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BEFORE THE UNITED STATES OF AMERICA 

OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION 

SECRETARY OF LABOR 

Complainant, * OSHRC DOCKET NO. 13-1124 

v. * 

INTEORA HEALTH MANAGEMENT, INC. * 

Respondent. * 

* * * * * * * * * * 

BRIEF OF PETITIONER INTEGRA HEALTH MANAGEMENT, INC. 

Kefu 

/~ C. McCormick 

Whiteford, Taylor & Preston, L.L.P. 

7 Saint Paul Street, Suite 1800 

Baltimore, Maryland 21202 

( 410) 34 7-8700 

kmccormick@wtplaw.com 

Counsel/or Petitioner, 

Integra Health Management, Inc. 
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TABLE OF CONTENTS 

s·r A TEMEN1' 0 F TlIE CASE ................................... ' ............................................................ 1 

S'fA TEMEN1' OF FACTS ...................................................................................................... 3 

ST AND ARD FOR APPLICATION OF GENERAL DUTY CLAUSE ............................... 10 

ARGUMENT ......................................................................................................................... 11 

I. The ALJ erred in holding that criminal acts of violence by third parties 

constitute a recognized hazard to employees of lntegra within the meaning 

of the general duty clause .......................................................................................... 11 

A. The general duty clause is not applicable to potential injuries resulting 

from criminal assaults by third parties ........................................................... l 2 

1. Both the legislative history and enforcement history of the Act 

controvert the Secretary's position that the general duty clause 

may properly be applied in the context of acts of criminal violence. 12 

2. No reasonable benchmarks can be set to govern the applicability 

of the general duty clause to third party crimes against 

employees, and the manner of its application in this case 

contravenes public policy .................................................................. 15 

3. OSHA's prior issuance of a guidance document regarding 

workplace violence against healthcare and social service workers 

does not support application of the general duty clause in the 

instant case ......................................................................................... 2 0 

B. Assuming arguendo that the general duty clause may apply to acts 

of criminal violence, the ALJ erred in concluding that the risk of 

such assaults constituted a recognized hazard on the facts of this case ......... 22 

II. The evidence presented at the hearing does not support the ALJ's conclusion 

that the abatement measures proposed by the Secretary would have abated the 

hazard ......................................................................................................................... 26 
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III. Application of the general duty clause on the facts of the instant case would be 

unconstitutional due to the absence of fair notice to Integra ..................................... 29 

IV. In the alternative, this case must be remanded for a new hearing due to the ALJ's 

consideration of evidence outside the record ............................................................. 31 

V. The facts of this case do not support the ALJ' s classification of Citation One, 

Item One as a serious violation .................................................................................. 34 

CONCLUSION ...................................................................................................................... 35 

ii 
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TABLE OF AUTHORITIES 

Statutes 

29 ·u.s.c. § 654 ............................................................................................................... passim 

29 u.s.c. § 666(k) ................................................................................................................. 34 

Judicial Decisions 

Butz v. Economou, 43 8 U.S. 478 (1978) ................................................................................ 33 

Champlin Petroleum Co. v. OSHRC, 593 F.2d 637 (5th Cir. 1979) ...................................... 28 

Connally v. Gen. Constr. Co., 269 U.S. 385 (1926) .............................................................. 29 

Crowell v. Benson, 285 U.S. 22 (1932) ................................................................................. 33 

Donovan v. Royal Logging Co., 645 F.2d 822 (9th Cir. 1981) .............................................. 29 

Fabi Constr. Co. v. Sec '.Y of Labor, 508 F.3d 1077 (D.C. Cir. 2007) .................................... 11 

Metzler v. Arcadian Corp .• 1997 OSHD (CCH) P3 l ,31 l, 

1997 U.S. App. LEXIS 12693 (5th Cir. 1997) ...................................................................... 21 

Nat'/ Realty & Constr. Co. v. OSHRC, 489 F.2d 1257 (D.C. Cir. 1973) .............................. 26 

Oil, Chem. & Atomic Workers Int'/ Union v. Am. Cyanamid Co., 

741F.2d444 (D.C. Cir. 1984) ............................................................................................... 15 

United States v. Abilene & S. R. Co., 265 U.S. 274 (1924) ................................................... 33 

Commission Decisions 

l.'SA Equip. Co., LLC. 24 BNA OSHC 1476, ....................................................................... 11 

Greene Construction Co. & Massman Construction Co., 

4 BNA OSI-IC 1808 (No. 5356, 1976) ................................................................................... 16 

lll 
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Landcoast Insulation, Inc., 23 BNA OSHC 1168, (No. 09-0625, 2010) ............................... 34 

Pelron Corporation, 12 BNA OSHC 1833 (No. 82-388, 1986) ...................................... 15, 16 

ALJ Decisions 

Megawest Financial Inc., 17 BNA OSHC 1337, 

1995 OSAHRC LEXIS 80 (No. 93-2879, 1995) .............................................. 2, 13, 14, 22-25 

Legislative and Administrative Materials 

EEOC, Enforcement Guidance: Consideration of Arrest and Conviction 

Records in Employment Decisions Under Title VII of the Civil Rights Act 

of 1964 (No. 915.002, April 25, 2012) ............................................................................ 18, 19 

H.R 16785, 91st Cong., 2d Sess., 5(1) (1970) ...................................................................... 13 

OSHA, Guidance for Preventing Workplace Violence/or Healthcare 

and .'facial Service Workers (2015) .................................................................................. 20, 21 

SENATE COMM. ON LABOR AND PUBLIC WELFARE, LEGISLATIVE HISTORY 

OF THE OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970, 92ND CONG., 

1 ST SEss. (Comm. Print 1971) ............................................................................................... 13 

Publications 

Donald Morgan & Mark Duvall, OSHA 's General Duty Clause: 

An Analysis of its Use and Abuse, 5 BERKELEY J. OF EMPL. & LABOR LAW 283 (1983) ...... 14 

Jillian K. Peterson et al., How Often and How Consistently Do 

Symptoms Directly Precede Criminal Behavior Among Offenders 

With Mental Illness?, 3 8 LAW AND HUMAN BEHAVIOR 43 9 (2014) ...................................... 19 

Heather Stuart, Violence and Mental Illness: An Overview, 

2 WORLD PSYCHOLOGY 121 (2003) ....................................................................................... 19 

iv 
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STATEMENT OF THE CASE 

Integra Health Management, Inc. (''Integra") is a privately held corporation with 

the mission of connecting vulnerable, underserviced members of the community 

("Members") with medical care and associated support services. To accomplish that 

mission, Integra employs teams of community health workers called Service 

Coordinators, 1 who work in communities to engage with Members in person and via 

telephone. This case arises out of the tragic killing of a Service 

Coordinator, by a Member outside of the Member's home on December 10, 2012. 

Following an investigation, OSHA issued a Citation alleging a violation of the 

general duty clause of the Occupational Health and Safety Act of 1970 (the "Act"). The 

hazard cited by OSHA as supporting the violation of the general duty clause was that of 

"being physically assaulted by members with a history of violent behavior." This case is 

thus premised upon Integra's alleged failure to abate a hazard consisting of the risk that 

third parties would engage in criminal acts of violence upon Integra employees. 

