James S. Frank, a Member in the Health Care and Life Sciences and Labor and Employment practices, and Serra J. Schlanger, an Associate in the Health Care and Life Sciences practice, co-authored an article for the American Health Lawyers Association (AHLA) entitled “Hospitals’ Heavy Lifting:  Understanding OSHA’s New Hospital Worker and Patient Safety Guidance.”

The article, published in AHLA’s Spring 2014 Labor & Employment publication, summarizes OSHA’s new web-based “Worker Safety in Hospitals” guidance, explains how the guidance relates to OSHA’s existing regulatory framework, and details what OSHA considers necessary for an effective Safe Patient Handling Systems as well as an effective Safety and Health Management System.

The article goes on to forecast what OSHA’s Hospital Safety guidance will mean in the future for employers in the healthcare industry, including:

  1. More Whistleblower Complaints;
  2. Heavier enforcement by OSHA;
  3. Increased enforcement by the Joint Commission; and
  4. Greater interest in safety and health related legislation.

 

Finally, the article provides recommendations for what hospital and health system employers can do now to prepare for these developments, including:

  1. Reviewing and digesting the new OSHA hospital patient and employee safety resource;
  2. Work with employees and/or contractors to improve Safe Patient Handling Programs and/or a Safety and Health Management Systems; and
  3. Prepare for more safety-related whistleblower complaints by setting up effective processes to quickly investigate and address complaints and employee injuries and illnesses.

 

Below are some excerpts from the article:

On January 15, 2014 the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) launched a new online resource to address both worker and patient safety in hospitals.

According to OSHA, a hospital is one of the most dangerous places to work, as employees can face numerous serious hazards from lifting and moving patients, to exposure to chemical hazards and infectious diseases, to potential slips, trips, falls, and potential violence by patients—all in a dynamic and ever-changing environment. . . . Continue Reading Hospitals’ Heavy Lifting: Understanding OSHA’s New Hospital Worker and Patient Safety Guidance

By Eric J. Conn, Head of Epstein Becker & Green’s OSHA Practice Group

OSHA recently announced a campaign to raise awareness about the hazards likely to cause musculoskeletal disorders (MSDs) among health care workers responsible for patient care.  Common MSDs suffered in the patient care industry include sprains, strains, soft tissue and back injuries.  These injuries are due in large part to over exertion related to manual patient handling activities, often involving heavy lifting associated with transferring and repositioning patients and working in awkward positions.

“The best control for MSDs is an effective prevention program,” said MaryAnn Garrahan, OSHA’s Regional Administrator in Philadelphia. “[OSHA’s] goal is to assist nursing homes and long-term care facilities in promoting effective processes to prevent injuries.”

As part of the campaign, OSHA will provide 2,500 employers, unions and associations in the patient care industry in Delaware, Pennsylvania, West Virginia and the District of Columbia with information about methods used to control hazards, such as lifting excessive weight during patient transfers and handling.  OSHA will also provide information about how employers can include a zero-lift program, which minimizes direct patient lifting by using specialized lifting equipment and transfer tools.  Here is a resource regarding Safe Patient Handling from OSHA’s website.

Employers in the healthcare industries should be on high alert, because whenever OSHA provides information about hazards it believes are present, a focus on enforcement is soon to follow.  This is particularly true when it comes to hazards for which OSHA has no specific standards or regulations, like ergonomics.  In these circumstances, OSHA is limited in its enforcement to use of Sec. 5(a)(1) of the OSH Act – the General Duty Clause.  The General Duty Clause is used by OSHA to issue citations in the absence of a specific standard, in situations where employers have not taken steps to address “recognized serious hazards.”  Efforts like OSHA’s present campaign to advise healthcare employers about hazards in their workplaces, is OSHA’s way of making you “recognize” the hazard, so the Agency can more easily prove General Duty Clause violations.

Of course, there are plenty of other reasons that healthcare employers should take note of the rate of MSD cases in patient care work.  Continue Reading OSHA Launches Ergonomics Campaign in Healthcare Industries

By Frank C. Morris, Jr. and Jordan B. Schwartz

An employer’s wellness program—despite certain “penalty” provisions—was recently held not to be discriminatory under the Americans with Disabilities Act (“ADA”) by the U.S. Court of Appeals for the Eleventh Circuit in Seff v. Broward County.  The Eleventh Circuit found the wellness program, sponsored by Broward County, Florida (“County”), was established as a term of the County’s insured group health plan and, as such, fell under the ADA’s bona fide benefit plan “safe harbor” provision.  This ruling is welcome news for employers with or considering wellness programs.

