There's one hospital violence statistic the healthcare industry should know and it involves a dollar value. The United States Court of Appeals for the District of Columbia Circuit has dismissed a hospital's appeal against a $12,471 fine imposed by OSHA. The reason for the fine was that the hospital failed in its duty of care to protect employees from the recognized hazard of patient aggression towards staff.
Historically, hospital violence statistics have been difficult to compile due to substantial underreporting in the healthcare industry. However, since the Occupational Health and Safety Administration (OSHA) published a review of Workplace Violence in Healthcare in 2015 - in which incidents of hospital violence were four times more commonplace than in any other industry - there has been greater awareness of the threats to staff safety in healthcare settings.
The greater awareness - and campaigns such as End Nurse Abuse, Raise Your Hand, and Silent No More - have resulted in multiple states passing legislation to better protect healthcare workers. There is also a bill passing through Congress (H.R. 1309) which, if passed by the Senate, will set minimum requirements for hospital violence prevention and reporting incidents of violence.
OSHA Acts as Hospital Fails in its Duty of Care
Shortly after OSHA published its review, the agency received an anonymous tip claiming that the BHC Northwest Psychiatric Hospital in Pennsylvania (also known as the Brooke Glen Behavioral Hospital) was failing to protect staff against patient aggression by not implementing its own safety policies. OSHA inspectors investigated the tip and found eight areas in which the hospital was failing to protect staff from injuries or the consequences of injuries, for which the hospital was fined a total of $32,158.
The hospital agreed to seven of the eight citations, but contested the claim it had failed in its duty of care to protect employees from a recognized hazard as required under the Occupational Safety and Health Act of 1970. The alleged violation of the hospital's duty of care - for which the hospital had been fined $12,471 - was heard by an Administrative Law Judge, who upheld OSHA's citation and penalty. The Administrative Law Judge found:
The hospital had failed to update or implement various written safety policies that were intended to prevent staff from sustaining injuries from aggressive patients.
Staff training consisted of a PowerPoint presentation, but the hospital failed to produce evidence of how or if the presentation was made available to employees.
The system being used to communicate psychiatric emergencies relied on phone inadequately distributed throughout the hospital.
An alternative emergency communication system - the use walkie talkies - failed due to a lack of devices that frequently did not work.
Post-incident debriefings did not occur consistently; and when they did, OSHA's expert witness found they did not meaningfully contribute to workplace safety.
Staff were under no obligation to report incidents of workplace violence that did not result in an injury requiring first aid.
Hospital Contests Verdict, but Court Dismisses Appeal
The BHC Northwest Psychiatric Hospital contested the verdict of the Administrative Law Judge, arguing that the low recorded rate of injuries caused by patient aggression demonstrated it was complying with the General Duty clause. However, Appeal Court judges dismissed the appeal - stating the low recorded rate was attributable to the hospital's poor policies and procedures for recording staff injuries.
Furthermore, the appeal judges noted in their opinion, just as a workplace accident is not evidence of a violation, “a low rate of workplace accidents cannot alone establish compliance with the General Duty Clause”. They added “a reasonably prudent employer familiar with the circumstances of the industry would have protected against the hazard in the manner specified”.
The dismissal of the appeal means not only will BHC Northwest Psychiatric Hospital have to pay the $12,471 fine, but also introduce measures recommended by OSHA's inspectors and expert witness to improve the safety of employees at the hospital. These measures include developing a system for employees to report workplace safety concerns anonymously, and providing employees with a readily available system of emergency communication that is effective throughout the hospital.
The Implications of this Court Case for Healthcare Organizations
The dismissal of the appeal is significant because of the observation by the Appeal Court judges that an injury does not necessarily need to occur before an employer can be found in breach of OSHA's General Duty clause; and because of the comment that “a reasonably prudent employer familiar with the circumstances of the industry would have protected against the hazard in the manner specified”.
Consequently, whatever requirements are included in the final version of H.R. 1309, healthcare organizations should consider OSHA's recommended safety measures to avoid being found in violation of the General Duty clause. The fine on this occasion may have been a relatively modest $12,471; but, even if no injuries occur, a larger healthcare organization could be fined a lot more for not providing the means to anonymously elevate safety concerns or alert colleagues to an emergency.
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