It is undisputed that the Commission has never previously found a violation of the 

general duty clause in the context of an act of criminal violence against an employee. As 

set forth below, the general duty clause cannot properly be applied to criminal acts by third 

parties in the factual circumstances of this case. Application of the clause in this context 

runs afoul of both the legislative history of the Act, as well as its enforcement history over 

the more than four decades since the Act was passed. Further, the inherent unpredictability 

1 Subsequent to the events at issue in this proceeding, the position of Service Coordinator 

was retitled to Community Coordinator. (Tr. 758). This Brief will use the term Service 

Coordinator in light oftbe fact that this terminology was used throughout the hearing. 

1 

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of criminal conduct, as well as W1 employer's lack of control over individuals outside its 

workforce, renders unworkable any attempt to define a measure by which an employer's 

acts can be evaluated in determining compliance with the general duty clause in the event 

of a criminal attack on an employee by a third party. 

Even if the general duty clause were held to be potentially applicable to a third 

party's criminal assault of an employee, the ALJ's decision below must nevertheless be 

reversed. The record in this case fails to demonstrate that physical assaults by Members 

constituted a recognized hazard at lntegra. Indeed, the facts of this case on the question of 

a recognized hazard pale in comparison to those of Megawest Financial Inc., 17 BNA 

OSHC 1337, 1995 OSAHRC LEXIS 80 (No. 93-2879, 1995), the sole prior litigated case 

involving acts of violence against employees, in which an ALI concluded that the facts at 

issue did not demonstrate that the risk of attacks was a recognized hazard. Reversal of the 

ALJ's decision is further warranted due to the Secretary's failure to meet his burden of 

establishing the feasibility of measures that would have materially reduced or eliminated 

the hazard. 

Finally, assuming arguendo that the Commission were to accept the Secretary's 

position as to the applicability of the general duty clause, this case must be remanded for a 

new hearing due to the ALJ's conduct in relying upon facts not contained in the record in 

assessing the credibility of one of Integra's primary witnesses. Specifically, in explaining 

the weight he would give to the testimony of Dr. Melissa Arnott, Integra's Vice President 

of Community Programs, the ALJ invoked facts relating to the university from which Dr. 

Arnott received her doctoral degree, which led the ALJ to discount Dr. Arnott's testimony 

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1 

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based on his assessment of the university's quality. Such matters were not the subject of 

any evidence whatsoever during the hearing. Integra was thus deprived of any opportunity 

to address this matter, which the ALJ explicitly relied upon in assessing the weight to be 

given to the testimony from Integra's chief witness on the issue of its programs and 

employee training. 

STATEMENT OF FACTS 

Integra was founded in 2007. (Tr. 754). The company employs community health 

workers, known as Service Coordinators, who seek to assist individuaJs experiencing 

chronic health conditions and gaps in recommended health care in obtaining access to such 

care, including preventive care. (Tr. 754-55). Members are referred to Integra by health 

care providers or their health insurers, based on a review of the individuals' claims 

histories to identify individuals who are not receiving medical or preventative care 

consistent with their health conditions. (Tr. 755). These are frequently individuals with 

whom the insurance provider has previously been unable to make or maintain contact. (Tr. 

756). 

When an individual is referred to Integra, Integra assigns a Service Coordinator to 

work with the Member. (Tr. 757). As explained by Integra's President, Michael Yuhas, 

the assigned Service Coordinator attempts to "locate the individual, introduce ourselves in 

terms of what we are doing, which is really to help them get connected with health care 

services." (Tr. 756-57). Prior to assisting a Member, the Service Coordinator seeks to 

obtain the Member's consent to receive assistance from lntegra. As Mr. Yuhas testified, 

"if they don't c<.msent, we won't do anything more. If they do, then we will figure out 

3 
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what the barriers are to them being connected with their primary care doctor or other 

practitioners and work with them to help get appointments set up, make sure they're 

getting to their appointments, being reminded to take the medications they've been 

prescribed, et cetera." (Tr. 757). 

These services are provided by Integra' s Service Coordinators, who, as community 

health workers, are .. non-clinically trained people." (Tr. 757). As Mr. Yuhas explained, 

"we're not providing clinical services. We don't really train them or want them to be 

doing anything clinical in nature relative to a condition. We're really just trying to get the 

individual connected with things just like a family member might ... if that person existed, 

for the people we work with." (Tr. 757-58). 

Integra began operating in Florida in May 2012. (Tr. 760). Integra was contracted 

by Amerigroup to provide support services to certain individuals enrolled in that 

company's health insurance plan who could benefit from the community health worker 

service model provided by Integra. (Tr. 756-60, 786). Integra then commenced the 

process of recruiting, hiring and training a local team of Service Coordinators and a 

supervisor to work with these Members. (Tr. 759-60). At the outset, that team included 

Whitney Ferguson and Laurie Rochelle. (Tr. 83 7). Ms. Ferguson had already been 

working with lntegra as a Service Coordinator prior to relocating to Florida. Ms. Rochelle, 

who was hired as the team supervisor, holds a license in mental health counseling and had 

maintained a private counseling practice prior to joining Integra. (Tr. 243-44). As 

additional Members were referred for services, lntegra hired additional Service 

Coordinators in the late Summer and Fall of 2012. (Tr. 843). 

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Integra is fully committed to and takes very seriously the training of its community 

health worker employees. Community health workers (CHWs) are a critical resource in 

providing in-community support to underserved individuals with health care needs. In 

2009, the Department of Labor's Bureau of Labor Statistics created a distinct occupation 

code for CHWs. The services defined within the CHW occupational code include: assisting 

individuals and communities to adopt healthy behaviors; conducting outreach for medical 

personnel or health organizations to implement programs in the community that promote, 

maintain, and improve individual and community health~ providing information on 

available resources; providing social support and informal counseling; advocating for 

individuals and community health needs; providing services such as first aid and blood 

pressure screening; and collecting data to help identify community health needs. 

While the DOL has formally recognized the community health worker as an 

occupational classification, there exist no national standards for the training of such 

employees. For that reason, Integra commissioned the development of a structured online, 

interactive training program referred to throughout this proceeding as the "Neumann 

training," to be provided to employees as part of lntegra's broader employee training 

procedures. That program's content was initially developed by Dr. Melissa Amott, 

lntegra's Vice President of Community Programs, and Dr. Thomas Krajewski, Integra's 

Medical Director. (Tr. 876-78, 881-83, 1025). The program was refined in conjunction 

with the faculty of Neumann University, and Neumann University now offers the training 

as a certificate program. (Tr. 883-85). The Neumann training consists of fifteen training 

modules that are presented in an online format, with interactive discussion features that 

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allow employees to communicate with managers regarding the contents of the lesson. (Tr. 

889-90). 

One of the modules contained in the Neumann training program is dedicated to 

workplace safety. (Tr. 882, 913; Exhibit J). Integra mandates that newly hired employees 

complete the Neumann training at the outset of their employment, and pays their salary 

during the time that it takes them to complete the training course. (Tr. 893-94). In 

addition to this formal online training program, Integra's training also provides for the 

Service Coordinators to observe face-to-face meetings with Members conducted by more 

senior staff - referred to as "shadowing" at various points during the hearing. (Tr. 766-67, 

791-93, 961). 

The online, interactive safety instruction offered via the Neumann training is also 

supplemented by face-to-face training from Integra management. Service Coordinator 

safety training instructs staff to avoid any situation where real or perceived threats to 

personal safety may be present, to advise their supervisor of any real or perceived safety 

issue, to take another Service Coordinator with them to meetings with a Member if they 

felt doing so was necessary, and generally how to perform their job duties safely in the 

community. (Tr. 231-32, 794-95, 821-22, 932, 941-42). Integra conducted a total of three 

two-day face-to-face training programs in the Fall of 2012 for its new Service Coordinator 

team in Florida. (Tr. 789-91, 839-42, 957-59). Those trainings encompassed safety 

discussions that included role playing scenarios and demonstrations (Tr. 875-76, 959), 

community-based shadowing, and included written safety-related materials distributed in 

connection with the online and face-to-face training sessions. (Tr. 956-57; Exhibit F). 

