Bill Borwegen does not mince words when it comes to occupational safety and health in service-producing industries. "Most of the workers in this sector think OSHA's the name of a small town in Wisconsin." Borwegen's comment on the state of occupational safety and health issues plaguing the burgeoning service sector is said only half jokingly.
Borwegen, the occupational health and safety director for the Service Employees International Union (SEIU), is particularly outspoken when it comes to criticism of the federal agency. "There are more injuries and illnesses in the healthcare sector than any other sector of the economy. Yet there are hospitals in this country that OSHA has never been into -- ever. It's just not right."
Over 100 million Americans work in service industries, compared with 19 million in manufacturing and 6 million in construction. In 1997, nine industries each incurred over 100,000 nonfatal injuries that resulted in either lost work time, medical treatment other than first aid, loss of consciousness, restriction of work or motion or transfer to another job. Together, those nine industries comprised 30 percent of the 1997 national nonfatal injury total of 5.7 million. Of those nine industries, eight were service-producing.
Borwegen argued that despite these statistics, OSHA does not proportionally inspect the service sector. When OSHA does inspect, he feels that the experience may actually be more hindrance than help because the citations do not reflect the hazards that are hurting workers. Using the example of healthcare, Borwegen complained that OSHA citations ignore ergonomic hazards despite high back-injury rates, thereby giving employers an indirect acceptance of ergonomic hazards. He maintained that OSHA citations hardly reflect the hazards indicated by injury statistics.
Borwegen is adamant that OSHA has neglected to change as the economy has changed, becoming increasingly irrelevant for growing numbers of the nation's workers. "OSHA has failed to develop a program to focus their inspections in the industry sectors where the data show most workers are getting hurt and ill."
The diverse service sector spans dozens of types of businesses, including healthcare, computer services, transportation, communications and utilities, wholesale and retail trade, finance, insurance and real estate, and federal, state and local government. For the 10-year period between 1996 and 2006, the Bureau of Labor Statistics (BLS) projects that the total United States labor force will grow by 18.6 million. Of that 18.6 million, 17.6 million -- or 95 percent -- is expected to be in service-producing industries.
OSHA is hardly oblivious to the growth of this sector, the hazards found in it -- or the reproaches of its critics. "We are trying to respond. Given our size and our budget, it is hard to stay right at the cutting edge. But we certainly see the problem, we recognize the problem, and we are addressing the problem," said Jordan Barab, special assistant to OSHA Administrator Charles Jeffress. "There is a general consensus that we need to move in that direction, but it's easier said than done. As always, we go where the high rates are, and that is in industrial and manufacturing operations." Barab did acknowledge, though, that the shifting economy and the number of incidents in the service sector -- particularly healthcare -- has caused the agency to reassess its tactics. "We do have to make accommodations and figure out new ways to address the issue."
In fact, the agency has already begun to shift its focus and resources, according to Marthe Kent, OSHA director of safety standards programs. She argued that OSHA is paying more attention to the service sector than ever before. "We are regulating and doing compliance activities and voluntary activities in the service sectors with a vigor and an attention that we have not put on those sectors before."
Kent offers a laundry list of the regulatory initiatives that will have major impact in the service industry sectors, including everything from the recently issued ergonomics standard to a safety and health programs initiative designed to encourage service industry employers to establish the same types of programs that have worked well for manufacturing sector employers.
According to Kent, OSHA has stakeholder meetings slated for this year to discuss amending the bloodborne pathogens standard. The agency also plans to set air contaminant limit standards, an initiative that will have major impact in hospitals, nursing homes, dental offices, clinics and veterinary clinics. "There are many people in these industries who are developing occupational asthma as a result of exposure to glutaraldehyde, and this permissible exposure limit will protect against that," Kent explained. Also on OSHA's plate is a final rule on tuberculosis (scheduled for early summer) and a recordkeeping rule scheduled to go final.
"That's quite a bit of regulatory activity in this coming year that's really targeted toward the service sector industry," Kent concluded.
Not everyone agrees with Borwegen's assessment of OSHA's oversight of service industries. "Clearly we've seen OSHA step up their efforts in the trucking industry over the last few years," said Stuart Flatow, director of the OSHA policy group of the American Trucking Associations. Flatow attributed the increased scrutiny to a vacuum left by the Department of Transportation in enforcing workplace safety and health. "Anyone that does not think OSHA is increasing its visibility in trucking can talk to any number of trucking company safety directors." Flatow believes OSHA's presence in the trucking industry will only increase, causing safety directors to pay more attention.
Dan Turman, a safety consultant for Hardee's Food Systems, believes OSHA's focus on more traditional industrial sectors is appropriate. "In most restaurants, our injuries are slip and fall injuries. We don't have a lot of lost work days and we don't have a lot of fatalities."
