Fax sent by narteott. .0sHa 81-25-11 15 :55 Pg: 2/12 U.S. Department of Labor I .. Occupational Safety and Health I 7 I 382 Harlow Street Bangor, ME 04401 . - Phone: (207)94l--8177 FAX: (2U7)941--8l79 To: Inspection Number: $14683558 Inspection - Ol/19/2011 flhe Acadia Hospital - I and its successors Issuance Dame: 01/25/2011 268 Stillwater Avenue Bangor, ME 04401 'g - . 4r~~ 268 Suuwam 1; er, Mn 04401 This Citation ami Notification of Penalty (this Citation) demibes violations ofthe Occupational Safety and Health Actof 1970. is (ardbasedontheseviolations. Younutstabgttaetiteviolations Pleaerefertothe - eorritmctionvriththisform. . - Posting-The in a prominent place at or near the location of the violation(s) cited herein, or if it is not practicable bwausc ofthe namre ofthe where it will be readily observableby all affected employees. This Citation must remain posted until the violation(s) cited herein hu.(have) been abated, . orfor3 workingdays (excluding weekends and`Federalholidays), whichever is longer. Thepenalty Informal informal conference is not required. tohave such support an adjustment to the citation(s) and/or penalty(ies). sue?s re1atedtothisCitat:ion andNotiicationofPena1ty, youmusttakecareto mer theinfomtalconference, shouldyoudecidetodoso. tocoutestmustbe submittedtothe areaDirecto1?within 15 workingdays ofyour rcceiptofthis Citation. ngeteriz Fax sent by I 287941817 BANGOR . .0SHA 81-25-11 15 :56 Pg: 3/12 I U.S. Department of Labor _l?spertl?m Number: 314683558 Occupational Safety and Health Administration - - Issuance Date: 01/25/2011 if I ?l . .. Company Name: The Acadia Hospital Inspection Site: 268 Stillwater Avenue, Bangor, MB 04401 . Type or vietnam; Serious Section of the Occupational Safety and Health Act of 1970: The employer did not furnish employment and aplaceofemployment orlikelytocausedeathor serious physical ?harm to employees in that employees were exposed to physical assaults by violent, patients: . Facility--wide From Iamtary l, 2008?througl1 December 31, 2010 there have been at least 115 hospital employees identilied in the OSHA 300 LOG that have been assaulted on the job by violent patients resulting in approximately 1741 restricted duty days and around 570 days away from work as well as at least 76 non-recordable cases resulting in broken teeth, prescription glasses broken in physical assaults, munitions, human bites, being punched in the face,or being hit and kickedby violent patients. During the current reporting year there were at least five instances ofparticuln severity. On April 30, 2010 a in admis ions was choked andbeatenbyapatient. Thenextday, May 1, 2010 the satire violentpatient choked, beat, aggressively smashed face in the other Some feasible and acceptable means to abate the hazard of workplace violence in the Acadia Hospital include but are not limited to: 1. Ensure thatallpatientsare screened forpotential violencebeforebeingadmitted tothehospital. lnaddition, consider using hand-held metal detecting wands to discover concealed weapons and consider using closed circuit TV and other surveillance systems in order to discover workplace violence quickly. 2. Conduct extensive training so that all effected employees are aware ofwhat the homital's workplace violence plan inandwheretheinformationearlbe found. to patients, . clients, and employees that violence is not permitted or tolerated. Further, train all employees on recognizing when a patient is exhibiting aggressive or violent behavior and techniques for timely deescalating that behavior. Workplace violence training includes 1) The Acadia Hospital Workplace Violence Program; 2) Risk Factors that 3) Early situations that may lead to assaults; 4) Ways to prevent or dinhse volatile situations or aggressive behavior; 5) The standard response plan for violent situations including the availablity of assistance, response to alarm systems and comnmnieationproccd11res;6) Waystocleal with hostilepeopleotherthanpatients andclients, suchas relatives I citation ami Notification or Penalty Page of 12 OSHA-2 (Rev. 9/93) . Fax sent by 287941817 BRHGOR. .0SHR 1211-25-11 15 :5s Pg: 4/12 U.S. Depalimeltt of Labor Inspection Number: 314683558 ji- i Occupational Safety and Health Administration I Issuance Date: 01/25/2011 .. .. . . .. . Company Name: The Acadia Hospital Inspection Site: 268 Stillwater Avenue, Bangor, ME 04401 and visitors; 7) Progressive behavior control methods and safe methods to apply restraints; 8) Ways to protect oneself and coworkers including use of the"buddy system"; 9) Policies and procedures for reporting and record keeping; 10) Information cm multicultural diversity to increase staff sensitivity to racial and ethnic issues and . differences; and ll) Policies and procedures for obtaining medical care, counseling, worker compensation, and legal