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In addition to the face-to-face training sessions, Integra conducted a set of twiceweekly telephone calls in which the Service Coordinators were required to participate.2 

One of these weekly calls was led by the supervisor of the Florida Service Coordinator 

team, while the other was led by Drs. Melissa Amott and Thomas Krajewski. (Tr. 289-91, 

849-50). During their weekly calls, Drs. Arnott and Krajewski facilitated discussion 

related to service chaJlenges regarding individual Members, reviewed specific training 

points, and responded to inquiries regarding safety considerations and other workplace 

issues. (Tr. 766-67, 849-50, 1027). 

Integra also employed a practice commonly referred to as the "buddy system," 

under which employees who felt in any way a real or perceived threat in interacting with a 

Member were to take a second Service Coordinator or other Integra employee with them 

for Member visits. (Tr. 231-32, 793-94, 821-22, 847-48). Service Coordinators 

commonly used a regular partner for these purposes, and were instructed to contact a 

supervisor if they were not readily able to arrange for another employee to accompany 

them in meeting with the Member. (Tr. 793-94, 821-22, 847-48). Service Coordinators 

were instructed that, if they believed a real or perceived threat to their personal safety 

existed with a particular Member, they should not meet with that Member or meet only 

when a second Integra employee was present. (Tr. 794-95). The company has always 

directed its Service Coordinators to leave any meeting immediately if they felt unsafe. (Tr. 

932, 941-42). It is undisputed that no employees were ever disciplined for delaying a 

meeting to ensure a second employee could accompany them, and that no employee ever 

2 These weekly telephone calls were referred to throughout the hearing as .. rounds." 

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suffered a loss of pay or other disciplinary action as a result of not completing a particular 

number of meetings with a Member or otherwise refusing to interact with a particular 

Member. (Tr. 191, 313). 

Finally, Integra maintained a written workplace violence policy, which provided in 

relevant part that: 

(Exhibit C). 

Violence by an employee or anyone else against an 

employee, supervisor or member of management will not be 

tolerated. The purpose of this policy is to minimize the 

potential risk of personal injuries to employees at work and 

to reduce the possibility of damage to company property in 

the event someone, for whatever reason, may be unhappy 

with a company decision or action by an employee or 

member of management. 

If you receive or overhear any threatening communications 

from an employee or outside third party, report it to your 

Direct Supervisor at once. Do not engage in either physical 

or verbal confrontation with a potentially violent individual. 

If you encounter an individual who is threatening immediate 

harm to an employee or visitor to our premises, contact an 

emergency agency (such as 911) immediately. 

All reports of work-related threats will be kept confidential 

to the extent possible, investigated and documented. 

Employees are expected to report and participate in an 

investigation of any suspected or actual cases of workplace 

violence and will not be subjected to disciplinary 

consequences for such reports or cooperation. 

Violations of this policy, including your failure to report or 

fully cooperate in the company's investigation, may result in 

disciplinary action, up to and including discharge. 

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was a Service Coordinator hired in late Summer 2012 as part of 

Integra's Florida service team. (Tr. 136). One of the Members Ms. was assigned to 

work with was an individual who had been diagnosed with schizophrenia 

and other chronic medical issues. When Mr. was referred to lntegra there was no 

evidence of prior psychiatric hospitalizations or history of a connection with his Primary 

Care Physician for medical care. His history reflected injectable medication compliance 

and case management services for the schizophrenia diagnosis and an unrelated acute 

medical hospitalization and follow-up care related to that condition (Tr. 141). 

At the hearing, OSHA provided evidence of criminal record. The 

compliance safety and health officer who conducted the agency's investigation, Jason 

Prymmer, acknowledged, however, that record contained no evidence of any 

violent activity subsequent to the 1990s. (Tr. 225-26). 

Ms. conducted three face-to-face meetings with during October and 

November 2012. (Tr. 139-40). Although Ms. notes from one of those meetings 

indicate that Ms. felt "uncomfortable, so she asked the member to be respectful or she 

would not be able to work with him'', the sole evidence adduced at the hearing on that 

issue indicated that the comment at issue was of a flirtatious, as opposed to a threatening, 

nature. (Tr. 232-33). 

Ms. traveled to residence for a fourth face-to-face meeting on 

December 10, 2012. (Tr. 119). When arrived at the house, emerged armed 

with a knife and fatally stabbed her. (Tr. 83). 

9 

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Following Ms. death, OSHA commenced the investigation that culminated in 

the issuance of the Citation underlying this proceeding. Citation One, Item One of the 

Citation charges Integra with a violation of the general duty clause contained in Section 5 

of the Act. Specifically, Citation One, Item One alleges that Integra failed to keep its 

workplace free from exposure to "the hazard of being physically assaulted by members 

with a history of violent behavior." (Exhibit 1). 

A hearing was held before Administrative Law Judge Dennis L. Phillips ("ALJ") 

from May 6, 2014 to May 9, 2014. The parties each filed post-hearing briefs and posthearing reply briefs. By a Decision and Order dated June 11, 2015 (the "Decision"), the 

ALJ affirmed the Citation.3 

STANDARD FOR APPLICATION OF GENERAL DUTY CLAUSE 

The Citation at issue in this case was issued pursuant to the general duty clause, 

codified at 29 U.S.C. § 654. The clause provides that an employer: 

[S]hall furnish to each of his employees employment and a 

place of employment which are free from recognized hazards 

that are causing or are likely to cause death or serious 

physical hann to his employees. 

In construing the general duty clause, the Review Commission and the courts have 

held that in order to establish a violation of the clause, the Secretary has the burden of 

establishing four distinct elements: 

3 The Citation also contained Citation 2, Item 1, which was based upon Integra's failure to 

notify OSHA following Ms. death. As noted by Integra at the hearing, Integra 

reported Ms. death to workers' compensation, but did not also notify OSHA. (Tr. 

86, 168). Integra therefore does not seek review of the ALJ's decision with regard to 

Citation 2, Item 1. 

10 

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To prove a violation of this provision, known as the "genera] 

duty cJause," the Secretary must show that: (1) a condition or 

activity in the workplace presented a hazard; (2) the 

employer or its industry recognized the hazard; (3) the 

hazard was likely to cause death or serious physical harm; 

and (4) a feasible means existed to eliminate or materially 

reduce the hazard. 

CSA Equip. Co., LLC, 24 BNA OSHC 1476, 2014 OSAHRC LEXIS 9 at "'2 (No. 12-1287, 

2014); see also Fabi Constr. Co. v. Sec'y of Labor, 508 F.3d 1077, 1081 (D.C. Cir. 2007) 

(same). 

ARGUMENT 

I. The ALJ erred in holding that criminal acts of violence by third parties 

constitute a recognized hazard to employees of Integra within the 

meaning of the general duty clause. 

The hazard underpinning the Citation at issue in this case is that of "being 

physically assaulted by members with a history of violent behavior." As discussed infra, 

the general duty clause cannot properly be applied to criminal acts by third parties in the 

factual context of the instant case. Such an application of the general duty clause runs 

contrary to both the legislative history of the Act, as well as the entirety of its enforcement 

history, as the Secretary has acknowledged in this proceeding that the instant case is 

wholly without precedent. 

