DECISION AND ORDER
This proceeding is before the Occupational Safety and Health Review Commission
(Commission) pursuant to sections 2-33 of the Occupational Safety and Health Act of 1970, 29
U.S.C. §§ 651-678 (OSH Act). Following a fatality-related safety and health inspection, the
Occupational Safety and Health Administration (OSHA) issued two citations to Integra Health
Management, Inc. (Integra or Respondent), alleging a violation of section 5(a)(1) (the general
of the OSH Act and a violation of OSHA’s reporting standard. Integra filed a
timely notice of contest, bringing this matter before the Commission. A hearing was held in
Tampa, Florida from May 6 to May 9, 2014. Both parties filed post-hearing briefs and post-hearing reply briefs. For the reasons set forth below, the Court affirms both citations.
Integra admits that, as of the date of the alleged violations, it was an employer engaged in
business affecting commerce within the meaning of section 3(5) of the OSH Act. (Answer at ¶¶
II, III). Based upon the record, the Court finds that at all relevant times Integra was engaged in a
business affecting commerce and was an employer within the meaning of sections 3(3) and 3(5)
of the OSH Act. The Court concludes that the Commission has jurisdiction over the parties and
subject matter in this case. (Answer at ¶ I, where Integra admits jurisdiction).
The parties stipulate to the following facts:
Integra, based in Owings Mills, Maryland, performs mental and physical health
assessments and coordinates case management via contracts with various
insurance companies. These assessments are performed by employees known as
“community service coordinators.” Integra performs these services in four states:
Tennessee, Pennsylvania, Maryland, and Florida. There are no company offices in
Florida; service coordinators work from their homes or in the field. The Integra
service coordinator program focuses on helping clients receive appropriate medical
care. Service coordinators are assigned a caseload of clients and are responsible for
calling them and for face to face meetings during which the clients are assessed and
encouraged or persuaded to register for services. Insurance companies apparently
refer these clients to companies such as Integra due to chronic difficulties in
contacting them. Many of the clients suffer from mental
On December 13, 2012, an inspection was initiated when the OSHA Tampa Area
Office received an anonymous phone call reporting a workplace violence fatality.
Three days earlier, on December 10, 2012, [redacted], an Integra service
coordinator, was fatally stabbed by a mentally ill client. The victim was meeting the
assailant at his house for a required face to face visit to conduct an initial
(Jt. Pre-Hr’g Statement, at p. 8).
Integra provides mental and physical health assessments and coordinates healthcare/case
management services. It is hired by insurance companies to help their insureds avoid hospital
admissions and emergency room visits. Integra has about 62 employees. On December 10,
2012, one of its employees, [redacted], went to work. She was a newly- hired Integra Service
Coordinator (SC) working out of the Tampa, Florida branch. She was 25 years old, and had
about three months on the job. She had no prior experience in the community health or social
worker industries. [redacted] had a virtual office consisting of her home in Lakeland, Florida, a
computer, a phone, and her car. In the morning on December 10, [redacted] took and received
phone calls. She then drove out into “the field,” to Apartment 1, 37020 Coleman Avenue, Dade
City, Florida, to make an unscheduled visit to [redacted], age 53. (Tr. 88, 198, 248, 1064-65;
Exs. C-5, at p. 8, C-6, at p. 3, C-8, C-27, at p. 2, R-P, at p. 1, R-T, at p. 3, R-GG, R-LL; Jt. Pre-Hr’g Statement, at p. 8).
Mr. [redacted], a diagnosed schizophrenic, was on [redacted]’ list of clients, called
“members,” for which she was responsible.
[redacted] had a history of violent behavior. He
had been convicted of violent crimes and incarcerated for many years.
This history of violent
behavior was not reported by anyone to [redacted] when [redacted] was assigned to her.
[redacted] attempted to contact [redacted] by telephone on September 9, September 16, and
September 23, 2012. These three attempts were unsuccessful because [redacted] could not locate
a valid telephone number for [redacted]. (Tr. 136-41, 270-75, 356-57).
