 10,000 workers. State mental health and substance abuse social workers averaged 155 per 10,000 workers over the past five years; psychiatric technicians are at 429.6 per 10,000 workers; nursing, psychiatric and home health aides at 412.8 per 10,000 workers; health care support occupations at 506.6 per 10,000 workers; and nursing assistants at 132.1 per 10,000 workers.

Workplace violence against this nation’s caregivers not only causes serious physical injuries and sometimes death, but it can also lead to mental health problems and post-traumatic stress disorder — conditions that often keep healthcare workers from ever returning to the job, even after their physical injuries have mended.

OSHA’s Slog

Workplace violence against healthcare workers has been a problem for decades. It became particularly acute in the 1980s with funding cuts across health care and social services left frustrated people waiting in long lines for dwindling services. Compounding the problem was a wave of deinstitutionalization closed mental health institutions across the country, leaving patients and clients with limited treatment from social workers and hospital emergency rooms.

Unions representing healthcare workers pressured OSHA to address workplace violence issues and in the late 1990’s, OSHA issued guidance on workplace violence for healthcare and social service workers (updated in 2012) as well as late night retail workers. OSHA also began citing employers under the agency’s General Duty Clause which can be used when there is no standard covering a specific hazard.

CalOSHA has an effective workplace violence standard and nine other states — 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.

If federal OSHA does not finalize a workplace violence standard in the next 27 months, it may be decades before healthcare workers receive the protection they need.

Federal OSHA began work on a workplace violence standard for healthcare and social service workers in 2016, shortly before the end of the Obama administration. Unfortunately, the Trump administration did not move forward on that rule, and Biden’s OSHA is prioritizing COVID-19 and heat standards ahead of workplace violence. Today, well over two and a half years into the Biden administration, OSHA has still not taken the first step — the small business (SBREFA) review — toward issuing a final standard. It is highly unlikely that OSHA will even be able to issue a proposed standard, much less a final standard by the end of this Presidential term.  Progress on the standard has fallen victim to budget cuts and the agency’s lack of strategic direction in its regulatory agenda.

OSHA’s regulatory budget was cut by 10% under the Trump administration and has still not recovered to its FY 2016 level. Meanwhile, the agency fails to understand that unless standards are finalized, there is nothing to stop a Republican administration from slowing or stopping progress.

The bottom line is that in the unfortunate event of a Republican takeover of the White House in 2025, workplace violence will again be relegated to to regulatory dungeon. To be clear, if federal OSHA does not finalize a workplace violence standard in the next 27 months, it may be decades before healthcare workers receive the protection they need.

Workplace violence is not the only OSHA standard to fall victim to a failure of strategic focus. Aside from COVID-19 in healthcare institutions, in the 27 months remaining in this Presidential term, OSHA is on course to finalize NONE of the major standards its working on now — workplace violence, infectious diseases, heat, process safety management, tree care or emergency response.

Workplace Violence: House Action; Senate Inaction

In 2019, the House of Representatives passed H.R. 1309 with bipartisan support. A similar bill, H.R. 1195 was passed by the House in 2021, also with bipartisan support.  The legislation directed OSHA to issue an interim final standard within one year of enactment, to propose a final standard within two years of enactment, and to issue a final standard within 42 months of the date of enactment. The OSHA standard would require employers in the health care and social service sectors to develop and implement a comprehensive plan for protecting workers from workplace violence. The bills would also have covered public employees in the 23 states where public employees are not currently covered by OSHA.

The American Hospital Association opposed the legislation and an OSHA standard, citing “prohibitive costs” and that workplace violence is already a “top priority” that hospitals take seriously.

No action was taken in the Senate on either bill.

Union Action

As with most workplace safety and health issues, the best solution for workers is strong contract language requiring employers to establish and implement a workplace violence program similar to the programs described in OSHA’s guidance. Workplace violence is an increasing important topic for the organizing and bargaining activities of some healthcare worker unions who report that the COVID-19 pandemic has led to increasing rates of workplace violence.  Unfortunately, other healthcare worker unions have eliminated or sharply reduces their health and safety offices, leaving their healthcare workers largely on their own. (Are you listening AFSCME and SEIU?)

One thought on “Healthcare Worker Shootings: Where is OSHA’s Workplace Violence Standard?”
  1. We need a standard. We need training on how to observe/report possible violent acts at work. In high risk workplaces we need a labor-management meeting or a special staff meeting on the topic of Violence in the Workplace. If there is no OSHA protection we need to file grievances to abate the hazard of violence or potential violence.

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