.. 1 

UNITED STATES OF AMERICA 

OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION 

SECRETARY OF LABOR, 

Complainant, 

v. 

INTEGRA HEAL TH MANAGEMENT, 

INC. 

Respondent. 

OSHRC Docket No. 13-1124 

BRIEF OF AMICUS CURIAE CHAMBER OF COMMERCE 

OF THE UNITED STATES OF AMERICA IN SUPPORT OF 

RESPONDENT INTEGRA HEALTH MANAGEMENT, INC. 

Steven P. Lehotsky 

Warren Postman 

U.S. CHAMBER 

LITIGATION CENTER, INC. 

1615 H Street, N.W. 

Washington, D.C. 20062 

(202) 463-5337 

Jacqueline M. Holmes 

JONES DAY 

51 Louisiana Avenue, N.W. 

Washington, D.C. 20001 

Telephone: (202) 879-3939 

Facsimile: (202) 626-1700 

COUNSEL FOR AMICUS CURIAE 
TABLE OF CONTENTS 

Page 

I. STATEMENT OF INTEREST OF AMICUS CURIAE .......................................... 1 

II. SUMMARY OF ARGUMENT ............................................................................... 2 

III. ARGUMENT .......................................................................................................... 3 

A. THE INHERENT RISK OF CRIMINAL ACTS BY CUSTOMERS 

OR CLIENTS IS NOT A RECOGNIZED HAZARD WITHIN THE 

MEANING OF THE GENERAL DUTY CLAUSE .................................... 3 

1. The General Duty Clause Does Not Apply To The Normal 

Activities Of Business ....................................................................... 5 

2. Purported Hazards Attributable To Third-Party Conduct Are 

Not Covered By The General Duty Clause ....................................... 6 

3. The Secretary And The ALJ's Open-Ended Definition Of The 

Alleged Hazard Fails To Give Employers Notice Of The 

Conditions Or Practices They Must Prevent.. ................................. 12 

B. THE SECRETARY FAILED TO PROVE THAT THERE WERE 

FEASIBLE AND EFFECTIVE MEANS OF ABATING THE 

ALLEGED RECOGNIZED HAZARD ..................................................... 14 

C. THE SECRETARY SHOULD NOT BE PERMITTED TO UTILIZE 

VOLUNTARY GUIDANCE TO EFFECTUATE SWEEPING 

POLICY CHANGE WHERE HE HAS FAILED TO ENGAGE IN 

RULEMAKING ......................................................................................... 16 

IV. CONCLUSION ..................................................................................................... 19 

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TABLE OF AUTHORITIES 

Page 

CASES 

Am. Textile Mfrs. Inst., Inc. v. Donovan, 

452 U.S. 490 (1981) ..................................................................................................... 17 

Bristol Steel & Iron Works, Inc. v. OSHRC, 

601 F.2d 717 (4th Cir. 1979) .................................................................................... 7, 16 

Donovan v. Royal Logging Co., 

645 F.2d 822 (9th Cir. 1981) ........................................................................................ 14 

Empire-Detroit Steel Div. v. OSHRC, 

579 F.2d 378 (6th Cir. 1978) .......................................................................................... 3 

Ford Motor Co. v. FTC, 

673 F.2d 1008 (9th Cir. 1981) ...................................................................................... 19 

Indus. Union Dep 't, AFL-CIO v. Am. Petroleum Inst., 

448 U.S. 607 (1980) ..................................................................................................... 17 

Nat'/ Realty & Const. Co., Inc. v. OSHRC, 

489 F.2d 1257 (D.C. Cir. 1973) ........................................................................ .4, 14, 19 

Oil, Chem. & Atomic Workers v. Am. Cyanamid Co., 

741F.2d444 (D.C. Cir. 1984) ..................................................................................... 11 

Pa. Power & Light Co. v. OHSRC, 

737 F.2d 350 (3d Cir. 1984) ......................................................................................... 11 

Pratt & Whitney Aircraft v. Secy of Labor, 

649 F.2d 96 (2d Cir. 1981) ........................................................................................... 11 

R.L. Sanders Roofing Co. v. OSHRC, 

620 F.2d 97 (5th Cir. 1980) .................................................................................... 13, 14 

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Ramsey Winch Inc. v. Henry, 

555 F.3d 1199 (10th Cir. 2009) ................................................................... .4, 10, 11, 16 

Sea World of Florida, LLC v. Perez, 

748 F.3d 1202 (D.C. Cir. 2014) ............................................................................... 9, 10 

Secy of Labor v. Beverly Enters., Inc., 

Nos. 91-3144 ................................................................................................................ 12 

Secy of Labor v. Green Cons tr. Co., 

No. 5356, 1976 WL 6135 (Rev. Comm. Oct. 21, 1976) ................................................ 7 

