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Sadly, workplace violence continues to be reported in the news almost every day. While OSHA has no specific regulation addressing workplace violence, a recent court decision supports OSHA’s use of the General Duty Clause in workplace violence cases.  OSHA has taken notice and is paying increasing attention to the violence issue, particularly in the healthcare industry.

In 2016, the New England Journal of Medicine published a comprehensive review of “Workplace Violence against Health Care Workers in the United States.”  The review included data from the Bureau of Labor Statistics showing healthcare workers are nearly four times as likely to require time away from work as a result of violence.

The review also reported that, although employees in the healthcare and social assistance sectors account for 12.2% of the working population nearly 75% of workplace assaults occurred in a healthcare setting.

Among other recent workplace violence incidents:

80% of EMS personnel have been attacked by patients.

Homicide is the second leading cause of workplace death for home healthcare workers.

78% of Emergency Department physicians and 100% of Emergency Department nurses have experienced violence from patients in 2016.

The annual incidence of physical assault in a psychiatric setting is 70%.

Among nursing homes with dementia units, 59% of nursing aides reported being assaulted by patients weekly and 16% daily.

46% of nurses reported some form of workplace violence during their five most recent shifts.

Between 2000 and 2011, there were 154 shootings with injury either inside or on the grounds of American hospitals.

In a recent lawsuit: Labor v. Integra Health Management, No 13-1124 (March 4, 2019), the Occupational Safety and Health Review Commission (OSHRC) upheld a violation of the General Duty Clause when it found an employer did not adequately address workplace violence hazards. The company employed “service coordinators” to help its clients obtain medical care.  Health insurers sent the clients to Integra Health Management after reviewing claim histories to identify individuals who are not receiving appropriate care.  In this particular case, the service coordinator was assigned to visit a client at his home and notes in her report detailed his strange and sometimes erratic behavior.  On a follow-up visit a few months later, the service coordinator was stabbed by the client nine times and died.

After an investigation, OSHA issued Integra a citation stating that the company exposed employees to the hazard of being physically assaulted by clients with a history of violent behavior.  A lower court affirmed the citation and found that Integra’s workplace violence policy and training were inadequate and that the company failed to provide the service coordinator with medical and criminal history about the client.  The judge also found the company failed to review the notes of the service coordinator and take steps to assist her in working with the client. Integra was also cited for failing to report an employee’s death.

Integra appealed the decision on the grounds that the hazard of being assaulted by clients with a history of violent behavior was not a hazard recognized by the industry.  In May of 2019, the OSHRC upheld the lower court’s decision.

What does this mean for employers in the healthcare industry?  All employers must have a workplace violence policy in place, train on that policy, and most importantly, follow the policy.  Employers can also assess their work environment and proactively use engineering controls (ex. cameras, panic buttons) and administrative controls (not allowing employees to work alone or ensuring access to reliable communication) to reduce risks. The employer must also document any issues that arise and communicate those issues to reduce the risks of repeated violations.

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