Posts Tagged ‘violence’

When domestic violence finds its way to the workplace

Wednesday, June 20th, 2012

The deceased: a police officer. A nurse in training.
The perpetrators: A prison guard. A surgeon.
These recent deaths were two of the approximately 5,000 on-the-job fatalities that occur each year, and both both were related to domestic violence. We mention the professions of the parties involved simply because domestic violence is often assumed to be an issue that doesn’t happen to “people like me” or that it primarily occurs in certain economic strata. These myths and stereotypes are part of the reason that it can be such a hidden problem.
In the case of Officer Kevin Ambrose, a 36-year veteran of the Springfield MA police department, he was shot and killed in the line of duty while protecting Charlene Miller and her baby from a former boyfriend. Miller was also shot but survived; Miller’s baby was unharmed, largely thanks to Officer Ambrose’s courage. The assailant, Shawn Bryan, a Rikers Island corrections officer, took his own life after the shooting.
Last week, Jacqueline Wisniewski was stalked and gunned down in Buffalo Hospital. Her murderer was a surgeon at the hospital, her coworker and a former boyfriend. The hospital and nearby schools were locked down for a few hours after the incident because it was unclear if this was a targeted incident or a shooting spree. Timothy Jorden, a trauma surgeon at the hospital and a former army Special Forces weapons expert, was identified as the assailant by witnesses and an all points bulletin was issued. He was found dead at his home two days later.
These tragic events are part of a phenomena called “domestic abuse” or “domestic violence” – misleading terms at best. The word “domestic” softens the edges of a brutal reality, and implies that it is something that happens behind closed doors, not our business. Yet it is indeed something we should be making our business and it is clearly not something that is confined to the home. Increasingly, the violence plays out or culminates in the workplace as assailants are stalked; it also takes the lives of working police officers and first responders.
According to a recent report in the Annals of Epidemiology, homicide is a leading cause of occupational death in U.S. women. There were 142 homicides among women at work resulting from intimate partner violence from 2003 to 2008. While the rate of homicides in the workplace has been trending down, the percentage of homicides against women at work increased in 2010 to 13 percent. Those at highest risk were in the health care, production, and office/administration professions. More than half the homicides occurred in parking lots and public buildings.
Types of workplace violence
Work violence generally falls in one of four buckets. It is helpful to segment them by type because the risk management and prevention measures can vary. The types of violence include:

  • Criminal outsiders, which includes robberies, rapes, and random violence by strangers. This type of violence is common in organizations that handle money, financial transactions, and drugs. Risk mitigation can include staff training and addressing environmental issues such as better lighting, customer/worker barriers, lockboxes, alarms, and closed circuit videos.
  • Organizational clients – this is violence committed by customers, patients, or other recipients of the business services. Healthcare workers in particular suffer many incidents at the hands of patients and family members. These might include rage-related incidents and incidents related to mental health issues or persons under the influence. Risk mitigation measureless include staff training and environmental controls.
  • Lateral or worker on worker violence, which includes the so called “going postal” incidents and retribution for firings or other work-related issues. Although these incidents are the ones that make the headlines, they are the least common. Mitigation measures include better hiring practices, such as background and reference checks, zero tolerance policies that are enforced (including anti-bullying measures), manager and supervisor training, anger and stress management training for workers, availability of an EAP. Particular measures may need to be taken at points of high stress, such as layoffs or job loss.
  • Domestic violence – this involves an employee involved with a spouse or significant other; it also includes coworkers who might be coincidentally caught up in events or first responders who are injured when trying to help the victims. This is the most difficult one to address since it stays “underground” until a serious point of escalation. The best way to deal with this potential is proactively as part of an organization’s health and wellness effort by publicizing the issue and publicizing the availability of resources to help. More and more progressive companies are addressing the issue. The Corporate Alliance to End Partner Violence is a national nonprofit organization dedicated to partnering with businesses to help reduce the costs and consequences of partner violence at work. From policies and programs to legal issues and legislation, CAEPV is a credible source for information, materials and advice. It’s an excellent source of best practices for corporate programs to prevent partner violence and offers concrete help for employers in starting a workplace program.

