It is frequently observed that many laws exist simply because we seem to have to legislate common sense; some of the most obvious among these are laws requiring the use of seatbelts in our motor vehicles. In healthcare, too, we have seen laws evolve over the past thirty or so years that tend to regulate common sense, including HIPAA and OSHA. While HIPAA seems to have been in the forefront over the past ten years, it’s time to look at how your ob-gyn practice is enforcing the OSHA regulations on a day-to-day basis. Why the renewed concern?
Current OSHA Enforcement Philosophy
Early in the first term of the current administration, there was an overall pledge to step up enforcement of all existing federal regulations. Enforcement of OSHA was no exception. While OSHA covers virtually every industry and workplace setting, a special focus was placed on healthcare. In this vein, the administration hired over 100 Certified Safety and Health Officials (CSHOs) with the intention of increasing the number of random inspections.
Along with increased inspections came the promise of increased penalties, including tripled penalties in significant cases. Moreover, there was the pledge to publicize especially egregious cases. As David Michaels, PhD, MPH, Assistant Secretary of the Occupational Safety and Health Administration of the United States Department of Labor stated:
“In some cases, ‘regulation by shaming’ may be the most effective means for OSHA to encourage elimination of life-threatening hazards, and we will not hesitate to publicize the names of violators, especially when their actions place the safety and health of workers in danger. To do this, we will issue more hard-hitting press releases that explain more clearly why we cited a specific employer.”
Evidence of this can be found in the number of enforcement press releases related to OSHA violations, which increased from 161 in 2008 to 588 in 2011. The publication of an OSHA violation related to your ob-gyn practice could have some far-reaching effects that could not only harm your practice’s reputation with patients and referring physicians, but could also scare off prospective employees and damage business relationships with insurers and your professional liability company.
The enforcement activities have also moved from a primarily whistleblower response mode to one of active, random inspections. Several states have taken up this posture as well under the authority of Section 18 (b) State Plan Inspections of the OSHA Act. This has led to random inspections of medical and dental offices with the intent of finding revenue-generating violations.
What Actions Need to Be Taken?
Some practices seem to have forgotten about the requirement for everyone in the practice to participate and to document their participation in annual OSHA training. Of course, we expect that OSHA training is part of your routine orientation process for new employees. As far as annual staff and provider training, one option we recommend is setting aside one half day for a training refresher course. Close the practice after morning clinic, order in lunch and gather all staff. A clinical staff member, office manager, or outside consultant should conduct the training on all relevant aspects of OSHA. As an aside, many practices find that this half-day session can also be used to refresh everyone on HIPAA regulations and other policies and procedures related to practice daily operations.
Be sure to document when the training was held, who conducted it and have participants sign a log indicating their attendance. Also, include a copy of any handouts or other materials that were used.
A second option is to use an online training company. These companies sell services in blocks of time that can be used at the employees and practices convenience. The employee simply logs on to the training program and goes through an interactive process, many times including a brief test, which is then documented. The practice manager can monitor the overall process to be certain that everyone complies.
What are the Key Points to Address?
The following is a list of the most frequently cited standards violations in medical practices. These should all be part of your annual training.
Exposure Control Plan
Engineering and Work Practice Controls (Increased emphasis on wiring, in particular the misuse of extension cords and inappropriately routed computer cables)
Contaminated Sharps Discarding and Containment
Recordkeeping - Sharps injury log, documented Hep B immune status or vaccination
Written Hazard Communication Program
Labels and Other Forms of Warning (we were in a practice recently that even had warning labels on its bottles of hand sanitizer)
Employee information and training
Increased Focus on Violence Prevention
Workplace violence is an increasingly recognized hazard in the health care industry and is now covered under OSHA policies. While most healthcare violence cases seem to take place in hospitals, particularly in emergency departments, we have had reports of incidents of violence in medical practices. In ob-gyn practices, the violence is generally not from a patient but from the patient’s spouse, significant other, or even parent, in the case of a minor.
The proactive approach to violence is to create a stand-alone written Workplace Violence Prevention Program. All staff should be trained to identify potentially violent situations and a plan should be in place for either deescalating the violent behavior or calling in the appropriate outside enforcement. In consideration of prevention, develop a flagging system for patients who may potentially be the perpetrator or the victim of violence in the practice and make sure that the staff understands what the response should be.
Day-to-day enforcement of OSHA regulations in your ob-gyn practice should be common sense. Make sure that the providers and staff understand and properly exercise their roles in this process.
L. Michael Fleischman