OSHA Inspections, Citations, and Penalties

Nursing and residential care facilities and hospitals are some of the most hazardous places to work in the country. The rate of occupational injuries and illness in nursing homes and personal care facilities is greater even than in hospitals, and nearly double that of private industry, at 7.3 illnesses and injuries per 100 workers. In fact, according to the U.S. Bureau of Labor and Statistics (BLS), one in five reported nonfatal occupational injuries in 2013 occurred among workers in the healthcare and social assistance industry, the highest number of such injuries reported for all private industries. Similarly, while the national average rate for injuries and illnesses involving days away from work, restricted work activity, or job transfer was 1.7 per 100 full-time employees, nursing and residential care facilities and hospitals had average rates of 2.6 and 4.5 per 100 full-time employees, respectively—a rate even higher than the 2.2 per 100 employees for construction workers (OSHA "Inspection Guidance").

Worker safety and health conditions in nursing and residential care facilities, hospitals, and other healthcare organizations are regulated either by OSHA or by state-specific, OSHA-approved plans. "State-plan" states have standards that are at least as effective as the federal OSHA requirements—in fact, several states have standards that are more stringent, or have requirements that go beyond the federal requirements. OSHA has approved 22 state or territory plans that cover both private and public sector workers; 4 additional state plans and 1 U.S. territory plan cover public sector workers only (OSHA requirements still apply to private sector employees). For the purposes of this guidance article, the acronym OSHA will also include OSHA-approved state plans, unless otherwise noted. A link to information about laws applicable in state-plan states is available in Resource List.

OSHA has approximately 1,900 inspectors to inspect more than 8 million workplaces (AFL-CIO). Thus, like other regulatory agencies, OSHA relies on voluntary compliance by the regulated industries and uses its limited resources to inspect the worst situations. To do this, OSHA has established inspection priorities; the first three, which are classified as "unprogrammed inspections," are performed in response to an actual occurrence or allegation of hazardous working conditions at a specific worksite. The fourth priority is referred to as "programmed inspection" in that the inspections are programmed in advance, are based on objective or neutral criteria, and are aimed at specific high-hazard industries, workplaces, and occupations. Follow-up inspections are given the lowest priority.

The priorities for inspection are as follows:

Imminent danger. An imminent danger condition occurs when there is reasonable certainty that a danger exists that can be expected to cause death or serious physical harm either immediately or before the danger can be eliminated through normal enforcement procedures. According to OSHA, examples of imminent danger include working in an unstable trench; working where exposed electrical wire could cause a serious or fatal accident; and working where toxic substances or dangerous fumes, dusts, or gases could cause death or irreversible physical harm, shorten life, or reduce physical or mental performance. (OSHA "Questions"). For example, exposure to high levels of ethylene oxide gas...