Further, the general duty clause cannot be applied to incidents of criminal violence 

in a manner that allows for workable benchmarks for employers. Indeed, the primary 

response urged by the ALJ - assessment by Integra of Member backgrounds - raises 

intractable questions concerning how such a policy would be applied in the context of the 

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general duty clause, including the scope and sources of records to be reviewed, the 

circumstances under which an employer would be required to conduct such a review of its 

potential customers, how far back in time the employer should look, what sorts of crimes 

or violent actions would lead to disqualification, and whether an entity should properly 

deny its services to a customer based on the assumption that the customer's criminal 

history is suggestive of fUture violent conduct. Moreover, the ALJ's decision raises the 

imp1ication that the general duty clause may require in certain circumstances that an 

employer conduct a medical evaluation of customers to "evaluate" whether a customer has 

a medical or psychological condition that might make him or her more likely to cause 

physical harm to employees. How such a requirement could be reconciled with customers' 

privacy rights and the various statutes that flatly prohibit the limitation of services to those 

with actual or perceived mental disabilities is entirely unclear. 

Finally, even if the general duty clause were held to be potentially applicable to a 

third party's criminal assault of an employee, the record in this case fails to demonstrate 

that physical assaults by Members constituted a recognized hazard at Integra. 

A. The general duty clause is not applicable to potential injuries resulting 

from criminal assaults by third parties. 

1. Both the legislative history and enforcement history of the 

Act controvert the Secretary's position that the general duty 

clause may properly be applied in the context of acts of 

criminal violence. 

The ALJ's Decision in this case depends, at its core, upon the premise that the 

hazards encompassed by the general duty clause include the risk of criminal assaults upon 

employees by third parties. Application of the general duty clause in that context is at odds 

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with both the purpose of the general duty clause as reflected in the Act's legislative history 

and the enforcement history of the Act during the more than four decades since its 

enactment. 

The legislative history of the Act contains no suggestion whatsoever that the 

"recognized hazards" encompassed by the general duty clause would potentially include 

criminal behavior by individuals not under an employer's control. See Megawest 

Financial Inc., 17 BNA OSHC 1337, 1995 OSAHRC LEXIS 80 (No. 93-2879, 1995) 

("[N]owhere in the legislative history pertaining to the Act or in the scope of the thenexisting standards was there any implication that OSHA should police social behavior."). 

To the contrary, the scope of the general duty clause was substantially narrowed 

over the course of the legislative process. Compare H.R. 16785, 91st Cong., 2d Sess., 5(1) 

(1970) (requiring employers to furnish place of employment "which is safe and healthful"), 

with 29 U.S.C. § 654 (requiring that place of employment be "free from recognized 

hazards"). That narrowing the general duty clause appears to have been driven by 

concerns that a broad general requirement would have the effect of discouraging the 

adoption of specific standards. See SENATE COMM. ON LABOR AND PUBLIC WELFARE, 

LEGISLATIVE HISTORY OF THE OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970, 92ND 

CONG., lST SEss. (Comm. Print 1971) at 380 (statement of Senator Dominick: "The major 

thrust of the Act contemplates the establishment of specific standards. The existence of a 

vague general requirement increases the risk that its enforcement will form the basis for the 

law's enforcement to the detriment of the setting of specified standards."). Indeed, the 

Act's legislative history suggests that the general duty clause was envisioned as a stopgap 

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measure to facilitate the addressing of existing hazards prior to the adoption of specific 

standards applicable to the hazard at issue. See id. at 852 (report of the House Education 

and Labor Committee: general duty clause to protect "employees who are working under 

such unique circumstances that no standard has yet been enacted to cover this situation") 

(emphasis in original); see also id at 150 (report of the Senate Labor and Public Welfare 

Committee: "[t]he general duty clause ... would simply enable the Secretary to insure the 

protection of employees who arc working under special circumstances for which no 

standard has yet been adopted").4 The history of the Act is thus fundamentally at odds 

with the Secretary's present attempt to apply the general duty clause to criminal acts of 

violence committed by third parties. 

The absence of Congressional intent for the general duty clause to encompass 

criminal assaults by third parties is further demonstrated by the absence of any past case in 

which a violation of the Act has been found in comparable circumstances. Indeed, the 

Secretary has acknowledged in this proceeding that only one case involving an alleged 

violation of the general duty clause on the basis of workplace violence has ever been 

previously litigated in the more than forty-year history of the Act. See Secretary's PostHearing Brief at 24. That single case, discussed infra, did not result in a finding of a 

recognized hazard. See Megawest Financial Inc., 17 BNA OSHC 1337, 1995 OSAHRC 

LEXIS 80 (No. 93-2879, 1995). The Secretary's claim in the instant case - that Integra 

4 For further discussion of the Act's legislative history, specifically relating to the general 

duty clause, see Donald Morgan & Mark Duvall, OSHA 's General Duty Clause: An 

Analysis of its Use and Abuse, 5 BERKELEY J. OF EMPL. & LABOR LA w 283 (1983). 

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violated the general duty clause by failing to abate the hazard of criminal assaults on its 

employees by third parties - is thus entirely without precedent. 

Simply stated, neither the Act nor its legislative or enforcement history supports the 

Secretary's contention that the general duty clause imposes upon an employer a duty to 

anticipate and prevent criminal attacks on employees by third parties. See Pelron 

Corporation, 12 BNA OSHC 1833, 1835 (No. 82-388, 1986) ("To respect Congress' 

intent, 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."); see also Oil, Chem. & Atomic Workers Int'! Union v. Am. Cyanamid 

Co., 741 F.2d 444, 449 (D.C. Cir. 1984) ("We are not prepared to speculate that, although 

Congress was thinking only about tangible hazards such as chemicals, it would, had it 

considered the subject, have decided that any employer-offered choice which leads to 

injury rather than discharge is a violation of the Act. ... It seems to us safer, therefore, to 

confine the term 'hazards' under the general duty clause to the types of hazards we know 

Congress had in mind."). 

2. No reasonable benchmarks can be set to govern the 

applicability of the general duty clause to third party crimes 

against employees, and the manner of its application in this 

case contravenes public policy. 

The fact that there has never been an administrative or court decision finding a 

violation of the general duty clause arising out of acts of criminal violence is indicative of 

the impracticality of applying the clause in this context. Such an application of the clause 

gives rise to intractable questions of defining the limits of an employer's responsibilities, 

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and places an unworkable burden on employers to predict criminal behavior on the part of 

persons not under their control. 

The foundational premise of the ALJ's decision in this case is that an employer 

may violate the Act by failing to anticipate that one of its customers may choose to break 

the law by violently attacking one of its employees. On that basis, the ALJ concluded that 

Integra's failure to predict, and take adequate steps to prevent, such criminal behavior ran 

afoul of the general duty clause. However, the decision of a human, imbued with free will, 

to engage in a violent attack on another person is inherently resistant to prediction. 

Classification of the possibility that an individual will engage in such conduct as a 

recognized hazard under the general duty clause is directly contrary to the principle that the 

clause is to be applied as encompassing only those risks which an employer can reasonably 

be expected to prevent. See, e.g., Pelron Corporation, supra; Greene Construction Co. & 

Massman Construction Co., 4 BNA OSHC 1808 (No. 5356, 1976) (noting that 

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."). 

