Enforcement and Inspection, Personnel Safety

Workplace Violence: OSHA Enforces General Duty Violations in Health Care

An OSHA standard to mitigate workplace violence in healthcare facilities does not appear to be on the horizon, but this is not because OSHA is not aware of the main provisions that would be included in such a standard. In fact, it is not uncommon for OSHA to issue citations against healthcare employers whose employees are attacked, harmed, threatened, or verbally abused in ways employers know can occur and for which there are reasonable and readily available preventive measures employers are also aware of.

Hospital violence

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Accordingly, the citations contain explicit instructions on measures the employer can take to protect employees from violence. Should OSHA eventually issue a workplace violence standard, employers that have already adopted these measures will be ahead of the game in coming into compliance.

Five Recent Citations

OSHA issues workplace violence citations under the General Duty Clause (Clause) of the U.S. Occupational Safety and Health (OSH) Act. Moreover, OSHA’s use of the Clause to cite healthcare employers whose employees were the victims of workplace violence has been increasing after a long period during which it was little used. In 2016, the U.S. Government Accountability Office found that between 1991 and 2014, OSHA issued 18 General Duty Clause citations to healthcare employers for failing to address workplace violence; 17 of these citations were issued between 2010 and 2014. Our review of OSHA news releases for 2017 and so far for 2018 found at least 5 General Duty citations against healthcare employers because of violence against employees.

Serious Physical Injuries

Measures needed to abate workplace violence hazards at a healthcare facility may be extensive, and for some employers, they may be costly. At the same time, OSHA’s penalties for failing to provide healthcare employees with a safe working environment, as required by the General Duty Clause, can exceed $200,000, especially if they are found to be serious or repeat violations.

In one of the more recent cases, OSHA proposed a penalty of $14,505 because of a healthcare employer’s alleged failure to protect employees from “physical assaults such as biting, kicking, punching, and scratching that resulted in serious physical injuries such as but not limited to lacerations, contusions, sprains, strains, headaches, and concussions.”

Under the citation, the employer was given a little more than 2 months to abate the hazards. OSHA’s citation goes on to provide 4 pages of possible abatement measures. The employer is not required to adopt each and every measure, but the employer must provide OSHA with an abatement certification letter that describes the measures it adopts to effect abatement. All employees must be informed of the measures. Moreover, OSHA must be satisfied that measures it believes will be effective have, in fact, been adopted.

OSHA’s Recommended Measures

Abatement measures described in the citation include:

  • Development and implementation of a written “comprehensive workplace violence prevention program,” which includes designation of a person responsible for operating the program, a clear statement about how employees can obtain medical attention, and information on how employees can obtain emotional and mental health care;
  • Development of administrative and engineering controls, including a violence prevention committee wherein employees comprise at least 50 percent of membership; reliable and readily available means of communication; and response teams of employees proficient in crisis de-escalation;
  • Development of a recordkeeping system to ensure that all workplace violence incidents are investigated and that postincident debriefing and root-cause analysis occur;
  • Development programs to train employees about the violence prevention program;
  • Development of a safety committee for the facility; and
  • Annual review of the prevention program and updates, as necessary.

OSHA provides additional information about workplace violence and its prevention at https://www.osha.gov/dsg/hospitals/workplace_violence.html.