When OSHA comes knock-knock-knocking

MGMA Connexion, Jul 2004 by Dunn, Sheila

Seven rules to avoid the poorhouse

A clinic employee accidentally pricked with a contaminated needle called the local Occupational Safety and Health Administration (OSHA) office and lodged a formal complaint against her employer, which refused to offer safety needles to employees. OSHA soon visited the office and discovered more than $40,000 worth of violations. The employer negotiated to get the fines reduced by $20,000.1

In another case, a disgruntled employee called OSHA, reporting that his employer had no OSHA manual and that patient areas weren't disinfected often enough. The surprised employer received a three-page letter from OSHA containing the employee's allegations and demanding a written response and copies of all applicable OSHA policies.2

OSHA has inspected thousands of physicians' offices in the last few years. The most common citations were for violations of the Bloodborne Pathogens Standard and the Hazard Communication Standard.3

What would happen if an OSHA inspector visited your medical practice?

Rule 1: Check the inspector's ID

First, ask to see the compliance officer's identification. S/he should present a plastic photo identification badge clearly saying "OSHA -United States Department of Labor." Without this ID, you may be looking at an imposter.

Unless the OSHA inspector is following up a previous inspection, s/he is at your practice to conduct a programmed inspection or a surprise inspection.

Programmed inspections - Only large facilities receive programmed inspections -usually every two years - because of OSHA criteria such as injury rates, death rates, exposure to toxic substances or a high number of lost workdays for the industry.

OSHA does not have enough inspectors to oversee all workplaces under its jurisdiction, so it gives first priority to investigations of imminent danger, usually within 24 hours of the complaint. Next it investigates fatalities or catastrophes, which include three or more employees hospitalized for more than 24 hours or instances that have received significant publicity. Third in priority are employee safety complaints that, depending on the nature of the allegation, will lead to either a complaint inspection or a complaint investigation conducted by phone, fax or letter. The employer must respond to OSHA in writing; OSHA then provides a copy of the written response to the original complainant. Take those investigations seriously because an inadequate response will trigger an on-site inspection.

Surprise inspections - A surprise OSHA inspection will most likely stem from a complaint by an employee or, less often, a patient regarding possible unsafe working conditions or an imminent danger in the workplace.

Rule 2: Get the details

Ask the OSHA inspector to wait while you gather your management team, including your practice's OSHA safety officer. Before you allow the inspector past the reception area, find out the reason for the inspection, its scope and anticipated length. Determine which documents the officer wishes to inspect and under what regulatory authority. If possible, determine which employees OSHA intends to interview and what areas of the workplace s/he wants to examine.

If the inspection is based on a complaint, ask to see and copy the document. Although OSHA will conceal the identity of the complainant, the information will be helpful.

If the inspector lacks a warrant, it is your constitutional right to deny him/her access to your facility rather than consenting to an inspection. However, OSHA's right to inspect is clear, and the agency takes a dim view of employer resistance. Delay an OSHA inspection only when you have a critical need to buy time to come into compliance.

Don't offer the inspector food or beverages. This could be interpreted as bribery of a federal agent - a felony. And don't succumb to the temptation to leave OSHA inspectors waiting for several hours in the reception area. Give them top priority.

Rule 3: Designate a point person

Designate one management-level contact person to accompany the inspector in your facility. Instruct all receptionists to inform this point person if and when an OSHA inspector arrives. The obvious choice is your facility's OSHA safety officer.

Once the inspector gets past the reception area, never let him/her out of your sight. Provide an escort to keep him/her focused on the purpose of the visit. Depending on expertise, each OSHA compliance officer will focus on different aspects of a health care facility. The inspector may conduct a wall-to-wall inspection or focus on a specific issue.

Rule 4: Loose lips sink ships

If the inspector has a warrant, you don't need to provide records that it does not specify. be careful about providing OSHA with company documents, and don't volunteer information. You are not required to bear the cost of making copies or allowing use of your copying equipment. Technically, if the inspector wants to copy information by hand, s/he may do so.

Your practice's point person need not be able to answer every question asked by the OSHA inspector and should not try. While the point person must be able to, for instance, show the OSHA inspector the location of the hazard communication plan, s/he does not need to know the details, such as the antidote for a particular hazardous chemical. If the point person cannot answer a question, s/he should write it down and ask someone who knows the answer. What managers and supervisors say may be used against the employer.