Employees in the healthcare sector, particularly in nursing care, are involved in more accidents, contract more illnesses, and sustain more injuries than workers in any other industry, according to 2017 data from the Bureau of Labor Statistics. (Editor’s Note: See many more related statistics at: http://bit.ly/2ZD9plg.)

The cost of making a mistake that imperils employees’ safety, under rules created by the U.S. Occupational Safety and Health Administration (OSHA), has increased. Starting in January, healthcare organizations and other employers now pay more in fines when investigators find they are not protecting their employees’ safety.1

“The increased fines pertain to everybody across the board,” says Kelly Ogle, MS, CMPM, CHOP, director of OSHA and HIPAA services, DoctorsManagement LLC in Knoxville, TN. “We’ll have larger fines based on what we didn’t do or aren’t doing right. They’ll start with the maximum amount they can fine you and then determine how many people will be affected.”

The increase was mandated in the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 as an inflationary rate adjustment, which occurs annually.1 A violation can range from not emptying a sharps container and causing an accident to not giving staff required training or maintaining proper documentation of that training, Ogle says.

“When OSHA goes in and fines a facility, they write somebody up and give them the maximum amount of a fine,” she explains. “If they’re doing everything else good, and are making sure their compliance program is good, and training is what it’s supposed to be, OSHA will look at that, and reduce the fine amount.” To avoid hefty fines, make sure to take the following steps to stay in compliance with current regulations:

Conduct employee safety check annually. “Determine the hazards in your office, like not having a sign with radiation symbols in the X-ray area,” Ogle suggests. “Use a checklist to see what you need to fix.” The annual assessment should address staff training, ensuring every employee is up to date. OSHA provides a compliance assistance quick start guide that includes eight steps and OSHA requirements, available online at: http://bit.ly/2ICpkuG.

Ask for an OSHA consultation. A surgery center’s designated compliance officer or a compliance consultant can conduct an OSHA walk-through, looking for examples of noncompliance with federal workplace safety regulations.

“You make an appointment, and consultants come out and inspect and let you know what to do to fix any problems they find,” Ogle says. “They can write up citations like those you would have gotten and explain to you how to fix them.”

The walk-through might help uncover instances of workers not wearing personal protective equipment when it is needed or employees not washing their hands correctly. These types of findings might suggest the need for additional training, such as directing employees to watch a handwashing video, Ogle says.

Surgery center staff might think this level of compliance detail is trivial. But it is important to show regulators that the center held training and documented it, she adds.

Think outside the compliance box. Sometimes, healthcare organizations receive OSHA citations that blindside them. There are some daily activities that a site assumes is fine (but actually are not acceptable).

For instance, Ogle once worked with a physician-owned anesthesiology group in a children’s hospital. The group’s nurses were not hospital employees, but they had to walk through the hospital to see patients. If one of the anesthesiology group’s employees was injured while walking in the hospital (outside of their employer’s offices), then the injury would have to be reported to the hospital and to their employer, the physician-owned anesthesia group.

“If OSHA investigated the injury, then the doctor would get part of the fine because he’s supposed to make certain the working environment is safe for them,” Ogle explains. “The main person that would be responsible is the actual employer.”

The entity that owns the setting where the injury occurred also shares some of the responsibility, she adds. “If an employee has to make a stop at the drugstore for items to stock carts, and then the person falls, it’s partially the drugstore’s fault,” Ogle says. “But if the employee files a claim with the employer and the insurance company and complains to OSHA, then everyone gets involved in the investigation.”

This means that surgery centers should be cautious about sending employees out on work-related errands. “If I’m an employer, and I want to make sure my employees are as safe as they can be, I may not send them out to run errands if I know they’re bad drivers,” Ogle says. “I might pick up the items myself.”

It is also important for surgery centers to think like OSHA does: If a disgruntled employee complains about practices at the surgery center, then OSHA might investigate, Ogle adds. “OSHA can walk in tomorrow for no reason,” she warns. “But, generally, they find out about violations because of a complaint.”

When OSHA investigates a surgery center, the investigators will not look at just the area of the complaint. “They’ll walk through every step, check documentation, look through the sharps container, and write their final information down on what’s going wrong,” Ogle explains.

“They’ll dig through everything to make their visit worthwhile. And the fines are per violation. If you have overfilled a sharps container, that’s one violation. If you are not disposing of them properly, that’s two.”


  1. Federal Register. Department of Labor Federal Civil Penalties Inflation Adjustment Act Annual Adjustments for 2019. Published Jan. 23, 2019. Available at:  http://bit.ly/2IRDqHU. Accessed April 25, 2019.