New York State

Occupational Safety & Health

Hazard Abatement Board

Public Hearing on

“Proposed Standard for Safety and Security in the Public Sector throughout New York State”

Testimony of Jonathan Rosen, MS CIH

Director, PEF Occupational Safety & Health Department

on behalf of the New York State Public Employees Federation, AFL-CIO

June 16, 2003

Introduction

My name is Jonathan Rosen and I am the Director of the Occupational Safety & Health Department for the NYS Public Employees Federation (PEF).  I have a master’s degree in industrial health and I am also a certified industrial hygienist. I was appointed to Chair the American Industrial Hygiene Association’s Workplace Violence Prevention Task Force and have several publications on the subject.  I am currently a co-investigator on a federal NIOSH research grant that is assessing the effectiveness of OSHA’s Violence Prevention Guidelines in the NYS Office of Mental Health (OMH). Additionally, I have conducted numerous training programs and spoken at conferences throughout the United States on workplace violence prevention, particularly in healthcare. In the thirteen years I have worked for PEF, I have concentrated much of my efforts on preventing workplace violence. Workplace violence is the most significant cause of injury, stress, and workers’ compensation costs for PEF members.

Workplace Violence is a Significant Hazard

            Violent incidents are a major disruption to operations. It is in the interest of all parties to prevent violence and minimize the impact when it occurs. According to the Bureau of Justice National Crime Victims Survey,[1] there were an estimated 1.7 million non-fatal workplace assaults annually in the United States from 1993-1999. Although public employees are only 16% of the national workforce, they were 35% of the victims of workplace assault. This is because public employees provide care and services to society's most difficult populations: the sick, the mentally ill, and the incarcerated. Public employees also have a high degree of public contact. For example, PEF represents employees who investigate medical professionals and are involved in proceedings that revoke professional licenses.

Occupational Injuries and Illness Survey, State and Local Government, New York State

            New York participates in the US Bureau of Labor Statistics (BLS) survey of occupational injuries and illnesses in both the private and public sectors. Key survey data on assaults in New York’s public sector are in the tables below. 

            There was an average of 6,908 assaults and violent acts in local government and 1,569 in state government during 1999-2001. There were approximately 900,000 local employees and 190,000 state employees.  Assault was the second leading cause of injury after overexertion. Disturbingly, the number of assaults on state employees increased considerably between 1999 and 2001. The range of lost workdays is also significant for both local and state government employees. State employees who are assaulted tend to have a greater number of lost workdays. Cases classified as greater than 30 days lost time were an alarming 23% for state employees and 9% for local employees over the three-year period.

            In 2001, there were 40,752 local government cases in the BLS database and workplace assaults comprised 15% of the cases. For state government, there were 8,540 cases, 20% of which were workplace assault incidents. These data demonstrate the significant gap between PESH enforcement and public sector injury and lost time experience.

Assaults and Violent Acts in NYS Public Sector 1999-2001

*Rates are per 10,000 employees

Note: Total includes stabbing, biting, hitting, beating and other types of assaults.

Source: Bureau of Labor Statistics, U.S. Department of Labor, Survey of Occupational Injuries and Illnesses, in cooperation with participating State agencies.

New York Civil Service Department Workers’ Compensation Data

            According to New York State Civil Service Department data, workers’ compensation claims classified as “patient/inmate assaults” were about 12% of all cases for all bargaining units, encompassing approximately 190,000 state employees. This doesn’t include additional assaults that are within the category “struck by an object or individual." Direct workers’ compensation costs from assaults are estimated to be greater than $8.5 million. Indirect costs include hiring replacement workers, retraining, overtime, and administrative costs. These costs are estimated to increase direct costs by a 5 to 1 ratio. Therefore, the State’s total costs for state employment related to workplace violence are estimated to be $42.5 million. Keep in mind that this only includes cases that involve six or more days of lost work time. Also, many workers don’t report their work-related injuries and handle minor injuries through their regular health benefits.

          Five of the state agencies with the greatest rate of injuries are: OMH, the Office of Mental Retardation and Developmental Disabilities (OMRDD), the State University of New York, the Department of Correctional Services, and the Office of Children and Family Services. To help put the safety issues in these agencies in context, the chart below shows workers’ compensation rates from all causes, including assaults. These rates are higher than those experienced by some of the nation’s most hazardous industries. For example, mining had an accident rate of 4.0 per hundred workers per year and construction had 7.9 accidents per hundred workers per year in 2001.[2] In contrast, the five state agencies had annual workers’ compensation accident rates of 14.4 to 19.9 per hundred workers in FY 2001/02 (see Table 1). This discrepancy is even more extreme considering that the comparatively lower mining and construction injury rates are based on all reported injuries, while the state agency rates reflect the more rigorous threshold of 6 days lost time.

