In the year to September 2023, the Occupational Safety and Health Administration issued 626 citations for OSHA violation cases in healthcare. The top ten reasons for citations in the health care and social assistance NAICS category (where indicated) were violations of:
- The bloodborne pathogen standard
- The hazard communication standard
- The respiratory protection standard
- The control of hazardous energy standard
- OSHA’s form filling requirements
- The formaldehyde standard
- OSHA’s general requirements
- The asbestos standard
- The wiring methods, components, and equipment standard.
- The exit route standard (maintenance, safeguards, and features)
OSHA does not publish citation-by-citation information because of the volume of citations issued each year across all industries. Federal OSHA – not including state plans – issued 45,950 citations nationwide in the year to September 2023. Nonetheless, it is possible to tell from aggregated data that the 626 citations for OSHA violations in healthcare resulted in more than $1.5 million in fines.
More than a quarter of the 626 citations (162) were attributable to violations of the bloodborne pathogen standard. However, the number of citations for violations of this nature were almost four times the number of inspections for violations of the bloodborne pathogen standard – indicating that citations are coded for the leading violation when multiple violations are found.
Examples of OSHA Violation Cases in Healthcare
To demonstrate how multiple violations can be coded according to the leading violation, in 2016, OSHA responded to an employee’s complaint alleging violations of the bloodborne pathogen standard at Altamont Ambulance Service Inc. in Illinois. After conducting an investigation, OSHA issued twenty-four citations for OSHA violation cases in healthcare and fines totaling $290,100. The five willful, sixteen serious, and three other-than-serious violations of OSHA included the failure to:
- Establish an exposure control plan for bloodborne pathogens.
- Make hepatitis B vaccinations available to all employees.
- Train employees about chemical hazards and precautions.
- Develop an emergency response plan.
- Dispose of, clean or launder contaminated PPE.
- Train workers in operations level emergency response.
- Communicate decisions on the use of PPE to employees.
- Develop a respiratory protection program to protect against infections.
- Mark, keep clear, and properly light emergency exits.
- Follow electrical standards for wiring, components, and equipment.
- Train workers how to use fire extinguishers.
The failure to train employees is a common factor in OSHA violation cases in healthcare with regards to bloodborne pathogens. In some cases, it can be the leading violation. In 2013, the Atlanta Health Careers Institute in Georgia was fined $62,000 for violations of the bloodborne pathogen standard, with $60,000 of the total being attributable to the employer failing to train workforce members on the hazards and precautions – despite being cited for exactly the same violation one year earlier.
Hazard Communications and Respiratory Protection
During the first year of the COVID-19 pandemic, the healthcare industry suffered a huge loss to its workforce. It has been estimated that 3,607 US healthcare workers died, while a further 440,000 contracted the virus out of a workforce of around 9.7 million. By October 2020, eighty-five healthcare establishments had been cited for COVID-19 failures, yet some healthcare organizations continued to violate the hazard communication and respiratory protection standards.
In one case, the West Suburban Nursing and Rehabilitation Center, Illinois, was fined $83,000 for failing to conduct a hazard assessment for unvaccinated employees, failing to maintain distancing between employees failing to monitor the movement of patients suspected to have COVID-19, and failing to ensure all workforce members were trained on the effective use of respirators – one year after an employee had contracted the virus while working at the rehabilitation center and had died.
Speaking about this case, OSHA Area Director Jake Scott said: “Simply wearing a respirator is not enough. Employers must ensure respirators fit correctly and maintain a face-to-face piece seal to ensure they protect the user from the spread of infectious diseases. After more than a year of fighting this pandemic, employers should know the procedures to minimize workers’ risk of exposure and take every precaution.”
Other Types of OSHA Violation Cases in Healthcare
Outside of the “top ten reasons”, there were reassuringly low numbers of OSHA violation cases in healthcare for hazards one might expect to be more common. Violations of the General Duty clause only appeared as the lead violation in seven OSHA violation cases in healthcare, violations of the air contaminants standard appeared in four cases, and violations of the ionizing radiation standard appeared in only two. Notably, there were no violations of OSHA’s whistleblower protections.
OSHA vigorously pursues whistleblower enforcement action when employees are retaliated against or discriminated against for making a complaint to OSHA. For example, in 2012, an employee of the North Star Behavioral Health System raised concerns about the safety of the drinking water at the organization’s Anchorage facility. The employee was fired and ordered to refrain from future contact with regulatory agencies. Instead, the employee made a whistleblower complaint to OSHA.
Following an investigation into the complaint, the health system was told to reinstate the employee and pay him nearly $60,000 in back wages plus $2,018 compensatory damages, $75,000 for his emotional distress, and $100,000 in punitive damages. The health system was also required to repay approximately $35,600 in attorney fees. Consequently, it is important to be aware that OSHA violation cases in healthcare do not only relate to occupational injuries and illnesses.
Healthcare Organizations Must Comply with All Applicable Standards
Healthcare organizations generally do a good job complying with OSHA standards. Indeed, it is quite an achievement for the industry as a whole to only get 626 OSHA citations out of an all-industries total of 45,950 citations (excluding state plans). Nonetheless, there are still some organizations who – either through a lack of knowledge or a willful disregard for the rules – fail to comply with all applicable standards.
If you have a responsibility for safety and health in a healthcare environment, and you are not sure about which standards are applicable to your organization, you have three options. You can download our OSHA compliance checklist, seek advice from an OSHA compliance expert, or contact OSHA directly on 800-321-6742 (OSHA). In some circumstances, you may qualify for a free on-site OSHA consultation or a grant towards developing a workplace training program.
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