OSHA: Employer Failed to Protect Nurse Killed By Patient

A national home health agency failed to provide adequate safeguards to protect a licensed practical nurse who was killed by a patient during a home visit, an OSHA investigation determined.

OSHA cited the company for one willful violation under its general duty clause and one other-than-serious violation for not providing work-related injury and illness records to OSHA within four business hours, as required. It proposed $163,627 in penalties.

Nurse makes home visit to a known danger

The victim in this case was a 63-year-old licensed practical nurse who worked at Elara Caring, a home health agency operating in 17 states, including five branches in Connecticut.

According to OSHA’s investigation, employees providing home care services for Elara Caring were exposed to physical assaults “by patients who exhibited aggressive behavior and were known to pose a risk to themselves and others.” Specifically, employees were hit, punched and struck with objects while performing their job duties.

Moreover, the employer had not developed and implemented adequate measures to protect workers from this recurring hazard, OSHA found.

The recurring hazard escalated on Oct. 28, 2023, when the nurse was killed during a home visit to a halfway house for sex offenders in Connecticut. The patient, a convicted rapist, has been charged with murder, felony murder and attempted first-degree sexual assault.

In OSHA’s view, the employer violated the agency’s general duty clause, which requires employers to provide a workplace “free from recognized hazards that are causing or are likely to cause death or serious physical harm” to employees.

“Elara Caring failed its legal duty to protect employees from workplace injury by not having effective measures in place to protect employees against a known hazard and it cost a worker her life,” said OSHA Area Director Charles D. McGrevy in Hartford, Connecticut. “For its employees’ well-being, Elara must develop, implement and maintain required safeguards such as a comprehensive workplace violence prevention program. Workplace safety is not a privilege; it is every worker’s right.”

OSHA: Develop a workplace violence prevention program

According to OSHA, employers should have in place a comprehensive workplace violence prevention program to address workplace violence. The plan should include:

• management commitment and employee involvement
• implementation of a written program including the establishment, membership and role of a Workplace Violence Safety Committee
• analysis of home environments upon new patient admission
• hazard prevention and control
• training and education, including resources for impacted employees
• recordkeeping, and
• solicitation of employee feedback during the review process.

Here, OSHA pointed out some specific things Elara Caring could’ve done to reduce the hazard of workplace violence, such as:

• Developing procedures for tracking employees’ location when conducting home health visits
• Requiring employees and management to communicate and confirm an employee’s arrival and departure times for home health visits
• Providing clinicians with comprehensive background information on patients before home visits
• Providing emergency panic alert buttons to clinicians
• Positioning each medication lockbox at each patient’s residence as close as possible to an exit
• Allowing clinicians to complete data entry in their vehicle rather than in the patient’s residence, where data entry and attention to tablet screens is likely unsafe.
• Developing procedures for the use of safety escorts for visits to patients with high-risk behaviors, and
• Providing personal safety devices, such as mace or pepper spray, to clinicians who visit patients or potential patients at a remote location, and providing training on this equipment, ensuring it is maintained and in working order at all times.

For more on workplace safety, here’s what to include in an emergency response plan.

Info: Investigation into visiting nurse’s death finds home care agency failed to protect workers against workplace violence, 5/1/24.