Why should employers care?
Employers are involved in domestic abuse whether they want to be or not. Futures Without Violence delineates Seven Reasons Employers Should Address Domestic Violence not the least of which are that it is a pervasive issue, it poses security and liability issues, and it results in significant lost time and lost productivity. A 2003 CDC study revealed that domestic violence accounts for nearly 8 million lost work days, the equivalent of more than 32,000 full-time jobs.
Plus, it is a morale issue. Studies show that 84% of surveyed employees believe that employers should get involved in the solution to the problem of domestic abuse. Yet there is a discrepancy, because at the time of this survey, just 13% of executives surveyed thought it was the company’s job to help solve the problem.
Workers’ comp is simply not an issue that can easily be siloed off from other aspects of a workers’ life. We certainly see that with health issues and so-called lifestyle issues that complicate worker’s comp claims. So, too, with domestic violence. While the employer may or may not be shielded from compensability in incidents of work violence, that sometimes simply opens the door to liability in the courts for other reasons: negligent hiring, lack of security, etc. While it’s important to address the safety issues directly related to the job, it makes economic sense to have health and safety be part of an overarching wellness program that addresses health-related issues that occur both on and off the job.

Violence in healthcare: 61% of all workplace assaults are committed by healthcare patients

Monday, March 5th, 2012

According to a recent NCCI Report on Violence (summary) (Full Report, PDF), “the majority of workplace assaults are committed by healthcare patients.” While there is good news in the fact that workplace homicides and assaults are on the decline, the NCCI report says this:
“The decline in the rate of workplace assaults has lagged the steady decline in the rate for all lost work-time injuries and illnesses. This reflects a notable change in the composition of the US workforce and, in particular, the ongoing increase in the share of healthcare workers, who experience remarkably high rates of injuries due to assaults by patients. This is especially common in nursing homes and other long-term care facilities. In fact, 61% of all workplace assaults are committed by healthcare patients. For assaults, coworkers make up just 7%, and someone other than a healthcare patient or coworker comprises 23%. The remainder is unspecified.”
In a post last year on healthcare workers and on-the-job violence, we talked about some of the perpetrators:
“While many assaults are by patients, friend and family members of patients also can commit the assaults. There are also rapists or muggers who are targeting healthcare settings or solitary workers; drug addicts and robbers, who are looking for medications; and domestic violence brought into the workplace. And it’s unclear why violence is on the rise. Many point to staff shortages. Others see the preponderance of alcohol, drugs, and ready access to weapons as contributing factors; others think that hospital administrators do too little in the area of prevention.”

In the list above, we overlooked a huge and growing segment: elderly patients, patients with Alzheimer’s, and people suffering from mental illness.
Prevention Tools
OSHA: Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. See also the slide show overview version
The Emergency Nurses’ Association has issued a good Workplace Violence Toolkit.
We also found that WorkSafeBC has put together a series of excellent short video clips for various health care settings.




