A Physician's Guide to OSHA regulations
Complaints are on the rise, especially in the area of infection control. We'll tell you how to keep on the right side of the law.
How safe is your office?
Beyond the goal of a better work environment, there's another good reason to take the question seriously. "Employees in physician offices are becoming more aware of the law and of their rights as employees," says Amber Hogan, former senior industrial hygienist with the Occupational Safety and Health Administration. The result: Complaints are on the rise, especially in the area of bloodborne pathogens.
Between Oct. 1, 2000 and Sept. 30, 2003, OSHA cited physician and dental offices 480 times for violations of the rules on bloodborne pathogens, with total initial penalties exceeding $285,000.
Luckily, the rules aren't that hard to comply withand they do create a safer office. "We welcome the OSHA guidelines in my small practice," says GP Liza A. Shiff, of San Jose, CA.
Seven rules for a safe and healthy practice
There are six OSHA standards that apply to physician offices, whatever their size. A seventh standarddealing with ionizing radiationapplies only to offices that offer X-ray services.
Bloodborne pathogens. Aimed at reducing occupational exposure to bloodborne diseases, this rule targets the human immunodeficiency virus, the hepatitis B virus, and the hepatitis C virus. In 2000, Congress updated the rule when it passed the Needlestick Safety and Prevention Act. The idea was to get doctors and other medical providers to use newer, safer devices in order to reduce the risk of needlestick and other sharps injuries.*
Among the basic requirements of the standard:
a written exposure control plan, updated annually to reflect changes in technology. The plan needn't survey every new device on the market, but it should show why you chose the various devices for your practice. Also, be sure to document the input of all employees involved in the selection process.
use of safer, engineered needles and sharps
use of the right protective equipment (gloves, face and eye protection, gowns)
use of universal precautions
no-cost hepatitis B vaccines to exposed staff
medical follow-up after an exposure incident
proper containment of all regulated waste
identification (via labels or color-coding) of regulated-waste containers, sharps disposal boxes, and the like
Practices no longer need to maintain a sharps-related injury log detailing when, where, and how injuries occurredand which devices were involved.
Hazard communication. If your office contains hazardous chemicals of any kind (alcohol, disinfectants, anesthetic agents, sterilants), your employees have the right to know about them. To comply with OSHA, you must have a written list of the hazardous chemicals stored or used in your office. For each of these, your employees must also have access to the manufacturer-supplied Material Safety Data Sheet. The MSDS outlines the proper procedures for working with a specific substance and for handling and containing it in a spill or other emergency.
Exit routes. You must provide safe and accessible building exits in case of fire or other emergenciessomething of particular concern to practices in larger physician-owned buildings. At minimum, you're expected to establish exit routes to accommodate all employees in a defined workspace and to post easily visible evacuation diagrams.
Electrical. These rules deal with the safe use and location of such equipment as computers, faxes, copiers, sterilizers, centrifuges, refrigerators, microwaves, ECG and X-ray machines. There are also rules for offices that use special electrical equipment and wiring (because they store or use flammable gasses, for example).
Reporting occupational injuries and illnesses. Medical and dental offices are currently exempt under federal law from keeping an injury and illness log. But you might be required to keep a log under state law if you practice in a state with its own occupational safety and health plans. (For a list of these states, see "States with OSHA-approved health and safety programs".)
All work-related fatalities must be reported to the nearest OSHA office. You also must report to OSHA if three or more employees are hospitalized in a single work-related incident.
OSHA poster. Every practice must display this notice of employee rights in a conspicuous place. (Liza Shiff of San Jose displays hers in the employee lounge.) Besides outlining your staff's rights to a safe workplace, the poster also must tell employees how to file a complaint. Posters can be downloaded from OSHA's Web site ( www.osha.gov/Publications/poster.html ) or ordered free-of-charge by calling 800 321-OSHA.
Ionizing radiation. Practices that offer X-ray and related imaging services must:
survey the different types of radiation used
designate restricted areas to limit employee exposure
supply personal radiation monitors (film badges or pocket dosimeters) to employees working in restricted areas
label rooms and equipment, as needed, with caution signs
Depending on the nature and location of your practice, you may need to take into consideration other OSHA guidelines or recommendations. The most common ones relate to latex glove sensitivity, ergonomics, indoor air quality, workplace violence, and injury and illness prevention.