The first time [redacted] visited [redacted], on October 12, 2012, she went to his house
unannounced, introduced herself and Integra, and arranged a return visit for October 15, 2012 to
conduct an initial assessment. [redacted] reported in her progress note report for that day that
during their conversation, [redacted] “said a few things that made SC [[redacted]] uncomfortable,
SC asked member to be respectful or she would not be able to work with him.” She also
documented in her progress note report that “[b]ecause of this situation, SC is not comfortable
being inside alone with member and will either sit outside to complete assessment or ask another
SC to accompany her.”
(Tr. 136-43, 273-75, 356-59; Exs. C-7, C-25, R-KK at pp. 73, 77, R-MM).
A few days later, on October 15, 2012, [redacted] arrived at [redacted]’s house for their
appointment at about 2:45 p.m. When she presented him with the Integra “Consent to Receive
Services” form to sign that would give Integra his consent to provide him with services,
[redacted] refused and told [redacted] that he would not sign anything without his case manager
He then pointed to a picture of The Last Supper, crediting it to Michelangelo,
stated that Jesus was his father and that he and other people in his community, including a
waitress, were also in the picture. [redacted] noted in her progress note report that she planned to
meet again with [redacted] the following week to schedule an appointment with him, Ms. Jones,
and herself. On October 15, 2012, Ms. Rochelle approved [redacted]’ October 15, 2012 progress
(Tr. 149-50, 280, 297, 360-62; Exs. C-7, at p. 6, R-EE, at p. 2, R-KK at p. 78).
On November 2, 2012, Dr. Arnott sent [redacted] an email identifying [redacted] as a
member missing a consent form. Later that day, [redacted] sent Dr. Arnott an email response
saying: “[redacted] refused to sign a consent unless his case manager was present. I am working
on that situation, but he has not been entirely cooperative in setting an appointment and does not
have a phone.” Shortly thereafter, Dr. Arnott responded: “Can you contact the CM [Case
Manager] and introduce yourself and our services and possibly schedule to go see the member
with the CM. Sounds like the member trusts the CM.” Minutes later that same day, [redacted]
responded by email and informed Dr. Arnott that she had “been in contact with his CM and she
was willing to meet, but the member would not agree on a date. There is a note on it. I will
probably just schedule a time with her and show up unannounced at his house.” (Ex. R-EE).
On November 14, 2012, [redacted] returned unannounced to [redacted]’s house at about
2:05 p.m., without his case manager, Ms. Jones, present. During this meeting, [redacted] initially
told [redacted] that he was not [redacted], and that he was actually his twin brother. He then
admitted to being himself. [redacted] agreed to sign the consent form without his case manager
[redacted] brought a chair outside so [redacted] could sit and the two spoke for about
twenty minutes. He also told [redacted] to “get a cowboy hat and go to a rodeo.” They set up a
meeting for November 26, 2012 for [redacted] to return to conduct the initial assessment.
one from Integra’s management approved [redacted]’ November 14, 2012 progress note report.
(Tr. 150-52, 189, 363-65; Exs. C-7 at p. 7, C-8, at p. 9, R-KK, at p. 79).
On November 26, [redacted] arrived at [redacted]’s house to conduct the initial
assessment, but [redacted] was not at home. She left a note on his door. No one from Integra’s
management approved [redacted]’ November 26, 2012 progress note report. (Tr. 152, 189; Exs.
C-7 at pp. 7-8, R-KK, at pp. 79-80).
On her final December 10, 2012 visit, [redacted] had still to assess [redacted] and his
The assessment was never completed by [redacted].
Instead, during her unscheduled
visit to his home, [redacted] attacked [redacted] at 12:45 p.m., and stabbed her about 9 times,
reportedly with a butcher knife. She attempted to run away, but [redacted] chased her while
stabbing her repeatedly. He then went inside his house, leaving her mortally wounded on his
front lawn. A passerby saw [redacted] lying on the ground, and drove her to Pasco Regional
Hospital, where she died of her wounds at 1:30 p.m. [redacted] was arrested, incarcerated and
charged with murder in the first degree, a capital felony, but on about May 3, 2013 was found
mentally/physically unable to stand trial before the Florida state criminal court. (Tr. 152-55, 365-66; Exs. C-5 at p. 1, C-6, at p. 3, C-8, R-P, R-T).
On Monday, December 10, 2012 at about 7:05 p.m., OSHA received an anonymous
telephone call reporting a fatality in Dade City, Florida. The OSHA Duty Officer followed up
the tip and prepared an OSHA Fatality/Catastrophe Report (OSHA Fatality Report) on about
December 12, 2012 that described the circumstances surrounding [redacted]’ death.