Apart from the inherent unpredictability of criminal behavior, the exercise of 

defining the circumstances in which the risk of criminal acts by customers or other third 

parties is sufficiently high to warrant action by the employer resists the dmwing of 

meaningful lines and lends itself instead to ex post facto analysis. This concern is amply 

demonstrated by the instant case. 

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In discussing the feasibility of various abatement measures, the ALJ concluded that 

Integra not only was obligated to conduct a background review of potential members, but 

also to deny services to those "with a history of violent behavior." See Decision at 89. 

Such a conclusion, if accepted, leads inevitably to intractable issues concerning how an 

employer must set the boundaries of such a policy. The first such issue centers on the 

types of employers who would be subject to such a duty. While the ALJ's Decision was 

based in part on the idea that Integra's employees deal with individuals more likely to 

commit assaults than the general public - a dubious proposition discussed in further detail 

il?fra - logic dictates that any employees who routinely make calls at customers' homes, 

such as utility workers and deliverymen, will in the course of their duties encounter 

individuals with criminal backgrounds in equal or greater number than those encountered 

by Integra's employees. If the premise that the general duty clause placed upon Integra an 

obligation to screen its Members before sending employees to their homes is accepted, 

there is no rational way to define that obligation in such a way that it would not also apply 

to a range of employers whose workers perform work in the homes of their customers. 

Such a dramatic rewriting of the Act's requirements is ill suited to be accomplished via 

application of the general duty clause in individual cases as opposed to the issuance of a 

standard and the attendant notice and comment procedure. 

Even if the Commission were to accept the notion that an employer may in some 

circumstances be obligated to conduct criminal background checks on its customers, that 

conclusion raises further issues as to how such inquiries would be conducted and the scope 

of the information to be sought by the employer. For example, the ALJ's comment 

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l 

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regarding the denial of services to individuals "with a history of violent behavior" calls 

into question what sort of activities in an individual's history would be sufficient to 

warrant exclusion, and how far into an individual's past an employer should be expected to 

look in order to comply with the general duty clause. The facts of the instant case 

demonstrate the inherent limitations of setting such parameters: the ALJ's Decision reflects 

that the most recent recorded violent act of the individual who attacked Ms. dated to 

1998, fourteen years before the events underlying the Citation. See Decision at 4 n.3. 

The ALJ's conclusion that Integra could address the risk of assault - and thereby 

avoid violation of the general duty clause - by simply denying service to individuals with 

violence in their past also raises substantive issues of public policy. Such a result would 

place the burden on employers to choose which members of the public should be denied 

services based on their past actions. notwithstanding the fact that such individuals arc not 

presently under any restriction by the police or civil authorities. The suggestion that 

employers are under a duty to screen out such individuals is particularly problematic 

where, as in the instant case, the services offered by the employer are specifically directed 

at improving the situation of uniquely vulnerable persons. Further, given the racial 

disparities in criminal prosecutions in this country, any policy that an employer may enact 

to screen out individuals from receiving services based on their criminal histories would 

raise troubling concerns of discrimination. Indeed, in the context of hiring decisions, the 

United States Equal Employment Opportunity Commission ("EEOC") has taken the 

position that blanket exclusion of candidates on the basis of criminal record runs afoul of 

the nation's antidiscrimination statutes. See EEOC, E11forcement Guidance: Consideration 

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of Arrest and Conviction Records in Employment Decisions Under Title VII of the Civil 

Rights Act of 1964 (No. 915.002, April 25, 2012) ("African Americans and Hispanics also 

are incarcerated at rates disproportionate to their numbers in the general population. . . . 

National data, such as that cited above, suppmts a finding that criminal record exclusions 

have a disparate impact based on race and national origin."). 

Finally, it must be noted that the conclusions reached in the ALJ's Decision with 

regard to the risk posed by Integra's Members rest upon a disturbing line of reasoning, 

namely that the Service Coordinators are at a heightened risk because many of the 

individuals they serve are mentally ill. See, e.g., Decision at 68 (suggesting that "personal 

inquiries may be conducive to hostile reactions by a severely mentally ill member with a 

history of violence"). As noted supra, the Members served by Integra are not individuals 

who have been deemed incompetent to live freely by the authorities. No scientific 

evidence was presented at the hearing in suppo1t of the notion that individuals with mental 

illness pose a heightened risk of violence, and that assumption is not borne out in the 

scientific literature on the issue. See, e.g., Jillian K. Peterson et al., How Often and How 

Consistently Do Symptoms Directly Precede Criminal Behavior Among Offenders With 

Mental fllness?, 38 LAW AND HUMAN BEHAVIOR 439, 439 (2014) ("Although offenders 

with mental illness are overrepresented in the criminal justice system, psychiatric 

symptoms relate weakly to criminal behavior at the group level."); Heather Stuart, 

Violence and Mental Illness: An Overview, 2 WORLD PSYCHOLOGY 121 (2003) ("First, 

mental disorders are neither necessary, nor sufficient causes of violence .... Second, 

members of the public undoubted.1y exaggerate both the strength of the relationship 

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between major mental disorders and violence, as well as their own personal risk from the 

severely mentally ill. It is far more likely that people with a serious mental illness will be 

the victim of violence."). 

The ALJ's suggestion that the Act obligates Integra to conduct its own screenings 

of the members of the public that it serves, and to exclude individuals from service in 

reliance on such screenings via the making of predictions as to future criminal behavior, 

represents an unprecedented expansion of the general duty clause that is at fundamentally 

odds with both public policy and the legislative and enforcement history of the Act, in 

addition to being wholly inconsistent with industry practice. 

3. OSHA's prior issuance of a guidance document regarding 

workplace violence against healthcare and social service 

workers does not support application of the general duty clause 

in the instant case. 

In its September 18th Briefing Notice, the Commission requested that the parties 

address "the effect, if any, of OSHA's Guidance for Preventing Workplace Violence for 

Healthcare and Social Service Workers." It is Integra's position that the Guidance for 

Preventing Workplace Violence for Healthcare and Social Service Workers ("the 

Guidance'') does not provide support for the Secretary's position in the instant case as to 

the applicability of the general duty clause. 

As an initial matter, the Guidance expressly disclaims any effect on an employer's 

obligations under the Act. See Guidance at ii ("This publication does not alter or 

determine compliance responsibilities which are set forth in OSHA standards and the OSH 

Act."); id. at iv ("This guidance document is advisory in nature and informational in 

content. It is not a standard or regulation, and it neither creates new legal obligations nor 

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alters existing obligations created by the Occupational Safety and Health Administration 

(OSHA) standards or the Occupational Safety and Health Act of 1970 (OSH Act or 

Act)."); id. at l (characterizing document as "voluntary guidelines"). 

