Health Care Workers Unprotected

I. Introduction

On March 8, 2012, John Shick walked into Western Psychiatric Institute and Clinic at the University of Pittsburgh with one motive on his mind, to cause harm to others. Upon his arrival, Shick opened fire in the lobby. His shooting rampage left one person dead and six others wounded.3

Although we cannot know for certain, the incident might have been prevented if the Western Psychiatric Institute were required to have a plan to prevent violence, as recommended nearly two decades ago by the Occupational Safety and Health Administration (OSHA).4

But OSHA never issued a rule to require employers to create such a plan. The Western Psychiatric Institute, in turn, had no “policy or procedure that specifically addresses therisk of patient on staff violence,” according to a draft report on the shooting.5

The insufficiency of OSHA’s actions to prevent workplace violence is emblematic of overallshortcomings in the agency’s efforts to protect health care workers. The government’s responsibility, as written in law, is “to assure so far as possible every working man andwoman in the Nation safe and healthful working conditions.”6 But OSHA is not fulfilling that obligation for health care workers, who suffer more injuries than workers in any other sector in the United States.7 In 2010, for instance, health care employers reported 653,900 workplace injuries and illnesses,8 more than 152,000 more than the next most afflicted industry sector, manufacturing.9

The rate of injuries and illnesses per worker, as opposed to absolute totals, is slightly less in the health care sector than in some others. But for certain types of injuries, the rates of affliction of health care workers (as well as the absolute totals) are by far the highest among all industries.10

Of all workplace violence incidents in the United States that result in lost workdays, 45 percent are in the health care sector.11 Meanwhile, the rate of work-related musculoskeletal disorders for nursing aides, orderlies and attendants was the highest in the nation in 2011, and more than seven times the national rate for all employees.12 As in the case of workplace violence, no specific rules are on the books to protect health care employees from hazards that cause musculoskeletal disorders.

Health care is one of the largest industries in the United States, and is growing rapidly. In 1997, the health care and social assistance sector (the category used by the government that encompasses medical care and other forms of social assistance) employed 13.6 million people.13 By 2010, the sector employed 18.1 million people.14 By 2020, it is expected to add another 5.6 million jobs.15

Officials at OSHA are well aware of the risks facing health care workers. The agency has documented problems in advisory publications and has taken some actions, such as establishing a program focusing on risks in nursing homes.

But OSHA has devoted relatively little effort to addressing the safety risks at health care facilities compared to its work in other highly afflicted industries. For example, health care workers outnumber construction workers more than two-to-one, but OSHA conducts only about one-twentieth as many inspections of health care facilities as construction sites.16

The paucity of inspections is only part of the problem. Enforcement efforts also are frustrated by a dearth of safety rules relating to the types of risks facing health care workers. This gives inspectors a limited menu of choices to cite facilities for safety violations. A last resort for the agency is to rely on its catch-all “general duty” clause, which requires employers to provide conditions that are “free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employee.”17 But the evidentiary standard for the general duty clause is so high that few cases are brought pursuant to it.

For instance, in 2012, OSHA initiated a “national emphasis program” to focus on risks faced by employees of nursing homes and residential care facilities. “Ergonomic stressors” was the first hazard listed in the announcement of the program.18 But OSHA has issued nursing homes and residential facilities just seven citations for unsafe ergonomic conditions in the past two fiscal years.19 (The agency reports that it also has issued at least 56 Hazard Alert Letters “outlining ergonomic hazards and providing employers examples of feasibleabatement methods they can implement to help prevent ergonomic related injuries to workers.”20)

OSHA’s leader, Assistant Secretary of Labor David Michaels, acknowledges that health care safety problems need to be addressed. “It is unacceptable that the workers who have dedicated their lives to caring for our loved ones when they are sick are the very same workers who face the highest risk of work-related injury and illness,” Michaels said in a2011 statement accompanying the release of data showing rapidly increasing injury rates among health care workers.21

When OSHA has created standards to protect health care workers, as it did in recent decades to address hazards posed by bloodborne pathogens and ethylene oxide, its actions have generated laudable results. Its rules have greatly reduced the threat of cancer to health care workers, reduced the incidence of hepatitis B by 95 percent and virtuallyeliminated workers’ risk of contracting HIV/AIDs.

But OSHA has not begun to create standards to address health care workers’ susceptibility to ergonomic hazards or workplace violence. For its part, OSHA said in response to questions posed by Public Citizen to Michaels’ office that it “does not have resources to move forward on all rulemaking necessary to address all the pressing workplace health and safety hazards.”22 [OSHA’s complete response to the questions is published in the Appendix of this report.]

In fairness to OSHA, the adversity it faces goes well beyond a shortage of resources. The process for creating standards has become so cumbersome and subject to interference that the agency could not possibly fulfill its mandate. For instance, the agency published a rule in 2000 to protect workers in all industries from ergonomic hazards, but Congress repealed the rule before it took effect.23 During the first term of the Obama administration, OSHA proposed a rule that merely would have added a column to reporting logs for employers to indicate whether an injury was a musculoskeletal disorder. Even that modest step was first delayed by the administration, then blocked by Congress.24

But, regardless of where one places the blame, the record in the health care arena plainly indicates that the government is failing to fulfill its obligation to provide adequate protection to workers. To comply with the law that authorizes its existence, OSHA needs to dramatically increase the number of inspections of health care facilities and issue binding standards to ensure that workers are protected from widely acknowledged hazards.

Doing so will require significantly more funding, as well as more cooperation from both Congress and the executive branch in developing needed safety rules. A failure to do so would amount to an acknowledgement that the nation’s promise to protect workers fromserious hazards is an empty one.