Hospital Violence Captures Regulators’ Attention


By Liz Carey

Lowell, MA ( – The Occupational Safety and Health Administration (OSHA) has levied a $208,000 penalty against a Massachusetts behavioral health services firm it says failed to protect its employees from assaults by patients.

The citation comes two years after an inspection at the facility where OSHA found serious violations in May 2015. According to OSHA, the facility did not take the appropriate actions to abate previous violations, including logging violent interactions with patients. 

OHSA found that UHS of Westwood Pembroke, Inc., doing business as Lowell Treatment Center, failed to take the necessary steps outlined in a formal settlement agreement the agency reached with the facility in 2016, after inspections revealed numerous worker safety violations. 

A follow-up investigation by OSHA in January of 2017 found that not only had the facility not taken steps to protect employees, but that it had also failed to follow through with logging incidents and adequately preparing annual reports. In one incident, a case manager was leaving an adult unit when they were attacked by a patient and punched and scratched all over their body. The attack resulted in a black eye, a scratched cornea and extensive bruising and required the case manager to take several days off of work to recover.

Assaults on hospital employees, like those identified at the Lowell facility, by patients is gaining attention from regulators, as government officials come to grips with the disturbing emerging trend.

In 2014, the US Bureau of Labor Statistics reported that 52 percent of all the incidents of workplace violence reported across the country occurred against workers in the healthcare and social assistance industry.

In 2015, OSHA found that there were more than 11,000 violent incidents against employees in the healthcare and social assistance sector — a number that is nearly as high as all other industries combined.

In January of this year, nurses who were part of National Nurses United, asked OSHA to pass regulations that would prevent workplace violence in healthcare settings.

“Registered nurses urge OSHA to act immediately to help protect nurses and all healthcare workers, as well as patients and families, from violence in healthcare settings — a serious problem for far too long,” said Jean Ross, a Minnesota registered nurse and co-president of National Nurses United. 

During OSHA’s public stakeholder meeting on workplace violence in healthcare settings in January, the nurses spoke to OSHA about the violence they face. Allysha Shin, a registered nurse in California, testified about an incident in December 2016 where a combative patient attacked her and other hospital employees.

“The patient ripped out of her restraints, pulled out one of her IVs, tore her gown off and got out of bed,” Shin testified. “She kicked me in the chest and stomach multiple times. It took approximately six people to re-restrain her to the chair. Were it not for the patient’s loud screaming and cursing, my co-workers may not have known to come help me. The patient was also at risk of harm, and for 30 minutes, most of the nurses and other staff on the unit could not attend to their own highly acute patients because we did not have properly trained personnel from outside the unit who could help handle combative patients.” 

Shin testified that these incidents are preventable, if hospitals are prepared to deal with them.

“As registered nurses, we all experience the fear and insecurity when our employers are unprepared to handle violent situations or unwilling to do what is required to prevent violence from occurring in the first place,” Shin testified. “OSHA must act swiftly to create a robust workplace violence prevention standard, because every day we wait, healthcare workers are placed at extreme risk of physical violence and psychological harm.”

And in April, speaking to the Risk and Insurance Management Society Inc.’s annual conference, Mark Walls, vice president of communication and strategic analysis for Safety National Casualty Corp., said OSHA is beginning to pay closer attention to these attacks.

“This is a growing problem,” he said, according to Business Insurance. “And a very difficult to manage problem.” 

Some individual states are working to address the problem.

The California Division of Occupational Safety and Health Administration Standards Board adopted the first workplace violence prevention standard for healthcare workers in the US, which took effect on April 1.

The bill, SB 1299, requires that general acute care hospitals, acute psychiatric hospitals and special hospitals have to report workplace violence incident at their facilities to the Cal/OSHA. In turn, Cal/OSHA is required to report the total number of incidents at each hospital, the outcomes of inspections or investigations, any citations levied against the hospital because of the incident, and what recommendation were made for the hospital to prevent further incidents.

“It’s not like (workplace violence against healthcare workers) is a new thing,” Martin King, director of corporate risk management for Kaiser Foundation Health Plan Inc. told Business Insurance. “It’s always been there. It’s just becoming more visible, with the reporting of it. The first things we have to do is capture it.”

Initially, medical centers resisted the reporting, King said, because of workers’ compensation concerns.

“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 told Business Insurance. “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.” 

Officials say the reporting of it will force change, and that California’s actions will lead other states to act as well.

But abuse at facilities continues to endanger healthcare workers, said Galen Blanton, OSHA’s regional administrator in Boston, MA. “Our inspectors found that employees throughout the Lowell Treatment Center continued to be exposed to incidents of workplace violence that could have been greatly reduced had the employer fully implemented the settlement agreement.”

UHS of Westwood Pembroke is one of the nation’s largest healthcare management companies operating 350 behavioral health facilities, acute care hospitals, ambulatory centers and freestanding emergency departments across the US, UK, and US Virgin Islands.

Judy Merel, spokeswoman for UHS, said in an interview with that it would release a statement about the OSHA announcement, but had not responded to calls and emails for comment by press time. 

According to OSHA, UHS will challenge OSHA’s findings.  

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