However, if the County’s wellness program had not been found to be a part of the County’s health benefits plan, then potential plaintiffs or the Equal Employment Opportunity Commission (“EEOC”) would likely have argued that the wellness program runs afoul of the EEOC’s views on “voluntariness” requirements for employer-sponsored wellness programs.

The ADA’s Impact on Wellness Programs

Wellness initiatives seek to boost employee productivity and reduce both direct and indirect medical costs, which are desirable outcomes for employers.  Employer-sponsored wellness programs have grown exponentially over the past decade, as employers have increased their focus on controlling health care costs and improving the overall safety and health of employees.  According to recent studies, approximately 46% of participating employers had implemented wellness programs.  Despite the growing popularity and positive aspects of wellness programs, legal uncertainties surrounding these programs—including restrictions imposed by the ADA, the Genetic Information Nondiscrimination Act (“GINA”), and the Health Insurance Portability and Accountability Act (“HIPAA”)—have presented obstacles to their implementation and growth.

Certain ADA restrictions have contributed to many employers declining to start wellness programs. Specifically, the ADA prohibits employers from making disability-related inquiries or requiring medical examinations of prospective or current employees unless they are job-related or subject to a business necessity exception. On the other hand, voluntary medical exams are permitted so long as the information obtained is kept confidential and not used to discriminate. There is little guidance, however, either from the courts or the EEOC, analyzing whether an employer-sponsored wellness program that encourages participation by providing incentives, or penalizes non-participation, can be considered “voluntary” and therefore permissible under the ADA.

The ADA has certain safe harbors for insurers and bona fide benefit plans that exempt such programs from ADA restrictions. Under these safe harbors, employers, insurers, and plan administrators are permitted to establish a health insurance plan that is “bona fide” based on underwriting risks, classifying risks, or administering such risks that are based on or not inconsistent with state law. Thus, if a wellness program qualifies for the ADA’s safe harbor provision, an employer need not worry whether such program otherwise would have been considered voluntary. Notably, the EEOC has not addressed wellness programs and the ADA’s safe harbor provision.

Seff v. Broward County

In October 2009, the County adopted a wellness program for its employees as part of its health plan open enrollment. The wellness program consisted of three parts: (1) a biometric screening consisting of a “finger stick” to measure glucose and cholesterol; (2) disease management for five specified conditions; and (3) an online Health Risk Assessment (“HRA”). Participation in the program was not required as a condition of participation in the County’s health plan, but employees who did not undergo the screening or complete the HRA incurred a $20 bi-weekly charge subtracted from their paychecks.

In response to this program, current and former County employees who enrolled in the County’s health insurance plan and incurred the $20 bi-weekly fee filed a class action lawsuit in the U.S. District Court for the Southern District of Florida. They alleged that the wellness program’s biometric screening and online HRA violated the ADA’s prohibition on non-voluntary medical examinations and disability-related inquiries. The County argued that its wellness program was part of its health plan and, as such, fell under the ADA’s safe harbor provision.

The primary question addressed by the district court was whether the wellness program was a “term” of a bona fide benefit plan, which would allow it to come within the ADA’s safe harbor provision for such plans. In granting summary judgment to the County, the district court determined that the program was indeed a “term” of the County’s group health plan based on the following three factors:

  1. The health insurer offered the wellness program as part of its contract to provide insurance, and paid for and administered the program;
  2. The wellness program was available only to plan enrollees; and
  3. The county presented a description of the wellness program in at least two employee benefit plan handouts. Continue Reading Employer-Sponsored Wellness Program Held Lawful Under the ADA

By Eric J. Conn

In what seems to be a trend, OSHA has again delayed its rulemaking process for an Injury and Illness Prevention Program (commonly known as I2P2) standard. The announcement came during a National Advisory Committee on Occupational Safety and Health meeting in late June.  According to OSHA officials, we should not expect the next rulemaking phase, a small business review process, to begin until at least Labor Day.  I2P2 programs, which aim to reduce workplace injuries by requiring employers to proactively find and fix workplace hazards, have been on OSHA’s regulatory radar for quite some time.

Agency hold-ups, however, and more recently, election-year politics, have left the rulemaking process at a standstill.  The timeline below illustrates OSHA’s “progress” to date on the I2P2 Rule:

To justify the Agency’s most recent delay, an OSHA official explained that OSHA is still ironing out the proposal it plans to present to the SBREFA panel. OSHA stressed that it wants to deliver a “complete” proposal, including a range of alternatives that the Agency is considering.  Excuses aside, OSHA’s inability to get past this early step in the rulemaking process signals a long and difficult road ahead for the I2P2 rule.  After OSHA convenes the SBREFA panel, it still has to publish its proposed rule and solicit stakeholder comments before releasing a final rule.  Based on the time-consuming nature of this process and the delays we have already seen from OSHA, we probably will not see substantial movement on the rule until 2013.  Still, it is never too early for employers to start preparing.

