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The History of [Medical] Workers Memorial Day [OSHA]

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The OSHA Precursor
By Matthew Pelletier

[Director of Public Relations]

Compliance and Safety LLC

ME-P Readers and Subscribers

Workers Memorial Day [WMD] is a commemoration day that is celebrated in the U.S and abroad each year on April 28th. It is meant to remember those who have been killed or left disabled as a result of an injury suffered at work. And, it’s an opportunity to recognize the preventable nature of most workplace accidents and bring greater awareness to safety campaigns and legislation.

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So, you are more than welcome to read, review and use any of the content from our memorial page on your ME-P website.

http://complianceandsafety.com/blog/workers-memorial-day-2013/

Assessment

Richard Nixon signed the Occupational Safety and Health Act, in 1970, which created OSHA to “assure safe and healthful working conditions for working men and women by setting and enforcing standards and providing training, outreach, education and assistance.”

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The Newtown, Conn School Massacre [Lessons to Learn?]

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REPRINT: This re-publication is provided as a service to our readers, as we mourn the children and victims of the Newtown, Conn massacre. The workplace – healthcare setting analogy is self-evident.

Hospital Workplace Violence Risk Factors

[An NIOSH Summary and Review]

By Dr. Eugene Schmuckler MBA CTS

By Dr. David Edward Marcinko MBA CMP™

www.CertifiedMedicalPlanner.org

Domestically, the impact of workplace violence in the US became widely exposed on November 6, 2009 when 39 year old Army psychiatrist Maj. Nidal M. Hasan MD, a 1997 graduate of Virginia Tech University who received a medical doctorate in psychiatry from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and served as an intern, resident and fellow at the Walter Reed Army Medical Center in the District of Columbia, went on a savage 100 round shooting spree and rampage that killed 13 people and injured 32 others.

In April 2010 he was transferred to Bell County Jail in Belton, Texas. An Article 32 hearing, which determined whether Hasan would be fit to stand trial at court martial, began on 12 October 2010. Hasan subsequently deemed fit, was arraigned on July 20 2011 and trial was scheduled for March 2012. It was rescheduled again, but is now ongoing and in the news; almost daily.

The NIOSH

The National Institute for Occupational Safety and Health (NIOSH) summarizes the risk factors for occupational violence to hospital workers. These include:

  • working directly with volatile people, especially if they are under the influence of drugs or alcohol or have a history of violence or certain psychotic diagnoses;
  • working when understaffed — especially during meal times or visiting hours;
  • transporting patients and long waits for service;
  • overcrowded, uncomfortable waiting rooms;
  • working alone;
  • poor environmental design;
  • inadequate and/or ineffective security;
  • lack of staff training and policies for preventing or managing crises with potentially volatile patients;
  • drug and alcohol abuse;
  • access to firearms;
  • unrestricted movement of the public; and
  • poorly lit corridors, rooms, parking lots, and other areas.

Occupational Violence 

Violence occurring in other occupational groups is most often related to robbery. In healthcare settings, however, acts of violence are most often perpetrated by patients or clients. Family members who feel frustrated, vulnerable, and out of control; and colleagues of patients (especially when the patient is a gang member) are also identified as perpetrators of abuse! However, the presence of co-workers has been identified as a potential deterrent to assault in healthcare.

Healthcare and social service workers face an increased risk of work-related assaults stemming from several factors, including:

  • the prevalence of handguns and other weapons — as high as 25% among patients, their families, and friends. Handguns are increasingly used by police and the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals;
  • the increasing number of acute and chronically mentally ill patients now being released from hospitals without follow-up care, who now have the right to refuse medicine and who can no longer be hospitalized involuntarily unless they pose an immediate threat to themselves or others;
  • the availability of drugs or money at hospitals, clinics, and pharmacies, making staff and patients likely robbery targets;
  • situational and circumstantial factors such as:
    • unrestricted movement of the public in clinics and hospitals;
    • the increasing presence of gang members, drug or alcohol abusers, trauma patients, or distraught family members;
    • long waits in emergency or clinic areas, leading to client frustration over an inability to obtain needed services promptly;
  • low staffing levels during times of specific increased activity such as meal times, visiting times, and when staff is transporting patients. This also includes isolated work with clients during examinations or treatment;
  • solo work, often in remote locations, particularly in high crime settings, with no back up or means of obtaining assistance such as communication devices or alarm systems;
  • lack of training of staff in recognizing and managing escalating hostile and assaultive behavior; and
  • poorly lighted parking areas.