'The age of the Guidance, along with the concomitant lack of enforcement history, 

also militates against the Guidance being given weight in this proceeding. The current 

Guidance updates the original publication first issued in 1996, and updated in 2004. Y ct in 

the nearly 20 years since the Guidance was first published, OSHA has issued no standard 

addressing the issue of violent acts against employees. See Metzler v. Arcadian Corp., 

1997 OSHD (CCH) P31,311, 1997 U.S. App. LEXIS 12693 (5th Cir. 1997) ("[C]ourts 

have consistently held that standards are the preferred enforcement mechanism and that the 

General Duty Clause serves as an enforcement tool of last resort."). Nor has there been 

any litigated case involving such circumstances. The absence of any enforcement activity 

or rulemaking in this area, coupled with the explicitly voluntary nature of the Guidance, 

demonstrates that the Guidance has no bearing on this case. 5 

5 Additionally, even if the Guidance could be deemed to be applicable in the abstract, no 

evidence was presented at the hearing to suggest that any of the voluntary steps suggested 

by the Guidance would have had the effect of reducing the likelihood of an attack in the 

specific context of the work being performed by Integra's Service Coordinators. Indeed, 

the Service Coordinators are neither healthcare nor social service workers in the traditional 

sense. Instead, the Service Coordinators meet with Members to identify social, economic, 

behavioral, and environmental baniers to their receipt of medical care and other resources 

and to arrange for the Members to have those needs met. (Tr. 754-55). The Service 

Coordinators do not provide medical care, nor do they perform the functions of social 

workers. Most significantly, they do not perform the sort of high-risk tasks, such as 

removing children from a home or carrying or dispensing prescription medicationi that are 

cited in the Guidance as supporting the need for heightened safety measures. 

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B. Assuming arguendo that the general duty clause may apply to 

acts of criminal violence, the ALJ erred in concluding that the 

risk of such assaults constituted a recognized hazard on the 

facts of this case. 

The Citation at issue defines the applicable hazard as that of "being physically 

assaulted by members with a history of violent behavior during a face-to-face interaction." 

The ALJ 's conclusion that this constituted a recognized hazard at Integra is unsupported on 

the record of this case. 

As noted supra, the Megawest decision is the only previous case in which the 

Commission or an ALJ has considered the question of whether violent, criminal acts of 

third parties served by the employer constitute a recognized hazard. The proposed 

application of the general duty clause was rejected in that case, and there has not been any 

decision supporting its applicability in similar circumstances in the twenty years since 

Megawest was decided. 

In the instant case, the ALJ suggested that Megawest could be distinguished on the 

grounds that the violent acts at issue in Megawest were more "random" and less connected 

to the employees' work than in the instant case. Decision at 66-67. That characterization 

fundamentally misconstrues Megawest, and a review of the circumstances underlying the 

Megawest decision demonstrates that the circumstances of the present case are far less 

indicative of the existence of a recognized hazard than the facts which were deemed 

insufficient to support a violation in Megawest. 

The employer in Megawest operated an apartment complex in Lauderhill, Florida. 

Megawest Financial Inc., 17 BNA OSHC 1337, 1995 OSAHRC LEXIS 80 at *l (No. 93-

2879, 1995). The enforcement proceeding stemmed from a complaint filed with OSHA by 

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the small group of employees who worked at the management office on site at the 

apartment complex. The evidence produced at the hearing indicated that the police 

considered the area in which the apartments were located as "probably one of the highest" 

crime areas in the city, and that police responses to 911 ca1ls were often delayed due to the 

high volume of calls received for the area. Id at *6-*7. The case involved the employer's 

alleged violation of the general duty clause, with the alleged hazard consisting of 

"exposure to assault and battery by tenants of the apartment complex." Id at *2. 

The facts adduced at trial revealed that Megawest's employees had been the subject 

of multiple attacks by tenants. One such incident involved a tenant spraying mace in the 

eyes of two employees after being informed that Megawest would not return a security 

deposit. Id at *8. In another incident, a tenant injured an employee's finger by slamming 

a telephone on it. Id at *9. In a third incident, a tenant scratched and slapped an employee 

during a dispute about the tenant's use of the office telephone. Id. at *11-*12. In addition 

to the actual physical attacks, the ALJ's decision noted that the evidence indicated that 

staff members were "often subjected to threats or belligerent conduct." Id. at *7. These 

included a threat to pour boiling water on office staff, a threat to shoot anyone knocking to 

collect rent, and a threat to kill a night security officer following the towing of a tenant's 

car. Id. at*9, *10, *21. 

Given the responsibilities of the office staff, the ALJ acknowledged that their work 

"resulted in direct confrontations between the staff and the residents." Id at * 19. 'This 

stemmed from the fact that the staff's duties involved giving notice of evictions, refusing 

to return security deposits, addressing maintenance disputes, and collecting rent. Id. at 

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*19-*20. Indeed, Megawesfs president went so far as to acknowledge at the hearing that 

he "considered responding to tenant threats to be a normal part of the staff's job." Id. at 

*20. All of this stands in stark contrast to the nature of the duties performed by Integra's 

Service Coordinators, who were providing a voluntary service at no charge that Members 

could choose to accept or reject. 

Notwithstanding the incidents involving past attacks on Megawest employees and 

the at-times adversarial nature of their relationship with the tenants, the ALJ concluded that 

assaults by tenants did not constitute a recognized hazard supporting the alleged violation 

of the general duty clause. In so holding, the ALJ noted the absence of precedent on the 

issue, and cautioned that "enforcement in this arena could place extraordinary burdens on 

an employer requiring it to anticipate the possibility of civic disorder." Id. at *4. On that 

point, the ALJ noted that "[g]enerally, when an employer addresses safety hazards in the 

workplace, he is dealing with inanimate objects or processes over which he can exercise a 

certain degree of control. A difference regarding employees is that the employer now must 

deal with people, capable of volitional, deliberate acts." Id. at *26-*27. This was 

recognized as particularly true of "third pa11ies not in its employ," over which an employer 

has "even less control." Id. at *27. The ALJ went on to acknowledge the fundamental 

difference between criminal activity by third parties and types of hazards generally 

regulated via the general duty clause: 

The Secretary now asks employers to anticipate and 

prevent criminal behavior on the part of non-employees. 

Such behavior, while certainly hazardous to its victims, is 

completely different from any other hazards addressed by the 

Act. The hazard of physical assault in the present case arises 

not from the processes or materials of the workplace, but 

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Id. at *27-29. 

Page: 32 

from the anger and frustration of people. The anger and 

frustration may be fueled by drugs, alcohol, or mental health 

problems. But the assaults are intentional acts, deliberately 

committed by reasoning (though, perhaps, irrational) beings. 

Violence is, unfortunately, an all too common occurrence 

nowadays. It impacts upon all segments of society and is by 

no means limited to the workplace. While the threat of 

workplace violence is omnipresent, an employer may 

legitimately fail to recognize that the potential for a specific 

violent incident exists. It may reasonably believe that the 

institution to which society has traditionally relegated control 

of violent criminal conduct, i.e., the police, can appropriately 

handle the conduct. To validly assess an employer's actual or 

constructive knowledge of workplace violence, it must be 

acknowledged that violence occurs when an intellect actively 

seeks to cause it, that violence exists in society and may 

occur unpredictably, and that society empowers the police to 

control the conduct. For these reasons, a high standard of 

proof must be met to show that the employer itself 

recognized the hazard of workplace violence. It is not 

enough that an employee may fear that he or she is subject to 

violent attacks, even if that fear is communicated to the 

employer, and even if the employee is one whose knowledge 

can be imputed to the employer. Nor is it sufficient that there 

has been a previous injury from a violent incident. 

The reasoning of Megawest applies with equal force in the instant case. As 

recognized in that decision, the violent conduct of a third party is an inherently 

unpredictable act of a different nature than the hazards typically regulated under the 

general duty clause. Significantly, the ALJ presiding in Megawest concluded that such 

violent acts were not a "recognized hazard" notwithstanding the fact that the employees in 

that case had been subject to frequent threats and occasional physical attacks. Here, in 

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contrast, although there was testimony of isolated verbal threats by Members, the Secretary 

did not produce a scinti1la of evidence to suggest that any Service Coordinator suffered an 

actual workplace injury prior to the attack on Ms. on December 10, 2012. The record 

evidence does not support the ALJ's decision that physical assaults by Members 

constituted a recognized hazard within the scope of the general duty clause. More 

fundamentally, the basic observation underlying the Megawest decision, namely that 

violent criminal behavior by non-employees ''is completely different from any other hazard 

addressed by the Act,'' applies equally here. Id. at *28. Given the absence of a recognized 

hazard to support the citation, Citation One, Item One should have properly been 

dismissed. 

