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Violence against health care workers captures regulators’ attention

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PHILADELPHIA — Workplace violence against health care workers has caught the attention of federal and state safety regulators, particularly in California, which is requiring extensive incident reporting. 

The U.S. Occupational Safety and Health Administration is “paying close attention” to assaults by patients against health care employees and other violent incidents, Mark Walls, Chicago-based vice president of communications and strategic analysis for Safety National Casualty Corp., said at the Risk & Insurance Management Society Inc.’s annual conference in Philadelphia on Wednesday.

“This is a growing problem, a very difficult-to-manage problem,” he said. 

In the waning days of the Obama administration, OSHA announced it would commence a rule-making for a standard to protect health care and social assistance workers from workplace violence nationwide. In 2015, there were more than 11,000 violent incidents against employees in the health care and social assistance sector — a number that is nearly as high as all other industries combined. 

“Health care is a big focus area of OSHA right now,” said Rich Reynolds, workers compensation manager, benefit operations, for Providence Health and Services in Renton, Washington. “We’re seeing a lot more frequency of pop-up inspections.” 

The California Division of Occupational Safety and Health Administration Standards Board unanimously adopted the first workplace violence prevention standard for health care workers in the United States last year, with the standard taking effect April 1. 

General acute care hospitals, acute psychiatric hospitals and special hospitals must report incidents of workplace violence at their facilities to Cal/OSHA, which is required under Senate Bill 1299 to post a report each January on the total number of incidents reported, the names of the hospital facilities, the outcomes of inspections or investigations, the citations levied against a hospital based on a violent incident and recommendations for the prevention of violent incidents in hospitals. 

“It’s not like (workplace violence against health care workers) is a new thing,” said Martin King, director, corporate risk management, treasury, for Kaiser Foundation Health Plan Inc. based in Oakland, California. “It’s always been there. It’s just becoming more visible, with the reporting of it. The first thing we have to do is capture it.”

Part of the initial challenge for Kaiser was different reporting silos existed for OSHA recordable injuries, workers comp claims and sharps incidents, but it eventually implemented an integrated reporting system, he said. 

“Ironically, the biggest issue that we had with this was that people at the medical centers were worried that they were going to get dinged with workers comp claims,” he said. “We assured everybody that if you get yelled at by a patient, you are required to send a report, but it’s not going to be an accepted claim automatically.”

But the reporting requirement bought to light that incidents such as being yelled at by patients were resulting in lost-time claims or employee demands for accommodation, he said. 

Paul Posey, president and CEO of Ascension Care Management in St. Louis, recently had to report to the board of its captive insurer about the implementation of a systemwide workplace violence prevention standard, which resulted in a 60% increase in reported workplace violence incidents, and “try to explain to them why that’s actually a good thing.” 

“If you think about where we are going as a society relative to the lack of behavioral health facilities and care, all of those behavioral health issues are now playing out in emergency departments, so for us it’s a really significant issue,” he said. “Not only do we capture it, report it and make sure we’re being compliant, we have to think about how we begin to bring behavioral health training into the front lines of our emergency departments.” 

Mr. Reynolds observed that the challenge is “not always a behavioral mental health issue,” he said. “Another thing that causes a lot of problems is the growing drug problem in the United States.”

But the public reporting component of OSHA’s electronic record-keeping rule will lead to action in states beyond California, he said. 

“California’s already there,” Mr. Reynolds said. “California historically from an OSHA perspective tends to be ahead of everyone else and much more stringent on data reporting and information being shared. But I think you will see that spread across the entire nation. I think there’s going to be more awareness at the fed level. It will take them a little time to catch up, but I think there’s going to be a lot better and more stringent data reporting.”