OSHA has cited Danbury Hospital in Danbury, Conn., where an 86-year-old patient shot a nurse three times in March, for failing to provide its employees with adequate safeguards against workplace violence. The nurse has not returned to work.

The citation carries with it a proposed fine of $6,300.

OSHA's action follows an inspection begun in January 2010, in response to worker complaints.

OSHA's inspection identified several instances during the past 18 months in which employees in the hospital's psychiatric ward, emergency ward and general medical floors were injured by violent patients. In addition, there have been about 25 cases over the past five years in which hospital employees lost workdays or were put on restricted duty after being injured by patients. OSHA found that the hospital's workplace violence program was incomplete and ineffective at preventing these incidents.

As a result, OSHA has cited the hospital for an alleged serious violation of OSHA's general duty clause for failing to provide a workplace free from recognized hazards likely to cause death or serious injury to workers, in this case the hazard of employees being injured by violent patients.

"This citation points to the need for the hospital to develop a comprehensive, continuous and effective program that will proactively evaluate, identify, prevent and minimize situations and conditions that place workers in harm's way," said Marthe Kent, OSHA's New England regional administrator.

OSHA's citation encompasses several suggested means of abatement that the hospital can pursue to address the workplace violence issue. These include:

• Creating a stand alone written violence prevention program for the entire hospital that includes a hazard/threat assessment, controls and prevention strategies, staff training and education, incident reporting and investigation, and periodic review of the program.
• Ensuring that the program addresses specific actions employees should take in the event of an incident and proper reporting procedures.
• Ensuring that security staff members trained to deal with aggressive behavior are readily and immediately available to render assistance.
• Ensuring that all patients receiving a psychiatric consultation are screened for a potential history of violence.
• Using a system that flags a patient's chart any time there is a history or act of violence and training staff to understand the system.
• Putting in place administrative controls so that employees are not alone with potentially violent patients in the psychiatric ward.
• "Workplace violence is a serious issue affecting many workers and employers across this nation, but it is one that can be addressed within the workplace if employers take systemic, thorough and continual action," said Kent. "The safety and health of employees depends on this action."