While OSHA’s rule will likely allow for some degree of program flexibility, we expect that it will require employers’ I2P2 programs to include the following core components:

  • Management leadership;
  • Employee participation;
  • Hazard identification, prevention, and control;
  • Education and training; and
  • Program evaluation.

Further, an I2P2 rule will likely draw from current voluntary consensus standards for I2P2 programs, such as the ANSI/AIHA Z10 and the OSHAS 18001 standards, as well as state I2P2 laws and regulations (34 states currently incentivize or require employers to implement I2P2 programs through legislation or regulation).

No matter the Rule’s ultimate requirements, employer compliance will be crucial.  The I2P2 rule has the potential to become one of the most frequently used weapons in OSHA’s enforcement arsenal.  For example, if a workplace injury occurs, OSHA may not only cite the employer under applicable hazard-specific standard, it will likely also tack on an I2P2 violation. Alternatively, if a workplace injury occurs, but there is no hazard-specific standard for OSHA to cite, OSHA will rely on the I2P2 rule to impose fines against employers.  In either case, OSHA’s reasoning would be that the injury never would have happened if the employer had an adequate I2P2 program in place.

This type of enforcement pattern is already playing out at the state plan level.  Consider California for example, where employers have been subject to a state I2P2 standard since 1991.  Twenty-one years later, California’s I2P2 standard is the most frequently cited standard.  The bottom line is that although OSHA may not issue a final I2P2 rule until sometime in 2013, or later, employers should consider the potential far-reaching implications of the rule for safety, their budgets, and their reputations.

 

Bonnie I. Scott, a Summer Associate (not admitted to the practice of law) in Epstein Becker Green’s Washington, DC, office, contributed significantly to the preparation of this post.

By Paul H. Burmeister

The OSHA/Hyatt Hotels saga continued with a recent exchange of letters between OSHA and the hotel chain’s attorney.  In April, OSHA issued a “5(a)(1) letter” to the CEO of Hyatt Hotels, indicating that OSHA believed there were ergonomic risks associated with the daily work activities of the company’s housekeeping staff.  The letter put the hotel chain “on notice” that while OSHA did not believe that a “recognized hazard” existed at the  time of the inspection, such that a General Duty Clause citation should issue, if the same hazard was later identified in a subsequent inspection, OSHA would assert that this letter made the hazard a recognized one, for purposes of enforcement.  Therefore, if the hotel chain does not follow OSHA’s recommendations, subsequent inspections would likely result in a citation.  As well publicized as this battle has been, OSHA would likely take the same position with other hotel operators.  In other words, the entire industry may now be “on notice.”

The OSHA letter culminated what was nearly a year-long OSHA investigation of Hyatt hotels across the country.  The inspection activity was prompted in 2010 by multiple employee complaints filed in concert by housekeepers (through their Union, Unite HERE) across the country complaining of ergonomic injuries related to bending, stooping, twisting, and lifting while cleaning and making beds.

Hyatt responded to the OSHA letter through counsel and pointed out that despite the numerous employee complaints, OSHA did not have the evidence to issue one citation to the hotel chain.  In its response letter, Hyatt also reiterated its serious concern that the housekeepers’ union was using the Agency to drive its organizing efforts in the hospitality industry.

Hotel employers should be on alert for OSHA inspections at their properties.  As OSHA inspections involve interaction with local management, training at the property level is key to successfully managing an OSHA inspection.  Hotel operators with more than one location should also be aware of OSHA’s efforts to amplify the impacts of a single enforcement action throughout an entire corporate enterprise and to pursue follow-up inspections at related facilities in search of high dollar Repeat violations.  Accordingly, OSHA activity at one of your facilities should be clearly communicated to other similarly-situated facilities, and any of OSHA’s findings should be corrected throughout the enterprise.

By Julia E. Loyd and Eric J. Conn

Last week, the U.S. Department of Labor’s Occupational Safety and Health Administration (“OSHA”) launched a new National Emphasis Program targeting Nursing Homes and Residential Care facilities (“Nursing Home NEP”).  In an accompanying Press Release, OSHA announced that the Nursing Home NEP aims to protect workers from safety and health hazards “common in medical industries.”  Effective upon its announcement and for a three-year period thereafter, the NEP focuses on ergonomic hazards (e.g., strains and sprains from patient  handling), exposure to bloodborne pathogens (e.g., needlestick injuries), workplace violence (e.g., assaults by patients or others), and other hazards commonly found within nursing homes and residential care facilities (e.g., exposure to hazardous chemicals or infectious diseases).

