Integra Health Management failed to protect employee from workplace violence hazards

??????????????????????????????TAMPA, Florida – After the horrific murder of a Florida health care worker in 2012, an administrative law judge affirmed in June that her employer failed to protect her from workplace violence.

Judge Dennis Phillips of the Occupational Safety and Health Review Commission determined Integra Health Management – now operating as Integra ServiceConnect LLC – did not protect Stephanie Ross, a 24-year-old social service coordinator. Her client, with severe mental illness and a violent criminal history, fatally stabbed Ms. Ross outside his home in December 2012. On the job for approximately three months, she had prior meetings with the man and had recorded in her case notes that she was uncomfortable being alone with him.

Like other social service coordinators, Ross visited dangerous and violent clients in their homes and coordinated case management. To perform mental and physical health assessments, she transported clients in her vehicle.

“The safety of social service workers in the field is a serious concern. Many face threats and violence in the workplace. Integra put its workers at risk of injury or worse by choosing not to implement commonly recognized safety practices and protocols,” said Leslie Grove, OSHA’s director of the Tampa Area Office. “Employers must take every reasonable precaution to protect employees against safety and health hazards in the workplace, including physical assaults.”

OSHA investigators found Integra knew the assailant had exhibited several high-risk behaviors, including a history of violence, criminal behavior, schizophrenia and paranoia, but took no steps to protect its employee. The agency also discovered multiple incidents where Integra employees were victims of aggression and verbal and physical threats from clients. OSHA concluded that the company did not conduct a hazard assessment of the service coordinator position or develop a written program to prevent workplace violence hazards.

Investigators issued two serious citations with full penalties to Integra in March 2013 for failing to protect employees from violence in the workplace and not reporting Ross’ death to OSHA. The company contested the citations that went before the commission for review. Judge Phillips found that Integra’s approach to safety was inadequate, and the company should have taken precautions to prevent injury by hiring and training its employees appropriately. The citations bring penalties of $10,500.

In future health care industry inspections, the U.S. Department of Labor’s Occupational Safety and Health Administration announced recently that it would expand its enforcement resources to focus on workplace violence and other safety and health risks.

Based in Owings Mills, Maryland, Integra Health Management is a health care service company specializing in community-based nonclinical support for individuals with health care and related social service needs. Integra contracts with insurance companies to perform mental and physical health assessments and coordinates case management for high-risk, high-cost members. It operates in Tennessee, Pennsylvania, Maryland and Florida.

On June 25, OSHA announced that it added musculoskeletal disorders, bloodborne pathogens, workplace violence, tuberculosis and slips, trips and falls as key hazards for investigators to focus on in health care inspections. The action targets some of the most common causes of workplace injury and illness in the health care industry.

Bureau of Labor Statistics data from the preliminary Census of Fatal Occupational Injuries shows fatal work injuries in Florida accounted for 218 of the 4,405 fatal work injuries reported nationally in 2013. Additional details are available at

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Is it Medical Treatment or First Aid?

iStock_000015979253XSmallIn response to a request by the National Athletic Trainers’ Association, OSHA has reevaluated its classification of the application of kinesiology tape as constituting medical treatment.

In her Letter of Interpretation dated July 6, 2015, Amanda Edens, Directorate of Technical Support and Emergency Management writes “Pursuant to 29 CFR 1904.7, first aid treatment includes ‘any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc.’ The use of kinesiology tape and other types of elastic taping is included within the definition of first aid treatment, and thus the use of such tape alone would not be considered medical treatment.”

The entire Letter of Interpretation can be view here.

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D&D Manufacturing faces more than $321K in fines

OSHA InspectorEL PASO, Texas - OSHA issued 13 citations to D&D Manufacturing Inc. following a recent inspection prompted by a formal complaint. The inspection identified 13 safety and health citations for exposing workers to amputations and other serious injuries from unsafe machinery, including a violation for ignoring the danger of allowing employees to work with a defective 500-ton metal press that the company knew had repeatedly dropped without warning.

Completed under OSHA’s National Emphasis Program on Amputations, the inspection resulted in $321,750 in proposed department fines for D&D. This inspection follows one in December 2014 that resulted in 36 federal citations for serious safety violations.

“D&D is aware of the dangers at its production facility, but has done nothing to correct them. An employee could have been seriously injured,” said Diego Alvarado Jr., OSHA’s area director in El Paso. “There is no reason, or excuse for a company to ignore basic safety requirements.”

OSHA cited the company for four willful, one repeated, six serious and two other violations. In addition to allowing workers to use the defective press, D&D did not ensure that employees on the production floor wore appropriate eye protection, given the risk of flying metal particles blinding them.