Prymmer investigated the claim by interviewing Integra officials and employees,
CO Prymmer followed OSHA’s workplace violence directive as guidance and
consulted with the OSHA regional office in Atlanta, Georgia as to what questions he should ask
Integra employees to get pertinent information. CO Prymmer interviewed several Integra
representatives, management and non-management, including many SCs, face-to-face, over the
telephone, and via e-mail. He learned about Integra’s business model, the role of the SCs, and
Integra’s approach to safety in the workplace. He also investigated [redacted]’ role specifically,
and the circumstances surrounding her death. (Tr. 81-155; Exs. C-3, C-4, C-33; Jt. Pre-Hr’g
Statement, at p. 8).
As a result of the OSHA investigation, the Secretary issued Integra two citations alleging
violations of the OSH Act. The Secretary alleged that Integra committed a serious violation of
the general duty clause because Integra employees “were exposed to the hazard of being
physically assaulted by members with a history of violent behavior.”
The Secretary asserted
that, as illustrated by the stabbing on December 10, 2012, Integra did not furnish employment
and a place of employment which were free from recognized hazards that were causing or likely
to cause death or serious physical harm to employees because Integra “service coordinators
regularly interacted on their own directly with members with a history of violent behavior.” For
this serious citation item, the Secretary proposed a $7,000 penalty. (Tr. 346; Exs. C-1, C-6, at
The Secretary also cited Integra for an other-than-serious violation of 29 C.F.R.
§ 1904.39(a) because Integra failed to timely report [redacted]’ death to OSHA.
(Ex. C-1, at p.
9). The Secretary proposed a $3,500 penalty for this citation item. (Ex. C-1, at p. 9). Integra
claimed in its Answer that it did not violate the general duty clause because its “existing
procedures meet or exceed the general industry standards concerning the events that lead to the
events referenced in the citations.”
(Answer, at ¶ IX).
Hiring requirements for Integra SCs included a bachelor’s degree, and at least one year of
experience in the field of Behavioral Health was desired.
Integra also looked for “individuals
who have particular characteristics and traits that … are indicative of their ability to relate to
people, to engage in conversation, to … help them be accepted as a coach in essence.” (Tr. 98,
104-05, 590, 758; Exs. C-9, C-10).
At the time of her death, [redacted] had just recently graduated from the University of
South Florida with a degree in psychology. She was enrolled in a program to get a teaching
certificate to be a teacher. She had no previous experience working with the mentally ill and had
no previous experience or certifications in social work. She had never had a job where she
visited people at their homes. Despite this lack of experience, [redacted] was hired, according to
her team lead at the time, because of “that heart that she wanted to help others.” CO Prymmer
testified that during the course of his investigation he learned that [redacted] was very motivated,
wanted to do a good job, and wrote good progress note reports. (Tr. 105, 136, 199, 248-49; Ex.
R-KK, at pp. 82, 84).
[redacted]’ job as an Integra SC was to coordinate community resources for Integra
“members.” These members were people that had been identified by the member’s insurance
company as those who incurred high costs associated with emergency room care and in-patient
hospitalization. These members had a history of non-compliance with their medical orders – i.e.,
they were failing to fill their prescriptions, or they were failing to schedule or show up to their
doctor’s appointments. Insurance companies, and in this case, Amerigroup, contracted with
Integra to address these “gaps in care.” For example, a gap in care would be when a diagnosed
diabetic did not get retinal eye examinations. “That would be something a health plan would
know about because they have seen claims come in with a diagnosis of diabetes and they’re not
seeing claims come in for these lab tests.” Integra and Amerigroup entered into a contract, with
the possibility of annual renewal, to address these “gaps in care” and achieve a cost-savings goal
for the insurance company. (Tr. 87, 270, 755-56, 772, 786, 1017-18).
