Episode #39 Help! OSHA is Here!

What would you do if OSHA showed up at your office? How would you respond?  In this episode, the Divas discuss what to expect during an OSHA inspection and importantly what to do or not do while inspector is onsite. 

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Transcript

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SPEAKER_00 0:04

Welcome. I'm Leslie Cannon. I'm Mary Gavoni. I'm Linda Harvey.

SPEAKER_01 0:10

I'm Olivia Juan, and together we are the Compliance Divas. Help! OSHA's here. What do I do now? My name is Olivia Juan, and I'm with the Compliance Divas. Welcome to the Compliance Divas Podcast. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please subscribe to the Compliance Divas podcast at our website, thecompliancedivas.com. It can be very challenging and quite stressful to respond to an OSHA complaint letter or to greet an OSHA investigator who randomly shows up at your office or shows up because there's an allegation of a complaint. So we thought this would be an excellent topic for the divas to discuss and give you some insight how a complaint investigation works. So I'd love to start with our diva, Mary. Mary, can you explain to our listeners the difference between receiving a letter from OSHA versus an unexpected visit where they just show up?

SPEAKER_00 1:29

Absolutely. If you receive a letter from OSHA with an allegation or a complaint, that is typically the result of either a current or a former employee who has made an allegation that is deemed by OSHA to be not a serious violation, meaning there's no imminent threat of injury. And documentation to dispute that is requested and so forth. So it's it you have to take it seriously because it is actually something that OSHA could take action on if you don't respond to it, but it's not considered to be a very serious matter, in OSHA's opinion. Now, there are two reasons why somebody may show up at your door, the OSHA inspector may show up at your door. One is that there it has been a complaint and there is perceived to be a very imminent or serious threat. An employer perhaps not providing any personal protective equipment or exposure to hazardous chemicals or something that could be even life-threatening. And they will not send you advance warning that there's been a complaint. They will show up and give you a copy of that complaint. The other may be some type of an emphasis program. We've talked in a previous podcast about the national emphasis program that was initiated at the federal OSHA level because of COVID-19 exposures in the workplace. And some states, Tennessee, Olivia, your home state has had a local emphasis program in place for several years now where unannounced inspections may happen, no complaint issued. They're just showing up to make sure that healthcare facilities, dental practices are compliant, and other states have them as well. I know Michigan is one of them. My home state has had a state emphasis program in effect during COVID-19. So all of these issues have to be taken seriously. And we're going to talk a little bit more about how you deal with those folks, how you respond. But again, the letter not as serious. Full-on OSHA inspector shows up at your door, then you better be ready for whatever is coming.

SPEAKER_01 4:18

Thanks, Mary. Some good points there. So really, based on the level of danger, OSHA may prefer to investigate that complaint by letter, as you pointed out. And I want our listeners to be sure that they understand that you have five working days to respond to that letter. So we don't want to miss that time frame. I've actually had a dental office that did that, which makes it a little bit more complicated to work through it. Um, they will detail the nature of the complaint. And also don't forget to post a copy of that letter in a conspicuous place for the employees, such as a break room. And I know dentists are always reluctant to do that if they don't agree with the allegation of the complaint, but it is mandatory. And another point to supplement what you beautifully stated is that, you know, if there's an allegation of a complaint that they feel rises to the level of imminent danger, you know, they're they're going to stop in unannounced and make a follow-up within 30 days. So this is such a timely topic. Linda, we'd like to talk to you about how the OSHA representative will identify themselves and what happens if a dental office, I get this question a lot at seminars, is you know, can you tell them to come back at another time? You know, how would that be handled or addressed by OSHA?