Secy of Labor v. Inland Steel Co., 

No. 79-3286, 1986 WL 53521 (Rev. Comm. July 30, 1986) ........................................ 5 

Secy of Labor v. Integra Health Management, Inc., 

2015 WL 4474372 (ALJ June 22, 2015) at *35 .................................................... passim 

Secy of Labor v. Megawest Fin., Inc., 

No. 93-2879, 1995 WL 383233 (Rev. Comm. ALJ June 19, 1995) ................ 6, 7, 8, 10 

Secy of Labor v. Morrison-Knudsen Co., 

No. 88-572, 1993 WL 127946 (Rev. Comm. April 20, 1993) ...................................... 4 

Sec '.Y of Labor v. Otis Elevator Co., 

No. 03-1344, 2007 WL 3088263 (Rev. Comm. Sept. 27, 2007) ................................... 4 

Secy of Labor v. Pelron Corp., 

No. 82-388, 1986 WL 53616 (Rev. Comm. June 2, 1986) .................................. 3, 5, 12 

Usery v. Marquette Cement Mfg. Co., 

568 F.2d 902 (2d Cir. 1977) ......................................................................................... 16 

Voegele Co. v. OSHRC, 

625 F.2d 1075 (3d Cir. 1980) ....................................................................................... 14 

STATUTES 

29 U.S.C. § 654(a)(l) .......................................................................................................... 3 

29 U.S.C. § 655 ................................................................................................................. 17 

-lll-
OTHER AUTHORITIES 

Commission Release (Sept. 18, 2015) ................................................................................. 4 

Recommendations for Workplace Violence Prevention Programs in LateNight Retail Establishments, OSHA 3153-12R (2009) ............................................... 17 

Secretary's Guidelines for Preventing Workplace Violence for Health Care 

and Social Service Workers, OSHA 3148-01 R (2004) ................................... 16, 17, 18 

Secretary's Guidelines for Preventing Workplace Violence for Healthcare 

and Social Service Workers, OSHA 3148-04R(2015) ......................................... 17, 18 

-IV-
Pursuant to the Commission's September 18, 2015 briefing notice, the Chamber of 

Commerce of the United States of America ("Chamber") respectfully submits this brief in 

support of Respondent Integra Health Management, Inc. ("lntegra"). The Chamber's 

brief addresses the three principal issues identified in the Commission's briefing notice. 

I. STATEMENT OF INTEREST OF AM/CVS CURIAE 

The Chamber is the world's largest business federation. It represents three 

hundred thousand direct members and indirectly represents an underlying membership of 

three million professional organizations of every size, in every industry sector, and from 

every region of the country. An important function of the Chamber is to represent the 

interests of its members in matters before Congress, the Executive Branch, and the courts. 

To that end, the Chamber regularly files amicus briefs in cases that raise issues of 

concern to the nation's business community. 

The vast majority of the Chamber's members are subject to the Occupational 

Safety and Health Act ("Act"). As potential respondents to citations issued by the 

Secretary of Labor, these members have a vital interest in ensuring that the Secretary and 

the Commission correctly interpret and fairly enforce the Act. This interest is particularly 

important where, as here, the Secretary seeks to effectively announce-in the absence of 

notice-and-comment rulemaking-that an employer may be liable under the general duty 

clause for the criminal conduct of one of the customers its employees are hired to serve. 

This decision has the potential to reach far beyond Integra, or even the health care 

industry, and to impact employers in many industries where employees must interact with 

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customers, face-to-face, to perform their work. As a result, the Chamber has a significant 

interest in the Commission rejecting such a rule. 

II. SUMMARY OF ARGUMENT 

The Secretary's citation in this case seeks to significantly expand the traditional 

scope of Section 5( a)( 1) of the Act, the general duty clause, while at the same time, 

undermining the deliberative approach that OSHA has historically applied to the 

announcement of new rules of general applicability. Against a tradition of express 

restraint in policing social behavior via the general duty clause, the Secretary seeks to 

hold an employer liable for failing to abate, not the materials or conditions of its 

workplace, but the deliberative, uncharacteristic, and entirely unpredictable actions of 

one of its member customers-a third party whose actions were both shocking and 

beyond the employer's control. That theory is not tenable. 

In the first place, the Secretary has not established the existence of a recognized 

hazard. In a perhaps understandable but ultimately misguided attempt to eliminate 

inherent risk, the Secretary and the ALJ have defined the hazard as a task that is the very 

core of many employers' businesses: face to face meetings with clients. But the 

Commission has long held that activities central to an employer's business cannot be 

recognized hazards under the general duty clause, and has long avoided attempting to 

regulate criminal activity of third parties under the Act. Defining the hazard in this way 

also makes it impossible for the Secretary to establish that the employer may feasibly and 

effectively abate the alleged hazard. Finally, the Secretary should not be permitted to 

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" 

rely upon voluntary guidelines that expressly disclaim any legal effect in establishing a 

violation of the general duty clause, in this case or any other. 

