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Safe Patient Handling Likely To Make Some Democrats' Safety, Health Platforms

July 07, 2015

Ergonomics concerns at inpatient health care facilities will almost certainly get mentioned in at least some of next year's Democratic presidential platforms on safety and health, worker advocates say -- with candidates likely to call for mandates on hospitals to install mechanical lifting in place of manually moving patients.

It may be the only specific OSHA issue to make it into the campaigns' position papers, with observers noting that OSHA in recent years has gotten scant attention in national electoral politics. However, they say the nationwide push for safe patient handling has evolved into a strong enough issue to garner political attention.

Republicans are targeting regulatory concerns from the opposite direction, with OSHA among the agencies they say have moved too aggressively on rules and enforcement. OSHA got mentioned several times in testimony for a recent GOP-driven Senate hearing on the impact of regulations (see related documents).

OSHA under the Obama administration has increasingly targeted ergonomics in general, using the OSH Act general duty clause in some cases. Critics call that a stretch of its legal authority, particularly given a congressional veto 14 years ago against the ergonomics standard crafted under President Clinton. OSHA announced recently its intent to pursue musculoskeletal disorder (MSD) hazards in hospitals and residential care facilities as part of a new inspection emphasis within that sector (see related story).

Presidential campaigns will probably take a look at safe patient handling with an eye toward including the issue in policy platforms, even if OSHA concerns largely draw less attention. Worker advocates are banking on broad public interest in the subject, especially with health care's huge role in the economy, to persuade campaign staffs to latch onto the issue. “I think it's something everybody can identify with, so we're flagging that,” says Keith Wrightson, worker safety and health advocate for Public Citizen’s Congress Watch division.

The advocacy group in a long-term project has been working to foster dialogue on safe patient handling and recently kicked off a series of in-depth reports on MSD incidence in the health care sector, with particular emphasis on dangers to nurses from manually lifting patients (see related documents). Sources say nurses' advocates are also actively talking with campaigns in an effort to raise the issue's profile among presidential contenders.

Wrightson says his organization has started a “big run” on safe patient handling and that, as part of the group's campaign planning, advocates are trying to get the candidates to talk about hazards to nurses and other health care workers. “We would like to see them say something in January,” ahead of the key New Hampshire primary, he says. Advocates hope that the issue's broad appeal to female voters -- roughly 82 percent of the health care industry is staffed with women -- will prod the presidential campaigns to embrace it, he says.

Public Citizen also has a specific legislative proposal on hospital ergonomics, saying OSHA enforcement through the general duty clause cannot do nearly enough to address the issue. The group cites research reported in 2013 that OSHA’s National Emphasis Program on risks faced by employees of nursing homes and residential care facilities had resulted in seven citations for unsafe ergonomic conditions in 2011 and 2012.

Advocates contend that MSDs, which they say are often are caused by manual patient handling activities, are the leading cause of injuries for health care workers, especially nursing aides, orderlies and assistants. They cite Bureau of Labor statistics data showing the rate of work-related MSDs requiring days away from work for nursing aides was nearly six times higher than for average workers in 2013. Such injuries accounted for 53 percent of total cases of reported injury that occurred to nursing assistants that year, according to Public Citizen.

A proposed new federal law -- which worker advocates say presidential campaigns will be pressured to support -- could be modeled after a 2013 bill introduced by Rep. John Conyers (D-MI) and 16 other members, which would have directed the secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, nurses and all other health care workers by establishing a safe patient handling, mobility and injury prevention standard. Various OSHA stakeholders including the American Industrial Hygiene Association urged lawmakers around that time to get behind the legislation (see related story).

Various states have already adopted their own safe patient handling laws, including California (see related story), though advocates call them generally too weak to ensure adequate worker protections against MSD. California's legislative action renewed interest in seeing a national standard put in place. California’s law, which has taken years to implement, applies to general acute care hospitals, but not to hospitals within the state's Corrections or Developmental Services departments. The law excludes skilled nursing, long-term, outpatient and primary care facilities.

Trained lift teams or other staff must use lift devices, consistent with the registered nurse’s judgment, under the state law, and only under exceptional circumstances may workers lift unassisted. Employers must bear the costs of installing the mechanical systems, which has been a major concern for business groups about the safe patient handling concept generally.

The national push for safe patient handling, highlighted by California enacting the law, leads proponents of federal mandates requiring hospitals to make such changes to hope for political support. Some believe MSD injury rates, coupled with the earlier failure of the OSHA rule, will spur White House contenders to emphasize safe patient handling.

“This is a huge issue that relates back to ergonomics rules,” Wrightson says. “That's what we're hoping for … a mention on safe patient handling. We think that's a piece that actually has a chance.” -- Christopher Cole (