Health Wonkery, FL money trail, work violence report & more

Thursday, February 2nd, 2012

Louise Norris jumps into the political fray with this week’s Health Wonk Review – Campaign 2012 Edition at Colorado Health Insurance Insider. It’s a great edition with some solid submissions, and we are smitten by the great historic voting photos that Louise used to punctuate the posts. Check it out.
Other noteworthy news
Follow the money – In the continuing saga of Florida’s physician-dispensed workers comp drugs and the associated costly price tag for employers, Joe Paduda looks at the behind-the-scenes opposition muscle aimed at any legislative attempts to put limits on this practice. He cites a recent research report, which tracked more than $3 million in political donations to “one Mirimar address, dozens of companies.” The Florida Independent news story goes on to say, “In suburban Tampa, a single-story building at 610 South Blvd. is home to countless political committees in Florida and all over the country, and is known as a veritable political action committee mill. A similar story lies in Miramar, where two doctors — Paul Zimmerman and Gerald Glass — run dozens of companies that, altogether, have funneled more than $3 million into state political campaigns and committees in recent years.” Joe notes, “$3.2 million total shows clearly just how important Florida is to dispensing companies and their affiliates.”
Violence in the Workplace“Workplace homicides ‘Are not crimes of passion committed by disgruntled coworkers and spouses, but rather result from robberies.’ And the majority of workplace assaults are committed by healthcare patients.” These are a few top line findings in the NCCI research report on Violence in the Workplace. Although homicides are trending down, they comprise 11% of workplace fatalities. You can download a copy of the complete report, which is part of NCCI’s ongoing research into the topic of work violence.
New blog of note – The folks at PRIUM, a workers’ compensation utilization management company, have recently launched Evidence Based, a blog that will focus on our favorite topic – workers comp – with particular emphasis on the over-utilization of prescription drugs in the treatment of injured workers. Recent posts have dealt with state efforts to control narcotics. See recent posts on Arizona: The Simple Path to Controlling Narcotics in Non-Monopolistic States and Ohio’s New Rules: A Good Start (with a Potential Gap).
Getting social – Pro tip for social media users: If you are going to file a workers’ comp claim, you should think twice about posting party pics on Facebook – judges may take them into consideration when evaluating the merit of your claim.
The Feds & Fraud – In Government Executive, Kellie Lunney explores the reasons why the federal workers’ comp program remains vulnerable to fraud. According to a study by the Government Accountability Office, limited access to data is a key culprit. “Specifically, we found that limited access to necessary data is potentially reducing agencies’ ability to effectively monitor claims and wage-loss information,” the report stated. In addition, agencies’ overreliance on self-reported data from claimants, the frequent use of physicians not employed or selected by the government, and the expense involved in conducting investigations and prosecutions have stymied efforts to stamp out fraud. GAO noted that investigations are the “most costly and least effective” way to reduce fraud, but the ability to prosecute those who cheat the system is a valuable deterrent.
OSHA Posting Compliance – Employers, did you remember to post OSHA Injury & Illness Reports on Feb 1? If not, make sure that you do. Rules require that employers post “…the official summary of all injuries and illnesses occurring in the previous year. The information must be compiled on the OSHA Form 300A or an equivalent and posted in a conspicuous place or places where notices to employees are customarily posted. The information must remain up through April 30, 2012.” For more information and to learn if this requirement applies to your organization, check out OSHA’s Recordkeeping page.
Quick takes

Risk, repackaged drugs, bizarre cases and other news notes

Wednesday, January 11th, 2012

Risk RoundupPolitical Calculations blog hosts this week’s Cavalcade of Risk, replete with a post rating system. Check it out.
Florida repackaged drugs issue redux – Dave DePaolo posts about a new effort to put a price cap on Florida’s repackaged drugs. He posits that changing economic and regulatory conditions might create a more favorable climate for passage. He also talks about how “capping the price of drugs has been hotly contested by the Florida Medical Association (FMA) and a company called Automated Healthcare Solutions (AHCS).” AHCS is a firm whose executives have contributed heavily to politicians to prevent such legislation. A Tampa Bay news report talks about how the state’s pill mill crackdown was held up by proponents of doc dispensing, including AHCS principals: “The two Miramar workers’ compensation doctors have helped pump about $3 million into the political system through a dozen companies in the past year.” A story in the Florida Independent covers an earnings report for top lobbyists, noting that, “Among the companies to have spent the most on lobbying is Automated HealthCare Solutions, a group whose co-chairmen have become fixtures on the political scene. According to the Current, Automated HealthCare has posted minimum lobbying expenditures greater than $300,000.” For more on why repackaging controls are needed, see Joe Paduda’s posts: Drug Dispensing by Docs and Repackagers and the myth of AWP.
The big five – Roberto Ceniceros reports that Top 5 workplace injury causes make up 72% of direct workers comp costs, according to a research report by Liberty Mutual Group. “Overexertion–or injuries caused by lifting, pushing, pulling, holding and carrying–costs businesses $12.5 billion in direct annual expenses and accounts for more than 25% of the national burden.” This was followed by falls on the same level, falls to a lower level, bodily reaction, and struck by object.
Violence in Nursing – In When it hurts to help, Victoria Ison reports on workplace violence in nursing. Many might assume most violence is perpetrated by patients or intruders but not so: “Assistant nursing professor Cindy Thomas said the most common form of violence currently seen in health care occurs between nurses. She said violence between physicians and nurses is second, and violence between patients and nurses is actually third most common.”
Strange suitsTop 10 Bizarre Workers’ Comp Cases for 2011. From an eye-related injury after hitting a bowling ball with a sledge hammer to a fall from a helicopter while attempting to capture a deer with a net – read Thomas Robinson’s picks for workers comp lawsuits with strange circumstances. Robinson reminds us that, “one must always be respectful of the fact that while a case might be bizarre in an academic sense, it was intensely real, affecting real lives and real families.”
Brief takes