Integra’s approach to fulfilling its end of the contract was to personally find these non-compliant members, determine what obstacles prevented them from following doctor’s orders,
and connect them with community resources that would empower them to get back on track,
medically. Obstacles that the member might be facing may be traced back to a lack of basic
needs being met. Many of these members were not getting food, clothing or shelter, preventing
them from even thinking about medical care. Integra SCs, described as “feet on the street,”
would personally contact these members and help them with their basic needs, “as a family
member might,” so that they could eventually address their medical needs. Along with a salary,
SCs got a $350 monthly gas allowance for using their own personal cars to meet, visit, and
handle members. SCs were expected to personally drive, in their privately owned vehicle,
members to doctor’s appointments. (Tr. 315, 418, 438, 453, 757, 779, 896, 926-27).
Integra asserted that Amerigroup “typically” sent Integra background information about
potential members before Integra assigned a member to a SC that included the following: 1)
member’s name, address and telephone number, 2) name of primary care physician, 3) primary,
secondary and tertiary diagnosis, 4) prescriptions and their costs, 5) substance abuse and mental
health conditions, 6) name of health plan case manager, 7) number/cost of inpatient behavioral
health admissions, 8) number/costs of Emergency Room admissions, and 9) total medical costs
per member per month. Integra supposedly transmitted this information to the SC team lead in
Tampa, who assigned each SC approximately 35-38 members for which they were responsible.
The team lead assigned members to SCs based on geographic location, for “geographic and
scheduling efficiencies;” and not by member risk. When assigned a new member, the record
shows that SCs sometimes might have only a member’s residence address and a telephone
number if one was available. (Tr. 87-88, 127-28, 254-55, 315, 915-16; Ex. C-28, at pp. 12-14,
Resp’t Answers to Sec’y First Set of Interrogatories).
For each member, Integra required the SC make two telephone contacts and two face-to-face contacts, per month. SCs were also required to personally visit with any member admitted
to a hospital within seven days. The SC first had to obtain a consent form signed by the member,
because Integra would be working with the member regarding his or her health. Integra then
required SCs to complete a written health “Needs Assessment” of the member during a follow-on
face-to-face meeting within 30 days of obtaining the consent form. The Needs Assessment
included topics such as the member’s health, daily activities including bathroom habits, legal and
criminal history, substance abuse, and medications. To complete the Needs Assessment, the SC
asked the member questions and transcribed the member’s answers “in real-time during the face-to-face.” Using the Needs Assessment as a baseline, the SC developed a service plan to meet the
health, social, and community care management needs of the member with the goal to preempt
members from unnecessary hospitalizations. All interactions with members were documented in
progress report notes that were recorded and uploaded into Integra’s electronic database, called
ServiceConnect, for the team lead to review and ultimately approve.
Integra’s services were
measured based on whether it was saving Amerigroup money by reducing unnecessary
hospitalizations. (Tr. 87-96, 250, 255, 351-52, 1017-18; Exs. C-8, C-34).
Jason Prymmer, OSHA CO. CO Prymmer testified that Integra conducted a program in
Florida where SCs coordinated heath care related services for mentally and/or physically disabled
members. Most members were severely mentally ill, with maladies including bipolar disorder
and schizophrenia. Most members also had criminal backgrounds.
Many were substance
abusers. CO Prymmer testified that Dr. Arnott told him during a face-to-face interview that
when [redacted] was killed Integra did not: 1) have a workplace violence prevention program, 2)
perform criminal background checks on members, and 3) identify “high risk groups” before
assigning SCs their individual caseload.
Integra did not require SCs to perform their own
background checks on members. He testified that Integra was paid “based on the two phone calls
and two face-to-face visits and the … seven-day period hospital readmission.” Integra’s SCs
helped members schedule medical and social services appointments, drive members or arrange
for travel to their appointments, and assisted them in completing paperwork. SCs were required
to “track down” and visit with the many members who did not have telephones. Members
generally lived in publicly provided housing located in “high crime neighborhoods.” SCs often
met with members alone in areas off the beaten path, in areas where the general public could not
see them; e.g. trailer parks, government housing projects, and high crime areas.
Integra had no
office in Florida. SCs worked out of their homes and privately owned vehicles, and drove out to
members’ residences. (Tr. 87-93, 109-10, 127-28, 134-35, 177, 786; Exs. C-8, R-QQ, at pp. 14-15).
CO Prymmer testified that Dr. Arnott developed the Neumann University training
(Neumann training), an about 40 hour online training course for SCs.