Additionally, the company failed to make sure employees used hearing protection in areas where noise levels were above the acceptable limits. The repeated violation was for failing to have all illuminated exit signs lit.

View the citations at

D&D Manufacturing fabricates stamped, metal components for equipment manufacturers. The company has headquarters in Bolingbrook, Illinois, and employs about 37 workers in El Paso. It also has a facility in Mexico.


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OSHA fines 2 employers more than $196K

Work AccidentOSHA issued 25 repeat, 15 serious and two other-than-serious safety and health citations to Sterling Seating, a furniture manufacturing plant in North Arlington, New Jersey. On Target Staffing, a staffing company that provided laborers to Sterling, received one repeat and two serious health citations. The inspection was initiated in January after a complaint was received alleging unsafe working conditions at Sterling’s plant. Inspectors observed hazards to temporary workers, resulting in a separate inspection of the staffing company.

Sterling was cited for exposing workers to amputation hazards while operating machinery by not using procedures to prevent inadvertent machine start-up, known as lockout/tagout. The company was also cited for not training employees about the effects of hazardous chemicals used in the workplace, including methylene chloride, combustible dust and formaldehyde. The company also received citations for electrical, exit hazards, and struck-by hazards from boxes stacked unsafely, and for multiple safety violations related to methylene chloride and fire hazards. Proposed penalties in the amount of $176,330 were levied against Sterling.

On Target Staffing was cited for not having a written hazard communication program or training, or documentation of a hazard assessment. Proposed penalties in the amount of $19,800 were levied against the staffing agency.

“Sterling Seating has repeatedly violated basic safety and health standards and exposed its employees to needless hazards,” said Lisa Levy, area director of OSHA’s Hasbrouck Heights Area Office. “Host employers and staffing agencies share a responsibility for worker safety. Those that fail to ensure that safety will be held legally responsible.”

To view the citations:

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Emphasis placed on musculoskeletal disorders, bloodborne pathogens, workplace violence, tuberculosis, and slips/trips/falls

iStock_000009123775XSmallWASHINGTON — Targeting some of the most common causes of workplace injury and illness in the healthcare industry, OSHA announced the agency is expanding its use of enforcement resources in hospitals and nursing homes to focus on musculoskeletal disorders related to patient or resident handling, bloodborne pathogens, workplace violence, tuberculosis, and slips/trips/falls.

U.S. hospitals recorded nearly 58,000 work-related injuries and illnesses in 2013, amounting to 6.4 work-related injuries and illnesses for every 100 full-time employees, almost twice as high as the overall rate for private industry.

“Workers who take care of us when we are sick or hurt should not be at such high risk for injuries — that simply is not right. Workers in hospitals, nursing homes and long-term care facilities have work injury and illness rates that are among the highest in the country, and virtually all of these injuries and illnesses are preventable,” said Dr. David Michaels, Assistant Secretary of Labor for Occupational Safety and Health. “OSHA has provided employers with education, training and resource materials, and it’s time for hospitals and the health care industry to make the changes necessary to protect their workers.”

OSHA has advised its staff through a memorandum that all inspections of hospitals and nursing home facilities, including those prompted by complaints, referrals or severe injury reports, should include the review of potential hazards involving MSD related to patient handling; bloodborne pathogens; workplace violence; tuberculosis; and slips/trips/falls.

“The most recent statistics tell us that almost half of all reported injuries in the healthcare industry were attributed to overexertion and related tasks. Nurses and nursing assistants each accounted for a substantial share of this total,” added Dr. Michaels.  “There are feasible solutions for preventing these hazards and now is the time for employers to implement them.”

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Must reinstate injured conductor and pay $536K in damages

iStock_000016656836XSmallwhistlebower2SEATTLE – North America’s second-largest freight railroad, Burlington Northern Santa Fe LLC, must reinstate a train conductor and pay the man $536,063 in back pay, damages and attorney’s fees after a federal investigation found the rail operator retaliated against its employee after reporting a knee injury.

BNSF filed disciplinary charges against the conductor after he reported the injury, which occurred in November 2010 while enroute from Vancouver to Pasco. The employee filed a Federal Railroad Safety Act anti-discrimination complaint with OSHA in February 2011. Company officials fired him in August 2011 despite knowing that his injury report was protected by law.

After an investigation, OSHA investigators determined the railroad violated federal laws protecting whistleblowers and ordered the reinstatement and financial compensation.

“Disciplining an employee for reporting an injury is illegal,” said Ken Atha, regional administrator for OSHA’s Seattle office. “Those who do so face negative repercussions. Retaliatory actions can discourage other workers from speaking up, which may result in an unsafe work environment.”