For all of these reasons, and those stated by Integra in its Petition, the Commission 

should reverse the ALJ decision and vacate the Secretary's citation in its entirety. 

III. ARGUMENT 

To establish a violation of the general duty clause, 29 U.S.C. § 654(a)(l), the 

Secretary must prove that (1) an activity or condition in the employer's workplace 

presented a hazard to employees; (2) the cited employer or its industry recognized that 

the condition or activity was hazardous; (3) the hazard was causing or likely to cause 

death or serious physical harm; and ( 4) there were feasible means to eliminate or 

materially reduce the hazard. Empire-Detroit Steel Div. v. OSHRC, 579 F.2d 378, 383-84 

(6th Cir. 1978). As requested in the Commission's briefing notice, the Chamber 

addresses all but the third of these elements, as well as the impact of the Secretary's 

Guidelines for Preventing Workplace Violence for Health Care and Social Services 

Workers on the Secretary's citation. 

A. THE INHERENT RISK OF CRIMINAL ACTS BY CUSTOMERS OR 

CLIENTS IS NOT A RECOGNIZED HAZARD WITHIN THE MEANING 

OF THE GENERAL DUTY CLAUSE. 

The Secretary's and the ALJ's definition of the purported recognized hazard in 

this case is contrary to Commission precedent and congressional intent. The Commission 

has long recognized that hazards under the general duty clause must be "defined in a way 

that apprises the employer of its obligations, and identifies conditions or practices over 

which the employer can reasonably be expected to exercise control." Sec '.Y of Labor v. 

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Pelron Corp., No. 82-388, 1986 WL 53616, at *3 (Rev. Comm. June 2, 1986); Sec '.Y of 

Labor v. Otis Elevator Co., No. 03-1344, 2007 WL 3088263, at *3 (Rev. Comm. Sept. 

27, 2007) (same). In other words, the Secretary must identify "a preventable 

consequence of the work operation." Sec '.Y of Labor v. Morrison-Knudsen Co., No. 88-

572, 1993 WL 127946, at *19 (Rev. Comm. April 20, 1993). Precise and limited 

definitions of "hazards" under the general duty clause are necessary because "Congress 

intended to require elimination only of preventable hazards." Nat'/ Realty & Const. Co., 

Inc. v. OSHRC, 489 F.2d 1257, 1266 (D.C. Cir. 1973). Because the general duty clause 

focuses only on preventable hazards, the Secretary and the Commission have traditionally 

limited its application to conditions and materials of the employer's workplace, as 

opposed to the social behavior of third parties. Ramsey Winch Inc. v. Henry, 555 F.3d 

1199, 1206 (10th Cir. 2009). 

The Secretary defines the applicable hazard here as the risk of Integra employees 

"being physically assaulted by [Integra members] alleged to have a history of violent 

behavior." Cmn. Release at 1 (Sept. 18, 2015). The ALJ altered this definition slightly, 

characterizing the hazard as the risk of "being physically assaulted during a face-to-face 

meeting by a member with a history of violent behavior." Sec '.Y of Labor v. Integra 

Health Management, Inc., 2015 WL 4474372 (ALJ June 22, 2015) ("ALJ Op.") at *35. 

These sweeping definitions are not cognizable recognized hazards under the general duty 

clause for three independent reasons: face-to-face interactions with Integra's members, 

and the risks that those interactions entail, are the core activity of Integra' s business, and 

eliminating them eliminates the business; the general duty clause does not apply to the 

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actions of third parties that are outside the employer's control and whose potentially 

hazardous conduct is not readily recognizable by the employer; and the Secretary's 

definition makes no attempt to inform Integra, or any other employer, when necessary 

face-to-face interactions cross the line from benign to hazardous. 

1. The General Duty Clause Does Not Apply To The Normal Activities Of 

Business. 

The Commission has held that the normal activities of a business do not represent 

the types of "hazards" that the general duty clause was intended to regulate. This is 

because "an employer cannot reasonably be expected to free its workplace of inherent 

risks that are incident to its normal operation." Sec '.Y of Labor v. Inland Steel Co., No. 

79-3286, 1986 WL 53521, at *3 (Rev. Comm. July 30, 1986). Indeed, "[t]o permit the 

normal activities ... [of] industry to be defined as a 'recognized hazard' within the 

meaning of section 5(a)(l) is to eliminate an element of the Secretary's burden of proof 

and, in fact, almost to prove the Secretary's case by definition, since under such a 

formula the employer can never free the workplace of inherent risks incident to the 

business." Petron, 1986 WL 53616, at *3 (emphasis in original). 

Human interaction, of course, is an essential component of numerous businesses. 