CO Prymmer testified
that Session 8, In-Home & Community Safety, dealt with workplace violence or safety,
including: 1) Screening Dangerous Members, 2) Identifying Risky Situations, 3) Safety in the
Community, 4) Recognizing High Risk Behaviors, and 5) Minimizing Risk on the Job. CO
Prymmer testified that two slide presentations in Session 8, concerning Screening Dangerous
Members and Safety in the Community, consisted of general bullet points with no assigned
additional readings or classroom training. He testified that the bullet points, including the
“Partner with someone” bullet point, were not mandates and following them was up to the self-discretion of each SC.
The terms “Dangerous Member,” “dangerous situation,” or “potential
danger” used in the Screening the Dangerous Member presentation were not defined. He further
said that the Screening the Dangerous Member slide presentation showed that “[t]he employer
recognized somewhat of a hazard recognition of a dangerous member. The – the employer has –
has a recognition.” (Tr. 105-13, 347; Exs. C-6, at p. 7, C-15 through C-17).
CO Prymmer testified that the Safety in the Community slide presentation included bullet
points that stated that high risk behaviors included: 1) A history of violence or self-harm, 2)
Paranoia/Suspiciousness, 3) Psychosis/Confusion, 4) Substance Abuse, 5) Hopelessness, 6)
Verbal Threats, 7) Lack of Future Plans, and 8) Criminal Behavior. Another slide identified
more risk factors including: 1) Antisocial Personality, 2) Head Injury, 3) Family History of
Violence, 4) Noncompliance, 5) History of Impulsive Behavior, 6) Loud/Manic Behavior, and 7)
Possessor of Weapons. CO Prymmer testified that SCs first learned of the existence of any of
these high risk behaviors when conducting their face-to-face health assessment of the member in
the field. He further stated that the Safety in the Community slide presentation showed that
Integra recognized members with these risk factors as a hazard. He testified that Integra
recognized that its members could be violent and exhibit criminal behavior. CO Prymmer
testified that when he interviewed SCs “[t]hey had nothing good to say about it [Neumann
training] in terms of how to do their job and how to be safe on their job.” (Tr. 114-17; Ex. C-17).
CO Prymmer stated that there was a general statement regarding “Workplace Violence”
in Integra’s employee handbook that said “Violence by an employee or anyone else against an
employee, supervisor or member of management will not be tolerated.” He testified that the
general statement did not identify the specific types of workplace violence that SCs were most
likely to be exposed to. He stated that Integra “didn’t have a written comprehensive workplace
violence preventive program.” CO Prymmer also testified that many of the SCs received on-the-job training in the form of shadowing other SCs. Shadowing was not required and he reported
an instance where an Integra SC, Ellen Rentz, just went out and did face-to-face visits without
first shadowing anyone or completing the Neumann training. He testified that [redacted]
shadowed SC Andy Macaluso a couple times. (Tr. 117-26,134-35, 341-42; Exs. C-5, at pp. 1-2,
C-18, at p. 96).
CO Prymmer testified that he recommended Integra receive Citation one, Item one, a
violation of the general duty clause, because Integra “failed to materially reduce or eliminate the
hazard of workplace violence.” He stated that he relied upon OSHA Instruction Directive
Number: CPL02-01-052, effective date: September 8, 2011, Subject: Enforcement Procedures
for Investigating or Inspecting Workplace Violence Incidents (OSHA Directive 052).
that he also followed other publications and guidelines OSHA has for social service work and
health care. He testified that OSHA does not have a standard for workplace violence. He stated
that Integra was required to create a workplace violence prevention program because health care
and social services have a higher incidence of workplace violence than other industries. He
classified Integra as being in the social services and health care industries. He testified about the
known risk factors for OSHA compliance officers to consider as criteria for initiating workplace
violence related inspections. These include: 1) working with unstable or volatile persons in
certain healthcare, and social service settings, 2) working alone, 3) having a mobile workplace
and 4) working in high-crime areas. He testified that he considered these risk factors when
determining whether to cite Integra. He testified that the hazard present in this case was
workplace violence with SC and management face-to-face exposure to violent members who
have violent histories with a criminal background. He testified that [redacted] was exposed to
workplace violence when she was required to be around [redacted], a member with a violent
criminal background unknown to the employee, where no criminal background check was first
performed by the employer.
