Sometimes, system redress seems painfully inadequate.
Such is the case with the $7,000 OSHA penalty recently imposed for inadequate safeguards related to the case of murdered mental-health worker Stephanie Moulton. $7,000 is the maximum fine available for "a serious violation of the agency's "general duty clause" for failing to provide a workplace free from recognized hazards likely to cause serious injury or death." It's not just that the dollar amount seems paltry in light of the loss of life - it simply doesn't seem substantial enough to have any deterrent value.
And in truth, while the OSHA citation points to the employer, one could make the case that the employer is also a victim of an economic squeeze play, which has resulted in inadequate staffing and safety controls. State budget cutbacks worry mental health workers - a scenario that is no doubt playing out throughout the country - in mental health budgets, in public safety budgets, and in regulatory enforcement, just to name a few areas that affect the health and safety of workers -- and of the public.
Stephanie Moulton was working alone at one of the North Suffolk Mental Health Association's group homes in Revere when she was brutally murdered by a patient with a violent record. A week later and just miles away at the Lowell Transitional Living Center, a shelter for the homeless, a worker named Jose Roldan was also killed by person who had slipped through the cracks in the mental health system. Both these murders were discussed in-depth in stories that appeared in The New York Times: A Schizophrenic, a Slain Worker, Troubling Questions recounted Moulton's death, and Teenager's Path and a Killing Put Spotlight on Mental Care discussed the case related to Roldan's death.
An investigation into Moulton's death resulted in the issuance of a report in June: Report of the Massachusetts Department of Mental Health Task Force on Staff and Client Safety. The report found that:
- Years of budget cuts have negatively impacted service delivery and safety issues in the following areas:
--Inadequate numbers of, and inadequate pay for, direct-care staff
--Inadequate numbers of clinical staff with relevant training and experience
--Deficiencies in the overall number of acute and intermediate hospital beds and community-based services and beds
--Decrease in the role of psychiatrists and other highly-trained professionals in the care and treatment of individuals with the most serious mental illnesses
--Requiring some staff to work under conditions that do not provide for adequate safety
- There is an absence of system-wide use of a well-designed risk assessment process
- There is lack of clarity in policies and procedures for incorporating risk variables into Individualized Action Plans
- There is lack of sufficient access to and sharing of critical safety information
- There is lack of adequate coordination of care across different components of the service system
OSHA's citation includes recommendations the employer could take to address the workplace violence issue:
- Creating a stand-alone written workplace violence prevention program that includes implementation of workplace controls and prevention strategies; hazard/threat/security assessments; a workplace violence policy statement outlining and emphasizing a zero tolerance policy for workplace violence; incident reporting and investigation; and periodic review of the prevention program.
- Establishing a system to identify clients with assaultive behavior problems and train all staff to understand the system used.
- Putting in place procedures to communicate any incident to staff so that employees without access to client charts are aware of previous violent or aggressive acts by a client.
- Identifying the behavioral history of new or transferred clients, including conducting criminal and sexual offender records checks.
- Conducting more extensive training so that all employees are aware of the facility's workplace violence policy and where information about it can be found, including training employees to clearly state to clients that violence is not permitted or tolerated; how to respond during a workplace violence incident; recognize when individuals are exhibiting aggressive behavior and how to de-escalate the behavior; and identify risk factors that can cause or contribute to assault.
- Installing and positioning panic buttons, walkie-talkies, recording security camera systems and smart phone GPS applications to better monitor employee safety and increase staff communication and support; implement and maintain a buddy system on at least the second and third shifts, based on a complete hazard assessment.
Mouton's family is rallying for enactment of Stephanie's law, which would mandate panic buttons in mental health facilities. A good start and one among recommendations issued by OSHA in their Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. But such measures may be woefully inadequate in the face of reduced staffing. In an ongoing climate of budget cuts and a strong public appetite for decreased regulatory controls, mental health workers are likely to continue being at greater risk -- along with public safety workers such as police, firefighters, and healthcare workers, who also face dire staffing shortages.