SPEAKER_03 5:40

Thank you, Olivia. Yes, I kind of chuckle when you said that. Well, they can they come back at another time? Because that's going to be the first, you know, first um thought and perhaps the first words out of that uh receptionist's mouth when OSHA shows up. Um, can you just come back? We're too busy today, you know, come back next week or two weeks. And that's not gonna work. When an OSHA inspector shows up at your door, they're going to flash their US, you know, their identification badge, not an insurance card. So when this happens, we have to be prepared to be as courteous to this individual stepping in your door as it as it was anybody else, one of your trusted um sales truck, you know, partners and sales reps or a new patient walking in the door. Because before the inspection even starts, you don't want to get off on the wrong foot. And that's very important. And as you and Mary were just discussing, these these inspections are unannounced. And I would just like to make a quick point about the fact that OSHA would very rarely give any advanced notice. And I can't see that being um even probably applied in a dental industry or dental practice, um, because sometimes OSHA would would show up with an advanced notice if there was some kind of imminent danger and they need to get it fixed right away. And I typically think of those things happening in manufacturing plants or other industries, you know, construction, um, or they're investigating a fatality or something along those natures that really is they're going to show up unannounced, you know, to our clients' offices. And when they show that badge, you need to be very courteous. Um, ask if you ask them to have a seat for just a moment while you notify the doctor so you can accommodate their inspection and just get them off on a good note. Um, as part of the inspection process, they're going to think of it as a like a three-step process. So they're going to hold the opening conference. And during the opening conference, um, the law does say that you can have an worker, a representative of your of your team, attend that opening conference. So they may encourage you to have one of your team members there. It may be your office manager, it may be a clinical individual. And so during that opening conference, it's really important to one continue setting the tone for a positive, you know, experience with this inspector and just be as courteous as possible and not argumentative. And I think you've even shared a story in the past, Olivia, where a team member was argumentative with the inspector, and that just everything goes down the tubes then. And once you have an inspector who's not happy with you, they're going to take a whole different approach to your inspection. So during this opening conference, they're going to sit down and they're going to present you with the allegation, and they're going to present you with a list of your OSHA documents that they want to review. So you have time to go get that, get ready. You may want to have them use the conference room or someplace quiet, or if the break room is quiet enough, someplace where the inspector has a chance to sit down and there's a place for you all to talk. The main thing is not to freak out in front of the patients, run around like chicken little, if you will, because at that point, if you get everybody unnerved, um, then it's going to be a little bit hectic for all everyone involved, patients, staff, everybody. So then the after the opening conference, the inspector's going to have a walk around through the office and they're going to inspect everything. They're primarily going to be looking at what was in the complaint. However, OSHA can open up that inspection to other areas. So if it was a bloodborne pathogen complaint about PPE, for example, they may certainly look at your exits and your egress and other safety things in the building, hazardous chemicals and all those different areas. So just be mindful of that. And it's good to make sure that you answer questions that you're asked by the inspector. You don't have to volunteer more than what you're asked, yet be truthful in your answers. And it's also important that as the inspection is, you know, the inspector is walking around and the inspection's ongoing is to take your own notes. So as they ask you a question, jot down what you talked about. If they take a picture, something, take a picture as well. So you know everything that was discussed. And then this may take an all-day process. I'm thinking about one of our ambulatory surgery clients that had an inspection a number of years ago now, and it took two days. And just ironically, it was two weeks in between those two days because the inspector had a training program that she had to go to before she could come back. So that was an unusual circumstance. And in this case, the inspections were taking place in ambulatory surgery centers because of a national emphasis program in that area. So they showed up and announced pretty much everybody in our area. So let's see, we've gone through the opening conference, we've talked a little bit about the walk around and taking notes. And you know, if Ocean Inspector brings up apparent violations, you are permitted to remediate something while they're on site. You cannot create documents and sign it and training sheets for events that didn't happen, but you're allowed to begin to remediate while they're on site because that will lessen your fines. Then at the end, oh, I didn't mention Livia that the inspector will also interview some of your employees privately. And the employer is not permitted to ask those individuals what they discussed or tell them what to say. So be mindful about that. And so if you're not holding annual training in your office, then and the culture is not one of culture of safety and high standards in a practice for whatever reason, that may come out with an employee when they talk to the OSHA inspector. As a matter of fact, it came out with one of our ambulatory surgery centers, Olivia. There was one surgical tech who once or twice a year would cut herself on a dirty scalpel because she was too fast to jump to the table, you know, to tray where they were passing off instruments before the doctor could barely sit it down and get her, get his hand out of the way. So she expressed a concern about that. And we had to discuss that with the OSHA inspector. But then finally, when the inspector has finished the walk around, there'll be the closing conference. And they'll talk more about the apparent violations and some ways to correct them, deadlines, and possible fines. Nothing definitive. Um, you'll get that more in writing later. But OSHA does um allow up to six months before they issue any citations for the violations. So one of our surgery centers, um, the inspector walked out. So if you don't hear from me, that's good news. She was quite vague, Olivia. It was almost unsettling because you want to know when are they going to hear something, but they do have to mail it out in a certain time frame, otherwise, it's within six months. So hope that gives our listeners some ideas of what to expect when an ocean inspector shows up at your door and how to manage it in a professional, calm manner.