II. The evidence presented at the hearing does not support the ALJ's conclusion 

that the abatement measures proposed by the Secretary would have abated 

the hazard. 

Assuming arguendo that the risk of being physica11y assaulted by a Member 

constituted a recognized hazard, enforcement of Citation One, Item One must properly be 

denied due to the Secretary's failure to establish that the proposed abatement measures 

would have materially reduced the hazard. 

The Secretary's burden on this point has been described as that of specifying "the 

particular steps a cited employer should have taken to avoid citation, and to demonstrate 

the feasibility and likely utility of those measures." Nat'/ Realty & Constr. Co. v. OSHRC, 

489 F.2d 1257, 1268 (D.C. Cir. 1973). The Secretary failed to meet that burden in the 

instant case. 

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The sole witness offered by the Secretary to testify as to the efficacy of the 

abatement measures, Janet Nelson, acknowledged that she could not state that further 

training would reduce the Service Coordinators' potential exposure to violence.6 (Tr. 615-

16). Likewise, Ms. Nelson acknowledged that violent incidents could still occur even if 

the "buddy system" being utilized by Integra at the time of the incident were codified into 

a more formalized program. (Tr. 625). 

Perhaps most tellingly, Ms. Nelson acknowledged that as to one of the central 

abatement measures proposed by the Secretary, namely implementation of checks to 

determine the threat posed by new Members, she could offer only a "guess" regarding 

potential effectiveness: 

(Tr. 650). 

Q: In your opinion, does a risk - violence risk 

assessment, uh, does that decrease the incidence of 

workplace violence? 

A: I don't know statistics on that, but yes, the more 

information you have on what you're walking into, 

the better off you are. 

Q: (Nodding affirmatively). 

A: So I guess I would say yes. 

Ms. Nelson was similarly noncommittal when questioned c-0ncerning other 

proposed abatement measures: 

6 Ms. Nelson, the sole expert witness offered by the Secretary, acknowledged that she had 

never before been qualified as an expert, that she does not hold a doctoral degree and has 

not undertaken any doctoral studies or served as a faculty member at any institution of 

higher learning, and that her sole publications consist of a two-page newsletter article and 

self-published materials. (Tr. 563-67). 

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(Tr. 615). 

(Tr. 625). 

Page: 35 

Q: In your opinion, even though Service Coordinators 

are not clinicians, would more - more adequate, 

more, uh, appropriate safety training have made them 

less exposed to the workplace violence, risk of 

workplace violence? 

A: I don't know if they would be less exposed. They 

may be better able to assess -

Q: Hum-hum. 

Q: Are you saying that, uh, Integra should have required 

its Service Coordinators to always be partnered? 

A: No, no. Uh, I think given the population they're 

dealing with and because they have a paucity of 

information, that double teaming on an initial, uh, 

helps. Does that mean violence won't happen? It 

still could. It still could. 

Further, Ms. Nelson offered no statistical or other evidence as to the potential 

efficacy of any of the proposed abatement measures beyond her own conclusory 

statements.7 Such unsubstantiated generalizations are insufficient to support enforcement 

of a citation. See Champlin Petroleum Co. v. OSHRC, 593 F.2d 637, 640 (5th Cir. 1979) 

("It is the Secretary's burden to show that demonstrably feasible measures would 

materially reduce the likelihood that such injury as that which resulted from the cited 

hazard would have occurred."). 

7 Ms. Nelson was likewise unable to provide testimony concerning the extent to which the 

proposed abatement measures had been adopted in the industry. 

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Ill. Application of the general duty clause on the facts of the instant case would be 

unconstitutional due to the absence of fair notice to Integra. 

The general duty clause is unconstitutionally vague as applied in Citation One, Item 

One. The Supreme Court has recognized that "[A] statute which either forbids or requires 

the doing of an act in terms so vague that men of common intelligence must necessarily 

guess at its meaning and differ as to its applications violates the first essential of due 

process of law." Connally v. Gen. Constr. Co., 269 U.S. 385, 391 (1926). This is 

particularly applicable in the context of the broad language of the general duty clause, 

which raises "certain problems of fair notice." Donovan v. Royal Logging Co., 645 F.2d 

822, 831 (9th Cir. 1981). As stated in Donovan, "these problems dissipate" only when the 

clause is read .. as applying when a reasonably prudent employer in the industry would 

have known that the proposed method of abatement was required under the job conditions 

where the citation was issued." Id. 

The Decision's conclusion as to the enforceability of Citation One, Item One is 

wholly at odds with the principle recognized in Donovan. The record in no way suppo11s a 

contention that a "reasonably prudent employer" in Integra's position would have known 

that it was required to implement the proposed methods of abatement. To the contrary, the 

Secretary's own expert was unable to even identify how many employers in the 

community health industry use any of the abatement measures at issue. Instead, Ms. 

Nelson repeatedly couched her testimony as describing "best practices." (Tr. 616, 642-43, 

673, 722, 731). Whether a potential program or policy represents a "best practice" in an 

industry, however, is plainly a different matter entirely than the question of whether a 

reasonably prudent employer would have known the program to be required. Notably, the 

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Secretary offered no statistical evidence regarding the extent to which other employers 

have adopted the proposed abatement measures, nor did the Secretary introduce any other 

form of evidence from which it could be concluded that the safety programs utilized by 

Integra were below the standard of those used by other employers in the community health 

industry. In contrast, Integra's Medical Director, Dr. Krajewski, who has more than thirty 

years' experience as a physician with extensive experience in the community health field, 

testified that the training methods employed by Integra in 2012 were "above and beyond" 

the industry standard. (Tr. I 023-27). In elaborating on that point, Dr. Krajewski 

explained: 

(Tr. 1028). 

A: Well, because in a community you have that initial 

training period. For example, community mental 

health worker, peer support, specialists who are out 

there, they typically get the training right up front and 

they get a certificate that they've been trained. But 

there is very little training that occurs later on. It 

might be a once a month meeting - staff meeting that 

they can talk about. Our training that we had had 

weekly plus the on-site training plus the on call 

availability to continue to do training and answer 

questions immediately was no one bas that out 

there at all. 

Q: And you're talking about your particular industry? 

A: Yes. As far as I could tell, no one - no one had that 

out there. 

Finally, the unconstitutionality of the clause as applied in this case is demonstrated 

by the fact that the Review Commission has at no time in the past ever issued a decision 

holding an employer to be in violation of the general duty clause based on its failure to 

prevent a criminal act by a third party of the type at issue in this case. Underscoring this 

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point, in the course of its investigation OSHA designated this matter as a "novel" case. 

(Tr. 227-28). 

Viewed in their totality, these circumstances dictate that a reasonably prudent 

employer in Integra' s position would not have known that the Act required the adoption of 

the methods of abatement identified in Citation One, Item One. Given that fact, the 

general duty clause, as applied in this case, is unconstitutionally vague. 

IV. In the alternative, this case must be remanded for a new hearing due to the 

ALJ's consideration of evidence outside the record. 

