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The Occupational Safety and Health Administration does not sufficiently protect health care workers, conducting too few inspections and failing to develop standards to guard against known hazards, consumer advocacy group Public Citizen argued in a July 17 report.
Despite having a higher incidence of injuries than any other occupational sector, the health care industry receives a fraction of the attention from OSHA compared with other high-risk industries, the report said. For example, workers in the health care and social assistance sector suffered more than twice as many injuries as those in the construction sector during 2010, but OSHA conducted about one-twentieth as many inspections in health care as construction.
“The government has a legal duty to provide a safe workplace for every employee in the country, but it isn't fulfilling this duty for health care workers,” Keith Wrightson, Public Citizen's worker safety and health advocate, said in a telephone news conference.
In response to the Public Citizen report, an OSHA spokeswoman told BNA that employers have the legal responsibility of providing safe workplaces and the agency's role is to make sure they “take ownership over this issue.”
“OSHA has a variety of tools at its disposal to hold employers accountable for safety and health, and we are committed to improving safety and health conditions for our nation's health care workers,” the spokeswoman said.
Public Citizen's report comes amid vast expansion in health care sector employment. The industry added 2.6 million jobs over the past decade--a 22.7 percent employment growth rate during a time when while employment in all other industries grew at a 2.1 percent rate, according to a Brookings Institute report issued in July.
In 2010, the heath care and social assistance sector employed 18.9 million workers who suffered 176,380 injuries that required days away from work, the Public Citizen report said. The construction sector employed 9.1 million workers who suffered 74,950 injuries, and the manufacturing sector employed 14.1 million workers who suffered 127,140 injuries.
During that time, OSHA conducted 2,504 inspections of health care and social assistance facilities, compared with 52,179 inspections of construction sites and 19,566 inspections of manufacturing sites.
The report suggested that the severity of injuries partially drives the asymmetry in inspection statistics. In 2010, 141 workers in health care and social assistance jobs died from occupational injuries, compared with 744 construction workers and 329 manufacturing workers.
Public Citizen's Wrightson said that OSHA should not shift its resources away from the construction manufacturing sectors in order to give the health care sector more attention.
“The point we try to hit on is they need more funding,” said Wrightson, who called OSHA “the red-headed stepchild of the federal government” due to its lack of political support and inadequate budget.
The Public Citizen report also argued that the lack of regulations applicable to health care handicaps inspectors, who are reluctant to cite employers under the general duty clause for a violation that does not correspond to a specific safety standard. The report noted that OSHA issued an ergonomic standard that could have protected health care workers in 2000, but Congress repealed it before it could take effect.
“In fairness to OSHA, the adversity it faces goes well beyond a shortage of resources,” the report said. “The process for creating standards has become so cumbersome and subject to interference that the agency could not possibly fulfill its mandate.”
Musculoskeletal disorders are the leading source of health care worker injuries and should be addressed through focused regulation, the report said.
A safe patient handling standard would guard against musculoskeletal disorders and ergonomic stressors, the report said. Ten states have passed such laws. As evidence of their effectiveness, Public Citizen cited in the report significant drops in overexertion injuries in Washington and Maryland after those states enacted safe patient handling laws.
Rep. John Conyers (D-Mich.) introduced the Nurse and Health Care Worker Protection Act (H.R. 2480) in June. That measure, which has garnered two Democratic co-sponsors in the Republican-dominated House, would require OSHA to implement a safe patient handling and mobility standard that would eliminate manual lifting of patients by health care workers.
OSHA announced July 16 a campaign to raise awareness about the hazards likely to cause musculoskeletal disorders among health care workers. The campaign will provide 2,500 employers, unions, and associations in Delaware, Pennsylvania, West Virginia, and the District of Columbia with information about hazard-control methods and about how employers can include a zero-lift program in their facilities.
OSHA's lack of an ergonomic-related standard limits its power during inspections, the report said. Although the agency launched a national emphasis program for nursing homes and residential care facilities in 2012, the agency has only issued seven citations for unsafe ergonomic conditions since October 2011, the report said.
In written comments included in the report, OSHA said that in the absence of a standard, the agency must meet a high evidentiary threshold when issuing a citation under the general duty clause.
Inspectors can issue Hazard Alert Letters in instances in which they identify ergonomic hazards but believe the conditions do not meet the general duty clause's evidentiary requirement, the agency said. OSHA said it has issued more than 55 letters regarding ergonomic hazards since it began the national emphasis program.
“At this time, OSHA is not pursuing a rule on safe patient handling for health care workers,” the agency said in the written comments, citing a lack of resources to support rulemaking for all pressing hazards.
Workplace violence, which can happen in situations when a worker is alone, in isolated areas, or late at night, is another major hazard in the health care industry, the report said.
Public Citizen recommended that OSHA develop a standard for workplace violence. It would require employers to adopt zero-tolerance policies for violence and threats, provide protection for employees to deter co-worker retaliation, and develop workplace safety plans.
Twenty-one states have enacted laws to address workplace violence in the health care industry. According to the American Nurses Association (ANA), these measures vary, generally mandating comprehensive antiviolence programs or increased penalties for assaults on health care personnel.
In 2004, OSHA published guidance on preventing workplace violence in health care settings.
The report identified injuries from surgical instruments and needles--which puts health care workers at risk for exposure to viruses, such as HIV and hepatitis B--as a third major concern.
Although Public Citizen lauded OSHA's bloodborne pathogen standard, it said the agency should update that rule to require injury logs that are reviewed to assess hazards. The updated standard would also mandate employers purchase best available technology in needles and instruments, and that they consult with workers before making those purchasing decisions.
OSHA has begun a review of the standard to determine the continued need for the rule, whether it overlaps with other regulations, and the degree to which technological, economic, and other conditions may have changed since it was last evaluated, the agency said in its spring 2013 regulator agenda. OSHA said it would end its review and issue findings in October.
Until OSHA can implement new standards, the agency should “vastly expand its use of the general duty clause to cite health care facilities for hazards that are not documented in existing rules,” the report said.
Officials from the Service Employees International Union and ANA appeared on the Public Citizen telephone news conference to back the report.
“We support the findings and recommendations in this valuable report,” said L. Toni Lewis, chair of SEIU Healthcare. “We believe that if these recommendations are followed, it will result in safer workplaces.”
Public Citizen's report, Health Care Workers Unprotected, is available at http://www.citizen.org/documents/health-care-workers-unprotected-2013-report.pdf.
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