Testimony delivered to the New York State Hazard Abatement Board by members of the University of Maryland Workplace Violence Research Group.

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
Jane Lipscomb, RN, PhD, FAAN
Kathleen M. McPhaul, RN, MPH
Cassandra Okechukwu, RN, MSN, MPH
Workplace Violence Research
University of Maryland, Baltimore
July 31, 2003

Introduction

Thank you for accepting this written "out-of-State" testimony. Although we were unable to attend the NY hearings, the nature of our work in New York and Maryland compels us to write in support of the proposed Standard for Safety and Security. We work on Workplace Violence Research at the University of Maryland, Baltimore. Dr. Lipscomb is an epidemiologist with 20 years of experience conducting research focusing on health care workers. She is the principal investigator of several grants through which she examines workplace violence in mental health, social service and home health work settings. She has presented both peer-reviewed and invited papers on the topic of violence and other workplace hazards among health care workers to national and international audiences. Kate McPhaul is an occupational health nurse with over fifteen years experience. She has a master's degree in public health/occupational health, and is pursuing a PhD in Occupational Health Nursing. Her dissertation is on the risk of violence in the home and community health workplace. Ms. Okechukwu completed her MPH at Johns Hopkins University with a NIOSH occupational health traineeship and has worked in various healthcare settings. Also, she has worked with Maryland Occupational Safety and Health on the issue of workplace violence.

You should know that a process for implementing comprehensive violence prevention programming is being documented in a federal research study in New York State Office of Mental Health facilities and the implications of this research for standard setting. Secondly, we have been involved in a qualitative assessment of the extent to which five PESH safety measures are in place and their effectiveness in NY's Intensive Case Management Program. Finally, we think you should be aware that there are numerous examples of the power of regulation to reduce safety and health threats to working people. Some of these will be reviewed.

Our testimony addresses three issues central to your evaluation of the need for a security regulation in New York State. Others have reviewed the extent and scope of the problem in New York State; therefore, we refer you to that testimony (Rosen). There are three other issues, however, which we will address;

• Feasibility of implementing comprehensive violence prevention programs
• Impact of violence prevention regulatory activities on New York health care workplaces, and
• Evidence of injury and illness reduction following OSHA regulations

Feasibility of implementing a comprehensive violence prevention program

The NIOSH Project "Evaluation of OSHA Violence Prevention Guidelines in Mental Health" under the direction of Dr. Jane Lipscomb, is concluding after four years. Seven OMH facilities (4 intervention sites and 3 control sites) participated in this intervention effectiveness study. The project supported and documented a comprehensive joint labor-management committee process for hazard identification, communication between direct care staff and management, and hazard controls. A road map for using hazard assessment information from computerized databases, environmental audits, staff focus groups, and staff surveys is in place. Efforts to evaluate the program's impact on physical assault are underway. Qualitative data indicate that the program has been extremely beneficial in hazard control activities.

Effectiveness of safety measures in the Office of Mental Health ICM program

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

Five focus groups of Intensive Care Managers (ICM's) were conducted between June 2002 and June 2003. The discussions focused on the safety risks to ICM's and their perception of the effectiveness of the five safety measures mentioned above. While there is a general sense that some aspects of safety have improved following the mandated safety improvements, the job of ICMs remains dangerous and much could still be done to improve their safety. For example, most ICM's across the State report having access to a means to summons assistance, usually a cell phone. This represents an overall improvement from before the mandated safety measures but exposure to violence is still a significant hazard facing ICMs. ICMs in the focus groups continued to report exposure to potentially life threatening violent situations while on duty.

Violence prevention training, a critical feature of any program varied across the State, according to ICM reports. Few ICMs reported that they are required to attend violence prevention training regularly. Those who attend mandated training complain that often it is comprised of "a set of outdated tapes". Others cited inability to access training due to class cancellation. Most express the desire to be consulted about the training needs of ICMs so that the training would be tailored to their specific risks. Finally, many ICMs report that training often leads to safety policy discussions, but typically, these discussions do not result in improved safety policies.