And human interaction carries a small but irreducible risk of human misbehavior. Here, 

the population Integra serves presents potentially elevated risks. By definition, Integra's 

clients are insufficiently resourced to maintain consistent medical care. ALJ Op. at *5. 

Their medical conditions are serious enough that regular care is required, and the 

consequences of failing to obtain that care severe. Id. at *6. In addition, as the ALJ 

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. ' 

found, "most" Integra members have criminal records, significant mental illness, or both 

(id. at *7), and "many" have histories of violent behavior. Id. at *33. Many have neither 

consistent shelter nor adequate food and, unsurprisingly, many do not have working 

telephones. Id. at *6. 

Eliminating human interaction will often undermine the core purpose of a 

business. Here, Integra's sole purpose is to connect its members to community and other 

social service resources that may help to improve their access to, and use of, medical 

care. See ALJ Op. at *34 (noting that members' "very behavior is the essence of 

Integra's business"). Consistent, reliable, face-to-face interactions are the only way for 

Integra to provide these services; if intermittent telephone communications were 

sufficient, Integra members would likely be adequately served by routine doctor's office 

reminder calls, but they are not. Id. at *9 (Integra CEO explaining "the only way you're 

going to engage some of these members is to really do it on a personal level and-talk 

face-to-face and get them engaged"). Refusing to meet with clients with a criminal 

history, or those with severe mental illness associated with a propensity for violence, 

would eliminate "most" oflntegra's member customers, and most of its business. That is 

not consistent with the general duty clause. 

2. Purported Hazards Attributable To Third-Party Conduct Are Not 

Covered By The General Duty Clause. 

Hazards under the general duty clause have traditionally been limited to those 

conditions or practices "over which the employer can reasonably be expected to exercise 

control." Sec'y of Labor v. Megawest Fin., Inc., No. 93-2879, 1995 WL 383233, at *8 

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·' 

(Rev. Comm. ALJ June 19, 1995). "The element of an employer's control is a crucial 

one when determining the employer's duty under the Act." Id. Indeed, the Commission 

has "consistently held that employers are not to be held to a standard of strict liability, 

and are responsible only for the existence of conditions they can reasonably be expected 

to prevent." Sec'y of Labor v. Green Constr. Co., No. 5356, 1976 WL 6135, at *2 (Rev. 

Comm. Oct. 21, 1976). 

The inherent risks that come with face-to-face interaction with a client or customer 

are fundamentally different from the hazards targeted by the Act. The Act focuses on 

hazards that arise from some condition inherent in the environment or the processes of 

the employer's workplace not dependent upon unpredictable human behavior, such as 

overexposure to lead or noise or the risk of electrocution. The general duty clause has 

served a modest purpose by filling "those interstices necessarily remaining after the 

promulgation of specific safety standards" under the Act. Bristol Steel & Iron Works, 

Inc. v. OSHRC, 601 F .2d 717, 721 (4th Cir. 1979). But the hazards covered by the Actwhether addressed by specific safety standards or the gap-filling function of the general 

duty clause-have one thing in common: they are aspects of the work environment that 

employers, through control of their workplaces, can both anticipate and reduce or 

eliminate. 

The ALJ's decision ran afoul of these principles in two respects. First and most 

importantly, it tasked the employer with responsibility for the acts of third parties 

completely outside the employer's control. The danger from these individuals "arises not 

from the processes or materials of the workplace, but from the anger and frustration of 

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. ' 

people." Megawest Fin., 1995 WL 383233, at *9. It is this "human factor" (id.) that 

separates interactions with an employer's customers or clients from the traditional 

hazards regulated by the Act and places patient care-and the distinct individuals to 

whom it is provided-beyond the scope of an employer's general duties of hazard 

correction and control. 

This rule reflects that "[ e ]mployers have less control over employees than they do 

over conditions[,] [as] employees have a will, an intention, and an intellect that drives 

their behavior, and they are not always amenable to control." Megawest Fin., 1995 WL 

383233, at *9. And, of course, employers have "even less control over the behavior of 

third parties [that are] not in [their] employ[,]" such as their customers. Id. Because the 

sole element of danger from face-to-face patient interaction arises, not from conditions of 

the workplace, but from the "wild card" of human behavior, face-to-face client 

interactions are "completely different from any other hazards addressed by the Act." Id. 

Indeed, while the threats associated with third-party patients may be "omnipresent, an 

employer may legitimately fail to recognize that the potential for a specific" violent act 

by an employer's customer exists. Id. 

The ALJ compounded this problem by adopting a breathtakingly broad definition 

ofwhat constitutes a "workplace": "member's homes, [employees'] personal vehicles, or 

[] public places such as hospitals, restaurants, and doctor's offices ... are [all] considered 

an lntegra workplace." ALJ Op. at *32. Under the ALJ's analysis, an employer cannot 

only be responsible for the activities of third parties, but for those activities at a 

customer's own home, in its employees' vehicles, and in an array of public places. But 

-8-
there was no evidentiary showing-nor could there be-that these are areas over which 

an employer could "reasonably be expected to exercise control." 