SPEAKER_01 12:28

Really, really good information, Linda. Mary, what can you share with us?

SPEAKER_00 12:34

Thanks, Olivia. I just wanted to go back to um when the inspector first shows up. If the inspector comes with a complaint about a serious violation, you absolutely need to let them come in at that point because it won't go well for you if you try to put it off. But if they're coming as part of an emphasis program, you do have the right to ask that they come back at a better time, but it doesn't mean you ask them to come back a week later. It's and I always coach my clients, and I've seen them it happen very successfully, where you say to the OSHA inspector, you know, we're happy to be fully cooperative, but right now we're in the middle of a very difficult procedure. And is it possible that you can either come back if it's in the morning, come back in the afternoon? They don't like necessarily to have to come back on a different day, but can you just give us some time to get through this procedure as long as there's not some imminent danger? If it's a simple um, I shouldn't say simple, it's it's as a result of a local emphasis program. So you have a 50-50 chance. They're either going to say, no, I'm coming in right now, or yes, it's okay. But you do it respectfully and you let them know that, you know, what is your reason why? We're in the middle of a very difficult procedure. Um, I had one practice that had several special needs patients being seen at that point. And it was, you know, it took the entire clinical team to help manage um those cases. And the inspectors were fine. They just said, all right, fine, we will come back. So you can ask, but they don't have to say yes.

SPEAKER_01 14:19

Good point, Mary. And I actually had that happen as well many years ago. I had suggested the same thing that you're discussing, and the dental practice called me and said it was successful in getting the inspector to come back because they were busy with a surgery procedure and they knew they'd want to talk to the employees, and that was not possible at that time. But you know, Linda mentioned a good point as well that, you know, if we try to decline, they'll bring up a warrant. Now, it might take them a couple hours to get the warrant, or it may be the next day or two days, but they're coming in. And so I wanted to get some input from Leslie, knowing that OSHA has the authority to get a warrant and to come on the premises and conduct an inspection, what pearls of wisdom do you have to offer to our listeners about this?