Cavlacade of Risk & other news from the blogosphere

Wednesday, October 5th, 2011

Risk roundup – Jay and Louise Norris of Colorado Health Insurance Insider host this week’s Cavalcade of Risk – it’s the Colorado nature edition. Congrats to the Norrises on their 5 year blogging anniversary and 10th issue hosting the Cavalcade.
Check the facts – At Comp Time, Roberto Ceniceros tells the story of an insurer relying on a newspaper’s crime report as the basis for denying a claimant’s workers comp benefits. While this situation might seem like one that wouldn’t surface all that often, we’d make the case that it is a cautionary tale for anyone who is using social media as an investigative tool.
Culture of Caring – Dave DePaolo has an interesting post on how the culture of caring relates to a workplace where the turnover rates are high, like fast food joints. Is high-touch communication and an early return-to-work model as effective when turnover is 120%? We’d note that high turnover is not only an impediment to return to work, it’s no doubt also a factor in the number of injuries that occur. New, untrained workers have more injuries. The Bureau of Labor Statistics data shows that more than 40% of work-related injury claims are filed by workers who have been on the job for 12 months or less, and a NIOSH study found that employees 24 years old or younger are two times more likely to suffer a nonfatal injury than their older co-workers.
Medical Costs – In our last news roundup, we linked to the Kaiser Family Foundation’s recent report that average family benefits premiums are up 9%. Joe Paduda of Managed Care Matters offers his thoughts on why premiums are up so much when medical costs are flat.
Workplace Violence – Michael Fox of Jottings by an Employer’s Lawyer posts about OSHA’s new directive on procedures for investigating workplace violence complaints. He notes that two industry groups get singled out for particular focus: Healthcare and Social Service Settings and Late-Night Retail Settings.
Anniversary of Patel Memo – At Lexis-Nexis, Robin E. Kobayashi commemorates the 10 year anniversary of the Patel Memo. Bonus points to you if you know what the Patel memo is. Here is a clue: it launched an entire workers comp-related industry.
Case to watch – The EEOC is suing Texas-based BAE Systems for violating the ADA by firing a man who weighed 680 pounds. The man had worked at his job for 16 years and had logged good performance evaluations. The intersection of obesity and the ADA is one to watch.
When light duty runs off the rails Safety News Alert discusses a case of a worker who returned to work on light duty. While on light duty, he received partial disability benefits because the job didn’t pay as much as his previous position. But the employee had trouble getting along with his supervisor and asked to be laid off – which the employer granted. The employee then applied for full work comp benefits. Check out the court’s decision.
New blog Well, new to us. TexasM Mutual Insurance Company’s blog has been up and running for about 15 months now, but we just discovered it via our Twitter feed. There are some good posts, particularly some good safety information. Texas Mutual Insurance Company is the state’s leading provider of workers’ compensation insurance, with approximately 32 percent of the market. (And remember, Texas is a state where private employers can choose whether or not to carry workers’ compensation insurance coverage.)
Also of interest…