The ALJ held otherwise in this case for two reasons: one, that Integra does control 

the amount of training and information its employees have prior to interacting with its 

members, and the procedures they use to do so; and two, that Sea World of Florida, LLC 

v. Perez, 748 F.3d 1202 (D.C. Cir. 2014), made actionable a similar hazard under the 

general duty clause. See generally ALJ Op. at *32-35. Neither of these arguments 

withstands scrutiny. 

It is obviously true that an employer can control the amount and type of training 

its employees receive, and the information those employees receive about potential 

members. Indeed, Integra presented extensive evidence of its existing training programs 

and procedures. See generally ALJ Op. at *9-14. Yet the ALJ' s analysis fails to require 

any showing that training could protect against the cited hazard at all. Thus, for example, 

while the ALJ faulted Integra for not consistently performing criminal background 

checks on its members (ALJ Op. at *34 ), he never explained how knowing that member 

had engaged in aggravated assault and battery nearly 15 years before her 

interactions with him (see ALJ Op. n.3 (describing criminal history related to offenses in 

the 1990s)) would have reduced the hazard presented by Ms. face-to-face 

meetings with him. 1 Similarly, although the ALJ faulted Integra for providing 

1 The ALJ's solution, instead, was that Integra should stop providing face-to-face services to any members 

with a history of violent criminal behavior, regardless of how temporally remote the behavior, and apparently also 

regardless oflntegra's own experience with that member. ALJ Op. at *44. But his finding that "many" Integra 

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(b)(6) (b)(6)
"inadequate" training and for assigning an "inexperienced" employee to Mr. case 

(see ALJ Op. at *34, *39-42), he never explains how better training or more experience 

would have helped Ms. fend off Mr. random knife attack. In other words, 

the ALJ never actually found that the employer had the ability to control the hazard he 

believed existed. 

The ALJ's reliance on the D.C. Circuit's divided Sea World opinion-with which 

the Chamber respectfully disagrees-fares no better. Sea World involved the hazard of 

direct interactions on Sea World property with a killer whale. Sea World, 7 48 F .3 d at 

1208. The Court held that Sea World had the ability to place barriers on its own property 

between the whale and trainer, and could eliminate personal interactions between trainer 

and whale without substantially impacting its product. Id. at 1213-14. In other words, 

the identified hazard was comprised of "conditions over which [Sea World] could 

reasonably exercise control." Megawest Fin., 1995 WL 383233 at *8. That case, 

however, does not support the broad proposition that an employer can be held responsible 

for the acts of third-parties that it cannot control. 

Numerous other authorities support this commonsense principle. For example, the 

Tenth Circuit refused to accept a definition of "recognized hazard" that included the risk 

of firearms in company parking lots because it was "too speculative and unsupported to 

[constitute] []the clear and manifest purpose of Congress." Ramsey Winch, 555 F.3d at 

(continued ... ) 

members had a history of violent behavior (id at *33) elucidates the fallacy in that position: Integra cannot 

eliminate services to "many" of its members and still remain a viable enterprise. 

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(b)(6) (b)(6) (b)(6)
'' 

1205, 1207 (internal quotation omitted); see also Oil, Chem. & Atomic Workers v. Am. 

Cyanamid Co., 741F.2d444, 449 (D.C. Cir. 1984) (refusing to apply a broad meaning of 

"hazard" under the general duty clause and instead "confin[ing] the term 'hazards' under 

the general duty clause to the types of hazards [the Court] kn[e]w Congress had in 

mind"). In reaching this conclusion, the Tenth Circuit observed that OSHA has 

historically exhibited an "express restraint in policing social behavior via the general duty 

clause." Ramsey Winch, 555 F.3d at 1206; see also Pa. Power & Light Co. v. OHSRC, 

737 F.2d 350, 354 (3d Cir. 1984) (recognizing that an employer's "duty does not extend 

to the abatement of dangers created by unforeseeable or unpreventable employee 

misconduct"); Pratt & Whitney Aircraft v. Sec '.Y of Labor, 649 F .2d 96, 104 (2d Cir. 

1981) (indicating the Act only requires employers to "guard against significant risks, not 

ephemeral possibilities"). 

The Commission should proceed with tremendous caution to the extent that it 

would extend the general duty clause to hold an employer liable for the social behavior of 

customers or clients that inheres in the nature of the employer's business. Although 

employers may have theoretical knowledge that third parties are capable of posing a 

hazard to their employees, human beings do not act with the same level of predictability 

as the processes and materials traditionally covered by the Act. Moreover, holding 

employers responsible for the independent acts of their customers or clients could result 

in perverse consequences, such as depriving disadvantaged and high risk individuals of 

important services. For all of these reasons, the ALJ's decision should be reversed and 

the Secretary's novel citation vacated. 