SPEAKER_02 15:15

Olivia, I think training is key. If we're caught unaware and by surprise, we're liable to say things that could actually hurt us when it comes to an OSHA inspection. So when we do our annual bloodborne pathogen training, how about we spend a few minutes talking about the what-if scenario, just like we would with telephone communication skills, where we have an idea of what it is each person is going to say, what their role is, what we could expect. And that way we can have more confidence that we can really seal through an OSHA inspection. And I love how Linda said that you really want to, you know, start off on the right foot and not the wrong foot. So just like we would with any patient communication or phone call, we want to be kind and considerate and accommodating, at least appear to be eager to accommodate. And that's only going to happen if we've had a little coaching in advance of an OSHA visit. So we say, okay, front office team, if someone comes in and they say they're from OSHA, first of all, let's you know get their identification. Let's make sure that this isn't just somebody that wants to, you know, see the lay of our office for other reasons. And uh, we also want to make sure that we're prepared to respond appropriately to questions that are asked. Uh, do you have an OSHA coordinator? We all have to have an OSHA coordinator. That's something that's a requirement is to have someone who's in charge of the OSHA plans, whether that be the doctor or whether that be a designated team member. So to be ready to answer those questions, yes, we have Susie who is our OSHA coordinator, and she'd be happy to spend time with you to go through your questions and to give you a tour of the office. However, as you mentioned, uh that there may be a reason that Susie can't do this. Susie's assisting right now, and it's not fair to the patient, it's not fair to the practice to drop everything and uh bring Susie out of clinical care and then uh have that person be spending time with the OSHA safety officer. So, in my opinion, if we have a bit of a script, a sort of a pre-prepared script, um, we are seeing patients this morning. Can you come in at noon at our lunch hour where the patients are cleared and our treatment rooms or you know, there's not contamination that you could be exposed to or aerosols. You know, if we somehow make it to the benefit of the OSHA safety officer to come in at a different time where we can spend the time, we want to spend the time with you. And then another thing that I think is very important is that first of all, yeah, the training has to take place. So you mentioned earlier, you can't recreate that training. It has to have already happened. And so if you aren't doing your annual bloodborne pathogen training, please do it. Please have the written policies, the exposure control plan. And by the way, the exposure control plan that's a key item that an OSHA safety officer is likely to ask any team member. Do you have a written exposure control plan? The next thing is, you know, where is it? And then after that might be show it to me. So everyone should know where the written plans are and uh be able to demonstrate knowledge of uh of the information that's in those plans. You can't you can't guarantee that someone's going to remember what they learned at training, but you can document that they had the training. So most employers aren't responsible for the memory of their team members, but they are responsible for making sure that training takes place and that the written plans are available and that the team members know where they are. So if a team member can't remember where an exposure control plan is kept, hint, hint, it's in your OSHA manual. An employer should be able to provide documentation that that training was provided, and that was one of the training topics. So that's part of what I consider to be preparation in advance. And then not only having the policies in place, but having training on those policies gives the team confidence because I think back to the days when I worked as a dental assistant, and I remember when somebody in the practice had an exposure incident. And from that moment on, from the moment that she got poked with that bloody instrument to the rest of the day, it was chaos. She was upset, the doctor was upset, nobody knew what to do, there was crying, the patients were put on hold. And it seemed to me that if they had had a policy from the time she set ouch to the time that she was out the door for medical care, because the place had been determined in advance where she would go and what the first age steps were, and what the conversation with the patient was, that people would be more confident that, hey, I'm working in a place where they care about my safety. They've taken the time to prepare me for the what-if scenario, and I have a path and a plan. If something happens, I know what to do. So I think that's what OSHA is looking for, is that they look to see that we have received the training, that we're uh confident in our policies, that we know how to access those policies. And of course, don't forget that training uh documentation needs to be maintained for three years. So if you haven't done it, you gotta do it because you can't recreate it. You certainly can't go back in time and recreate it. And I love how uh we talked earlier in the podcast about remediation, fixing something on the spot. Um, I love when when uh something is pointed out and it's taken care of right away when I do my amount inspection at a dental practice. I had one practice where they actually called the plumber, and the plumber fixed the eyewas station before I was finished with my training. When I walked out the door that day, their eyewas station was in perfect working order. So I know OSHA would appreciate that you are fixing things instead of being argumentative and instead of being uh you know digging your feet in, uh, and I know that happens too, where we get you know kind of prideful and you know, want to be right about things, to just be open and open to suggestion and to let OSHA know that you are more than willing to make your practice a safer place to be.

