WNYLaborToday.com Editor’s Note: The Center for Occupational & Environmental Medicine (COEM), located at Buffalo’s Erie County Medical Center (ECMC), is available to Workers both Union and non, providing care to those who are injured, impaired or who develop an illness as a result of workplace factors – which may include exposure issues, physical injuries, or any other job hazard.  The COEM is also a New York State Department of Health-funded Clinic for the diagnosis and treatment of occupational injuries and illnesses for Workers living in the five counties of Western New York.  The COEM also offers services for any Worker with other job-related medical needs, such as physicals required for employment or licensure - and they assist with completion of paper work for Worker Compensation Claims. With state-of-the-art diagnostic equipment and a highly-skilled and caring Staff, the COEM’s Health Care Services meet U.S. Occupational Safety & Health Administration (OSHA), U.S. Environmental Protection Agency (EPA) and Department of Health safety standards.  The COEM takes a different approach to the treatment of injured Workers through prevention, early diagnosis and treatment.  Opened in 2015, the COEM was developed with great support from Western New York Labor Unions and their Leadership.  The COEM, which is open Monday through Friday - 9 a.m. through 5 p.m., can be reached at 716-898-5858.

The author of this article is Nellie Brown (pictured below), who serves as the Director of the Workplace Health and Safety Program, a Statewide Program of the Worker Institute at Cornell University’s School of Industrial and Labor Relations.  Nellie provides Industrial Hygiene Services for the COEM.

Kelly is a Department Manager who works late hours for a Social Services Agency located in a high-crime area.  Recently she’s been diagnosed with high blood pressure and depression.  She is concerned that her department’s clientele are more likely than ever before to be edgy, verbally abusive and potentially violent.

With that example stated, I ask - how well is your workplace addressing violence prevention?

Let’s start with your workplace’s definition: “Workplace Violence” brings to mind fights, physical or sexual attacks, murder, property damage or arson - and certainly acts of terrorism.

Does your policy include the unauthorized possession of firearms, explosives or other weapons in the workplace?

Does your program’s policy cover verbal as well as physical issues?

OSHA (U.S. Occupational Safety & Health Administration) and NIOSH (National Institute for Occupational Safety & Health) have recommended including verbal harassment and threats - face-to-face, in writing or electronically - as these are not only problems in themselves, but also could escalate to other forms of violence.

Next, let’s use OSHA’s recommended program elements to critique your workplace’s program.

Have the risk factors for your workplace been identified?  - OSHA has more detailed Prevention Guidelines for Health Care and Social Services Organizations that have been recently updated, including those for late-night retail establishments and Taxicab Drivers.

Has a site inspection been done?

How easily can anyone enter your building(s) or reach private, rather than public, areas of your facilities?

Are your entrances/exits and parking areas well-lighted?

Do you have barriers where employees are handling money?

Even look at your desk top, are there any items usable as weapons (scissors, letter-openers)?

Security measures in Kelly’s building include an alarm system (which sometimes did not work), hot-alarmed doors (which sometimes did not lock properly), and an unarmed Security Guard stationed at the building’s main entrance, only. 

Have you been surveyed?  Were you asked about violent incidents (reported or unreported), as well as your concerns about risks, whether you work on-site or in the field?

So often, people won’t talk about these things – so an anonymous survey may work best.  People may open up about upsetting situations, such as finding the body of a Co-Worker who committed suicide or experiencing unwitnessed harassment by a nasty bully.

Kelly has witnessed robberies and violent crimes in and around her building, including an occasion when a man who had been shot entered the building and died in front of her.

Like so many people, Kelly had accepted these events as “part of the job.”

After all, she is a professional in her field: she thought that reporting these incidents or making a “fuss” about them could have created the impression that she couldn’t handle her job.

Has a records review been done?  This can reveal past incidents, patterns or trends in Workers’ Compensation reports, police reports, security problems or insurance reports - not only injuries, but also property damage or health problems (such as high blood pressure) from stressful situations.

Does your prevention strategy address a range of potential perpetrators?

Type I: Criminal Acts – These are strangers who have no legitimate business in that workplace. Nationally, about 79% of workplace homicides occur during criminal acts such as robberies.  Typically, these are smaller, more local news stories compared to the “disgruntled Worker” headlines.  This category includes terrorism, robbery, property damage, arson and sabotage, as well as an Employee being assaulted (including sexually).

Type II: Customer, Client, Patient – In this case, the perpetrator has a legitimate relationship with the workplace, but becomes violent during a business transaction or when being cared for as a patient.  And, yes, these could also involve out-of-control people with dementia, drug/alcohol problems or severe pain.

Type III: Employees - Only about 9% of violent acts are committed by Workers, such as Co-Workers, the boss or former Workers.

Type IV: Personal Relationship – A violent act can happen at the workplace simply because the perpetrator, who couldn’t reach the victim otherwise, knew where the victim worked.  This is the most common scenario for women killed at work. 

How does your workplace handle domestic violence?

What if you are granted an Order of Protection which mentions your employer’s property, an employee or a person working at an employer-owned location?

Does your policy require you to notify your employer about it?

It may be helpful for a victim of domestic violence to notify the employer so that workplace procedures could be put in place to protect a potential victim.

A Social Worker for over 15 years, Kelly has made many home visits to clients.