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3. The Secretary And The ALJ's Open-Ended Definition Of The Alleged 

Hazard Fails To Give Employers Notice Of The Conditions Or 

Practices They Must Prevent. 

The purported goal of the Secretary's citation in this case is to protect Integra 

employees from the broad risks associated with face-to-face interactions with certain 

Integra members. ALJ Op. at *34. Because this alleged hazard is a social phenomenon 

rather than a "condition or practice" of the workplace over which employers exercise 

control, Petron, 1986 WL 53616, at *3, this definition does not provide Integra-or other 

employers whose employees are required to interact face-to-face with customersadequate notice regarding the precise risks against which it is supposed to protect its 

employees. 

Presumably, neither the Secretary nor the ALJ could have intended to characterize 

all face-to-face customer/employee interactions as preventable hazards under the general 

duty clause, because most such interactions do not pose a "tangible and appreciable risk" 

to employees. Sec '.Y of Labor v. Beverly Enters., Inc., Nos. 91-3144 et al., 2000 WL 

34012177, at* 13 (Rev. Comm. Oct. 27, 2000). But the ALJ's sole limitation of the 

hazard to customer members "with a history of violent behavior" (ALJ Op. at * 3 5) 

similarly fails to provide the required notice. 

As noted above, general-duty hazards must be "defined in a way that apprises the 

employer of its obligations, and identifies conditions or practices over which the 

employer can reasonably be expected to exercise control." Petron, 1986 WL 53616, at 

*3. Moreover, an employer is entitled to fair notice that he may be charged with a 

violation of the general duty clause: "Like other statutes and regulations which allow 

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monetary penalties against those who violate them, an occupational safety and health 

standard must give an employer fair warning of the conduct it prohibits or requires, and it 

must provide a reasonably clear standard of culpability to circumscribe the discretion of 

the enforcing authority and its agents." R.L. Sanders Roofing Co. v. OSHRC, 620 F.2d 

97, 100 (5th Cir. 1980). Importantly, these notice concerns apply, not just to the 

Secretary's promulgation of specific standards, but also to her enforcement of the 

broadly-worded general duty clause. Id. 

The notice concerns raised by the ALJ' s amorphous definition of the alleged 

hazard are compounded by the sweeping nature of the citation at issue. There is no 

evident reason that the ALJ's analysis, if accepted, could not apply to any face-to-face 

customer interaction where the customer has a "history of violent behavior," whether 

known to the employer or not. The potential implications of that are staggering not just 

for the health care industry, but for other industries in which employees are required to 

interact with customers in their homes--cable companies, telecommunications 

companies, utility companies, appliance installation services, and the like. With little 

help from the decision or the Secretary, employers that wish to fulfill their general duty 

obligations will now have to decide: 

• What constitutes sufficient evidence of violent behavior? A criminal 

conviction? For what offenses? Civil liability? In what circumstances? 

Mere accusations? Dismissal from employment for workplace violence? 

• Is any history sufficient, or is there some temporal limitation? Is a 50-yearold's college bar fight a sufficient history of violent behavior? 

• What constitutes violent behavior? Is the employer required to consider 

mitigating circumstances, such as self-defense? 

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• How thorough must the employer's investigation be into the facts and 

circumstances of a potential customer's behavior? Is a criminal 

background check enough, or must the employer review civil records, 

employment records, and other materials as well? 

These are merely a small sampling of the questions that remain unanswered under the 

ALJ's novel and overly inclusive definition of the alleged hazard. Indeed, both the 

Secretary and the ALJ fail to separate in any meaningful way the alleged hazards from 

Integra's normal, everyday activities, and thus fail to give Integra and other similarly 

situated employers notice regarding the conditions they must abate. Because Integra 

"could not have been sufficiently apprised of [its] potential liability under the general 

duty clause" for failing to prevent face-to-face interactions with its members, the citation 

must be vacated. Sanders, 620 F .2d at 100. 

B. THE SECRET ARY FAILED TO PROVE THAT THERE WERE 

FEASIBLE AND EFFECTIVE MEANS OF ABATING THE ALLEGED 

RECOGNIZED HAZARD. 

Under the general duty clause, the Secretary had the burden to demonstrate and 

describe the feasibility, practicality, and economic viability of additional safety measures 

that Integra could have employed to "eliminate[ ]" or "materially reduce[ ]" the alleged 

recognized hazard. Nat'/ Realty, 489 F.2d at 1266-67; Donovan v. Royal Logging Co., 

645 F.2d 822, 830 (9th Cir. 1981). Although the Secretary does not have to propose 

safety standards that have gained wide-spread industry acceptance, prevailing industry 

standards are relevant to deciding the central question of whether a reasonable person 

would have utilized the precautions if faced with the alleged hazard. Voegele Co. v. 

