State fines Cherry Hospital
By Matthew Whittle
Published in News on August 9, 2012 1:46 PM
Cherry Hospital is facing more than $15,000 in civil penalties after being cited by the state Department of Labor over concerns of employee safety.
The citation, which was the result of an occupational safety and health inspection that began on Feb. 10 and includes three alleged serious health and safety violations and three alleged nonserious violations, was given to the hospital by state officials on Tuesday. Corrective action must be taken by Friday, meaning hospital officials must notify and show the state how they are addressing those violations.
However, while Cherry Hospital and state Department of Health and Human Services officials say they have not yet determined how they will respond to the citation, they do believe the complaints are largely without merit.
"We are reviewing those, but we do not agree with the majority of the findings in this report," Cherry Hospital CEO Luckey Welsh said. "We realize in our facility there are cases of patient aggression, but we are working to reduce those every day.
"Our goal every day is to provide a safe work environment for our staff and safe, quality care for our patients."
Delores Quesenberry, director of communications for the state Department of Labor, explained the investigation came about as the result of a "workplace complaint," and that while there are no specific standards for workplace violence, particularly in a health care setting, these instances fall under the general duty clause.
"The general duty clause requires employers to provide a safe and healthy workplace for their employees," she said.
That broad standard was reiterated in the "Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers," which was released in 2004 by the Occupational Safety and Health Administration. That 47-page document explicitly states that it does not contain new regulations, but rather advisory guidelines for dealing with "violence inflicted by patients or clients against staff."
And in general, the guidelines provided in the document include recommendations that management work with all levels of employees to develop systems to prevent and react to violence, that facilities chart and analyze when instances of violence take place and the circumstances surrounding those, that facilities implement tools and controls to prevent violent instances, that facilities increase safety and health training, and that facilities improve record-keeping program evaluation as well as suggestions for how those plans might be carried out.
The first serious violation, which led to a $6,300 fine, alleges that Cherry Hospital did not provide a workplace "free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that employees were exposed to: potential fatal or serious physical injuries as a result of being assaulted by psychiatric patients and as a result of physically intervening with violent psychiatric patients while working in psychiatric wards of the hospital."
Four instances involving patients attacking and injuring multiple health care technicians between March and May were the basis for the citation.
* On April 10, a health care technician was injured, straining his back, when he intervened as a patient attacked a doctor. A second technician also suffered injuries to her hand, knee and back while placing that patient in a nonviolent Crisis Prevention Institute hold.
* On March 15, one health care technician suffered a sprained right leg and Achilles injury as the result of an attack by a 6-foot, 7-inch, 350-pound patient. The patient also punched another technician in the jaw, who hurt his knee, arms, neck and back when he fell.
* On May 1, two health care technicians intervened between two fighting patients. One tech was scratched and hurt in her head and shoulder. The other received contusions and a strained finger.
* On May 13, a health care technician was placing a patient in a CPI hold when the patients punched him in the head, causing contusions. A second health care tech then intervened, resulting in scratches, a swollen hand and injuries to her knees and back.
Among the possible abatement techniques suggested in the citation are:
* Conducting hazard assessments of patient-on-patient and patient-on-staff violence to identify risks and abatement strategies such as additions of personal protective equipment, equipment, facilities, procedures, policies and staffing.
* Better tracking of all violence related episodes and events and the circumstances surrounding those, conducting statistical analysis of how such incidents might be prevented. Employee safety and health representatives should be any investigation teams.
* Increase frequency and quality of CPI training. Make CPI training more realistic. Review videos of actual incidents of patient violence as learning tools. Require all employees present when a patient becomes violent to help when necessary.
* Establish overall hospital policy addressing employee safety, emphasizing potential injuries from patient interactions as a hazard to employees -- a policy that "should reflect that such injuries to employees are not necessarily an inevitable part of the job." In addition, the citation recommends that management and affected employees work together to create the policy.
* Provide adequate resources, "including staffing of sufficient numbers to ensure employees have the ability to protect themselves, to control patients, and restrain patients as needed to prevent patient attacks on employees or other patients," as well as use employee buddy systems, minimize time and places employees are alone with patients, minimize the need for and use of double shifts, and make sure employees using CPI are physically able.
* Make sure staff members who may interact with potentially aggressive patients know they have been designated as such.
However, Welsh said, not only is the wording of this violation overly broad, there is nothing in the rule that it cites (General Statute 95-129) that refers to health care facilities, much less psychiatric hospitals.
"We can never, in any hospital in this state or in Cherry Hospital, provide an atmosphere completely free of hazards. You're never going to be able to do that when dealing with patients with behavioral issues," he said.
Additionally, he continued, the citation is written as though Cherry is not taking any sort of measures to decrease or prevent violent interactions. But, he explained, not only do staff undergo an extensive orientation and are continuously trained on CPI techniques, the hospital also has put in place new programs to improve the communication and culture of the facility.
"We are always looking for continuous improvement, but we do the majority of these already," Welsh said. "We did not fail in that one."
In fact, he said, they've seen a 50 percent reduction in injuries from patient aggression since 2010.
The second serious violation, which also led to a $6,300 fine, was: "Protective equipment was not provided when necessary whenever hazards capable of causing injury and impairment were encountered."
The instance leading to this was a facility-wide lack of personal protective equipment for employees from "hazards of injuries associated with training to use/administer self-defense and patient control procedures known as CPI in response to attacks from violent patients."
Hospital officials' concern with this violation, Welsh explained, is that CPI does not allow for the use of any type of personal protective equipment, and in fact the use of such equipment would be in violation of the internationally recognized CPI standards.
"This was a judgment by the inspector, not a fact or a violation," he said.
The third serious violation, for which there was no fine, was for the lack of an assessment to determine if violent patients created hazards necessitating personal protective equipment, and the lack of an assessment to determine if hazards necessitating personal protective equipment were presented by employee training to use self defense and CPI procedures in response to violent patients.
Here, Welsh said, his concern is that such assessments were completed in October 2011 and have been updated since, and were made available to the inspector, but that he did not pick up a copy before filing his report.
"For him to say we did not do that is incorrect," Welsh said.
The nonserious citations involved OSHA forms that were improperly filled out, leading to three separate $900 fines.
Cherry and DHHS officials now have until Aug. 28 to decide how to respond -- either by paying the fines, officially contesting the findings or requesting an informal conference to attempt to settle the issue.