Annals of Compensability: Violence as a “Normal” Working Condition

Thursday, September 22nd, 2011

Here is a very interesting case from Pennsylvania, where the definition of “normal working conditions” is fraught with terror (and which, as a result, closes the door to comp compensability while potentially opening another to lawsuits). But in our excitement to discuss this intriguing case, we get ahead of ourselves.
Greg Kochanowicz worked as a manager for the Pennsylvania Liquor Control Board. That might sound like an enforcement job, but ironically, his job was selling liquor from a retail outlet. On April 28, 2008, a masked man entered the store, pointed two guns at Greg and a co-worker, and forced them to empty the safe and cash register. The robber prodded the back of Greg’s head with one of the guns. After getting the cash, the robber used duct tape to tie Greg and his co-worker to chairs in the office. There was no physical harm – just the threat of violence if Greg did not cooperate.
Following this incident, Greg suffered from anxiety, depression and flashbacks. He was too traumatized to return to work. Diagnosed with PTSD, he collected temporary total benefits under workers comp for what Pennsylvania calls a “psychic” injury. (It is worth noting that in 1981 Greg’s brother was stabbed to death in a robbery, an incident for which Greg received no counseling or support.)
Abnormal Justice
Greg’s employer appealed the WCJ ruling. A split panel of judges (4-3) reversed the finding of compensability on the basis that armed robberies were a “normal” working condition – and only “abnormal” working conditions lead to compensability for PTSD/”psychic” injuries. That’s a very interesting notion, indeed.
In its reversal, the appeals court noted that robberies were quite common among the Liquor Control Board stores: in the five county area, there were 99 robberies since 2002, an average of one a month. In addition, employees were acutely aware of the risks. They received a written pamphlet entitled “Things you should know about armed robbery.” Greg had read the booklet and received training related to it. In fact, he followed the employer’s written protocol to the letter, thereby avoiding bodily harm to himself and his co-worker.
The appeals court is saying that armed robberies should come as no surprise to liquor board employees. They have been forewarned. And in the view of a majority of the judges, forewarned is foreclosed: there can be no compensability for a psychic injury as a result of normal working conditions. (Had Greg been shot, however, he would have had a compensable injury.)
OSHA to the Rescue?
The appeals court states that having a gun pressed to the back of the head is a “normal” working condition. If this is indeed true, then the employer has put employees in a workplace that is fraught with risk. This is something employers are not allowed to do.
Here is OSHA’s General Duty Clause:

“Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

If the court is correct, if armed robberies are a “normal” working condition, then the employer has failed to eliminate an unacceptable risk. By leaving unarmed employees in high risk areas, they are out of compliance with OSHA standards. Given their knowledge of the likelihood of robberies, they should place armed guards in each store, particularly in evening hours. Their failure to protect employees from an all-too-routine hazard is unacceptable and may be grounds for lawsuits.
This case is wending its way toward the PA Supreme Court, where the arguments of the dissenting judges, led by Renee Cohn Jubelirer, are likely to prevail. Greg will probably qualify once again for workers comp. Yes, he received training in violence; he was well aware of the risks in his job; he even handled the situation with exemplary composure. But there is nothing normal about having a gun pressed into the back of your head, unless you are an actor taping a cop show for cable TV.

Inadequate: Protections for mental health workers

Friday, August 19th, 2011

Sometimes, system redress seems painfully inadequate.
Such is the case with the $7,000 OSHA penalty recently imposed for inadequate safeguards related to the case of murdered mental-health worker Stephanie Moulton. $7,000 is the maximum fine available for “a serious violation of the agency’s “general duty clause” for failing to provide a workplace free from recognized hazards likely to cause serious injury or death.” It’s not just that the dollar amount seems paltry in light of the loss of life – it simply doesn’t seem substantial enough to have any deterrent value.
And in truth, while the OSHA citation points to the employer, one could make the case that the employer is also a victim of an economic squeeze play, which has resulted in inadequate staffing and safety controls. State budget cutbacks worry mental health workers – a scenario that is no doubt playing out throughout the country – in mental health budgets, in public safety budgets, and in regulatory enforcement, just to name a few areas that affect the health and safety of workers — and of the public.
Stephanie Moulton was working alone at one of the North Suffolk Mental Health Association’s group homes in Revere when she was brutally murdered by a patient with a violent record. A week later and just miles away at the Lowell Transitional Living Center, a shelter for the homeless, a worker named Jose Roldan was also killed by person who had slipped through the cracks in the mental health system. Both these murders were discussed in-depth in stories that appeared in The New York Times: A Schizophrenic, a Slain Worker, Troubling Questions recounted Moulton’s death, and Teenager’s Path and a Killing Put Spotlight on Mental Care discussed the case related to Roldan’s death.
An investigation into Moulton’s death resulted in the issuance of a report in June: Report of the Massachusetts Department of Mental Health Task Force on Staff and Client Safety. The report found that:

