Can a dialysis employer be responsible for injuries sustained by an
employee, inflicted by a violent patient? What do you think? (Post your thoughts and questions. Return on Friday to the answer to this question. Good luck, Mary

In today's litigious environment in the U.S., I believe the employer would be found liable to some degree - somewhere between 1%-100% - depending on the circumstances. This percentage of responsibility would probably be most strongly influenced by the policies and procedures that were in effect in the facility regarding violence.

The employer probably would want to avoid a trial to avoid the public airing of all past mistakes and wrong doings in their facilities. It seems to me that once the employee gets a lawyer, the most likely result is a out-of-court, non-disclosed settlement - with the dollar amount being inversely proportionate to the amount of documentation (P&P) that existed regarding violence.

What has been the finding in the US Post Office cases? I think there are some similarities here.

Wouldn't one think that in case of the U.S. Postal Service, it is a case of Post-Traumatic Stress Syndrome brought on by the high percentage of ex-military employed by the Postal Service?

Sounds like a case of worker's compensation to me. If an employee is working at a facility and receives injuries, that said employee is covered under state worker's compensation.

Further, if the employer has a violence policy (ie, a zero tolerance policy) and fails to act in accordance to this policy, they would probably lose in court in terms of liability. After all, why is the policy in place if we can't follow it? And if we have the policy, obviously there was a need to have it to begin with or it would never have been there.

Ironically, in several states that I know of, state surveyors and Networks are strongly recommending that facilities have weapons / firearms policies, as well as policies for dealing with disruptive / violent patients.

Just my thoughts...

Interesting topic. One that really has no easy answer.

I was struck that there might be some similarities between dialysis clinic violence and the infamous shootings at US Post Offices.

The lifestyle changes required of a person to be a compliant dialysis patient can be enormous and can cause a great deal of stress. Most of the patient care staff is now technicians, who have little or no education in helping patients effectively manage stress and lifestyle changes. The staff themselves are under ever increasing stress in facing higher and higher patient/staff ratios. Patients are trapped on machines for long hours in a repetitive, stressful environment.

I was wondering if any of the Post Office incidents had resulted in suits against the US Postal Service and if any juries had found the environment at US Post Offices a contributing factor. Are there relevant simiarities here?

Just to set things straight. Yes, all veterens have had weapons training. However, few, if any, of the veterens involved in incidents of public gun violence actually saw combat. Stories of combat-traumatized vets going on killing sprees are essentially myths.

I know the NRA's (not the NRAA) response would be to arm the dialysis staff. We'll have peace when everyone is packing heat.

Thanks to those of you who responded to the question for the week.

As promised, here is the answer to the question about whether an employer may be RESPONSIBLE for injury sustained by and employee and caused by a violent patient. The answer is.."it depends" (isn't that just like a lawyer). The answer depends upon whether an employer is aware of should have been aware that a patient is violent or has the propensity to be violent (based upon past actions or current indications, e.g. threats of violence). It also depends upon whether an employer has a violence protection plan in place, if there are recognized risks for violence, known to the employer.

Employers have both a legal duty and a moral obligation to provide a safe workplace. Employers should institute policies and procedures to prevent violence from occurring in their workplace:
 To prevent loss of life and injuries.
 To limit financial losses and potential liability.
These policies should include:
 Means to identify the potential for violence.
 Procedures to prevent the occurrence of violence.
 Plans to respond and mitigate further damage in the event prevention fails and an incident of violence occurs.

Under the General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health Act (OSHA) of 1970, employers are required to provide their employees with a place of employment that is �free from recognizable hazards that are causing or likely to cause death or serious harm to employees.� This duty includes inspecting the workplace to discover and correct a dangerous condition or hazard, and to give adequate warning of its existence.

The OSHA General Duty Clause has been interpreted to mean that an employer has a legal obligation to provide a safe workplace. An employer that has experienced acts of workplace violence, or becomes aware of threats, intimidation, or other potential indicators showing that the potential for violence in the workplace exists, or has the potential to exist, would be on notice of the risk of workplace violence and may be required to implement a workplace violence prevention program.

Would this apply to dialysis facilites? Who might be capable of violence in the dialysis facility? There have been two well publicized acts of violence in a dialysis facility. One involved the murder of an administrator by an employee (who then committed suicide) and in another case, the shooting of an employee by a dialysis patient (who also committed suicide). While violence to this extent is unusual, violent acts and threats of violence, and stalking are becoming more commonplace. Therefore, it is wise to have a "zero tolerance for violence policy" and a workplace violence plan in place. (If anyone wishes to have a sample "zero tolerance for violence plan", please contact me at 1-800 371-2900 or e-mail me and I will be glad to send you one.)

If an employee is injured in the workplace, he or she generally must look to workers compensation (as the exclusive remedy) for payment of medical bills and a percentage of lost wages (up to a maximum weekly amount) if he or she must be off work for a period of time.