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OSHA Increasingly Likely to Act Against Workplace Violence

Guest Article: Elizabeth E. Hogue, Esq.


Texas Children’s Hospital has been cited by the U.S. Department of Labor Occupational Safety and Health Administration (OSHA) for failing to protect employees from being physically assaulted by aggressive patients. In 2022, the Hospital recorded fifteen incidents in which aggressive patients attacked employees. The citation references an incident from November 10, 2022, for example, in which an aggressive patient “pulled a security officer to the ground by the hair and kicked them repeatedly in the chest and abdomen.” The officer lost consciousness, and was taken to the emergency room and hospitalized.

After an investigation, OSHA concluded that the Hospital had inadequate policies and procedures to protect its employees from physical assault by patients. Nurses and aides were among the workers exposed to physical threats and assault. This citation involving violence follows another issued by OSHA against a homecare agency.

OSHA issued a $98,000 fine for an alleged willful violation of applicable requirements related to exposure to workplace violence, including physical and sexual assault. The citation was based on an investigation that began after a staff member was assaulted by a homecare client. In this case, a staff member who previously took care of the client had warned the agency about sexual assaults by the client. OSHA concluded that the agency failed to protect its staff from life-threatening hazards of workplace violence. According to OSHA, the agency also failed to provide an effective workplace violence prevention program.

Specifically, OSHA took issue with two types of conduct by the agency:

  • Staff members were exposed to physical assault.
  • There was no system in place for staff to use to report threats and instances of violence to the agency.

Contributing to the vulnerability of home health, hospice, private duty, and HME staff is, of course, the fact that they work alone on territory that may be unfamiliar and over which they have little control.

If OSHA’s citations based on workplace violence are upheld, OSHA will likely require providers to pay a fine and to:

  • Develop and implement a written, comprehensive program to prevent violence in the workplace
  • Implement a hazard assessment of violence in the workplace
  • Develop and implement measures to control violence in the workplace, such as an option to refuse to provide services to clients in hazardous situations
  • Develop and implement a training program on violence in the workplace
  • Develop procedures to follow in instances of violence, including making reports and conducting investigations of such instances
  • Establish a system that allows staff to report all instances of violence, regardless of severity

Homecare staff provide increasingly important services under circumstances that can be difficult, to say the least. One of the highest obligations of all homecare providers is to protect their employees. Possible action by OSHA described above provides a “road map” for providers to follow as they continue to work to address the issue of violence against staff. Violence is not part of the job description!


©2023 Elizabeth E. Hogue, Esq. All rights reserved.

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