In addition to paying punitive and compensatory damages, OSHA ordered BNSF to rehire the employee and expunge his record of all charges and disciplinary action. The company must also conduct training for supervisors and managers on employee whistleblower rights and post a notice to employees of their whistleblower rights.

Both the employee and the railroad have 30 days from receipt of OSHA’s findings to file objections and request a hearing before the department’s Office of Administrative Law Judges.

With 38,000 employees, BNSF operates more than 7,000 locomotives and 32,500 miles of track.

OSHA enforces the whistleblower provisions of the FRSA and 21 other statutes protecting employees who report violations of various airline, commercial motor carrier, consumer product, environmental, financial reform, food safety, health care reform, nuclear, pipeline, public transportation agency, maritime and securities laws.

Under laws enacted by Congress, employers are prohibited from retaliating against employees who raise various protected concerns or provide protected information to the employer or to the government. Employees who believe that they have been retaliated against for engaging in protected conduct may file a complaint with the secretary of labor for an investigation by OSHA’s Whistleblower Protection Program. Detailed employee rights information is available online at

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More than 100 workers injured each year in Kentucky due to heat-related illness

FRANKFORT, Kentucky – The Kentucky Labor Cabinet wants to remind all employers and employees that high temperatures and humidity can have devastating effects if workers do not take proper precautions and procedures.

“Hot weather can make for dangerous conditions both outdoors and inside,” said Labor Secretary Larry L. Roberts. “In many cases, precautions such as water, rest and shade can be the difference between life and death for workers.”

Heat exhaustion can become heat stroke, which the Bureau of Labor Statistics reports kills an average of 30 workers each year in the United States. Each year in Kentucky, an average of 106 workers suffer heat-related injuries that result in days away from work. Three workers have died from heat stroke in Kentucky in the past four years.

OLYMPUS DIGITAL CAMERASymptoms of Heat-Related Illnesses

Labor-intensive activities in hot weather can raise body temperatures beyond the level that normally can be cooled by sweating. Heat illness can begin as heat rash or heat cramps, and quickly can become heat exhaustion and even heat stroke if simple prevention steps are not followed.

Heat exhaustion has symptoms of headache, nausea, dizziness, weakness, thirst or heavy sweating. Heat exhaustion can lead to heat stroke, which includes symptoms of fainting, seizures and confusion. Often, it is difficult for workers to recognize that they are experiencing these symptoms, so it is important for co-workers to be aware of each other’s actions and behavior. Heat stroke requires immediate medical attention.

Water, Rest and Shade

Workers can take various measures to combat heat exhaustion and heat stroke. They should consume small amounts of water frequently. Drinking water every 15 minutes, even if not thirsty, is important.

Employers should allow workers frequent rest breaks, especially during the first day and initial week of work. Workers must be acclimatized, which requires a gradual increase in workload and routine rest periods while the body can build a stronger tolerance to hot conditions.

Shade is important to help workers cool down outdoors. Exposure to full sunshine can increase heat index values by up to 15 degrees Fahrenheit.

The Heat Index

The U.S. National Oceanographic and Atmospheric Administration developed the heat index system, which combines both air temperature and relative humidity into a single value that indicates how hot the weather will feel. The heat index can be used to help determine the risk of heat-related illness for workers.

Heat Index

Risk Level

Protective Measures

Less than 91°F Lower (Caution) Basic heat safety and planning
91°F to 103°F Moderate Implement precautions and heighten awareness
103°F to 115°F High Additional precautions to protect workers
Greater than 115°F Very High to Extreme Triggers even more aggressive protective measures

When the heat index is near 91 degrees, workers should be cautioned. When the heat index is between 91 and 103 degrees, the risk level is at the moderate stage, and employers should implement precautions and heighten awareness. At 103 to 115 degrees, the risk level is high, and additional precautions should be taken to ensure worker safety.  At greater than 115 degrees, the risk is very high to extreme, and more aggressive protective measures are required, such as rescheduling all non-essential outdoor work, setting up clear drinking and work/rest schedules and conducting physiological monitoring of employees.

The heat index value is how hot the weather feels. For example, the actual temperature could be 88 degrees, but at 85 percent relative humidity, the result would be 110 degrees on the heat index chart.

The Labor Cabinet offers free online training about heat stress and other topics at

The Labor Cabinet is working in conjunction with the Federal Occupational Safety and Health Administration’s (OSHA) campaign to raise awareness about heat-related illnesses. To learn more, visit, or click here. An OSHA smartphone mobile app is available that calculates heat index for locations and provides guidance to prevent illness.

