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The Hidden Health Care Problem

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A major problem has managed to escape the public's attention amid all the bluster over health care: The people we rely on to take care of us are themselves suffering injuries and illnesses at an alarming rate, as shown in a report published today by Public Citizen.

What's more, insufficient action is being taken to address well-documented risks to health care workers, such as those posed by unsafe ergonomic conditions and undue threats of workplace violence. This shortcoming represents a violation of federal law, which calls on the government to ensure "so far as possible... safe and healthful working conditions" for every employee in the United States.

David Michaels, leader of the Occupational Safety and Health Administration, which is in charge of protecting workers, acknowledges the problem. "It is unacceptable that the workers who have dedicated their lives to caring for our loved ones when they are sick are the very same workers who face the highest risk of work-related injury and illness," Michaels said in a statement accompanying the release of data showing an increase in health care injuries.

There are many reasons health care workers are not being adequately protected. For starters, hospitals, nursing homes and other health care workplaces receive far fewer inspections than those in other industries. Even though health care workers outnumber construction workers two-to-one, health care facilities receive only one-twentieth as many visits from OSHA as construction sites. This is a striking contrast.

The dearth of inspections is only a partial explanation for the lack of protections afforded to health care workers. OSHA is hamstrung because it often lacks standards to rely on when its inspectors spot unsafe conditions. For instance, no standards exist to ensure safe ergonomic conditions or protect against undue risks of workplace violence. To issue citations for these hazards, OSHA inspectors must rely on the agency's catch-all general duty clause. Such cases require extra proof on the part of OSHA inspectors, which often discourages action.

Much of the blame for lacking standards can be laid directly at the feet of Congress and successive presidential administrations. OSHA in 2000 published a standard to protect workers from all industries from the dangers posed by unsafe ergonomic conditions. But Congress killed the rule two months into the administration of President George W. Bush. Early in the Obama administration, OSHA proposed a rule that would merely have required better reporting of musculoskeletal disorders. But the administration stalled the rule, then Congress blocked it. Meanwhile, myriad procedural obligations have been ladled onto OSHA, rendering it a herculean task to complete even the most simple rule.

Added to all of these adversities, OSHA's budget is minuscule in proportion to the magnitude of its obligations. Its $535 million allotment for 2013 might sound like a lot of money -- until one considers that the agency is required to oversee 7 million work sites. That's about $75 per work site, not taking into account other tasks that compete for OSHA's resources.

From its beleaguered position, OSHA has sought to address dangers to health care workers with ad hoc solutions, such as establishing a specialized program focusing on nursing home workers and by issuing non-binding warnings when it identifies an unsafe condition for which it lacks the evidence needed to pursue a case under the general duty clause.

But these are patchwork solutions. OSHA's nursing home program, for instance, does not include hospitals, which also have high injury rates. Meanwhile, the agency is not moving forward on a rule to protect health care workers from ergonomic stressors because it "does not have resources to move forward on all rulemaking necessary to address all the pressing workplace health and safety hazards," OSHA said in a written response to Public Citizen.

OSHA's improvised responses show that its leaders' hearts are in the right place. But the combination of acknowledged hazards and incomplete responses to them leaves no room but to conclude that the nation is failing to fulfill its promise to protect its workers.

As the health care field expands in coming years, the deficit in the government's obligations to its workers will only increase unless Congress, the administration and OSHA work together to repair the breach.