, 	 , ,1 

U.S. D~partment of La'. Office of the Solicitof 

Atlanta, 

61 FOfsyth 

Geofgia 

Stfeet 

30303 

SW 

•

July 11.2013 

Me. Ray H. Darling, Jr, 

Executive Secretary 

Occupational Safety and Health 

Review Commission 

One Lafayette Centre 

1120 20th Street, N.W., Room 980 

Washington, DC 20036-3419 

Re: 	 Secretary of Labor v. Integra Health Management, Inc. 

OSHRC Docket No. . Region IV 

Inspection No, 781282 i3-1I"Z. 'f' 

SOL Case No. 13-00965 

Dear Mr. Darling: 

Enclosed are the originals and one copy each of a Complaint and a Notice of Answer 

Requirement. 

Please file the originals and return to us the conformed copies. In our opinion, this ease is not 

appropriate for simplified proceedings as it involves a fatality. 

You will note from the Certificate of Service that copies of these documents have been served on 

the representative for Respondent. 

Very truly yours, 

Enclosures 

cc: 	 Kevin C. McCormick, Esq. 

Whiteford, Taylor & Preston LLP 

Seven Saint Paul Street 

Baltimore, MD 21202-1636 

Working for America's Workforce 
•
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IMPORTANT NOTICE 

You are hereby notified that you must plead or otherwise answer this Complaint, 

either denying or admitting each allegation, within 20 days of your receipt of the Complaint 

attached hereto. Failure to do so may result in dismissal of your notice of contcst. See Rule 34, 

Rules of Procedure, Occupational Safety and Health Review Commission. 

Prior to the assignroent of a case to Judge, the answer and all subsequent 

pleadings should be filed with the Executive Secretary, Occupational Safety and Health Review 

Commission, One Lafayette Centre, 1120 20th Street, N.W" Room 980, Washington, DC 20036­

3419, Subsequent to the assignment of the case to a Judge, and before the issuance of a decision, 

all pleadings should be filed with the Judge at the address given in the notice informing of such 

assignroent. See Rule 8(a), Rules of Procedure, Occupational Safety and Health Review 

Commission. 

The Complainant, Secretary ofLabor, may be served by addressing 

Mr. Stanley E, Keen, Regional Solicitor, U. S, Department of Labor, Sam Nunn Atlanta Federal 

Center, 61 Forsyth Street, S.W., Room 7T10, Atlanta, GA 30303, Attention: Jeremy K. Fisher, 

Attorney. 

Ifthe Respondent is to be represented in this proceeding by an attorney or other 

representative, the attached Designation of RepresentativelNotice of Appearance form should be 

completed and sent to the Regional Solicitor at the aforementioned address. 
. . '

•

u.s. Department of Labor Office ot !he Solicitor 

•

61 Forsytl1 Street SW 

Ananta. Georgia 30303 

Re: Secretarv of Labor v, Integra Health Management, Inc, 

OSHRC Docket No, ; Region IV 

Inspection No, 781282 

SOL Case No. 13-00965 

DESIGNATION OF REPRESENTATIVE 

I hereby certify that ..........~~. , whose appearance is noted below, is 

authorized to act as my representative in the above-captioned matter, to discuss all facts and 

information related thereto; to negotiate settlement; and 10 accept service of pleadings and other 

legal process on my behalf. 

Name (Print): _________ Date: ....._ ..._----­

Title: _________________-:-:_______ 

Signature 

Employer/Organization: _________...._ , _______ 

Nature ofOrganization: _____________________ 

Address: ________________________ 

--:-,------:::------------......­

Telephone: C'--'-)_"-__~E~xt~,___ 

NOTICE OF APPEARANCE 

The undersigned hereby enters appearance as representative of 

______________ in the above-captioned matter, 

Name (Print): _________ Date: 

Title: 

Signature 

Employer/Organization: _ ..._____.... 


Nature of Organization: 


Address: 


Telephone: ( ) Ext. 

Working[or Americll \' Worliforce 
. ' , ,

• • 


UNITED STATES OF AMERICA 

OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION 

SECRETARY OF LABOR, ) OSHRC DOCKET NO. 

) 

Complainant, ) REGION IV 

) 

v. ) Inspection No. 

) 781282 

INTEGRA HEALTH MANAGEMENT, INC., ) 

) 

) 

Respondent. ) COMPLAINT 

This action is brought to affinn the Citations and Notifications of Penalty issued 

under the Occupational Safety and Health Act of 1970, 29 U.S.C. § 651, et seq., hereinafter the 

Act, for violations of § 5(a) of the Act and the Safety and Health Regulations promulgated 

thereunder. 