assistance after a violent episode or Training on escalating behavior includes, but not limited to 1) Recognize warning signs. sucha confusion, frustration, blame, anger, and hostility; 2) Use methods to de-escalate violent and excalating behavior such as listening toconcerns, using clarifying questions, giving factual relocatingto aquietsetting, reassuring, making a sincere effort to clarify concerns, disingaging, and bringing to help; Respond to violence and potential violence by using venting techniques, preparing to evaluate, and contacting supervisors and security; 4) Use personal conduct to violence such as projecting calmness, moving slowly. speaking slowly, listening empathetically, having relaxed but attentive posture, establishing ground rules with consequences, and using 3) Use a systexnsuchas flagging a patient's?chart anytime there isahistory oractofviolcnce andtrainstaffto understand the tlaggitg system; Put procedures in place that would allow communication of any incident of incomactwitliapatient, sothatemloyees whomightuotltave 4) Ensure that adequate numbers ofproperly people (such as 'Response Teams" or Security . Department) are readily and immediately available to render assistance in the event ofaninddent violence and ensure that security has the training to`deal with aggressive and violent behavior. In addition. develop agood working relationship 5) workplaceviolence. aulthatfurnitnreis arranged toptevententrapment. -- 6) Limit employees from working alone or in secluded places with patients, including stairways and elevators. Use a buddy system where appropriate. - 7) Developand I hospital. For example, specify a workplace violence alarm system and a specitic, reliable response to that . system. Be very clear regarding the specific actions that the employees are-to take for a workplace violence situation such as a Citation an Notification Page 6 or 12 OSHA-2 (Rev- 9f93> Fax sent by 287941817 BANGOR . B1--z5--11 15 :57 Pg: 5/12 U.S. Department of Labor Inspection Number: Occupational Safety and Health Administration - Issuance Date: 01/25/2011 A . at Citatigm.nndM@tmimt .. . .. . . . - . . I I I . I i Company Name: The Acadia Hospital Inspection Site: 268 Stillwater Avenue, Bangor. ME 04401 . 'Green Code" or a 'Silver Code" as described in the?Acadia Hospital Directive titled: 'Overhead Paging System" dated October 16, 2008 and revised on August 31, 2010. Alarm systems may include use of panic buttons, beepets, cellular phones, surveillance cameras, and publc address alarms. The response to system must be reliable and may include response teams, security teams, security guards, or local law- The response system must include medical assistance for employees orotherinjuredp?rsoiis. Finally, workplace violence. 8) Develop and implement specific procudures for reporting incidents of workplace including both tiling charges. .9) Create a stand alone written Workplace. Violence Prevention Program for the howital which includes the following elements: i) A policy statement regarding violence in the workplace including a Zero-tolerance policy for workplace violence and assignment of oversight and prevention responsibilities. ii) A workplace violence hazard assessment and security analysis, including a list of the risk factors identified in employer will address the specidc hazards A step by step complete assessment includes analysis and tracking of records, monitoring analysis ofincidents, conducting employee screeing surveys; andanalysis of security. I `Development of workplace violence control including, administrative and engineering controls and used to prevent potential workplace Engineering controls may include 1) alarm systems, panic buttons, hand-held alarms, noise devices, cellular phones, radios, and reliable response to those alarms; 2) Installed and handheld meml detectors; 3) Closed circuit video; 4) Curved mirrors at hallway intersections; 5) Employee 'Safe - Rooms' "actout"andseparate econtrolsmay include: 1) Clear statement ot patients and visitors that violence is not permitted or tolerated; 2) Adequate staffing including responseteams, security. during times of greatest risk including during patient transfers, emergency responses, meal times, and at night; 4) Establishment of policies for when employees are not allowed to work alone; 5) Use of case management conferences with employees and management to discuss ways to treat potential violence patients effectively; and 6)Useofsecurityeseorts orthebuddy systemin` in elevators or stairways. . Citation and Notifmtien ot Penalty Page 7 of 12 osna-2 (sev. 9/93) Fax sent by 287941817 BANGOR. .0SHA 81-25-11 15 :57 Pg: 6/12 U.S. Department of Labor tmpmion Number; of px Occupational Safety and Health Administration Issuance Date: 01/25/2011 . Citation gflenaltyn . . .. .. I .. Company Name: The Acadia Hospital Inspection Site: 268 Stillwater Avenue, Bangor, ME 04401 iv) Institution of a recordkeeping system designed to report any violent The reports be in writing . and maintained for program review. Records must include medical records, safety meetings, OSHA 300 Logs. insurance records, police and law enforecement records, incidence reports, and records of near misses. v) Development of a workplace violence training program that includes a written outline or lesson plan. Workplace violence training includes: 1) The Acadia Hospital Workplace Violelnee Program; 2) Risk Factors that came or contribute to assaults;- 3) Early recognition of escalating behavior or recognition of warning signs or - situations that may lead to assaults; 4) Ways to prevent or diffuse violent situations including the- availability of assistance, response to alarm systems, and on procedures; 6) Ways to deal with hostile people other than patients and clients, such as relatives and visitors; 7) Progressive behavior control methods and safe methods to apply restraints; 8) Ways to protect oneself and coworkers, including use of the 'buddy system"; 9) Policies and procedures for reporting and recordkeeping; 10) lnfomtation on multicultural diversity to increase staff sensitivity toraeial andethuic issues and differences; and 11) Policies andprocedures for obtaining medical care, counseling, worker compensation, and legal assistance after a violent episode or injury. vi) Annual review of the workplace violence prevention which sliould be updated-as necessary. Such review and updates shall set forth any mitigating steps taken in response to any workplace violence incidents. Date By Which Violation Must be Abated: .03/ 16/2011 Proposed Penalty: 6300.00 Seepages 1 cimion and Notification orfPenalty Page ot 12 OSHA-2 (Rev- 9/93>_ Fax sent by 287941817 Beacon. .0SHA B1--25-11 15 :57 rg: 7/12 U.S. Department of Labor 314683558 Occupational Safety and Health - Issuance Date: 01/25/2011 Cigtion CompanyName: . I Inspection Site: 268 Stillwater Avenue, Bangor, ME 04401 . me Other . 29 CFR Each employer by this part to keqa records of fatalities, injuries, and illnesses did not record each fatality, injury, and illriess that was work-related, a new case and meets one or more ofthe general recording criteria: Facility wide On or about January 19, 2011 the employer did not rewrd on the calendar year 2008 OSHA the following recordable injuries/illnesses: - i a) patient assault on 2 North. This case is recordable because it resulted in four days restricted work activity, b) nonreccrdedunnumbered case, onoraboutlanuary 18, 2008 301, tirstreport ofinjury was tiled foranursewho tooth is considered to be a injury. c) nonrecordedunnumberedbase, injury. Date By Which Vi0lati011iMUStbe Abated: I Proposed Penalty: 900.00 ciaam and Notification of Penalty Page 9 of 12 OSHAJ azev. 9193) Fax sent by 287941817 BANGOR. .0SHR B1-25-11 15 :58 Pg! 8/12 U.S. Department of Labor Impection Number: 314683558 (Q Occupational Safety and Health Administration 19/2011 . - Issuance Date: 01/25/2011 if . 6, Qitatign and Notification of Peng . . . - .. .. - Company Name: The Acadia Hospital Inspection Site: 268 Stillwater Avenue, Bangor, ME 04401 . Citation 2 Item 2 'Iype of Violation: . I i 29 CFR Each etnployer required by this part to keep records of fatalities, injuries, and illnesses did not record each fatality, injury, and illness that was work-related, a new case and meets one or more ofthe general recording criteria: Facility wide On or about January 19, 2011 the employer did not record on the Calendar Year 2009 OSHA LOG the following recordable injuryillness: tassault in the 2 North hallway. This be recorded because a chipped tooth is consideredto be a signiicant injury. Date By Which Violation Must be Abated: Corrected During Inspection Proposed Penalty: - 900.00 Citation 2 Item 3 Type or Violation: Other - 29 CFR Each employer required by this part to beep records of fatalities, injuries, and illnesses did not record each fatality, injury, and illness thatwas work-related, anewcase andmeets om ormore ofthe general recording criteria: - Facility wide On or about January 19, 2011 the employer did not record on the Calendar Year .2010 OSHA LOG the following recordable injuries/illnesses: a) Line out case 6, on or about January 21, 2010 an employee suffered an ergonomic injury pushing a patient bed. This case is recordable because it resulted in one lost workday. . b) Line out case 38a, on or about August 1, 2010 an employee received an ergonomic injury to his back. Thiscaseis c) Lineout case45, onorabout March21, 2010 anernployeewas assaultedby apatienton3 North.- This case is recordable because it resulted in 175 day zestricaed work Date By Which Violation Must be Abated: - 03/01/2011 Proposed Penalty: . 