Table 1

Workers’ Compensation Case Rates per Hundred Workers – Source: NYS Civil Service Department

          As a health and safety specialist with more than twenty-five years of experience in both the private and public sectors, I see the injury crisis in these agencies akin to the mining disasters and industrial injury epidemic that gave rise to the passage of the OSHAct of 1970.  

Violence in OMH

When I first became involved in discussing assaults in OMH in the early 1990s, management would say, “that is an easy issue to resolve, we will just shut down the facilities.”  The attitude at that time was that assault was an inevitable part of the job. Labor’s view is that workers should be able to return home after a day’s work without being killed or injured. Getting punched, kicked, or beaten should not be part of any job!

Over many years of work, I have seen a shift in the agency’s view of the subject. The vehicle for change was the Multi-Union Health and Safety Committee (MUHSC). Additionally, in December 1996, Commissioner Stone incorporated “Safety” into the agency’s strategic plan as a key result area.

History of Joint Safety Work

In 1995, the unions convinced management that there was a need for a Trauma Response Policy.  Labor felt that OMH, one of the largest mental health systems in the world, should have a process for addressing the mental health of its own workers when they have been attacked. The policy established steps that facilities should take to provide support to injured workers, including assistance in receiving prompt medical care, workers’ compensation, emotional support and counseling, and post-incident debriefing.

Accident and Injury Data

In 1995, the MUHSC began reviewing data from the OMH Occupational Injury Reporting System (OIRS) that showed the severity of the assault problem (see tables below). OMH developed this system in the early 1990s and it has provided critical data to guide safety efforts. The decline in the numbers of assaults between 1995 and 1998 is mainly due to cuts in staffing. More than 2,000 direct care staff were eliminated between 1995 and 1998; therefore, fewer workers were exposed to potential assault in 1998.  However, the injury rates remained high and actually increased for some jobs, including nursing jobs.

Table 2

                *Percentage of assault/restraint related injuries which resulted in lost time, 12% of all accidents reported were

                assault/restraint related injuries which resulted in lost time.

Table 3 shows the injury rates for the seven jobs that experience the highest rates of assault in OMH. The rates are especially high for direct care staff including nurses, LPNs, and therapy aides. The Secure Hospital Treatment Aides (SHTA) have the greatest rate of assault because they work in the forensic hospitals. However, Secure Care Treatment Aides (SCTA), who work on secure wards in adult and children’s facilities, also have extremely high rates of injury. Table 3 also demonstrates a 25% cut in direct care staff (MHTAs and nurses) between 1995 – 1998. 

Table 3

OMH 1995 vs. 1998:  Rate of Staff Injury Due to Assault and Restraint

Rates are calculated as the number of cases per 100 workers

Safe and Therapeutic Environment Conference

            OMH management responded to the MUHSC focus on violence prevention by endorsing the Committee’s proposal for a two-day statewide conference that was funded by joint labor management funds and held in March 1999. The conference brought together six member teams from each OMH facility to prepare the implementation of a written violence prevention program called the Safe and Therapeutic Environment Plan. This plan was developed jointly between OMH and the unions, and based on OSHA violence prevention guidelines.

            Prior to the conference, PEF and CSEA conducted local pilot projects at several OMH facilities. These grassroots efforts helped lay the foundation for the development and implementation of the new statewide violence prevention policy and program.

Unfortunately, the implementation of the statewide policy is very uneven. In part, this is due to the fact that facility staff has been cut to the bone and the ability of hospitals to free up personnel to plan and implement programs is very strained. Additionally, many in the top management positions are reluctant to collaborate with labor or even middle managers. This was exemplified in 1996 when the leadership of Buffalo PC essentially ignored the recommendations that were developed during the one year pilot project. Certainly, it does no good to identify problems and solutions if they aren’t given reasonable consideration by local facility management, discussed with local union and patient representatives, and communicated to all facility staff.

After years of advocacy by the unions, OMH conducted “core curriculum” training and made “Preventing and Managing Crisis Situations” training mandatory for all staff who have patient contacts.  Currently, OMH and the unions are working as partners with the University of Maryland on a grant from the National Institute for Occupational Safety and Health in implementing OSHA’s Violence Prevention Guidelines in four OMH facilities.

