Hospitals escape sting of tough enforcement

None have citations for ergonomic hazards

The tougher enforcement touted by the U.S. Occupational Safety and Health Administration (OSHA) so far has failed to significantly affect the hospital sector. No hospitals have received citations related to ergonomic hazards, despite the fact that overexertion in lifting is the leading cause of injury in the industry.

Overall enforcement at hospitals has remained stable while enforcement efforts increased in other high-hazard workplaces, such as nursing homes. OSHA reported that overall inspections increased by 5.9%, and targeted inspections of high-hazard workplaces rose by 9.2% in fiscal year 2003.

In fiscal year 2003, OSHA conducted 537 inspections of hospitals, compared to 513 in fiscal year 2002 and 581 in fiscal year 2001. The most commonly cited standard was bloodborne pathogens.

Department of Labor Secretary Elaine Chao touted statistics that showed an increase in inspections and violations cited by OSHA and a decrease in injuries. "They are an indication of how seriously this administration takes its commitment to protect the safety and security of America’s workers," she said in a statement.

While there are several regional or local emphasis programs that include hospitals, they have not had the impact of the National Emphasis Program that targeted nursing homes. Since July 2002, OSHA has conducted about 1,000 nursing home inspections and issued citations against about 500 of them.

Seven nursing homes received "general-duty clause" citations related to ergonomics hazards, and OSHA issued another 104 ergonomic alerts. (OSHA administrator John Henshaw recently announced that he had ended the nursing home National Emphasis Program.)

Most programmed inspections of work sites are triggered by the emphasis programs and targeted inspections of workplaces with high injury rates. In hospitals, inspections most often are the result of complaints or referrals, says Dionne Williams, MPH, an OSHA industrial hygienist.

"The inspections are really based on the complaints we get," she says. "That’s the reason the numbers for that sector aren’t [higher]."

In fact, unions have not been aggressive in filing complaints related to ergonomic hazards. Without a standard, there isn’t much point, explains Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU) in Washington, DC. "We don’t file [ergonomics] complaints because we know it’s a waste of time. We know OSHA doesn’t cite for ergonomics. It would really undermine our relationship with our members to give them the impression that OSHA was actually out there protecting them from ergonomic hazards if we file a complaint."

Williams acknowledges that the lack of a standard makes ergonomics a more difficult area for inspectors. "The hurdle for ergonomics citations is far greater than for things for which we have a standard," she says. "Certainly, we’re issuing letters to get employers to correct wherever we find there are deficiencies in that area."

That impediment puts OSHA out of sync with the major health and safety issue facing nurses and other health care workers, Borwegen adds.

"They’re not getting to the crux of what is showing up on the OSHA 300 log," he says. "That’s why the agency is becoming increasingly irrelevant to growing sectors of the economy, especially health care. It’s really absurd to walk around the elephant in the room and basically ignore it."

OSHA is most likely to cite hospitals for failing to use safety devices to protect against bloodborne pathogens, failing to update the exposure control plan annually to consider new technology, and failing to include nonmanagerial employees in the selection of devices.

The next most common citations involve housekeeping hazards that could lead to slips and falls, such as water on the floor. According to data from the Bureau of Labor Statistics, slips and falls are the second greatest source of injury in hospitals, after lifting. "When we see hazardous conditions that would contribute to those types of injuries, we address it," Williams says.

The other top areas of enforcement in hospitals relate to obstructions to building exits.

In another development that may affect OSHA’s enforcement of the most egregious cases, the Occu-pational Safety and Health Review Commission ruled that an employer who failed to provide protective equipment or training to 11 workers exposed to asbestos committed only a single violation of OSHA personal protective equipment and training requirements.

In such cases, OSHA generally issues citations for 11 violations of the standard.

"OSHA has appealed a decision that could harm its ability to protect worker safety and health," Henshaw announced. "When an employer commits especially flagrant violations of its requirements, OSHA has a longstanding policy of citing each instance of the violative conduct."