By way of background, the Nursing Home NEP is not the first of its kind.  Nearly a decade ago, in September 2002, OSHA issued a virtually identical Nursing Home NEP, which targeted the same types of employers and all of the same hazards except for workplace violence.  Today’s OSHA evaluated the need for a new health industry NEP, and reviewed 2010 data from the Bureau of Labor Statistics.  That review revealed that nursing and residential care facilities still had one of the highest DART rates of all industries.  Specifically, the DART rate for nursing and residential care was nearly three times the national average.  Reacting to this data, the Assistant Secretary of Labor for OSHA, David Michaels, declared:

“These are people who have dedicated their lives to caring for our loved ones when they are not well. It is not acceptable that they continue to get hurt at such high rates. . . .  Our new emphasis program for inspecting these facilities will strengthen protections for society’s caretakers.”

As was the case with the 2002 NEP, the new Nursing Home NEP focuses primarily on ergonomic stressors relating to resident handling, exposure to blood and other potentially infectious materials, exposure to tuberculosis, and slips, trips and falls.  This NEP also addresses workplace violence, which was not part of the 2002 NEP.

What’s most interesting about the Nursing Home NEP, especially as compared to OSHA’s other Special Emphasis Programs, is its intended heavy reliance on the General Duty Clause; i.e. the catch-all duty in the OSH Act requiring all employers to provide a workplace free from “recognized hazards that are likely to cause death or serious physical harm.”  There are no specific OSHA standards for two of the primary hazards targeted by this NEP — (1) Ergonomics; and (2) Workplace Violence — so citations related to those two hazards will have to fall under the General Duty Clause.

In determining which facilities to inspect under the Nursing Home NEP, OSHA has prepared a list of Skilled Nursing Care, Immediate Care, and Nursing and Residential Care facilities with DART rates at or above 10.0 as reported in the CY 2010 OSHA Data Initiative (some 700 sites).  Each OSHA Area Office must conduct at least three Nursing Home NEP inspections per year.  The Nursing Home NEP also continued a recent trend by mandating that all approved State Plan OSHA Programs also adopt the NEP, and also conduct at least three Nursing Home NEP inspections per year.

Although the scope of this NEP covers only nursing homes and residential care facilities, practically speaking, it will have a major impact on the healthcare industry as a whole.  The reason is, a major component of the NEPs launched under the current OSHA leadership has been extensive training of OSHA’s compliance safety and health officers (CSHOs), who conduct the NEP inspections.  The training related to the Nursing Home NEP will arm CSHOs all over the country with a better understanding of the OSHA standards and General Duty Clause application to the supposed hazards common in nursing homes.  Those hazards happen also to be the same hazards that impact hospitals, doctors’ offices, rehab centers, and other healthcare workplaces.  The same broad impact was seen in the chemical industry after OSHA developed its Petroleum Refinery PSM NEP.  OSHA suddenly had a much larger group of CSHOs who understood the complex PSM Standard, and knew what to look for in PSM covered processes.  Even before the Chemical Facilities PSM NEP launched, chemical manufacturers were already seeing a surge in PSM enforcement because of the new army of PSM-knowledgeable CSHOs borne out of the Refinery NEP.  The healthcare industry will see the same surge.

To prepare for increased scrutiny under the Nursing Home NEP, industry stakeholders should evaluate and enhance their internal programs and policies as they relate to the hazards we know OSHA will be targeting.  A good starting point would be cross-check the programs against the NEP Directive and the referenced Guidance Documents within, such as OSHA’s:

  1. Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders;
  2. Directive on Enforcement Procedures for Investigating or Inspecting Workplace Violence Incidents;
  3. Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens Standard; and
  4. Nursing Home eTool.

Likewise, employers should be sure they are prepared to properly manage an OSHA inspection.  Epstein Becker Green’s national OSHA Group prepared an OSHA Inspection Checklist to help guide employers through the steps necessary to prepare in advance for a visit from OSHA, and to effectively manage an inspection once it begins.

By Casey M. Cosentino and Eric J. Conn

On March 20, 2012, the U.S. Court of Appeals for the Seventh Circuit vacated an ALJ’s decision penalizing Caterpillar Logistics Services, Inc. for allegedly failing to record an employee’s “work-related” musculoskeletal disorder (“MSD”) on the Company’s OSHA 300 log.  Caterpillar Logistics Services, Inc. v. Sec’y of Labor, No. 11-2958 (7th Cir., Mar. 20, 2012).  This case is significant because it stamps back (at least temporarily) an effort by OSHA to expand the meaning of “work-related” in the context of ergonomic injuries and OSHA Injury & Illness Recordkeeping.