  • Years of budget cuts have negatively impacted service delivery and safety issues in the following areas:
    –Inadequate numbers of, and inadequate pay for, direct-care staff
    –Inadequate numbers of clinical staff with relevant training and experience
    –Deficiencies in the overall number of acute and intermediate hospital beds and community-based services and beds
    –Decrease in the role of psychiatrists and other highly-trained professionals in the care and treatment of individuals with the most serious mental illnesses
    –Requiring some staff to work under conditions that do not provide for adequate safety
  • There is an absence of system-wide use of a well-designed risk assessment process
  • There is lack of clarity in policies and procedures for incorporating risk variables into Individualized Action Plans
  • There is lack of sufficient access to and sharing of critical safety information
  • There is lack of adequate coordination of care across different components of the service system

OSHA’s citation includes recommendations the employer could take to address the workplace violence issue:

  • Creating a stand-alone written workplace violence prevention program that includes implementation of workplace controls and prevention strategies; hazard/threat/security assessments; a workplace violence policy statement outlining and emphasizing a zero tolerance policy for workplace violence; incident reporting and investigation; and periodic review of the prevention program.
  • Establishing a system to identify clients with assaultive behavior problems and train all staff to understand the system used.
  • Putting in place procedures to communicate any incident to staff so that employees without access to client charts are aware of previous violent or aggressive acts by a client.
  • Identifying the behavioral history of new or transferred clients, including conducting criminal and sexual offender records checks.
  • Conducting more extensive training so that all employees are aware of the facility’s workplace violence policy and where information about it can be found, including training employees to clearly state to clients that violence is not permitted or tolerated; how to respond during a workplace violence incident; recognize when individuals are exhibiting aggressive behavior and how to de-escalate the behavior; and identify risk factors that can cause or contribute to assault.
  • Installing and positioning panic buttons, walkie-talkies, recording security camera systems and smart phone GPS applications to better monitor employee safety and increase staff communication and support; implement and maintain a buddy system on at least the second and third shifts, based on a complete hazard assessment.

Mouton’s family is rallying for enactment of Stephanie’s law, which would mandate panic buttons in mental health facilities. A good start and one among recommendations issued by OSHA in their Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. But such measures may be woefully inadequate in the face of reduced staffing. In an ongoing climate of budget cuts and a strong public appetite for decreased regulatory controls, mental health workers are likely to continue being at greater risk — along with public safety workers such as police, firefighters, and healthcare workers, who also face dire staffing shortages.

News roundup: Cavalcade of Risk, massive fraud scheme, investigator deaths, premium hardening & more