(Tr. 155-61, 239; Exs. C-5, at p. 8, C-33).
CO Prymmer further testified that the social service and health care industries recognize
the hazard of violence from exposure to persons with a violent behavior. He identified OSHA
Publication 3148-01R 2004, Guidelines for Preventing Workplace Violence for Health Care &
Social Service Workers (OSHA Guidelines), as a guide to help employers establish effective
workplace violence prevention programs. CO Prymmer relied upon the OSHA Guidelines when
determining that the social service industry recognized a heightened risk of workplace violence.
He testified that Integra recognized the hazard of workplace violence from exposure to persons
with violent behaviors based upon what he saw in the Neumann training and employee
handbook. He testified that Integra’s response to the threat of workplace violence prior to
[redacted]’ death was insufficient because Integra did not: 1) have a written comprehensive
workplace violence program, 2) perform criminal background checks on members and stop
providing services to members found to be dangerous, and 3) have procedures requiring SCs to
use a buddy system.
He also testified that he relied upon OSHA Directive 052, Appendix B –
Potential Abatement Methods, when he developed his list of recommended feasible abatements
in the citation.
(Tr. 161-66, 238-39, 362; Exs. C-5, at pp. 1-2, C-6, at pp. 8-9, C-32, C-33).
CO Prymmer testified that he also recommended that Integra be cited for failing to report
[redacted]’ death to OSHA within eight hours. He stated that Ms. Brown told him that Integra
did not do it. She told CO Prymmer that she did not think Integra was responsible for calling
OSHA to report the fatality.
He stated that Integra never kept OSHA injury and illness logs or
documented any incidence of workplace violence. CO Prymmer testified that it was his
understanding that an anonymous family member first reported [redacted]’ death to OSHA. (Tr.
88, 163, 167-68, 176-77; Exs. C-1, at p. 9, C-3, C-4, C-28, at p. 4; Jt. Pre-Hr’g Statement, at p.
Michael Yuhas is the President and CEO of Integra. He founded Integra in 2007. He
does not manage Integra’s “day-to-day operations.” Mr. Yuhas has a Master’s degree in
community clinical psychology, and has done additional graduate work towards a Doctorate in
public and mental health, and epidemiology. He has a background in psychology, mental health,
behavioral health and public health training. He has been in the health care business for more
than 25 years, having worked at Blue Cross BlueShield in Maryland, the National Institute of
Mental Health, the University of Maryland School of Medicine, and a company in Tampa called
Health Integrated. In these positions, he has worked in research, administration, and executive
level management. (Tr. 753-54, 785).
Integra began operating in Florida in May, 2012. Mr. Yuhas testified that Integra worked
“with people who fall through the cracks.” Integra’s members in Florida are covered by
Medicaid. According to Mr. Yuhas, Integra was paid based on the numbers of members it
worked with each month. These members most commonly have multiple chronic illnesses that
do not get treated properly. They do not access preventive care. They do not take their
medications or visit their primary care doctor. They regularly visit emergency rooms and are
often hospitalized. Their health care providers are often unable to contact them. Mr. Yuhas
testified that the health care insurers realize “that 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.”
The health care insurer identifies members for Integra and informs Integra of the members’
fundamental problems. At that time, Integra has no information concerning a member’s criminal
Integra locates the member and helps the member connect to health care services
and reminds them to take their prescribed medications. Mr. Yuhas testified that “it’s much more
common that these individuals are likely to have depression and anxiety disorders and other
mental health problems accompanying them.” He said that the range of mental health diagnosis
for members is from the mild end, a minor depression, to the more severe end of mental illnesses,
which is a cognitive disorder like a schizophrenia bipolar. He said members “have behavioral
health which can include mental health and/or substance abuse conditions.” He said that there
are members with criminal backgrounds that range from credit card fraud to violent crimes. SCs
help facilitate the care plan that members and their health care providers have set up. About 35
members are assigned to each SC. He said that Integra’s guidelines call for SCs to make
telephone calls to, and visit with, members several times a month. (Tr. 755-57, 760-65, 770-74,
778-79, 781, 786).
Mr. Yuhas testified that in Florida during the fall of 2012 Integra’s SC training included
training conducted online, face-to-face in the field, and by telephone each week. He said that
Integra asked its employees to “avoid any situation that shows any indication of danger, potential
danger.” He said that Integra recommended its SCs bring along another SC to member visits
where there was any indication of being unsafe going alone. (Tr. 767).