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ky_fiStarting January 1, 2016, Kentucky OSHA will adopt – with a few minor differences – Federal OSHA’s injury/illness reporting rule that went into effect January 1, 2015.  Sixty-three additional industries will now be required to keep work-related injury and illness logs (OSHA 300) if the employer employed more than ten (10) employees at any time during the previous calendar year.

Kentucky will adopt the “loss of an eye” reporting requirement and its time frame for reporting will be 72 hours vs. Federal OSHA’s 24 hour requirement. However, Kentucky will keep its definition of an “amputation” – an injury in which a portion of the body, including the bone, is removed.  Federal OSHA’s definition includes verbiage stating fingertip amputations with or without bone loss.

Kentucky’s current rule requires the in-patient hospitalization of three (3) or more employees to be reported within eight (8) hours.  The hospitalization of fewer than three (3) employees, as well as all amputations, shall be reported within 72 hours. Federal OSHA’s rule requires the reporting of all hospitalizations and amputations within 24 hours. Kentucky will retain its amputation and hospitalization reporting requirement as is written and will not adopt the Federal requirements.

Click here to learn more and read the letter from Secretary of Labor Larry Roberts updating employers on the new rule.

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confined _spaceOn May 4, 2015, OSHA added requirements for employee protection in confined spaces in the construction industry. The new subpart (29 CFR 1926 Subpart AA) will require a permit program. While the final rule is similar to the general industry confined spaces standard, it does address construction-specific hazards, improves enforceability, and includes technology advancements.

OSHA believes this final rule will reduce the average number of fatalities and injuries in confined spaces by 96%. (  The final rule goes into effect on August 3, 2015.

There are five (5) key differences from the construction rule, and several areas where OSHA has clarified existing requirements. The five new requirements include:

  1. More detailed provisions requiring coordinated activities when there are multiple employers at the worksite. This will ensure hazards are not introduced into a confined space by workers performing tasks outside the space. An example would be a generator running near the entrance of a confined space causing a buildup of carbon monoxide within the space.
  2. Requiring a competent person to evaluate the work site and identify confined spaces, including permit spaces.
  3. Requiring continuous atmospheric monitoring whenever possible.
  4. Requiring continuous monitoring of engulfment hazards. For example, when workers are performing work in a storm sewer, a storm upstream from the workers could cause flash flooding. An electronic sensor or observer posted upstream from the work site could alert workers in the space at the first sign of the hazard, giving the workers time to evacuate the space safely.
  5. Allowing for the suspension, rather than cancellation, of a permit in the event of changes from the entry conditions listed on the permit or an unexpected event requiring evacuation of the space. The space must be returned to the entry conditions listed on the permit before re-entry.

In addition, OSHA has added provisions to the new rule that clarifies existing requirements in the General Industry standard. These include:

  1. Requiring that employers who direct workers to enter a space without using a complete permit system prevent workers’ exposure to physical hazards through elimination of the hazard or isolation methods such as lockout/tagout.
  2. Requiring that employers who are relying on local emergency services for emergency services arrange for responders to give the employer advance notice if they will be unable to respond for a period of time (because they are responding to another emergency, attending department-wide training, etc.).
  3. Requiring employers to provide training in a language and vocabulary that the worker understands.

Finally, several terms have been added to the definitions for the construction rule, such as “entry employer” to describe the employer who directs workers to enter a space, and “entry rescue”, added to clarify the differences in the types of rescue employers can use.

“This rule will save lives of construction workers.  Unlike most general industry worksites, construction sites are continuously evolving, with the number and characteristics of confined spaces changing as work progresses.  This rule emphasizes training, continuous worksite evaluation and communication requirements to further protect workers’ safety and health.”

-Assistant Secretary of Labor for Occupational Safety and Health, Dr. David Michaels

For additional information regarding 29CFR1926 Subpart AA, please see OSHA’s Frequently Asked Questions – Confined Spaces.

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Melissa_MedleyLouisville, KY – Dwayne Towles, President of Advanced Safety & Health, LLC, announces the addition of Melissa Medley as a safety consultant, further complementing the team of dedicated occupational health and safety professionals at Advanced Safety & Health. “She is an energetic safety professional with a proven track record of implementing and managing well-designed safety and health management programs, specifically in the areas of manufacturing and food production”, said Towles.

Melissa brings with her an array of knowledge and expertise, particularly in the areas of hazard assessment, safety training, worker compensation, job safety analysis, and regulatory compliance. She also has experience with root cause analysis for injuries and vehicular incidents as well as development of safety campaigns/incentives.

Melissa holds a Bachelor of Science degree in Safety Science from Indiana University Southeast in New Albany, Indiana.  She is a certified First Aid Responder as well as a Certified Hearing Conservationist.  Additionally, Melissa is past-president of ASSE – Louisville Chapter.

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