Evidence for Illness and Injury Reduction Following Regulatory Action

Regulatory action in occupational health is usually preceded by enormous human tragedy and New York State is no exception. Working citizens of this state have suffered untold injury, emotional trauma, and, even death from occupational violence. Tragically, a proponent (Councilman James Davis) of the security standard was himself gunned down while advocating for the need for increased security. Occupational health regulations work, as evidenced by the following examples. The 1991 Vertical Fall Arrest standard promulgated in Washington State resulted in a significant decrease in the rate of falls. Furthermore the cost of injuries was significantly reduced as well because there was a reduction in mean paid lost days per event and a reduction in cost per fall.1 In 1989 the trenching and excavation standard was revised and a subsequent analysis of data from 47 States revealed a 2-fold decline in deaths. This decline in fatalities was present in both large and small workplaces.2 Even though exposure to violence cannot be measured in the air nor controlled by improved ventilation and exhaust, there are engineering-type controls in the form of security devices and alarms, metal detectors, lighting, door locks and hardware, audiovisual equipment, and architectural changes that reduce the need to rely on human factors to be effective.

At least two studies in Washington State have examined the impact of enforcement activity. One descriptive study analyzed OSHA inspection activity for carbon monoxide hazards. All workplaces with carbon monoxide exposures benefit from the ability to analyze these types of data. These data provided an assessment of effective controls and allowed the enforcement agency to target its inspections toward the highest risk workplaces.3 A more recent Washington State analysis examined the impact of OSHA enforcement activity on workers compensation claims in that state. They found a 22.5 %decrease in compensable claims in industries with OSHA enforcement actions compared to a 7.4 % in those industries without OSHA enforcement activity. OSHA activity in this study was not associated with "survivability" of the business, an oft-claimed prediction of increase regulatory activity. This study provides further evidence that regulation reduces both injuries and costs.4

The healthcare industry has been a recent target of increased OSHA activity due to improved understanding of the many risks, including violence, associated with work in health care. Ethylene oxide was regulated in the mid-80's and, as discussed above, required engineering controls were associated with lower ambient air levels of toxic ethylene oxide in hospital sterilizing rooms.5 OSHA has also regulated exposure to blood borne pathogens via needle stick injuries and other routes due to significant occupational illness in healthcare workers. A study of factors surrounding the adoption of safer needle devices found that State legislative activity on needle stick control was associated with healthcare employers using protective needle devices.6 Likewise, the promulgation of OSHA blood borne pathogen is credited for the decline of occupationally acquired HBV infections in healthcare workers from 8,700 cases in 1987 to just 800 new cases in 1995.7

Conclusion

In conclusion, we believe the long and traumatic history of violence against public workers in New York has risen to the level of government regulatory intervention. We have provided evidence of the feasibility of violence prevention program, the impact of violence prevention regulatory activities on New York health care workplaces, and evidence of injury and illness reduction following occupational safety and health regulations. We strongly recommend a comprehensive workplace security standard to protect New York public employees in their workplaces. Thank you.

References
1. Lipscomb HJ, Li L, & Dement J. (2003). Work-related falls among union carpenters in Washington State before and after the Vertical Fall Arrest Standard. American Journal of Industrial Medicine, 44 (2), 157-65.

2. Suruda A, Whitaker B, Bloswick D, Philips P, & Sesek R, (2002). Impact of the OSHA trench and excavation standard on fatal injury in the construction industry. Journal of Occupational Environmental Medicine, 44(10), 902-5.

3. Lofgren DJ, (2002). Occupational carbon monoxide violations in the State of Washington, 1994-1999. Applied Occupational Environmental Hygiene, 17(7), 501-11.

4. Baggs J, Silverstein B, & Foley M. (2003). Workplace health and safety regulations: Impact of enforcement and consultation on workers' compensation claims rates in Washington State. American Journal of Industrial Medicine, 43(5), 483-94.

5. LaMontagne AD & KT Kelsey, (2001). Evaluating OSHA's ethylene oxide standard: exposure determinants in Massachusetts hospitals. American Journal of Public Health, 91(3), 412-417

6. Sinclair RC, Maxfield A, Marks EL, Thompson DR, & Gershon RR, (2002). Prevalence of safer needle devices and factors associated with their adoption: results of a national hospital survey. Public Health Report, 117(4), 340-9.

7. Jeffress, Charles, Assistant Secretary of OSHA (June 22, 2000). Testimony before the subcommittee on workforce protections house education and the workforce committee. Available online at
http://www.osha.gov/pls/oshaweb/owadisp.show
_document?p_table=TESTIMONIES&p_id=164

For additional testimony on a proposed New York State regulation concerning workplace violence, click here.

For links and news concerning workplace violence, click here.