I 

Jurisdiction ofthis action is conferred upon the Commission by § IO(c) ofthe 

Act. 

II 

Respondent, Integra Health Management, Inc., is an employer engaged in a 

business affecting commerce within the meaning of § 3(5) ofthe Act. 

III 

The principal place of business of Respondent is at 10055 Red Run Boulevard, 

Suite lOS, Owings Mill, Maryland 21117, where it was engaged in miscellaneous ambulatory 

health care services as of the date of the alleged violations. 
. " e', • , . IV 

The violations occurred on or about December 10,2012, at 37020 Coleman 

Avenue, Apt. #1, Dade City, Florida 33525 (hereinafter "workplace"). 

V 

As a result of an inspection at said workplace by an authorized representative of 

the Complainant, Respondent was issued two Citations and Notifications of Penalty pursuant to 

§ 9(a) of the Act. 

VI 

The Citations and Notifications of Penalty, copies of which are attached hereto 

and made a part hereof as Exhibit A (consisting of three pages) and Exhibit B (consisting of 1 

page) identifies and describes the specific violations alleged, the corresponding abatement dates, 

fixed, and the penalties proposed. 

VII 

On or about June 25, 2013, by a document dated June 25, 2013, the Complainant 

received notification, pursuant to § \O(c) of the Act, of Respondenfs intention to contest the 

aforesaid Citations and Notifications of Penalty. 

VIII 

The penalties proposed, as set forth in Exhibits A and B are appropriate within the 

meaning of § 17(j) of the Act The abatement dates fixed were and are reasonable. 

WHEREFORE, cause having been shown, Complainant prays for an Order 

affirming the Citations and Notifications of Penalty, as aforesaid. 

2 

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ADDRESS: 

Office of the Solicitor 

U. S. Department of Labor 

61 Forsyth Street, S.W. 

Room 7T10 

Atlanta, GA 30303 

Telephone: 

(404) 302-5476 

(404) 302-5438 (FAX) 

SOL Case No. 13-00965 

• 


M. PATRICIA SMITH 

Solicitor of Labor 

STANLEY E. KEEN 

Regional Solicitor 

Office of the Solicitor, 

U. S. Department of Labor, 

Attorneys for Complainant. 

3 

U.S. Department of Labor Inspection Number: 781282 

Occupational Safety and Health Administration Inspection Date{s): 1211312012 - 0311112013 

Issuance Date: 06/06/2013 

Citation and Notification of Penalty 

Company Name: Integra Health Management, Inc. 

Inspection Site: 37020 Coleman Ave. Apt. #1, Dade City, FL 33525 

Citation 1 Item 1 Type of Violation: Serious 

aSH ACT of 1970 Section (5)(a)(I): The employer did not furnish employment and a place of 

employment which were free from reco gnized hazards that were causing or likely to cause death or 

serious physical harm to employees, in that employees were exposed to the hazard of being physicall y 

assaulted by members with a history of violent behavior: 

a) On or about December 10, 2012, an employee providing healthcare management services was 

fatally stabbed by a member with a violent criminal history. Employees acting as service coordinators 

regularly interacted on their own directly with members with a history of violent behavior. 

Among other methods, feasible means to abate this hazard include: 

1. 	 Create a stand-alone written Workplace Violence Prevention Program for all the service 


programs which include the following elements: 


• 	 A Workplace Violence Policy Statement including responsibilities of all staff and a 

policy that workplace violence will not be tolerated and every incident will be 

investigated; 

• 	 Implement a real-time log-inllog-out system; 

• 	 Hazard/Threat/Security assessment including records review, employee survey, and 

evaluation of the worksite for safe means of egress and potential restrictions; 

• 	 Training and education of all staff with a focus on the specifics ofthe Integra Program; 

• 	 Incident reporting and investigation; 

• 	 A system for reporting safety concerns internally; 

• 	 Periodic review of.the program; 

• 	 Ensuring employee involvement and input from direct care staff in all aspects of its 

Workplace Violence Prevention Program; 

• 	 Soliciting employee input from direct care staff from all parts oflntegra's operation; and 

• 	 Having a Safety Committee that includes direct care staff as full committee members. 

See pages I through 4 or lhis Citatlon and Notification ofPellalty for inmnnalion on employer and employee rights and responsibilities. 

Citalion and Notification of Penalty Page 6 of II 

EXHIBIT_--L-A-,--_oS_HA_.2__ 

0 
.~. 

U.S. Department of Labor Inspection Number: 781282 

Occupational Safety and Health Administration Inspection Date(s): 1211312012 - 03/1112013 


Issuance Date: 06/0612013 


Citation and Notification of Penalty 

Company Name: Integra Health Management, Inc. 