OSHRC, 625 F.2d 1075, 1080 (3d Cir. 1980). 

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The Secretary's evidence was inadequate in this case in two principal respects. 

First, for the same reason that the Secretary has not established the existence of a hazard, 

he failed to prove that his proposed means of abatement would effectively abate the 

defined hazard. That is because there is no connection between most of the Secretary's 

proposed means of abatement-background checks, additional employee training, and 

the like-and actually reducing the defined hazard. There is no evidence establishing 

that these abatement measures would reduce or eliminate the identified hazard; the 

Secretary's expert was unable to testify that they would (see generally Integra Pet. at 7-

8), and there is no reason to think that an unarmed employee, no matter how well trained, 

could successfully fend off a random knife attack such as the one Ms. faced. 

Second, the one proposed abatement that could reduce or eliminate the hazardrefusing to provide services to individuals with a "history of violent behavior"-is 

infeasible on its face. As the ALJ found, "many" Integra members fall into this category 

(ALJ Op. at *33); refusing to provide services to these individuals would have a 

substantial negative impact on Integra's business model. Thus, while Integra "could" do 

it, the Secretary did not establish that it "could" do so and remain a viable enterprise. 2 

Where, as here, the only effective means of abating an alleged hazard would be for 

an employer to refuse to serve a large portion of its clients or customers, a citation under 

the general duty clause is unsupported. 

2 The fact that Integra has permitted a handful of individuals with criminal backgrounds to "roll off' its 

member lists since Ms. death does not establish that it could do so with all such individuals and continue to 

operate a viable business. 

-15-

(b)(6) (b)(6)
C. THE SECRETARY SHOULD NOT BE PERMITTED TO UTILIZE 

VOLUNTARY GUIDANCE TO EFFECTUATE SWEEPING POLICY 

CHANGE WHERE HE HAS FAILED TO ENGAGE IN RULEMAKING. 

The Commission has also requested input regarding what effect, if any, should be 

given in this proceeding to the Secretary's Guidelines for Preventing Workplace Violence 

for Health Care and Social Service Workers. The short answer, for several reasons, is 

none. 

The Secretary should not, in effect, use the Guidelines as a substitute for his 

obligation to enforce the Act principally by promulgating specific standards under the 

Act's rulemaking provisions. Courts have long admonished the Secretary that "specific 

standards are intended to be the primary method of achieving the policies of the Act" and 

that "they should be used instead of the general duty clause whenever possible." Usery v. 

Marquette Cement Mfg. Co., 568 F .2d 902, 905 n.5 (2d Cir. 1977). Indeed, the limited 

purpose of the general duty clause is to address "those interstices necessarily remaining 

after the promulgation of specific safety standards." Bristol Steel, 601 F.2d at 721. Thus, 

the general duty clause-properly applied with judicious discretion-serves the limited 

purpose of insuring "the protection of employees who are working under special 

circumstances" that are inappropriate for specific standards. Ramsey Winch, 555 F.3d at 

1205 (quoting S. Rep. No. 91-1282, at 5186 (1970) (emphasis added)). 

The Secretary has never made any showing that workplace violence issues are 

"inappropriate for specific standards," though of course he has declined for years to 

promulgate any such standard. Ramsey Winch, 555 F.3d at 1205 (noting that OSHA has, 

at least since the mid-2000s, "recognized workplace violence as a serious safety and 

-16-
health issue" but "has not, however, promulgated any mandatory standards regarding 

workplace violence"). Instead, the Secretary has repeatedly promulgated "voluntary 

guidelines" addressing workplace violence in various contexts. See, e.g., Guidelines for 

Preventing Workplace Violence for Healthcare and Social Service Workers, OSHA 

3148-0lR (2004)3; Recommendations for Workplace Violence Prevention Programs in 

Late-Night Retail Establishments, OSHA 3153-12R (2009). 

These Guidelines, of course, have no legal effect. Yet the Secretary has 

sometimes attempted to point to similar Guidelines to establish key elements of a general 

duty clause violation-typically recognition and feasibility and effectiveness of 

abatement. It is not appropriate to do so. 

The OSH Act's rulemaking procedures set forth strict substantive and procedural 

standards-including notice to the regulated community and comment-with which the 

Secretary must comply in order to promulgate an enforceable regulation. See 29 U.S.C. 

§ 655. These procedures protect the regulated public by requiring the Secretary to 

substantiate the need for a standard to reduce a significant risk of harm, and the feasibility 

of the measures the Secretary wishes to implement. Id.; see also Indus. Union Dep 't, 

AFL-CIO v. Am. Petroleum Inst., 448 U.S. 607, 653 (1980) (requiring showing of 

"significant risk of harm" that the standard will alleviate); Am. Textile Mfrs. Inst., Inc. v. 