900.00 Seepages 1 th1ough?oftl1is caution mt or Penalty Page 10 or 12 OSHA-2 (Rev. 9/93) Fax sent by 287941817 Beacon. .0SHA B1-25-11 16:17 Pg: 9/12 U.S. Department of Labor lrnpection 314683558 Occupational Safety and Health Administration Issuance Date: 01/25/2011 Company Name: 'l`he Acadia Hospital Inspection Site: 268 Stillwater Avenue, Bangor, ME 04401 2 1116111 4 Type of Violation: 29 CFR A Log of all recordable work-related injuries and illnesses (OSHA Form 300 or equivalent), was not completed in the detail as required by the regulation: -- Facility wide On or about Iamtary 19, 2011, the 2008 OSHA. LOG bas inadequate descriptions of all 48 recorded injuries/illnesses. Each recorded `case just listed the injury or illness such as fractured right thumbbutfailedto explaininauy or Fom?exanpletheOSl-IA Log should say tloorinpatientroom301. Date By Which Violation Must be Abated: Corrected During Inspection Proposed Penalty: 900.00 other 1 29 CFR The Summary of_Work--Related Injuries and Illnesses (OSHA Form 300A or equivalent) was not properly certified: Facilitywide signed by the chief executive officer or the chief operations ofheer. I Date By Which Violation Must be Abated: Corrected During Inspection Proposed Penalty: 900.00 Citation and Notification or Penalty page 11 er 12 osm-2 om. 9j93) Fax sent by 287941817 BANGOR. .0SHA B1-25-11 16 17 Pg: U.S. Department of Labor Impection Number: 314683558 Occupational Safety and Health ?Adminisu?atiou - - . Imaanee Date: at I Company e: 'I`he Acadia`Hospiral Inspection Site: 268 Stillwater Avenue, Bangor, ME 04401 Citation Item 5 Type or Violation: Other 29 CFR The Summary of Work--Re1ated Injuries and I1 (OSHA Form 300A or equivalent) was not properly certified: . Facility wide` On or about January 19, 2011? the OSHA LOG for the year 2009 was not signed by the chief executive officer or the chief operations oflicer. Date By Which Violation Must be Abated: Corrected Inspection Proposed Penalty: 900--.00 114 I CO gt Area Director . - I cimim md or Pemlty Page tz or tz (Rev. 9/93) Fax sent by @87941817 Beacon. .ostm B1-25-11 16 17 Pg: 11/12 U.S. Department of Labor I - Occupational Safety and Health Administration . - 382 Harlow Street Bangor, ME 04401 . . - Phone: FAX: (207)94l-8179 - . .. .. . . . . I . DEBT COLLECTION NOTICE - Impe?io?Sih:: - Issuance Date: 01/25/2011 . . I 314%558 . Citation 1, Serious GMM- I - iiwbzb . To avoid additional charges, please remit payment to this OSHA Office for the total amount of the uncontested penalties summarized above. Make your check or money order payable to: Please indicate OSHA's Inspection Number (indicated above) on the remittance. OSHA does not agree to any restrictions or conditions put on any check or money -order for less than full orderas Ifapersonal check is issued, it will be converted into an electronic bankwill copyyour debityouraccountforthe amount ofthe check. The debit fromyouraecountwillthenusually occurwithin`24hotu?sandwillbe shown on your regular account statement. You will not receive your original check back.- The bank will destroy your original check, but will keep a copy of it. If the EFT cannot be completed because of insufticient funds or . Pursuant to the Debt Collection Act of 1982 (Public Law 97-365) and regulations of the U.S. Department of Labor (29 CFR Part 20), the Occupational Safety and Health Administration is required to assess interest, delinquent charges, and administrative costs for the collection of delinquent penalty debts for violations of the Occupational Safety and Health Act. Interest. all penalty debt amounts not paid within one month (30 calendar days) of the date on which the debt amount Thecunentinteresttateis date on which the penalty amounts (as proposed or adjusted) become a final order ofthe Occupational Safety and Health Review Commission (that is, 15 working days from your receipt of the.Citation and Notification of Penalty). unless you t'1le a notice of contest. Interest charges will be waived if the full amotmt owed is paid within 30 calendar days of the final order. - rex sent by 287941817 .0sun H1-25-11 16 17 pg: 12/12 . The Acadia Hospital neuagueht gm` gee; A debt is considered delinquent it it has mt been peru month (so calendar - days) ofthepenalty due date or ifa satisfactory paymentanangementhas notbeenmade. Ifthe debt remains delinquent for more than 90 calendar days, a delinquent chxge of three percent per amtum will be_ assessed accruing from the date that the debt became delinquent. Administrative Costs. Agencies of the Deparunentiof Labor are to assess additional charges for the recovery of delinquent debts. These additional charges are administrative costs incurred by the Agency in its attempttocollectanunpaiddebt. payment default letters. I . v- . WILLIAM J. CO Date Area Director