OSHA

The Guidelines established by the Occupational Safety and Health Administration (OSHA) seek to set forth procedures leading to the elimination or reduction of worker exposure to conditions causing death or injury from violence by implementing effective security devices and administrative work practices, among other control measures. Healthcare professionals need to be aware that violence can occur anywhere and in any practice settings.

In hospitals and clinics, which are more likely to report incidents of violence than private offices, the most frequent sites are:

  • psychiatric wards;
  • acute care settings;
  • critical care units;
  • community health agencies;
  • homes for special care;
  • emergency rooms; and
  • waiting rooms and geriatric units.

Impact

The impact of workplace violence is far-reaching and affects individual staff members, co-workers, patients/clients, and their families. Those who have been affected, directly or indirectly, by a workplace violence incident report a broad spectrum of responses — anger is the most common. There are also reports of:

  • difficulty returning to work;
  • decreased job performance;
  • changes in relationships with co-workers;
  • sleep pattern disturbance;
  • helplessness and symptoms for post-traumatic stress disorders;
  • fear of other patients; and
  • fear of returning to the scene of the assault.

Assessment

Link: Chapter 07: Workplace Violence

More: Medical Workplace Violence

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Medical Workplace Violence Prevention Guidelines

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Earliest Guidelines in California Program

By Eugene Schmuckler; PhD MBA MEd CTS

By Dr. David E. Marcinko MBA

[Certified Trauma Specialist]   

The impact of medical workplace violence became widely exposed on November 6, 2009 when 39 year old Army psychiatrist Maj. Nidal M. Hasan MD, a 1997 graduate of Virginia Tech University who received a medical doctorate in psychiatry from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and served as an intern, resident and fellow at the Walter Reed Army Medical Center in the District of Columbia, went on a savage 100 round shooting spree and rampage that killed 13 people and injured 32 others. In April 2010 he was transferred to Bell County Jail in Belton, Texas awaiting trial.

Federal Government Guidelines

The federal government and some states have developed guidelines to assist employers with workplace violence prevention. For instance, one of the earliest sets of guidelines for a comprehensive workplace violence prevention program was published in 1993 by California OSHA. This resulted from the murder of a state employee. In 1996, Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers was published by OSHA.

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OSHA Guidelines

In its guidelines, OSHA sets forth the following essential elements for developing a violence prevention program:

  • Management commitment — as seen by high-level management involvement and support for a written workplace violence prevention policy and its implementation.
  • Meaningful employee involvement — in policy development, joint management-worker violence prevention committees, post-assault counseling and debriefing, and follow-up are all critical program components.
  • Worksite analysis — includes regular walk-through surveys of all patient care areas and the collection and review of all reports of worker assault. A successful job hazard analysis must include strategies and policies for encouraging the reporting of all incidents of workplace violence, including verbal threats that do not result in physical injury.
  • Hazard prevention and control — includes the installation and maintenance of alarm systems in high-risk areas. It may also include the training and posting of security personnel in emergency departments. Adequate staffing is an essential hazard prevention measure, as is adequate lighting and control of access to staff offices and secluded work areas.
  • Pre-placement and periodic training and education — must include educationally appropriate information regarding the risk factors for violence in the healthcare environment and control measures available to prevent violent incidents. Training should include skills in aggressive behavior identification and management, especially for staff working in the mental health and emergency departments.

On May 17, 1999, Governor Gary Locke signed the New Workplace Violence Prevention Act for the state of Washington. This act mandates that each healthcare setting in the state implement a plan to reasonably prevent and protect employees from violence.

 

New Washington Workplace Violence Prevention Act

According to this act, prevention plans need to address security considerations related to:

  • physical attributes of the healthcare setting;
  • staffing, including security staffing;
  • personnel policies;
  • first aid and emergency procedures;
  • reporting of violent acts; and
  • employee education and training.

Prior to the development of an actual plan, a security and safety assessment needs to be conducted to identify existing or potential hazards. The training component of the plan must include the following topics:

  • general safety procedures;
  • personal safety procedures;
  • the violence escalation cycle;
  • violence-predicting factors;
  • means of obtaining a patient history form from a patient with violent behavior;
  • strategies to avoid physical harm;
  • restraining techniques;
  • appropriate use of medications as chemical restraints;
  • documenting and reporting incidents;
  • the process whereby employees affected by a violent act may debrief;
  •  any resources available to employee for coping with violence; and
  • the healthcare setting’s workplace violence prevention plan.

