Common Courage Press, a publisher for "an informed democracy," just released an expose on the American occupational health and safety scene. Written for the public by Lisa Cullen, a CIH and first-time book author, "A Job to Die For" weaves together the emotional toll of workplace accidents with the politics and regulatory aspects to provide a unique perspective on the current state of workplace safety and health. This is part one of a three-part series to appear inISHN.

An epidemic of uncontrolled illnesses and injuries rages through our nation's workplaces. It moves quietly, its devastation too dispersed to be recognized. Still, millions of workers injured or made ill each year and their families struggle in a wake of personal pain and loss of income. Here is one worker's story.

"The doctors don't think the infection will kill me," Sue reports matter-of-factly. After seven years of surgeries, pain and dealing with workers' compensation insurance, she has resigned herself to life after occupational injury.

Sue was an experienced nurse with ten years invested at the same long-term healthcare facility when she requested a lifting hoist for one of her patients. The patient had Multiple Sclerosis (MS), and her legs were growing weak as the disease advanced. Sue's employer denied the hoist request and a few weeks later the patient's legs crumpled as Sue moved her from her bed to a wheelchair. With her arms around Sue's neck, the patient was close enough to hear a "pop noise." She started crying as Sue said, "I'm okay. These things happen."

Sue wasn't okay; her neck broke. When the patient's legs buckled, her body weight suddenly hung on her interlocked fingers behind Sue's neck. Snap.

Managing to work for three more weeks, Sue finally accepted that she was badly injured. Several operations later, her neck was "wired together," and she suffered multiple draining infections at the wound site. After antibiotic treatments, the wire became infected with an antibiotic resistant bacteria. "At times, it was like pea soup coming out of my neck," she says.

Paying the price

Sue's injury has touched all aspects of her life. She walks stiffly - partly from the injury and partly from the pain - and can't really rotate her head. She has a constant headache, suffers recurring fevers and has permanent and severe nerve damage. She can't drive and finds even sitting in a car difficult; the distance she can travel limits family outings.

Sue calmly describes the financial loss, the constant physical pain, and how she has trouble simply watching her daughter play volleyball because she can't sit on the bleachers. "The bleachers shake too much, especially when the team scores and everyone jumps to their feet."

The nurse in Sue describes her ever-present headache as an "occipital migraine headache" and that the infection is caused by a bacteria called MRSA, which stands for Methicillin Resistant Staphylococcus Aureaus. She explains, "MRSA infections basically rot the bones away as it moves through them. It is usually found with amputations." Since the MRSA is in her neck bones, the spinal nerves encased by those degrading bones are becoming pinched, causing pain and loss of function.

Sue's neurological tests show her severe nerve damage. She is losing control of her arms; tasks requiring manual dexterity are moving slowly beyond her reach. Fighting to remain active, Sue recently purchased voice-activated software for her computer because she realizes that as her bones decay, she could eventually become paralyzed from the neck down.

It is this image of herself in a wheelchair that finally gets to Sue; fear and grief creep into her voice. MRSA may not kill her but the Sue that once was is gone, and the Sue that is yet to be will have her nerves crushed so badly that she will likely be wheelchair bound and pain ridden. One day, she will probably awake as the patient with a nurse helping her from bed to wheelchair.

The national toll

Every day, 165 Americans die from occupational diseases and 18 more die from a work-related injury. On the same day, more than 36,400 non-fatal injuries and 3,200 illnesses will occur in America's workplaces. Each year, this unknown workplace epidemic extends into nearby communities to claim the lives of 218 innocent bystanders and injure another 68,000.

America's millions of occupational diseases, deaths and injuries cost an unfathomable $155.5 billion annually; five times the costs of AIDS, three times the costs for Alzheimer's disease and almost as much as cancer. This already unimaginable number grows by another $13 billion when property damage, police and fire protection, and costs to innocent bystanders are added. We all bear the financial burden with reduced job opportunities, lower salaries, earlier social security payments, and higher costs for health insurance, workers' compensation and disability. The costs are nothing, however, compared with the toll paid in pain and suffering. Each year more than 66,700 dead workers leave irrevocably changed families, coworkers and friends.

Accidents vs. foreseeable consequences

Occupational health and safety problems can be fixed because accidents are preventable. An accident can be defined as an unexpected and unintentional happening that results in damage to people or property. Although it is common to say, "Hey, accidents happen," they are more complicated than that. In hindsight, most can be seen building from several causes, each representing a missed opportunity to step in and prevent the forthcoming damage. In fact, the safety and health profession is so averse to the term accident that the word incident has been widely substituted.

Although willful disregard of employee welfare does occur, most employers are not intentionally trying to maim or kill the very people that allow their businesses to operate. If Sue's employer, for example, was directly given the choice to either install a hoist or debilitate Sue, they surely would have chosen the hoist. On a cost basis alone, the hoist would have been the wiser decision. Sadly, many employers miss or ignore the subtle hints that offer the chance to prevent accidents. Some employers choose to dismiss them. Others simply don't know what to do.

Sue's back injury culminated from a number of shortsighted, poor judgments that placed employee welfare second to other considerations:

  • First, Sue's request for a hoist upset the patient; a hoist installed above her bed would be a glaring sign of her progressing deterioration. While compassion for the patient was expected and reasonable, it did not warrant the risk placed on both hospital staff and the patient.

  • Second, after multiple requests did not produce the hoist, Sue completed a two-page form that was supposed to go straight to the director of nursing. Because the director happened to be on vacation, the assistant director decided to implement a makeshift solution, taking the wheels off the bed to lower the bed closer to the wheelchair height. This actually increased the hazard by making the bed lower than the wheelchair. Now, the patient had to be lifted up into the wheelchair rather than be lowered into it.

  • Third, Sue's employer knew that the patient's legs were unstable. Doctor's orders required Sue to get the patient out of bed at 6 a.m. when her legs were weak from the dormancy of sleep. It was exactly for this reason that the doctor ordered that the patient be moved so early. On the morning she was injured, Sue had two people helping her. "When a patient can pivot on their own power, only one person is needed. I had two helpers or I never would have done it." Clearly, people in charge knew of the safety risk involved.

    The patient's collapse and the sudden distribution of her weight on Sue's neck were not the result of unforeseeable circumstances. The patient's fall was not beyond the employer's control; therefore, it could have been prevented. This "accident" was no accident. In light of the many ways Sue's injury could have been prevented, her loss seems all the worse.

    Employers make decisions all the time that can affect people's health and welfare. When safety and health are not at the forefront of every such decision, "accidents" build.

    Sue says, "It was a big stink, me charting for three weeks that she needed a lift and her not wanting it. But I did not want her to get hurt either." She adds quietly, "I think she died from the MS she had." Patients are fortunate to get nurses like Sue, not only experienced and competent but ones that genuinely care. No patient will receive Sue's nursing again. This, too, is a great and senseless loss.

    Footnote: Statistics cited drawn from Leigh, J. Paul et al. Costs of Occupational Injuries and Illnesses. Ann Arbor: University of Michigan Press, 2000. pg. 1-2, 13, and 259.

    "A Job to Die For: Why So Many Americans are Killed, Injured or Made Ill at Work and What to Do About It," by Lisa Cullen, can be ordered at