He testified that Integra’s work is within the community health work industry.
industry, according to Mr. Yuhas, was not social work because Integra’s industry was not
clinical. Mr. Yuhas described Integra’s industry as “community health work,” and explained that
“80 percent of the factors that impact people’s health are not related to health care at all. They …
are related to basic 101 issues, uh, barriers to care that are … educational, … psychosocial,
behavioral, environmental, and not clinical.” While doctors, nurses, and social workers, i.e.,
clinicians, focus on the other 20 percent of the factors that impact people’s health, Integra’s
industry, according to Mr. Yuhas, focuses on the non-clinical solutions that would connect
members to their clinicians. He said that it was not standard practice for the community health
industry to conduct criminal background checks before sending employees out to visit members.
Mr. Yuhas testified that there are no national or Florida regulations for the community health
industry. (Tr. 762, 768, 774-77, 883, 1018).
Dr. Melissa Arnott is the vice-president of community programs at Integra.
She has a Doctorate in counseling education from the University of Sarasota awarded in 2004,
master’s of science degree in counseling education in higher education and counseling from West
Chester University awarded in 1995, and an undergraduate degree in liberal studies with a
concentration in psychology from Neumann University awarded in 1993. She is a licensed
professional counselor in Pennsylvania and New Jersey; a licensed clinical addictions counselor
in New Jersey; a certified Addictions Counselor Diplomat in Pennsylvania, and an international
certified Advanced Alcohol and Other Drug Abuse Counselor. (Tr. 858, 861-62; Ex. R-TT).
Dr. Arnott joined Integra in August, 2010 as the team lead for Philadelphia, Pennsylvania
where she oversaw eight SCs in a new program. She helped train the SCs at her Philadelphia
office and was with them every day. She testified that she also “spent time with them
[Philadelphia SCs] in the field, much time training.” During the 18 months of that program, the
SCs in Philadelphia did the same thing as the SCs in Florida later did starting in May, 2012.
After Integra’s contract expired in Philadelphia about February, 2012, Dr. Arnott helped develop
Integra’s new program in Memphis and train its new team there comprising a team lead, lead SC,
and 6 SCs. In about May, 2012, she also created a similar SC program for Integra at Pittsburgh
and Harrisburg, Pennsylvania. She testified that even though the job was “not clinical”, she had
a clinician overseeing each of the teams. (Tr. 866-75, 897).
She developed the Neumann training for the new SCs along with Dr. Krajewski.
Neumann training was available by late August, 2012. Integra hired the majority of its SCs in
Florida in August/September, 2012. Dr. Arnott directly supervised Ms. Rochelle, Integra’s team
lead in Florida, from about April 30 through November 6, 2012. SCs in Florida and one or two
from Tennessee and Pennsylvania took the Neumann training in 2012.
Integra scheduled up to
49 hours for Florida SCs to take the Neumann Training from August 27 through September 7,
2012. The Neumann training consisted of 15 sessions, where the SC had to: 1) post at least two
paragraphs of reaction reflection responses for each session (represented 50 percent of the grade),
2) prepare a one-page paper (representing 25 percent of the grade), and 3) complete a final
examination (representing 25 percent of the grade). Integra paid $1,500 to Neumann University
each time a SC took the training. (Tr. 105-06, 340-50, 876-81, 888-90, 894-95, 998,1015-16;
Exs. C-15, C-16, at pp. 1-4, C-17, at pp. 4-5, R-J, R-Y).
Dr. Arnott said she felt it necessary to instruct SCs on how to identify and assess
dangerous members because they worked directly with persons who were mentally ill. She said
that the SCs used the Brief Psychiatric Rating Scale (BPRS) looking for psychotic symptoms
changing over time. She further said that the Team Lead would also look at the BPRS and
evaluate whether a member was making progress, a criteria for discharge. Dr. Arnott testified
that “the team lead is the one that discharges [members]” and “when it came time to discharging,
then that would be the team lead’s decision.” She considered standards for both social workers
and community health workers when developing the Neumann training. She testified that she
used the National Association of Social Workers’ (NASW) social worker standard for safety and
material from “SAMHSA.”