Assessment

The act further mandates that any hospital operated and maintained by the State of Washington for the care of the mentally ill is required to provide violence prevention training to affected employees identified in the plan on a regular basis and prior.

Front Matter: Front Matter BoMP – 3 

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Gulf Cleanup Training Ignores Advice from Health Agency

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Concerned Workplace Safety Experts 

By Sasha Chavkin, ProPublica – June 17, 2010 2:05 pm EDT

As we’ve reported, workplace safety experts have expressed concern that Gulf oil spill responders aren’t getting enough safety training [1]. On Wednesday, we spoke with a federal official who said the four-hour safety course that BP is providing to Gulf cleanup workers lacks basic information on health risks and is too short to cover the necessary material.

Joseph Hughes, director of the worker training program at the National Institute for Environmental Health Sciences, said the course fails to incorporate important information. Among the subjects not included are chemical inhalation, the health effects of dispersants, and the risks of direct contact with weathered crude oil.

Hughes’ agency, part of the Department of Health and Human Services, helped develop the training. “We tried to recommend what we thought the right training topics were, but all of those were not included,” he said.

ProPublica Reports

As we reported on Wednesday, cleanup workers are continuing to suffer health problems [2] [2] that they believe to be related to chemical exposure, including vomiting, dizziness, and nose and throat irritation.

Hughes also said the course’s four-hour duration — a fraction of the 24-hour training usually required for cleanup workers [3] [3] who may be exposed to hazardous materials — is insufficient and rests upon a faulty interpretation of safety regulations. In 1990, the Occupational Safety and Health Administration issued a directive following the Exxon-Valdez disaster that allowed the minimum training to be cut to four hours [4] [4] for workers performing low-risk tasks such as beach cleanup.

“The idea of the Exxon-Valdez exemption is that they would not have direct contact with crude oil or weathered oil,” Hughes said. However, he said that some spill responders receiving the four-hour training, such as booming and skimming workers on vessels, are “definitely having direct oil contact.”

The BP Spokesman

BP spokesman Toby Odone stated that the safety trainings are appropriate for the work people are doing. “Training for Vessels of Opportunity and shoreline workers is 4+ hours and includes properties of oil, insect bites, heat, marine operations such as laying and collecting boom,” Odone wrote in an e-mail. The Vessels of Opportunity program employs local boat operators and crews in cleanup activities.

Odone also wrote that workers going into oiled areas are accompanied by a technician with 40 hours of training, and that the training was approved by the government. “It was developed with OSHA and approved by OSHA and the US Coast Guard,” he wrote.

OSHA is in charge of monitoring workplace safety for the cleanup. We at ProPublica have been trying to get in touch with officials there since Monday to discuss the safety trainings, but haven’t yet gotten a response.

Hughes said that his office is pressing Unified Command — the interagency spill response team that consists of BP, Transocean, the Coast Guard and numerous federal agencies — to implement an eight-hour training course for those at greater risk of contact with hazardous materials. The course would include the chemical exposure curriculum that is not provided in the current trainings.

“The group that I’m still concerned about is the booming and skimming workers,” Hughes said. “There’s an effort under way to increase the training of those workers that’s being discussed at the highest level.”

On Wednesday, Aubrey Miller, senior medical adviser in Hughes’ agency, testified to a House subcommittee that OSHA is “working with BP to develop a new eight-hour curriculum [5] [5] for worker safety and health training,” according to a transcript of his remarks provided by the agency.

Hughes said he had not heard any dates for when this eight-hour training program would start.

wind

Assessment

As it stands, Hughes said the training goes against the precautionary principle — the concept that the possibility of harm is enough to warrant action to reduce the risks to public health.

We thought it was backwards,” he said of the current curriculum,“that it had a reduced amount of protection for workers.”

Link: http://www.propublica.org/feature/gulf-cleanup-training-ignores-advice-from-health-agency-official-says

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How Physicians Select Risk Management Advisors

More Difficult than Ever Before

By Brian J. Knabe MD, Certified Medical Planner

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Historically, the term “risk management” has brought to mind one subject for the practicing physician – medical malpractice.  Unfortunately, physicians today face a multitude of other risks which may be more insidious and daunting than malpractice.  It is important to recognize these risks, and to have the appropriate procedures and policies in place to mitigate the risks.  These risks come from the federal government, state government, insurance companies, patients, employees, and even prospective employees.  Some risks, many unique to small businesses and medical practices, include the following:

