Children’s Hospital & Research Center Oakland Statement on CalOSHA Citations
February 22, 2011
Oakland, Calif. – Children’s Hospital & Research Center Oakland today received notification by CalOSHA of citations having to do with administrative policies and procedures and supposed “workplace violence exposures.” We are disappointed that the California Nurses Association (CNA) is using this occasion to misrepresent the facts and sensationalizing these citations so that it can further its agenda rather than meeting at the bargaining table.
There are no issues more important at Children’s Hospital & Research Center Oakland than the safety of our employees, patients, families and physicians. We go to great lengths to ensure that our workplace is safe so that our staff can focus on caring for the children that we are privileged to serve. It is unfortunate that the very union that claims to put patients first is the very one who is inciting fear and mistrust of our wounded patients seeking emergency care.
Most of the citations have to do with administrative documentation regarding training policies and procedures, such as not including the instructor name on the log-in sheets for staff training. As with all visits we receive from regulatory agencies, we welcome the feedback and opportunity to continually improve and make the necessary changes in our written protocols.
There is one particular citation, however, that is of concern and which we expect to appeal. It deals with what is being characterized as “workplace violence exposures” arising out of the fact that our staff sometimes care for gunshot victims. The CalOSHA investigation appears to have been prompted by an incident that happened last October when a gunshot victim was dropped off outside the main hospital entrance. The concern had to do with ED staff responding to the victim before ensuring that the area surrounding the victim was safe. The investigation reflects an underlying presumption that, due to our urban location, violent criminals are likely to pursue victims who seek care in our ED, thereby posing a constant and major threat to the staff who works here. Indeed, at one point, the investigator compared Oakland to the violence found in the streets of Mexico City. The facts do not support this assertion.
In the past three years, 156,289 patients were treated in our ED. Of these, 77 (or 0.049% of all patients seen in the ED) were gunshot victims, and of these, only 26 victims (less than 0.017%) were 15 years of age or older. Most gunshot victims arrive by ambulance, helicopter or transfer from another facility; only a small percentage of victims were dropped off by vehicle, walk in or, in one case, bicycle (only 8 of the 77). In other words, the data speaks for itself: these children are victims of violent crime, and are brought here for us to care for them; the likelihood of shooting pursuit is extremely remote.
Nonetheless, over the last nine months, we have been diligently working at all levels – plant improvements, operations policies and staff training – to address staff and patient safety surrounding workplace violence. A new policy was crafted to address how staff is to provide emergency medical assistance for patients within 250 yards of the hospital consistent with maintaining staff safety. It was a complicated process (which included outside agencies such as EMS) as we attempted to harmonize CalOSHA’s perspective with our EMTALA obligations not to delay care. CalOSHA is critical of the time it took us to resolve and implement the new policy.
It is irresponsible for CNA to portray our hospital, our neighborhood and the City of Oakland as unsafe. It perpetuates a misperception that makes it all the more challenging for Children’s Hospital & Research Center Oakland and the City of Oakland to be attractive to all patients and families.
Children’s fully expects to appeal the CalOSHA citations because they are not justified by the facts. The incident last October that appears to have precipitated the CalOSHA visit was fully investigated by the Department of Health Services, and no irregularities in our response were found at that time.
EMTALA: Emergency Medical Treatment and Active Labor Law was enacted to insure access by all persons to emergency medical services and to prohibit discrimination in the provision of emergency services to persons presenting with the same or similar types of conditions. EMTALA (and its California equivalent) applies to anyone who presents for emergency services to most hospitals, including Children’s.
About Children’s Hospital & Research Center Oakland
Children’s Hospital & Research Center Oakland is Northern California’s only independent not-for-profit regional medical center for children. Children’s Hospital Oakland is a national leader in many pediatric specialties and sub-specialties including hematology/oncology, neonatology, cardiology, orthopedics, sports medicine, and neurosurgery. The hospital is one of only two solely designated California Level 1 pediatric trauma centers with the largest pediatric inpatient critical care unit in the region. Children’s Hospital has 190 licensed beds, 201 hospital-based physicians in 30 specialties, more than 2,700 employees, and an annual operating budget of more than $350 million. Children’s is also a premier teaching hospital with an outstanding pediatric residency program and unique pediatric subspecialty fellowship programs.
Children’s research program, Children’s Hospital Oakland Research Institute (CHORI), is internationally renowned for taking state-of-the-art basic and clinical research and translating it into interventions for treating and preventing human diseases. CHORI has 300 members of its investigative staff, a budget of about $50 million, and is ranked among the nation’s top 10 research centers in National Institutes of Health funding to children’s hospitals. For more information, go to www.childrenshospitaloakland.org and www.chori.org.