Wednesday, June 15th, 2011

Cavalcade of Risk – for the biweekly smorgasbord of risk-related news from the blogosphere, check out the new edition of Cavalcade of Risk hosted at Political Calculations.
The $17 million fraud – not chump change – Most employers and insurers get very heated on the topic of work comp fraud – as well they should. But while keeping an eye on the front door for shoplifting, some thieves are loading up the company safe from the back door. This week, four members of a California doctor mill were indicted in a $17 million workers’ comp fraud. This stunning scheme bilked the city of Los Angeles and 19 insurance companies. Joe Wheeler talks more about the fraud and how it exposes a weakness in the system. He rightly notes, “That this relatively small fraud provider ring offering obscure medical procedures could make off with millions of dollars before being caught should make anyone involved in workers’ comp benefits take a breath.” Note to employers: it’s not enough to think your insurer will manage everything – you need to take an active interest in managing and questioning claims, too.
In the line of duty – Louisiana flags are flying at half mast this week for two insurance investigators who were shot to death by an agent last week while investigating fraud. According to Insurance Times, investigators Kim Sledge and Rhett Jeansonne “…had gone to the Ville Platte office of suspended insurance agent John Melvin Lavergne to collect records. Lavergne shot the investigators and then killed himself.” Louisiana is now looking into whether fraud investigators should be able to carry guns.
Is the soft market finally hardening? – Joe Paduda talks about recent reports from Towers Perrin and Fitch Ratings pointing to firming work comp premiums. No, really!
Dollars for doctors – ProPublica has been featuring an ongoing series that investigates the financial ties between the medical community and the drug and device industry. You can follow the entire series from the above link. In addition to several feature stories, there were frequent updates in made in May, several of which discuss drug industry ties to medical societies. In October, ProPublica also rolled out a searchable database of physicians who have received drug money, gleaned from public disclosures of seven large pharma companies. For a sampling, here is Massachusetts.
Ferreting out the more obscure news… – Among all the informative and useful information he posts over at Comp Time, Roberto Ceniceros also manages to ferret out some of the quirkier workers comp stories. This week, he posted about Palin’s emails and the workers comp connection and last week, it was porn industry hazmat suits.
Confined space videosWorkSafeBC produces a lot of great safety resources. Recently, a three-part video series on confined space came to our attention – worth checking them out. Part 1: Safe Yesterday, Deadly Today; Part 2: Test to Live; and Part 3: Rescue: Just Calling 911 Doesn’t Cut It.

Health Wonk Review, Illinois reform, Missouri SIF, mobile risks & more news notes

Thursday, June 9th, 2011

Health Wonk Review – John Irvine & Matthew Holt host a hefty edition of Health Wonk Review over at The Health Care Blog – lots of good health wonkery there!
Illinois work comp reform – After all the sturm und drang in the Illinois reform process, we’ve had a breakthrough … a reform bill finally passed on the last day of the legislative session. In a Tale of Persuasion, AP’s Zachary Colman takes you step by step through the painful process. And at Managed Care Matters, Joe Paduda offers an excellent rundown of some of the key provisions in the Illinois work comp reform bill.
In other Illinois news, the matter of $10 million in repetitive stress claims filed by Menard County prison guards has taken some new twists. The Illinois house recently passed a bill requiring the release of the related workers’ comp test records in compliance with the Freedom of Information Act. A report obtained through the FOIA shows that locking and unlocking prison cells didn’t injure the guards.
Missouri’s second injury fund woesInjured workers in Missouri are being left in the lurch, according to a story in stltoday.com. about the state’s troubled Second Injury Fund Roberto Ceniceros posts more about Missouri’s financially-ill second injury fund.
Mobile risks – Andrew Simpson writes about the increased workers comp exposure as more workers go mobile in Insurane Journal. In the past, the workplace was a clearly defined place and the hours of operation were also clearly defined, but as more and more workers go mobile, things are much less clearly defined – the lines between professional and personal life are blurring. Plus, employers are often supplying the mobile devices to workers, increasing their exposure to claims that occur when off site or off the clock. “Insurance claims professionals say claims made by workers injured while doing things where the relation to their employment is unclear are on the rise and the increasing use of mobile devices is challenging traditional notions of work-related injuries.”
Workplace violence factorsThe Workplace Violence Blog posts about the prevalence of workplace violence as evidenced by a Society of Human Resource Management survey, and states that “Approximately $55 billion a year is lost to litigation awards, property damage and lost productivity from workplace violence. It is estimated that productivity can drop as much as 50% in the six to eight weeks following a workplace violence incident.” The post includes seven common organizational factors that contribute tow workplace violence.
Industry growth – Insurance is one industry that is poised for growth. According to a recent research report issued by IBISWorld, employment in TPAs and and claims adjusting is set to grow 5.7% annually between now and 2016. “Other industries in the IBISWorld top 10 fastest-growing for the next few years include sustainable building material manufacturers, multi-family home builders, used car dealers, remediation and environmental cleanup services.”
MRSA facts from the CDC – From the CDC, MRSA and the workplace, including a list of frequently asked questions. Staph infections, including antibiotic resistant MRSA, MRSA skin infections can occur anywhere. However, the CDC notes that some settings have factors that make it easier for MRSA to be transmitted. These factors, referred to as the 5 C’s, are as follows: Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness. Locations where the 5 C’s are common include schools, dormitories, military barracks, households, correctional facilities, and daycare centers.