Kathleen Evans, vice president of restaurant operations for Bob Evans Restaurants, pointed out that most restaurant injuries usually involve one person as opposed to, say, construction, which can involve a whole group of employees. "Of course, OSHA does get involved when necessary. But they should focus their time in other industries from the simple fact that most restaurant injuries are usually not life threatening and fairly minor in comparison with manufacturing accidents."
Turman agrees. "With limited resources and limited manpower, you go where the high priority issues are."
Others, like Ronald Baine Jr., safety manager at West Virginia University Hospital, believe certain industries may not require the oversight OSHA provides to the manufacturing and construction sector. "A hospital is almost a self-policing situation. Because of the vastness of the liability in hospitals, it is to their advantage to be as safe as possible."
Baine believes because of the legal ramifications of exposure, hospitals tend to do more to protect their workers than many other industries. "I would much rather be working in a hospital than in a more industrial situation" said Baine, who has worked in both healthcare and industrial environments.
In addition to self-policing, hospitals are also subject to the oversight of a number of agencies -- local and state departments of health, the Joint Commission on Accreditation of Healthcare Organizations and the Health Care Financing Administration -- which have some form of jurisdiction over this branch of the service sector. Gina Pugliese, director of the Premier Safety Institute, surmised that healthcare is there to protect and heal people and not increase their risk. Besides, she said, "It's just impossible for OSHA to get out and visit all the work sites."
Among critics' greatest concern is the lack of training for OSHA compliance officers. "For example, OSHA has developed guidelines for their compliance officers in conducting healthcare inspections, but they have not received adequate training to really know how to conduct these inspections," said David LeGrande, director of occupational safety and health for the Communications Workers of America (CWA). Both he and Borwegen offered the nursing home industry as an example of inadequate training of compliance officers.
"OSHA has begun to conduct more inspections in the nursing home industry because of the high injury and illness rates in this sector," Borwegen admitted, "but although they're going in there, they're not shooting straight." He offers instances of nursing homes cited by OSHA for lack of eyewash stations or frayed electrical cords, despite the high illness rates found in nursing homes. "It's all because of ergonomics, and yet they're not citing for ergonomics hazards," Borwegen said. He hopes to see the agency institute a one-week course on the healthcare industry for its compliance officers.
Barab said Borwegen will get his wish. This year OSHA will be initiating a more comprehensive training course that deals with healthcare issues for its inspectors. "A lot of our inspectors are not as familiar with hospitals and healthcare situations as they might be with a manufacturing situation or industrial situation. We felt that they needed additional training ... to familiarize themselves with the issues as well as with the general environment in healthcare."
The agency plans to work with healthcare unions as well as industry associations to incorporate some of the special characteristics of their institutions that may not be typical of industrial or manufacturing environments.
Still, the criticism that OSHA compliance officers are not trained in some of the hazards specific to the service industry does not sit well with Barab. He argued that the agency's inspectors are well trained in dealing with chemical and bloodborne pathogens hazards common to hospitals.
OSHA admits that its efforts in the service sector are often concentrated in healthcare because of its size as well as the number of injuries reported in the industry. "That's where the highest numbers of lost-time injuries are occurring, so that's where we are putting our attention both in terms of standards as well as guidelines," Barab said.
Part of the reason OSHA's gaze has focused on manufacturing in the past is that the agency, by statute, has an obligation to identify where the illnesses and injuries are occurring, based on employer reports or OSHA 200 logs.
"Given that the OSHA 200 log is the primary tool that OSHA uses to identify what they're going to do and there is so much underreporting, particularly in the service sector, there will not be any attention paid to those industries," LeGrande confirmed.
According to LeGrande, there is also relatively little unionization among most service employers, depriving the sector of union oversight which often monitors employers' activities with regard to safety and health. "In manufacturing, there is a high degree of unionization," he noted. "The history of safety and health has been in manufacturing, and there is much less opportunity for the employers to hide the cases by not putting them on the OSHA 200 log."
LeGrande further paints a picture of an agency shackled by inadequate staffing, budgetary constraints and political encumbrances. "Given the microscope that OSHA can be put under by those that might be hostile toward it -- like a Republican Congress -- there's no way that OSHA can really operate," he said. "The agency cannot be successful in an environment of constant political tension. No agency could."
Borwegen only partially agrees that OSHA's hands may be tied. "We have an agency that has a budget that is less than the budget the country spends on research in Antarctica," he conceded. Still, he points to the manufacturing and construction sectors as examples of the dramatic impact the agency can -- and does -- have. "You've seen a pretty remarkable drop in injuries and illnesses in these sectors of the economy." Borwegen believes that OSHA could have an equally dramatic impact -- and prevent many more injuries and illnesses -- if it moved into sectors where the agency has not established a presence.
"Part of it is they don't have much of a budget, but part of it is also just inertia. They're still in an industrial mind-set. They would have so much more impact if they changed course slightly and moved into this sector of the economy."
LeGrande isn't so sure. He believes OSHA can only be effective if it gets support -- both monetary and political -- from Congress and the White House. "I think it's an impossible situation the agency's in."