Assuming arguendo that the Commission were to conclude that the general duty 

clause is applicable to the facts of this case, and that the Secretary has produced evidence 

capable of supporting the existence of a recognized hazard and the feasibility of abatement, 

this case must nevertheless be remanded for a new hearing in light of the ALJ's decision to 

independently seek out and consider evidence outside the record in evaluating the 

credibility of Integra' s chief witness. 

One of Respondent's primary witnesses at the hearing was Dr. Melissa Arnott, 

lntegra's Vice President of Community Programs. Dr. Arnott, along with Dr. Krajewski, 

developed the core curriculum for the online Neumann training program in which the 

Service Coordinators participated and oversaw other training programs provided to the 

Service Coordinators. Her testimony concerning the nature of the Service Coordinator 

position and Integra's training programs dealt with core issues central to the Decision. 

Notwithstanding Dr. Arnott's nearly twenty-five years in working with the mental 

health community, the ALJ chose to largely ignore her testimony, and in doing so 

explicitly relied on information outside the scope of the record. In discussing Dr. Arnott's 

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educational background, the ALJ indicates that he engaged in some form of outside 

research concerning the school from which Dr. Amott received her doctoral degree: 

On November 8, 1991, the University of Sarasota, Inc. filed 

a voluntary bankruptcy petition No. 8:91-bk-14551-TEB 

under Chapter 11 in the United States Bankruptcy Court, 

M.D. FK. A plan was confirmed on April 8, 2002. Dr. 

Amott's resume shows that she worked in Pennsylvania 

from the time she was awarded her Master's degree in 1995 

through 2004, the year she was awarded her Doctorate 

degree in Florida, suggesting most of the work for her 

Doctorate degree was done off campus. In at least one 

instance, the University of Sarasota has been seen as a "nontraditional" university and had its doctorate programs called 

into question. See No. 78-2294, Dr. John Gullo v. Fla. Bd. 

Of Exam 'r of Psychology, 1979 WL 63236 (Fla. Div. Admin. 

Hrgs, Jwie 28, 1979 (noting that University of Sarasota does 

not have an accredited degree program that would qualify the 

plaintiff to sit for the board examination for certification). 

Decision at 22 n.36. 

Immediately after setting forth this infom1ation - which was not the subject of any 

testimony or other evidence at the hearing - the ALJ states that: "The Court is crediting Dr. 

Amott's Doctorate degree in counseling education with weight less than that accorded a 

similar degree awarded following completion of a full-time, resident study program taken 

over the course of several years at a traditional university with a suitable accredited 

program." Id. 

The ALJ thus explicitly relied upon information outside of the record, concerning 

an issue not raised by either party, in determining the weight given to Dr. Arnott's 

testimony. Compowiding this error, the sole authority cited by the ALJ concerning the 

purported deficiency of Dr. Arnott's alma mater was an administrative decision made a full 

25 years before Dr. Arnott obtained her degree. Id. 

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It is a basic principle of administrative law that a party is entitled to respond to the 

evidence against it and that the decision is to be made on the evidence in the record. See, 

e.g., Butz v. Economou, 438 U.S. 478, 513 (1978) ("[F]ederal administrative law requires 

that agency adjudication contain many of the same safeguards as are available in the 

judicial process. . . . A party is entitled to present his case by oral or documentary 

evidence, and the transcript of testimony and exhibits together with the pleadings 

constitute the exclusive record for decision.") (internal citation omitted); United States v. 

Abilene & S. R. Co., 265 U.S. 274, 288 (1924) ("Nothing can be treated as evidence which 

is not introduced as such."); id at 289 ("The objection to the use of the data contained in 

the annual reports is not lack of authenticity or untrustworthiness. It is that the carriers 

were left without notice of the evidence with which they were, in fact, confronted, as later 

disclosed by the finding made. The requirement that in an adversary proceeding specific 

reference be made, is essential to the preservation of the substantial rights of the parties."); 

Crowe// v. Benson, 285 U.S. 22, 48 (1932) ("Facts conceivably known to the deputy 

commissioner, but not put in evidence so as to pem1it scrutiny and contest, will not support 

a compensation order."). 

lntcgra was severely prejudiced by the ALJ's decision to consider matters outside 

the record in this respect, as it was deprived of any opportunity to respond to questions 

conceming the quality of Dr. Arnott's educational credentials, which were not the subject 

of any argument or dispute by the Secretary. The ALJ subsequently used this information, 

never before raised or addressed by either party, to make a detem1ination as to the weight 

to be given to the testimony of the individual most directly involved with Integra's tsaining 

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programs for its Service Coordinators. The ALJ's acts on this point warrant setting aside 

the Decision. 

V. The facts of this case do not support the ALJ's classification of Citation One, 

Item One as a serious violation. 

The Decision classifies Citation One, Item One as a serious violation. Assuming 

arguendo that the Commission were to affirm the ALJ's conclusion that the general duty 

clause was violated, such violation cannot properly be classified as a serious violation as 

that term is defined in the Act. 

With regard to classification of violations, the Act provides: 

For purposes of this section, a serious violation shall be 

deemed to exist in a place of employment if there is a 

substantial probability that death or serious physical harm 

could result from a condition which exists, or from one or 

more practices, means, methods, operations, or processes 

which have been adopted or are in use, in such place of 

employment unless the employer did not, and could not with 

the exercise of reasonable diligence, know of the presence of 

the violation. 

See 29 U.S.C. § 666(k) (emphasis added); see also Landcoast Insulation, Inc., 23 BNA 

OSHC 1168, 2010 OSAHRC LEXIS 59 at *14 (No. 09-0625, 2010) ("A 'serious' violation 

under § 17(k) of the Act is established if there is a substantial probability of death or 

serious physical harm that could result from the cited condition and the employer knew or 

should have known with the exercise reasonable di1igence of the presence of the 

violation."). 

For the reasons discussed supra, Integra did not know (and could not reasonably be 

expected to know) that it was in violation of the Act. The Review Commission has never 

previously concluded on facts even remotely analogous to the instant case that an 

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employer's failure to prevent violent, criminal acts by third parties constituted a violation 

of the Act. Further, the Secretary presented no evidence at the hearing as to any existing 

standard - in the community health industry or any other industry - with regard to use of 

the proposed methods of abatement so as to suggest that Integra was operating below 

industry standards and should have known that its failure to utilize those abatement 

measures would be deemed to be a violation. 

CONCLUSION 

For the reasons discussed supra, Integra Health Management, Inc. respectfully 

requests that the Commission reverse the ALJ's decision in the instant case and deny 

enforcement of Citation One, Item One. 

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CERTIFICATE OF SERVICE 

I hereby certify that on this 27th day of October, 2015, a copy of the foregoing 

Brief was served via first-class mail to: 

Charles F. James, Counsel for Appellate Litigation 

Heather R. Phillips, Counsel for Appellate Litigation 

Office of the Solicitor, U.S. DOL 

Room S4004 

200 Constitution Ave., NW 

Washington, D.C. 20210 

Pursuant to an agreement with the counsel for the Secretary, a copy of the 

foregoing Brief was also served via email to Grabel.Lee@dol.gov. 

2157383 

Kevin C. McCormick 

Whiteford, Taylor & Preston, L.L.P. 

7 Saint Paul Street, Suite 1800 

Baltimore, Maryland 21202 

(410) 347-8700 

kmccormick@wtplaw.com 

Counsel for Petitioner, 

lntegra Hea/Jh Management, Inc.