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Fewer OSHA inspectors may put healthcare ’a little bit more under the radar’


March 1, 2018

The AFL-CIO estimated last April that OSHA, given its staffing level at that time, would need 159 years to conduct inspections of every workplace in America. 

Today, under President Trump, that hypothetical task would take even longer.

During his presidential campaign, Donald Trump repeatedly expressed a desire to trim the federal workforce, something he swiftly took action on after getting sworn in. And OSHA is among the government agencies most impacted by his mandate.

OSHA lost 40 inspectors through attrition between Trump’s inauguration and early October, with OSHA making no new hires to replace them as of October 2, according to data obtained by NBC News through a Freedom of Information Act request. Those 40 vacant positions represent 4% of the OSHA’s total federal inspection force, which dropped below 1,000 in early October, NBC News first reported in January.

Getting an unexpected visit from an OSHA inspector is still more likely than, say, Bigfoot or the Loch Ness Monster showing up. But unless OSHA decides to add more inspector positions instead of subtracting them, the odds of seeing one in the wild are now even slimmer, according to one former OSHA official and other safety experts who spoke with Medical Environment Update.

And it goes without saying that this is a big problem — not only for healthcare workers, but also the safety folks who are tasked with keeping workers out of harm’s way.

“It is important for employers to have some anticipation or fear that there’s a strong likelihood that an OSHA inspector will show up at some point, especially for those who are inclined to cut corners,” says Jordan Barab, the deputy assistant secretary of labor at OSHA from 2009 to 2017 under President Barack Obama.

“If you don’t have enough inspectors around, that kind of reduces that likelihood to the point where it’s very unlikely any employer will ever see an OSHA inspector unless somebody gets killed in the workplace,” he cautions.

Barab is hopeful that Trump and Congress “will change course and realize they do need more resources” to be proactive instead of reactive. He says that means getting back to conducting necessary inspections in dangerous workplaces and creating "modernized standards" that will protect workers. But he is not overly optimistic.

“Ultimately, the only way to provide effective oversight over government agencies is for Congress to start doing its job again. But that may not happen until 2019 — and that will depend on the outcome of next November’s midterm elections,” Barab wrote on his blog, Confined Space. “Workers’ lives literally depend on the outcome.”

Some supporters of deregulation, however, argue that Barab is being an alarmist.

Christian Britschgi, responding to a Barab blog post, wrote on Reason.com, “As with most critiques of the Trump administration’s rather marginal regulatory rollbacks, these worries about a small decline in the number of safety snoops are overwrought.”

Despite Trump’s public campaign promise to “cut so much your head will spin,” a Labor Department spokesperson told NBC News that OSHA has hired “several additional inspectors” since early October and was recruiting at least two dozen more. Those new hires will “ensure that OSHA has the necessary personnel to carry out its important work,” Labor Secretary Alexander Acosta said in November.

Still, even if OSHA is permitted to fill some of those open inspector positions in the coming months, last year’s hiring lull could affect the agency’s future performance, argues Barab, who says it can take years to get a new inspector up to speed. 

“It takes a long time to hire government employees. It takes even longer to hire OSHA inspectors,” Barab says. “And then it takes a while for new inspectors to be trained so they can do inspections on their own. The other issue is [the government has not] lifted their hiring freeze for any other OSHA employees, which include whistleblower investigators, administrative people, managers, standards people.”

Meanwhile, due to limited resources and manpower, OSHA is prioritizing high-risk workplaces — such as construction sites and manufacturing plants — with increased rates of fatal accidents, serious injuries, and illnesses, the NBC News report said.

Asked by Medical Environment Update how the decrease in inspectors would affect the healthcare industry specifically, an OSHA spokesperson did not comment.

Chris Miranda, owner and president of MAC Safety Inc., a safety consulting firm headquartered near Pittsburgh, theorizes that the lower number of OSHA inspectors makes it even unlikelier that healthcare facilities will be subject to a random inspection.

“The healthcare industry is one of the highest-injury industries there is. … But it’s kind of been that one industry for whatever reason has flown a little bit under the radar,” says Miranda, who estimates that a third of his clients come from within the healthcare and insurance sectors. “When you eliminate inspectors, is [healthcare] an industry that’s going to kind of fly a little bit more under the radar?”

Miranda believes that with fewer OSHA inspectors, the agency will target lower-hanging fruit, like construction sites and machine shops, to reach inspection quotas.

“Now you go to the high-target areas. You drive by a construction site with 200 workers and I guarantee they’re going to find someone doing something wrong,” he says. “Are they going to go into a hospital and make sure people are handling needles properly and stuff like that? Nah. The frequency of inspections, I expect that will be the industry that drops — unless something terrible happens, obviously.”

The Labor Department said that in the 2017 fiscal year, OSHA actually increased its number of inspections for the first time in five years. But Barab agrees with Miranda, writing on his blog that the increase was “most likely because OSHA inspectors focused on easier and faster construction inspections to bolster the year-end numbers.”

Barab believes the healthcare industry should be more scrutinized, pointing out that in 2016 it was once again the sector with the most workplace injuries and illnesses, then rattling off a list of occupational hazards that are unique in healthcare.

“Hospitals are dangerous places to work, healthcare in general. OSHA could [put] more emphasis there. We tried to do that [under Obama], but it’s difficult because there are a lot of areas we need to put more emphasis on,” he says. “The problem with healthcare is there aren’t a whole lot of OSHA standards to cover the hazards.”

And that, Barab says, is another reason why OSHA inspectors may become scarcer.

Because OSHA doesn’t have any standards for, say, musculoskeletal disorders, that means that if employers are still creating unsafe work conditions, OSHA must instead use its general duty clause, he says. Proving that such a hazard can cause death or serious physical harm, is recognized by that employer or industry, and has a feasible means of abatement takes “a lot more time and resources.”

“So,” Barab continues, “a reduction in the number of staff that OSHA has means that they just won’t have the kind of time that they need to do these general duty clause citations. And that will disproportionally affect the healthcare industry.”

Karen K. Daw, MBA, CECM, an authorized OSHA trainer who works at Ohio State University, agrees that OSHA will be “a lot more selective” with their investigations and adds that having fewer inspectors may slow down the agency’s response time.

When healthcare employees may have never seen an OSHA inspector and now know the chances of seeing one are even more unlikely, how do you get them to take safety seriously?

Daw suggests a reminder that OSHA aren’t the only enforcement game in town.

“The healthcare environment [shouldn’t] be lax about this because, as we know, there are other regulatory agencies that have a say in how we conduct business,” she says. “So while OSHA might not be the ones who come knocking on your door, you may have one of these other agencies show up.”

Plus, Miranda believes employers have a “moral obligation to keep employees safe.”

“It kind of seems that one [political] party gets in and there’s a heightened focus on employee safety, then another party gets in and almost veers toward the employer side, like, ‘You guys are getting in our way and we’re trying to do something,’ ” Miranda says. “But all people are trying to do is make sure that employees are safe.”

Daw agrees. “At the end of the day, what should be driving you to do the right thing is integrity. That and staying off the 6 o’clock news.”

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