By way of background, OSHA requires employers to record certain work-related deaths, injuries, and illnesses.  See 29 C.F.R. § 1904.4(a)According to OSHA’s regulation, an injury is work-related if “the work environment either caused or contributed to the resulting condition.”  29 C.F.R. § 1904.5(a).  Employers are required to record such injuries on OSHA’s 300 Log, 300A Summary Form, and 301 Report.  MSDs are injuries to muscles, nerves, tendons, ligaments, joints, cartilage or spinal discs that were not caused by a slip, trip, fall, motor vehicle accident or similar trauma.

In the Caterpillar Logistics case, an employee experienced pain in her right arm after working five weeks in the Company’s packing department.  She visited the Company’s medical clinic, where the staff physician diagnosed her condition as medial and lateral epicondylitis (aka golfer’s elbow and tennis elbow).  The physician concluded, however, that the repetitive motions in the employee’s work alone did not contribute to her condition.  A five-member internal review panel agreed with the physician’s diagnosis and conclusion.  The Company, therefore, did not record the injury on the 300 Log as work-related.

After an inspection, however, OSHA determined that the employee’s injury was “work-related” and assessed the Company a citation for failing to record the injury.  An administrative law judge (“ALJ”) sustained OSHA’s determination.  In doing so, the ALJ concluded that “an employee’s work activities do not have to be the cause, but rather a cause of an injury or illness” in order to be recordable (emphasis added).   The ALJ also found the preponderance of the evidence showed the employee’s work activities were at least a contributing cause of the employee’s epicondylitis.  The Occupational Safety and Health Review Commission declined to review the ALJ’s decision, rendering the ALJ’s determination final.

On appeal, the Seventh Circuit vacated the ALJ’s decision and remanded the matter for further proceedings.  The Court criticized the ALJ for basing his decision on the sole physician to testify in support of OSHA’s position and ignoring the “strong indications that [his] favored witness got things wrong.”  Indeed, the Court discounted OSHA’s physician’s testimony because he failed to explain why, if the work activities in the packing department contribute to epicondylitis, no other worker in the Company’s 10 years of operations had contracted this same condition.  Additionally, the Court stated that OSHA, not the judiciary, must determine what “§ 1904.5(a) means in saying that an injury is work-related if working conditions ‘contributed to’ the injury.”  The Court proposed two alternative meanings for the “contributed to” requirement for OSHA to consider: (1) “increased the probability, above background levels, by a statistically significant amount;” or (2) “doubled the probability.”

Nevertheless, the Seventh Circuit was puzzled by the presence of the work-relatedness requirement in § 1904.4(a).  The Court reasoned that if the purpose of the injury log is to help the U.S. Department of Labor determine which occupations are hazardous and in need of enforcement resources and regulatory changes, then that purpose is best served if employers were required to record all injuries, not just the injuries that employers determine are connected to the workplace.  The Court further noted that eliminating the work-relatedness requirement would save employers time and the high expense of evaluating whether workplace factors contribute to injuries and illnesses.  For these reasons, the Court noted that “the Secretary may wish to take another look at § 1904.4(a).”

Because of the Caterpillar Logistics case, it remains unsettled whether an employee’s job duties must be the cause of an injury or illness or a cause to constitute work-relatedness.  At the very least, however, this decision reminds ALJs to weigh all the evidence in determining whether an injury or illness is work-related and/or an anomaly.  Employers should stay tuned for further guidance on how much workplace factors must contribute to injuries and illness to be considered work-related.  In the meantime, because the work-relatedness requirement is on OSHA’s radar, employers should review their regulatory obligations to record work-related injuries and illnesses, and ensure that they are maintaining in accurate injury and illness recordkeeping logs.

By Jay P. Krupin and Kara M. Maciel

Last week, on November 9, 2010, housekeepers employed by Hyatt Hotels filed complaints with OSHA alleging injuries sustained on the job. The complaints were filed in eight cities across the country, including Chicago, Los Angeles, San Francisco, Long Beach, San Antonio, Honolulu and Indianapolis.  Similar OSHA actions may occur in Boston, NYC, DC, Atlanta, Las Vegas, Miami, and Orlando with higher concentrations of hotel properties. This is the first time that employees of a single private employer have filed multi-city OSHA complaints, and it appears to be a coordinated effort with organized labor, UNITE HERE.

Read more on the Hospitality Labor and Employment Law Blog.