Inspection Site: J7020 Coleman Ave. Apt. # j, Dade City, FL 33525 


2. 	 Determine the behavioral histo!)' of new/transferred member; establish a system - such as chart 

tags, log books, and/or verbal census reports - to identify members with assaultive behavior 

problems (including threats ofviolence) and to communicate such pertinent information to all 

potentially exposed employees; train all staff to understand the flagging system; and have a 

system for holding members accountable for violent behavior through consequences or 

interventions. 

3. 	 Put procedures in place that would communicate any incident of workplace violence to all staff 

who could potentially be exposed to the member(s) involved in the violent incident in a timely 

manner, so that employees who might not have access to members' charts would be aware of a 

member's previous acts of violence or aggression. 

4. 	 Ensure that training is sufficient to make all employees aware of the company workplace 

violence policy, and how that written policy can be accessed. Training shall also include, but 

not be limited to: 

• 	 Instructing all employees to state clearly to members and employees that violence is not 

permitted or tolerated; 

• 	 Training all employees on effective methods for responding during a workplace violence 

incident; 

• 	 Training all employees on recognizing aggressive behavior exhibited by members or 

others, and on techniques for timely de-escalating the behavior; 

• 	 Instructing all employees about risk factors that cause or contribute to assaultive 

behaviors (including threats ofviolence); 

• 	 Training all employees to report all incidents of workplace violence, including assaults 

and threats of assaults, and instructed that such reporting is mandatory; and 

• 	 Training shall be conducted at orientation before employees are exposed to members, 

and annually as refresher training. 

5. 	 Implement and maintain a buddy system as appropriate based upon a complete hazard 

assessment which includes procedures for all statfto request and obtain double coverage when 

necessary, including but not limited to situations where an employee communicates that he or 

she feels unsafe being alone with a particular member. 

See pages I through 4 of this Citlltion and Notificelion of Penalty for information on employer and employee rights and responsibiHHes. 

CHalion and NOlitTcation of Pemdry Page 7 onl OSHA-2 

1 
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U.S. Department of Labor Inspection Number: 781282 

Occupational Safety and Health Administration Inspection Date(s): 12113/2012 - 0311112013 


Issuance Date: 06/0612013 


Citation and Notification of Penalty 

Company Name: Integra Health Management, Inc. 


Inspection Site: 37020 Coleman Ave. Apr. Ill, Dade City, FL 33525 


6. 	 Provide all staff with a reliable way to rapidly summon assistance when needed, such as an 

electronic alarm andlor walkie-talkies, including when an employee is with a member in the 

community and/or transporting II member in a vehicle. 

7. 	 Establish a liaison with law enforcement representatives. 

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM 

Date By Which Violation Must be Abated: 06/1412013 

Proposed Penalty: $7000.00 

See pages I through 4 of this Citation and Notification ofPenBlty for information on employer and employee rights and responsibilities. 

Citation and Notification or Penalty Page 8 of II OSHA-2 
•• 

U.S. Department of Labor 	 Inspection Number: 781282 

Occupational Safety and Health Administration 	Inspection Date(s): 12/13/2012 - 03/1112013 

Issuance Date: 06106/2013 

Citation and Notification of Penalty 

Company Name: Integra Health Management, Inc. 


Inspection Site: 37020 ColemallAve. Apt. #1, Dade City, FL33525 


Citation 2 Item I Type of Violation: Other-than-Serious 

29 CFR 1904.39(a): 

The employer did not orally report the death of an employee or the in-patient hospitalization of three or 

more employees because of a work-related incident: 

a. 37020 Coleman Avenue Apartment I Dade City, Florida - the employer failed to report a workrelated fatality to OSHA. Violation observed on or about 12/13/12. 

Date By Which Violation Must be Abated: 06/10/2013 

Proposed Penalty: $3500.00 

Leslie L. Grove III 

Area Director 

See pages I through 4 of this Citation Alld Nolification of Penally For inFonunlion on employer and employee rights and responsibilities. 

Citation and Notification of Penalty Pagc90FII 

EXlllBIT___-,~~--0_sH_A_-2-- ,t;2 1 
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CERTIFICATE OF SERVICE 

I certify that the foregoing Complaint and Notice of Answer Requirement were 

served this Iithday of July, 2013, by mailing true copies thereof, by certified mail to: 

Kevin C. McCormick, Esq. 

Whiteford, Taylor & Preston LLP 

Seven Saint Paul Street 

Baltimore, MD 21202-1636 

SOL Case No. 13·00965