Are nurses and health care workers facing more on-the-job violence?

Monday, March 14th, 2011

If you asked the average person to list professions with the highest rates of violent assault, few would put health care professionals high up on that list. But the reality is that when it comes to workplace violence, nurses, nursing aids, and paramedics have the dubious distinction of being very high up on the list; only police and correctional officers suffer a higher rate of on-the-job assaults. And many nurses say that the violence is only getting worse.
In a fact sheet on violence, The International Council of Nurses, a federation of more than 130 national nurses associations representing the millions of nurses worldwide, says that:

  • Health care workers are more likely to be attacked at work than prison guards or police officers.
  • Nurses are the health care workers most at risk, with female nurses considered the most vulnerable.
  • General patient rooms have replaced psychiatric units at the second most frequent area for assaults.
  • Physical assault is almost exclusively perpetrated by patients.
  • 97% of nurse respondents to a UK survey knew a nurse who had been physically assaulted during the past year.
  • 72% of nurses don’t feel safe from assault in their workplace.
  • Up to 95% of nurses reported having been bullied at work.
  • Up to 75% of nurses reported having been subjected to sexual harassment at work.

Last fall, the issue of safety for nurses and allied health professional was brought to the forefront after the deaths of two California healthcare workers in separate incidents. In October, psychiatric technician Donna Gross was strangled to death and robbed at Napa State Hospital. Days later, nurse Cynthia Barraca Palomata died after being assaulted by an inmate at Contra Costa County’s correctional facility in Martinez. The deaths have sparked a new push for better security and stronger worker safeguards, particularly in settings treating prisoners and psychiatric patients.
While the occupational danger in environments like prisons and psychiatric hospitals is recognized and real, these are hardly the only high-hazard settings in which nurses work. Hospital emergency rooms are widely recognized as a hazardous environment, but violence occurs in other wards, too. Last year, the Well, a NY Times healthcare blog, featured an article by RN Theresa Brown entitled Violence on the Oncology Ward. And the CDC recently spotlighted research focusing on an increase in assaults on nursing assistants in nursing homes. In that study, 35% of nursing assistants reported physical injuries resulting from aggression by residents, and 12% reported experiencing a human bite during the year before the interview. There are no healthcare settings that are immune. Assaults routinely occur in general hospitals, in health clinics, and in patients’ homes.
The perpetrators of violence are varied: While many assaults are by patients, friend and family members of patients also can commit the assaults. There are also rapists or muggers who are targeting healthcare settings or solitary workers; drug addicts and robbers, who are looking for medications; and domestic violence brought into the workplace. And it’s unclear why violence is on the rise. Many point to staff shortages. Others see the preponderance of alcohol, drugs, and ready access to weapons as contributing factors; others think that hospital administrators do too little in the area of prevention.
Some are seeking legislative relief that would require hospitals and healthcare facilities to have safety and security plans and training in place. In a posting on KevinMD.com, respected physician Kevin Pho suggests that the rising tide of violence against healthcare workers might be emblematic of a dysfunctional health system, where healthcare is viewed as a commodity, and the caregiver-patient relationship is deteriorating. He says:

“Sometimes the simplest approaches are the most effective. Rather than adding security or installing metal detectors to prevent hospital violence, doctors and nurses could do a better job of empathizing with patients who are under stress when they are hospitalized or are angry because they’ve waited hours for medical care. At the same time, patients must realize that health care professionals are doing the best they can with an overtaxed health care system and should never resort to violence or abuse.”

In HealthLeaders Media, John Commins discusses an innovative approach undertaken by the University of Wisconsin Hospital and Clinics – a program to codify risk of hospital violence.
Recently, the Emergency Nurses Association issued a Workplace Violence Toolkit, targeted specifically at emergency department managers or designated team leaders.