Donovan, 452 U.S. 490, 513 n.31 (1981) (requiring showing of technological and 

economic feasibility). Voluntary guidelines, on the other hand, are not subject to any 

3 This 2004 version of the Secretary's Guidelines is no longer available on OSHA's website, having been 

replaced by a 2015 version. The 2004 version is the only one that could possibly apply here, however. 

-17-
such strictures; the agency is free to promulgate them pursuant to whatever standards he 

wishes to apply. The Secretary should not, however, be permitted to use those guidelines 

as evidence of a recognized hazard, or abatement feasibility, when no such showing was 

made when the Guidelines were promulgated. 

Leaving those issues aside, the Guidelines cannot be used as evidence of a general 

duty clause violation here for additional, independent reasons. First, the Guidelines 

themselves explain that they "do[] not alter or determine compliance responsibilities" 

under the OSH Act, and "are not a new standard or regulation." Guidelines, Introduction; 

Guidelines at 3. The Commission should not use the Guidelines for a purpose that the 

Secretary has disavowed. Second, and as importantly, the 2004 Guidelines clearly focus 

on risks in hospitals, clinics, and the like-not on the risk of injury from job duties 

outside those contexts. See Guidelines at 6-7 (highlighting various issues, including use 

of hospitals for criminal holds, the availability of drugs or money at hospitals, poorly lit 

parking areas, and the like). 4 

The Secretary's efforts to hold an employer accountable for a general duty clause 

violation cannot be bolstered by relying on the Guidelines. And, in light of the lack of 

guidance that comes from case-by-case adjudication, the Commission should likewise be 

careful not to use this case to "establish [new] rules of widespread application" dealing 

4 Earlier this year, the Secretary revised the Guidelines to explicitly include "field work" and "social 

workers who make home visits" within their ambit. See Guidelines for Preventing Workplace Violence for 

Healthcare and Social Service Workers, OSHA Publication 3148-04R (2015). But those Guidelines cannot have 

applied to lntegra's conduct in 2012 and 2013-the time period that is the subject of the Secretary's citation. 

-18-
with face-to-face customer interactions. Ford Motor Co. v. FTC, 673 F.2d 1008, 1009 

(9th Cir. 1981). 

IV. CONCLUSION 

The Secretary's attempt to hold an employer responsible for the inherent risk of 

criminal behavior by third parties would vastly and improperly expand the traditional 

scope of the general duty clause. Such "adventurous enforcement of the general duty 

clause" is not the answer to alleviating hazards associated with face-to-face customer 

interactions. Nat'l Realty, 489 F.2d at 1267 n.37. The Commission should reverse the 

ALJ's decision and vacate the Secretary's citation. 

Date: October 28, 2015 

Steven P. Lehotsky 

Warren Postman 

U.S. CHAMBER 

LITIGATION CENTER, INC. 

1615 H Street, N.W. 

Washington, D.C. 20062 

(202) 463-5337 

Respectfully submitted, 

~~s'1 i o o ~ ""P \\i\n *'a c w ' .o I -.\f}V1~ J ue ne M. Holmes I 

JONES DAY 

51 Louisiana A venue, NW 

Washington, DC 20001-2113 

Telephone: (202) 879-3939 

Facsimile: (202) 626-1700 

COUNSEL FORAMICUS CURIAE 

-19-
UNITED STATES OF AMERICA 

OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION 

SECRETARY OF LABOR, 

Complainant, 

v. 

OSHRC Docket No. 13-1124 

INTEGRA HEAL TH MANAGEMENT, 

INC. 

Respondent. 

CERTIFICATE OF SERVICE 

This is to certify that on this 28th day of October 2015, a true and correct copy of 

the foregoing Brief was filed by hand with the following: 

John X. Cerveny, Executive Secretary 

Occupational Safety and Health Review Commission 

1120 20th St. N.W., Suite 980 

Washington, DC 20036-3457 

Copies of the foregoing Brief were also served by overnight mail and electronic 

mail on: 

Heather Phillips, Esq. 

Charles James, Esq. 

Office of the Solicitor 

U.S. Department of Labor 

Room S4004 

200 Constitution Ave., N.W. 

Washington, D.C. 20210 

Phillips.heather@dol.gov 

James.charles@dol.gov 

Kevin C. McCormick 

Whiteford, Taylor, Preston LLC 

7 Saint Paul Street 

Baltimore, Maryland 21202 

Telephone: (410) 347-8779 

Facsimile: (410) 223-4379 

kmccormick@wtplaw.com 

Counsel for Integra Health Management, LLC 

~10~1 ;iQ '~-'L{V} '±la0MAW/~ Ja ueli M. Holmes