SPEAKER_01 21:54

Great, thank you, Leslie. So confidence comes from preparation. As you well pointed out, we need to be prepared. So if they do come in unannounced, we are ready for it. Now I do know that in Tennessee, with our local emphasis program, they're not coming back. That's the whole point. They want to see the hazards in place. They want to see what happens during patient care. They have the authority to walk into the treatment room. The inspectors have personal protective equipment of their own. They have respirators. So they're prepared for these hazards and they want to see what hazards are being exposed to the employees. So really it's time to prepare. And I know in my practice, we are sending out a poster to our clients for them to display on top 10 considerations for the new year, just so they have a visual reminder of some common things that OSHA might cite. I wanted to share before we close and get some experiences from each other that if OSHA does come in unannounced, what we have suggested to our clients in Tennessee, and it's no secret with OSHA, because I wrote a blog about it and I let them read it before I released it to my website, that you can invite them to a private area, such as a private office or a consult room, if that's not available. You could use a break room, but I always caution people do not place the OSHA inspector in a break room with contaminated lab jackets on the back of the chairs because you already have violations right in front of their face. Then the next thing would be to bring out your paperwork. So whether you keep digital copies of your plans and training rosters and medical records and so on, or if you keep paper copies, bring that out to the inspector. That will take several hours for them to go through and evaluate. And then after they complete the paperwork, which has given everybody an opportunity to calm down, then they can begin their walkabout where they will uh investigate from the original complaint and interview employees and get feedback. And so hopefully, if you've done the things that Leslie talked about, you are prepared not only with good communication skills, but you have all your stuff in place. And so uh we feel that if you prepare and launch these things ahead of time, then it won't be such a stressful experience in dealing with whether you receive a letter or you have an unannounced visit or it's complaint driven and they show up. And so, any of the divas, do you have anything to supplement some of the things we talked about?

SPEAKER_00 24:43

Mary. I'm so glad that you brought up about the documentation and same thing for you, Leslie, that if your documentation, your training records, your policies, your exposure control plans, your hazard communication plan, all those things are updated, easily accessible, and organized, and you give those to an inspector to review, they that sets the tone for them, that they get it, that you at least are making what they're looking for as a good faith effort to be compliant. But when they ask for the documentation and everybody's kind of scrambling and asking, you know, I don't know where it is, do you know where it is? Or they bring out this binder that's got papers sticking out of it and safety data sheets that are just thrown in a folder and very unorganized, that you couldn't find something quickly if you needed to, then that sends, again, a very negative message to the OSHA inspector that you're not taking safety seriously. So being prepared is so important. And I know it's a chore for a lot of people to have to review those policies, or um, a lot of times the person who's the OSHA coordinator for the practice is a chair side assistant who also has other duties, um, but they need to be given some release time or have some time to be able to keep that organized because that says so much about who you are and your dedication to safety that goes much, much smoother for you if you do have an inspection.

SPEAKER_01 26:22

Thanks, Mary. Leslie, do you have some comments to share?

SPEAKER_02 26:28

Yes, Olivia, I want to remind our listeners that wearing the right PPE all the time is important, not just when the ocean inspector shows up, because as you mentioned, they do want to come in and they do want to see what kind of hazards employees are uh exposed to. So the proper eye wear, not just prescription glasses, but today it's space shield and goggles, uh wearing a clinical jacket so that forearms are covered, and and of course they're wearing a mask, a properly fitting mask, and in some cases respirators, depending on the circumstances. So those are the types of things that that need to be an everyday thing, not just uh, you know, uh-oh, OSHA's here. Utility gloves, yeah, and not just one pair of utility gloves in the sterilization room, but utility gloves for everybody who processes sharp contaminated instruments in the sterilization room, maybe with each person's name on their own pair of utility gloves.

SPEAKER_01 27:26

Good points, Leslie. And so we really want to take the time, allocate the time just like you would scheduling a patient. You want to schedule yourself to work on OSHA compliance so that you are prepared just in case there is an unannounced visit or you receive a letter, you'll be prepared. And so we appreciate you tuning in to this episode of the podcast. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please submit your questions to support at the compliancedevas.com. Any resources that we mentioned will be available on our website. Thanks for tuning in.