PEF lauds the progressive managers in OMH who have provided leadership in the violence prevention efforts. The experience of OMH and the public employee unions show that these interventions are effective. Injury rates have declined. However, they are still too high. It is now time to codify safety requirements into an enforceable public employee standard that will detail the minimum steps that public employers must take to protect employees from violence.  Just as we as a society are working diligently to increase security to prevent terrorist attacks, we need to prevent terrorism in the workplace.

OMRDD

            In contrast to OMH, OMRDD central management has rebuffed the unions every time we have offered to work to address safety and violence prevention efforts. In fact, OMRDD had established a health and safety unit in the early 1990s that was working to address these problems.  However, in the mid-1990s they abruptly abolished the unit and laid off the staff. When PEF offered to use joint labor management funds to develop violence prevention training programs and other interventions, management declined to collaborate.  Recently, PEF and CSEA were able to work with the University of Maryland to obtain a five-year, $2.5 million grant from the National Institute of Occupational Safety & Health to conduct an intervention study on violence prevention in New York State social service agencies. PEF and CSEA worked to get OMRDD to join the grant as a partner over a nine-month period, including high level meetings with the Commissioner of the agency. In the end, the agency refused to participate.

In 1999, PEF attempted to develop a pilot project on violence prevention with the Finger Lakes DDSO.  Local facility management and all of the unions supported the establishment of this project.  A number of violent incidents had heightened their concerns, and they were impressed with the process that had been employed in OMH.  However, this project never proceeded; we suspect OMRDD’s central office management blocked it.

OMRDD central doesn’t collect data on employee injuries even though the unions have pointed out that there is a critical need to do so.  Old Civil Service Department reports show overall injury rates in some OMRDD facilities as high as 30 or 40 workers’ compensation cases per one hundred employees per year.

PESH General Duty Actions

            I am familiar with four general duty citations issued by PESH relating to workplace violence within the past ten years.

1.                  In 1994, PESH cited the SUNY Health Science Center in Syracuse after a psychiatric nurse was assaulted. Our member’s ribs were broken when she entered a seclusion area alone, and without means to summon assistance or the presence of another staff member. The PESH order required the hospital to develop a system to avoid this hazard through policy changes, video cameras, alarms, or other methods.

2.                  In 1998, PESH issued a citation to the Washington Correctional Facility after a complaint was filed due to a nurse being sexually assaulted by an inmate in the prison hospital. The nurse sustained multiple injuries to her neck, head, face, elbows, legs, and right hand. The PESH order required the facility to establish written locking procedures for all doors in the hospital where inmates interact with staff, re-evaluate hospital post order and procedures, communicate the procedures to staff, and periodically inspect and review the procedures and program.

3.                  In 1999, PESH cited Buffalo Psychiatric Center as a result of the Judi Scanlon murder. Judi was an Intensive Case Manager, providing services to mentally ill clients living in the community. She was murdered by a client while conducting a home visit. The PESH orders required the employer to develop written safety procedures, provide ongoing training, a staff accountability system, accompanied home visits, and a means to summons assistance.

4.                  In 1998, PESH cited the Hudson River Psychiatric Center for exposing employees to the hazard of being assaulted. The orders required implementing a six-step program including a management policy, an employee alarm system, incident review and assessment, clinical reviews, and training.

General duty violations are rare, difficult to prove, time consuming, and often subject to lengthy delays and litigation. In contrast, a standard is much easier to enforce. Four cases in ten years are clearly not adequate to address this significant hazard. Furthermore, the general duty cases listed above averaged six months to a year and a half between the date of inspection and issuance of the violations.

On a positive note, I believe many of the violence prevention programs implemented in much of OMH would be found in compliance with a PESH inspection. On the other hand, there are still facilities that are not following agency directives and policies that would be cited. An enforceable standard would provide a reasonable tool, within the intent of the Public Employee Safety and Health Act, to address a major cause of injury and workers’ compensation.

The general duty violations listed above demonstrate that PESH has the ability to conduct inspections for this critical workplace hazard and issue meaningful orders that can protect affected worker populations. It is time to act.

Conclusion

            Over the course of these hearings, you are going to hear about the human tragedy of workplace violence. Every year public sector workers in New York State are experiencing permanently disabling injuries that are leading to a loss of their employment. After one year on workers’ compensation, public workers can be terminated under Civil Service Laws. For the sake of these public employees we must act now! You have been empowered to recommend that the Commissioner of Labor promulgate safety standards for public employees where no OSHA standards exist. Workplace Security and Safety meets those criteria. The hazard is serious in that it is causing death and serious physical harm. The hazard exists as demonstrated by the data and statistics we have shared with you. There are clearly reasonable steps that can be taken to abate the hazard as demonstrated by the excellent model programs in OMH and in the general duty orders issued by PESH. Please act without delay.