Following Integra Health Management employee’s death, OSRHC affirms decision in workplace violence violation

The Occupational Safety and Health Review Commission (OSHRC) affirmed an OSHA citation in a case where an employee of Integra Health Management, Inc., of Owings Mill, MD, was killed by a client with a history of violent behavior. OSHA investigators found that Integra knew about the member’s history of violence and criminal behavior as well as the member’s history of schizophrenia and paranoia, but it took no steps to protect its employee beyond the basic service training. This was a violation of section 5(a)(1) of the Occupational Safety and Health Act of 1970, or the general duty clause, which requires employers to address workplace violence hazards.

Integra employs “service coordinators,” who help clients (called “members”) obtain and maintain medical care. According to the decision, service coordinators are often tasked with tracking down members with whom health insurers have been unable to maintain contact. These members are often patients with chronic conditions such as mental illness, who avoid regular physician appointments and taking their prescription medications. If a member accepts Integra’s services, then the service coordinator contacts them a few times a month either by phone or face-to-face to help them make and keep appointments, take medication, and keep up with their care. Integra’s service coordinators are not clinically trained.

The violation occurred in December 2012 in Florida, when a recently-hired 25-year-old service coordinator who had no prior experience in social work was stabbed nine times while making a scheduled visit to a member’s home. The member had a criminal record, including counts of battery, aggravated battery with a deadly weapon, and aggravated assault with a weapon.

At the time of the violation, Integra’s service training included internet-based training on community safety and screening dangerous members. Part of the training advised service coordinators to obtain behavioral history of the members—including identifying high-risk behaviors like a history of self-harm and criminal behavior. At the time of the alleged incident, however, Integra did not require that such information be obtained, and the company did not perform background checks on its members.