Monday, July 19, 2010

Death by OSHA

In clinic the other day there was a rapid shuffling of feet to my door and a very young medical assistant said, "Doc, the safety people are here... do you know what to do if someone falls in the clinic?"

"My dear child," I intoned, "I certainly hope so at this point in my career... You see, even though the book answer is to start with the ABCs we can skip those if the patient is yelling..."

"No, no!... The safety people are here."

"Safety people? Are they going to ask me what to do?"

"Yes, unless your door is closed."

(Closing door)... "I've gotta know... It's killing me... What's the answer?"

"You pull a form double-ought XYZ from the red binder in the nurse manager's office and fill it out."

I kept the door closed.


  1. I work in college health. We now have to come up with SLOs...Student Learning Outcomes, as if we're faculty teaching a class.

    So here's an SLO from another college: "Students who come to student health will learn to be more responsible with their birth control and STI prevention (we can't say STD anymore).

    So what if the student doesn't want to be responsible?? Do they get an "F" in student health? Does the staff at student health get blamed for students who don't want to play this game? Shouldn't we be more concerned about quality of care and access to care? Do we have to justify our existence with some dubious method like SLOs?

    We are seeing over 100 students per day; that's a lot for a small college. We've got better things to do, like take care of the patients.

  2. "My Dear Child"????
    Your Future, I See... A Sexual Her-Ass-Meant Suit...

    I prefer to say "Exxxxxxx-cellent" in my Mr. Burns voice to things that are most definately Not Excellent...

    "Dr. Drackman, a Patient Shat in Room 2"


    Frank "Black Below the Waist" Drackman

  3. dear Nightingale,
    of course you are right, but the war is lost... only delaying battles remain.

    i was going for the addled-professor / grinch combo.

  4. Old fart, might be time to raid the Namenda samples...
    STI: Sexually Transmitted INFECTION(not Disease, cause Diseases are icky). I'll use it in a sentence.

    "Frank had a great weekend in Panama City except for the STI"

    Frank "Buttock Full o' Bicillin" Drackman

  5. i propose we change the term 'STI' to 'NMFI' for 'not my fault infection' or 'TJHTMI' for 'this just happened to me infection'. or we could stick with 'the clap'.

  6. You are a wiser and kinder man than I. I used to always follow up things like that with long, elegant memos about contradictions between the various rules.

    Cite OSHA 1910.1030 for example. Ask if patient must be decontaminated. What are proper procedures dealing with personal materials. Should drop eye glasses be returned to patient after being dropped on floor? cleaned and return? Disposed of as bio waste, and new pair issued?

    Must those assisting fallen patient be wearing protective clothing, if so, what kinds?

    If a bystander assist the fallen person, what woudl be done prior to allowing that person to leave the area?

    What are the boundries of areas of responsibility for slip/falls? May you assist a fallen patient in another area of the facility? in the cafeteria? parking lot?

    If the fall was caused by a wet or dirty floor, what documentation is necessary?

    You can go on and on. The Internet gives you chapter and verse of various rules and interpretations. They all conflict at some level. It can be devilish pleasure to point this out, in the form of long and polite questions.

    Glen in Texas

  7. hey glen,
    great idea and i wish i could see you do it, but to do it you actually have to read osha stuff. how do you do it?

  8. 911,

    Questioning conflicting prodecures are a tradition in the Rickover part of Navy.
    The training there gave me good recall for stuff I read.

    These days I'll read OSHA and other crap during meetings and seminars, and note where they conflict. Good example for hospitals, the NFPA (fire protection) codes ban most combustibles in hallways. Yet for infection control, the alcohol gels are every few feet. It tooks a couple of years for that to be fully resolved.

    The current implementation of EMR is another conflict. One law/rule makes requirement for what you must put in a record, another law/rule concerns privacy. Thus the doctor can be judged for the accuracy of the history included in the record, yet this week the head EMR geek for the government says they can omit things at patient request (HIV status among others).

    So if in 2014, you are asked by patient to omit high/weight/BMI, will you be sanctioned for a faulty history? or lauded for patient privacy?

    Question for your next staff meeting: If the 10 year old son of a patient removes a band-aid in the waiting room, and throws it in the trash..what do you do? Did that general trash just become medical waste?

    I have the sort of passive-agressive attitude to government rules I love to ask those questions. In a government job, I love doing that in writing, and making some management guy actually document a decision. So this week I'd ask "What items in a medical history may be omited from the EMR at patient's request?

    Glen in Texas

  9. i admire your fighting spirit. perhaps missing that part of tactical knowledge would have helped. good to hear from you doc.

  10. Remember, the primary job of employees of OSHA, FEMA, HHS, ahhh, hell the primary job of all federal employees is to protect their phony baloney jobs.

    Give me a Harumph!