Sloppy recordkeeping can lead practices to trouble with OSHA

Although longstanding protocols to protect workers from bloodborne pathogens and other hazards are generally followed, medical practices can be at risk for worker safety violations if they haven't written down their protocols.

"Recordkeeping is huge," said Pamela Dembski Hart, principal and founder of Healthcare Accreditation Resources, a medical practice consultancy in Boston. "It's amazing what people forget, because regulatory compliance is not a daily job. The most common mistakes are not having a written exposure control plan, and if they do, it's not updated at least annually, or it is not site-specific."

Practices need a hazard communication plan that includes a list of chemicals on site that present a possible danger. In addition, offices must have the material safety data sheet for each chemical from the manufacturer on file and available to employees.

"All these should be together, and everyone in the practice should know where they are," said Marshall Maglothin, principal of Blue Oak Consulting in Fairfax, Va., who has helped practices work with the Occupational Safety & Health Administration, the federal agency that enforces workplace safety.

Although experts say practices most often get tripped up by paperwork, it is fairly easy to rectify the situation. Templates for bloodborne pathogens and hazard communication plans are available on OSHA's website. Practices can call the agency with their questions and concerns.

"They should not fear us," said Bill Wilkerson, area director for OSHA in the Cincinnati region. "They can call us without identifying who they are."

OSHA consultants are available to visit medical practices and identify where they may be running afoul of regulations. Violations discovered during an OSHA consultant's visit typically will not directly result in a fine, but a practice should be prepared to address them.

"These programs are generally very good, but you just have to be careful," said Ian D. Meklinsky, a partner and specialist in employment and health care law with Fox Rothschild, a national firm based in Princeton, N.J.

Experts say that if a practice doesn't call OSHA and an inspector shows up, chances are the local office is focusing on this type of workplace, or someone contacted the agency. Many medical practices are too small to attract a routine inspection, but the agency will respond if an employee or patient complains of something not seeming right. Experts say that if an inspector shows up at a practice, it's particularly problematic if no written safety protocols are available.

The agency inspected 228 medical practices in 2006, but the number grew to 498 in 2010. Inspectors have visited 278 practices thus far in 2011. A great proportion of the inspections were in response to complaints. Retaliation against employees who complain is illegal, according to OSHA regulations.

"In small medical practices, more than half of all OSHA inspections occur as a result of complaints to OSHA," the agency said in an email in response to questions from American Medical News. "A large number of inspections in small practices are also initiated from planned inspection activities where OSHA focuses outreach efforts and inspections on specific hazards in a workplace."

Experts say that if an inspector shows up, he or she should be allowed on the site and will not interfere with patient care. Inspectors generally appear unannounced, and their identities should be verified.

A caution letter will be issued if an inspection uncovers problems. Practices have 15 days to make changes, respond to a complaint or attempt to negotiate a fine. Fines can go up to $7,000 for each first-time violation and increase to $70,000 for each repeated problem. Fines, which can be negotiated during conferences with OSHA officials, are based on the seriousness of the complaint, the size of the company and the economic state of the employer.

"The most important thing for an employer who receives a citation letter in the mail is to not ignore it," Meklinsky said. (See correction)