Stiff penalties for the seriously noncompliant
To get an idea of the ways doctors get in trouble with OSHA, we took a look at inspection data from California. In 2002, that state's OSHA conducted 48 inspections of physician offices. All but three were in response to complaints. The most-often cited violation involved bloodborne pathogens, followed by injury and illness prevention program, formaldehyde, hazard communication, portable fire extinguishers, and electrical equipment.
As a general rule, OSHA investigations occur in response to written, signed complaints. You can file a complaint by calling your local regional OSHA office. (For a list of regional and area offices, go to www.osha.gov/html/RAmap.html .) In states that have their own OSHA-approved state plans, employees may file a complaint with both state and federal OSHA. Complainants must provide enough detail for OSHA to assess whether the violation threatens physical harm or poses an imminent threat.
Federal whistleblower laws prohibit reprisals against employees who file a complaint. In fact, if the complainant is an employee, her name will remain confidential and she won't be asked to attend any initial meeting with OSHA officials. An employee representative can substitute.
The majority of OSHA complaints are handled as "phone/fax investigations"informal alerts that deliver the message, "We're aware you may not be in compliance. How do you plan to address the problem?" But if the complaint involves a serious violation, or if the practice has a history of egregious or willful citations, OSHA will do an on-site inspection. These are generally limited to the area where the violation occurred, although an inspector may document other violations that are in plain sight. Inspectors may also ask to review your written exposure control plan, accident log, and other relevant records.
Each citation issued carries a specific monetary penalty, up to $7,000 for serious violations and up to $70,000 for repeat violations. Not everyone pays the same amount, however. "Penalties are downscaled depending on the size of the business, its compliance history, its good faith efforts to correct problems, and other factors," says former OSHA official Amber Hogan.
For example, an ob/gyn practice in Cherry Hill, NJ, was initially fined $6,375 for six violations of the bloodborne pathogens rules. An informal settlement with the local OSHA office reduced that penalty by 25 percent.
Cited practices have a fixed amount of time to "abate"OSHA-speak for fixing the problem and getting back into compliance. Pictures and a well-documented letter are acceptable proofs of abatement.
A world of resources at your fingertips
If you're struggling with an OSHA-related issue, there's no dearth of resources available to help.
One untapped resource, says Hogan, is OSHA itselfin particular its offer of free state-run consultation services, which are specifically designed for small businesses. "Physicians don't take advantage of these because they see them as somehow linked to enforcement," she says. "That isn't the case." OSHA insists that the purpose of its consultations isn't to issue citations or impose penalties.
In fact, results of the consultation remain confidential. The AMA confirms thatsince the mid-1990s, when physicians pushed for a changeOSHA has switched its focus from hardcore enforcement to compliance assistance and education.
To get more information, go to www.osha.gov/dcsp/smallbusiness/consult.html .
Beyond free consulting, OSHA also makes health- and safety-related materials available on its Web site ( www.osha.gov ) and through the mail. Web-based items include CD-ROMs, PowerPoint presentations, and interactive training programs on topics ranging from asbestos to eye and face protection.
Another source of expert help is your county, state, or national medical society. An especially helpful resource is the AMA's "Health & Safety Management for Medical Practices." Published in 2001, the single-volume reference comes with a supporting CD-ROM, which includes a compilation of federal OSHA and other standards. To order, call 800-621-8335 or go online at www.amapress.com . List price is $50 ($40 for AMA members).
Finally, you can hire a private health and safety consultant. "I can do as little as a walkthrough, followed by a written report," says Jan Harris of Sharps Consulting, a Houston-based consulting firm. "Or I can do a complete on-site audit, after which I can put a whole program into placeevaluation, staff training, manual, posters, annual audit." Depending upon the practice and the amount of work involved, her doctor-clients pay on average $300 for a walkthrough and $1,800 for a complete on-site audit and program. Consultants like Harris also offer self-directed, fill-in-the-blank compliance manuals, which typically cost $170.
In short, there's a lot of help out thereand a lot of reasons for taking advantage of it. "The cost of prevention far outweighs the cost of higher insurance rates, post-exposure treatment, and lost work days," says Amber Hogan.
*See "These sharps rules can stick youbig time," July 12, 2002.
Wayne Guglielmo. A physician's guide to OSHA regulations. Medical Economics Mar. 5, 2004;81:90.
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