On one occasion, while visiting a new client, she rang the doorbell and heard a dog barking loudly.  The client answered the door and brought Kelly into the living room where a large dog was lying on the floor.  Meatball jumped up and stared at Kelly, watching her every move, glaring, growling and barking.  The client assured Kelly that Meatball was an old dog who wouldn’t hurt a fly - but, when Kelly handed some forms to the client for signature, Meatball bit Kelly’s outstretched hand.  The client had not kept up with her pet’s vaccinations - so, at the hospital emergency room, Kelly was advised to receive prophylactic rabies vaccine.

So, what about attacks by animals?

Imagine going onto someone’s property to make repairs, read a utility meter or take a blood sample from a house-bound patient and have a dog become defensive or even purposely set upon you.

Does your policy require the pet owner to shut the animal in a separate room or restrain it?

If this is not done, could you re-schedule the work?

Does your program address the risk factors which NIOSH has identified as common threads running through cases of workplace violence? - Interacting with the public; Exchanging money; Delivering services or goods; Working late at night or during early morning hours; Working alone; Guarding valuables or property; and dealing with violent people or volatile situations.

Harry is a divorced father who has had his child-support payments subtracted from his paycheck - leaving him with what he believes is insufficient money to meet his own living expenses.

He goes to the social services building at the end of the work day and notices that, as an Employee exited a side entrance, the door didn’t latch behind him.

Harry takes advantage of this to enter the building, finding Kelly in a corner office - which he interprets as a position of authority.  He addresses her with harsh and threatening language and a gun he carries is very much in evidence as a distinctive bulge in his jacket pocket.

After uncovering risks and hazards for your workplace, what should be done to address them?

The hierarchy of controls can be used here, just as for any other health and safety problem.

These are some examples:

Source Reduction - Moving a water meter to the outside of a building so that a Worker doesn’t have to go inside and face the dog or be chased off the property by an occupant with a gun; and Having a house-bound patient send in blood pressure data electronically.

Engineering Controls - Lighting and visibility, especially at doors and in parking areas; Video monitoring barriers; Metal detectors; Lockable bathrooms for Staff; Controlled access; Alarms on doors; Panic Buttons in offices; and Automatic Vehicle Locators for Field Workers.

Administrative Controls - Training: How to recognize early warning signs of potential violence; How to defuse confrontation (of course, good communication skills can’t solve all problems); Work practices and policies, such as eliminating long customer wait times that make people annoyed or angry; A Buddy System, rather than working alone; and providing an individual to escort Employees to their cars.

Personal Protective Equipment – Unfortunately, for most jobs, there’s not a lot to be done at this level (most people won’t be doing their jobs while wearing body armor); Personal alarms; Clothing with identifiers; and ID (Identification) Badges.

Are Violence Incident Reports being filled out - and not just for physical assaults, but also for verbal threats or harassment?

Also, take a look at the content needed on your Violence Report Form.

Beyond basic incident information, is there a need to protect privacy?  For example, upon request, the victim’s name could be removed from copies of the report if sensitive or protected issues are involved, such as a sexual assault, HIV infection, needle-stick injury or mental illness.

If you fill out an incident report, does your program’s policy protect you against retaliation?  Retaliation is discrimination against you because you filed a concern or made a charge of Workplace Violence or testified, assisted or participated in any manner in an investigation, proceeding or hearing about violence.

If it includes a denial of a promotion or a raise - for someone who engages in retaliation, what is the penalty?

What happens to incident reports?

Does your employer investigate each one, remedy the problem (including for future prevention), and report back to Employees on the results – such as improvements to security, a change in work practices or a disciplinary action (even if details are kept confidential)?

In Kelly’s case, the security measures are not working, as the security door did not close properly.

A Panic Button at her desk could work here to summon the guard or police.

At the moment, it is Kelly’s communication skills that she will have to use to defuse a confrontation - listening to Harry, getting him to sit down, offering assistance as appropriate, calming him down – which will be put to the test.

Of course, despite the most thorough risk assessment and prevention methods, the unpredictable can still happen - so does your workplace help people to recover from violent incidents?

Every crisis leaves its mark. 

Forgetfulness can be a tempting reaction, but this means that deep wounds could be left which may never heal, for the victim and/or others who feel remorse for not being there to help.

Does your workplace have a recovery plan, perhaps through your Employee Assistance Program (EAP)?  This can help you to recover faster and stay healthier, as well as be more productive on the job.

In the end, the confrontation with Harry, fortunately, had a good outcome.

Kelly was successful in calming Harry down and encouraging him to open up about his personal struggles and how devastated he has been by the separation from his children.

Kelly arranged for financial counseling and other services to assist him, then she escorted him to the front door in the presence of the Security Guard.

Kelly told the guard how Harry had been able to enter the building.

For Kelly, this incident became the “last straw” – she made work order requests for fixing the security door problem and installing Panic Buttons in the offices.

Kelly reported this incident and its ramifications in detail and discussed overall building security with her supervisor – the building’s location and clientele may warrant buzzing clients into some areas of the building or passing through a metal detector.

Workplace violence can have physical, mental or emotional outcomes.

While OSHA covers private workplaces, check your State to see if there are local requirements on this topic.

For example, New York has State Laws on workplace violence prevention.

One regulation covers Public Sector Employees - except in schools, while the other regulation deals specifically with schools.

Here in Western New York, the Center for Occupational and Environmental Medicine at the Erie County Medical Center is able to assist you in addressing this or other occupational injuries or illnesses.