Workers in the health care industries face the highest rates of workplace violence and are five times more likely to be subjected to violence at work than the public, according to the U.S. Bureau of Labor Statistics. Violence against health care workers made headlines again recently with the murder of UnitedHealthcare CEO Brian Thompson on Dec. 4, 2024, in New York City.

For attorneys advising health care clients, it is a stark reminder of the increase in violence becoming more prevalent in health care facilities, and the importance of taking proactive steps to provide a workplace free of violence.

Violence in health care settings can take many forms, including verbal threats, physical assaults, and, in extreme cases, deadly attacks. These incidents can originate from patients, family members, or even co-workers. The increase in violence is particularly difficult for in the health care industry considering that many of the cases involve patients with substance use disorders or a mental health diagnosis.

Emergency departments, psychiatric units, and nursing homes are particularly vulnerable, given the high-stress environments and the prevalence of patients with mental health or substance use disorders.

Legal Implications for Health Care Organizations under OSHA

Workplace violence presents potential liability to health care organizations. While there are currently no specific Occupational Safety and Health Administration (OSHA) standards that have explicit requirements specific to health care entities, OSHA has general authority under the General Duty Clause to investigate and issue citations to organizations that fail to provide employees with a place of employment that is "free from recognized hazards that are causing or are likely to cause death or serious physical harm."¹

For example, on Nov. 30, 2024, Signature Health agreed to enter into a settlement agreement with OSHA relating to serious workplace violence in its outpatient mental health treatment facility in Maple Heights, Ohio. In April 2024, a patient violently attacked a nurse practitioner. The patient was alleged to have stabbed an employee repeatedly with a knife the patient brought to the facility. OSHA found that the employer failed to furnish a place of employment free from recognized hazards that were causing or likely to cause death or serious physical harm to employees.

Signature Health agreed to resolve the OSHA citation, and implemented the following actions to ensure future compliance:

• Install weapons detection equipment.

• Hire risk consultation specialists to review its procedures.

• Establish a position focused on workplace violence prevention and emergency response.

• Strengthen its workplace violence prevention program by updating policies and procedures such as the Weapon Response and Preparedness Procedure.

• Conduct training for all employees on how objects – other than known weapons such as guns and knives – can be used as weapons.

• Establish workplace violence committees.

• Add signage stating no weapons allowed.

Recommendations for Attorneys

Given the nature of workplace violence in health care, attorneys play an important role in helping organizations mitigate risks and comply with applicable laws. Attorneys advising health care clients should consider discussing the following as best practices with their clients:

Develop comprehensive workplace violence prevention programs: Encourage organizations to adopt strategies, such as a workplace violence prevention committee, create and review risk assessments, establish reporting mechanisms, and develop emergency response plans. Health care organizations must consider the risks each workplace environment may present and the available tools employees may use to ensure a safe environment.

For example, nurses in a home health environment are particularly vulnerable due to their isolation, and do not have security officers readily available to help. Special attention should be given to each individual department within a health care system to ensure best practices are followed. OSHA's guidelines on workplace violence prevention can serve as a valuable tool for developing a violence prevention program.

Implement consistent staff training on safety protocols: Ensure that all employees receive training on recognizing, de-escalating, and responding to violent situations. Training should also cover the legal rights of employees and reporting protocols.

Audit security measures: Routinely review the adequacy of security measures, including surveillance systems, access controls, and the presence of security personnel. It is important that a committee regularly meets to review and update security measures and improve security strategies.

Report violence or threat of violence to law enforcement. In 2022, the Wisconsin Legislature passed Wis. Stat. section 940.204(2), which makes it a Class H felony to intentionally cause or threaten to cause bodily harm to a health care worker in response to action taken by the worker in their official capacity.

Many patients who are alleged to commit violent acts may not have the capacity to understand the nature of their actions. However, health care organizations would be well served in creating a committee to review each incident of violence to determine whether to report the incident to law enforcement.

Conclusion

Violence in health care settings remains a pressing issue that requires consistent attention. By developing robust prevention programs and ensuring compliance with OSHA guidelines, attorneys can help health care organizations protect their workforce and maintain a safe environment for both employees and patients.

This article was originally published on the State Bar of Wisconsin’s Health Law Blog. Visit the State Bar sections or the Health Law Section webpages to learn more about the benefits of section membership.

Endnotes

¹ See OSHA, 29 U.S.C. § 654(a)(1)(1970).