  • Medicare recoupment risk – challenges to coding and subsequent billing by the physician.
  • Medicare fraud.  Numerous laws can be used by the federal government to go after the physician, including the Medicare and Medicaid Anti-Fraud and Abuse Statute, the RICO statute, and the Federal False Claims Act.  The recently enacted Patient Protection & Affordable Care Act aims to save money by increasing funding for anti-fraud efforts.
  • Insurance fraud.  An inquiry from Medicare to look for fraud in a physician’s practice is often followed by similar efforts by insurance companies.
  • The HIPPA Act of 1996 creates new definitions and penalties to use against the physician.
  • Self referral risks.  Federal regulations in this area include the Medicare Anti-Fraud and Abuse Statute, the Medicare Safe Harbor Regulations, and the Stark Amendment.
  • Federal agency risks.  These include regulations from the Occupational Health and Safety Agency (OSHA), Health and Human Services (HHS), the Drug Enforcement agency (DEA), and even the Environmental Protection Agency (EPA).
  • Anti-trust risks.  The Department of Justice (DOJ) and Federal Trade Commission (FTC) formulate regulations in this arena.
  • Managed care contractual risks.  Most managed care contracts require the individual physician rather than the professional corporation to sign the contract, thus placing the physician’s personal assets at risk.
  • Medical malpractice risks.  Although the vast majority of claims are paid by the insurance carrier, there can be other adverse consequences for the physician.  These include the risk of increased premiums, non-renewal of policies, and difficulty in getting replacement insurance.
  • Loss of income due to death or disability.  Most physicians recognize the importance of life insurance, but the medical professional is actually much more likely to lose income due to disability at some point in his or her career.

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The practicing physician should seek the advice of professionals with expertise in these areas.  Every practice should have an experienced attorney on retainer.  It is very important to seek advice from fiduciaries – experts who have no conflicts of interest and who can therefore act in the best interest of the client.  A Certified Medical Planner is such a fiduciary with training and expertise in these areas.

http://www.CertifiedMedicalPlanner.org

It can be particularly challenging to find an insurance advisor with no conflicts of interest, as this industry is built upon product sales and commissions.  One such insurance advisor is Scott Witt, a fee-only insurance advisor with Witt Actuarial Services (www.wittactuarialservices.com).

Others can be found with an internet search for “fee only insurance advisor”.

Assessment

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Understanding the Mental Healthcare Regulatory Environment

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Appreciating the Rules

[By Carol Miller; RN, MBA]

Carol S. MillerLocal counties and municipalities are the primary providers of state mental healthcare for patients who lack private insurance coverage for such care.

Both children and adults may be eligible to receive assistance.

These counties provide a wide range of psychiatric and counseling services to the residents in their community as well as other types of assistance such as:

  • treatment services related to substance abuse;
  • housing;
  • employment services;
  • information and education service;
  • referrals;
  • consultative services to schools, courts and other agencies;
  • after-care services; and other related activities.

mental

Rules and Regulations

Accordingly, regulations from federal, state, and county governments have an impact on the day-to-day operations, procedures and processes of a county mental health center. Traditionally, there are three main types of regulations.

Federal Regulations — The United States healthcare system is guided by programs such as those established under the Centers for Medicare and Medicaid (in the case of county mental health programs, Medicaid is especially important), Americans with Disabilities Act (ADA), Occupational Safety and Health Administration (OSHA), Health Insurance Portability and Accountability Act (HIPAA), and others.

State Regulations — These include general legislative guidelines, state management of benefits and reimbursement of the Medicaid program, and state allocations of budgets, which impact the centers’ operations.

County Regulations — Each county defines its own County Mental Health Program and decides which services will be provided or excluded.

Assessment

County facilities generally include outpatient clinics, county mental health programs, short-term psychiatric facilities, day-care centers, de-toxification centers, residential rehabilitation centers for substance abuse, long-term care psychiatric facilities, and Veterans Affairs (VA) psychiatric centers. The county centers may be co-located with other county services such as social services, occupational rehabilitation services, information technology services, human resources, maintenance services, and others or may be independently located.

Conclusion

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Understanding Hazard Communication Labeling

An OSHA Requirement

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The Hazard Communication Standard

The OSHA Hazard Communication Standard requires proper labeling of all chemicals present in the workplace. Labels are usually provided on chemicals that are found in a healthcare practice, but when a substance is transferred from its original container to a different container, a label must be affixed to the secondary container to inform any employee who uses it of the contents and their potential risks.

Assessment

The Standard also requires education for employees regarding any chemical present in the workplace to which they may be exposed under normal conditions of use or in a foreseeable emergency.

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