She noted that best practices for the community health worker
“didn’t have any safety in there.” She also said that she looked at agencies where she had
worked and said that there was “very little safety training out there. And I never had safety
training in places I worked.” (Tr. 344-50, 876-81, 1002-03, 1102).
She initially said that the initial assessment form “was a health and behavioral health and
basic needs type assessment” that did not require SCs to have any clinical skills to complete.
Later on, she testified that when completing the assessment form, SCs recorded behavioral
observations, including whether a member was confused or depressed. She agreed that the
assessment form called for SCs to summarize their assessment of the member and state whether
member’s answers to their questions were consistent with their clinical observations. She also
said that the assessment form called for SCs to write a psychosocial note and watch GAF and
BPRS scores for each member over time.
(Tr. 873-74, 897, 1006-07; Ex. C-34).
She testified that both Neumann training and training given monthly by Dr. Krajewski
included on overview of psychotropic medications. She said by knowing the medications, SCs
know more about their members and possible medicinal side effects. She testified that the
Neumann training included a session entitled “Layperson’s Guide to Mental Health” where SCs
are given information about mood, thought, and personality disorders so that they know what to
expect when seeing members with any of these disorders. She testified that Session 13 dealt with
substance abuse and that Integra wanted its SCs to be able to identify when a member was
impaired. She testified that “20 to 25 percent of [Integra’s] members have severe mental
(Tr. 905-09; Exs. C-J, at p. 4, R-J, at pp. 4-5).
The Neumann training also included a PowerPoint slide in Session 8 that suggested SCs
“[o]btain critical history about previous unsafe behaviors” of members.
Dr. Arnott admitted
that Integra did not require SCs try to obtain such information before visiting with a member.
She testified that Amerigroup did not provide criminal background information about a member
She also said that when visiting a member for the first time SCs should assume
“anybody had the potential of violence.” Dr. Arnott testified that SCs would learn of a member’s
history of violence, or a family’s history of violence, when doing the initial assessment or from
any research they might do online.
She also admitted that, at the time of [redacted]’ death,
Integra did not require taking another SC along on a face-to-face visit when a SC suspected that
there was a potential danger. It was suggested that the SC ask another colleague to join the SC as
a “buddy” if the SC felt unsafe. It was up to the SC to arrange for a “buddy” to accompany them
on a face-to-face visit to a member. Dr. Arnott said if they were unable to do so, they were to go
to their supervisor, who would assign someone or go along themselves. Integra did not have a
written procedure for requesting a “buddy.” Dr. Arnott testified Integra had an unwritten
procedure where SCs told their “safety partner” and “program manager” where they were at all
She also testified that Integra saw no reason to conduct “takedown training” for SCs.
She said that Integra’s guidance to SCs confronting criminal behavior is to “just leave.” ( Tr.
344-54, 915-16, 923-24, 931-35, 938-41, 1012; Exs. C-15, C-16, at pp. 1-4, C-17, at pp. 4-5, R-J).
Dr. Arnott testified that she and Ms. Cooney conducted face-to-face training in September
and November, 2012 in Florida. She also said that Integra provided three additional safety
trainings pursuant to Integra’s yearly training schedule that were conducted by telephone or
She testified that SCs were expected to identify the high-risk behaviors listed in the
Neumann training’s Safety in the Community segment identified above while doing their face-to-face initial assessment of the member. Integra relied upon members self-reporting their own
criminal behavior, feelings of hopelessness and history of violence.
She said that Integra’s
initial assessment would be used anywhere in the health care industry. It was similar to those
used at doctor’s offices. (Tr. 344-50, 959-60, 974-79; Exs. C-15, C-16, at pp. 1-4, C-17, at pp. 4-5, R-A, R-G, R-Y).
Dr. Arnott testified that she reviewed [redacted]’ October 12, 2012 progress note report
shortly after it was created. She thought that [redacted] knew what she was supposed to do; be
outside or not go alone if she felt anything.
Dr. Arnott testified that she did not know whether
[redacted] had a history of violent behavior. She said she knew he had an injectable,
antipsychotic medication. She did not have confirmation from [redacted]’s psychiatrist whether
he was being properly monitored and medicated for his schizophrenia before [redacted]’ death.
Dr. Arnott testified that Amerigroup did not report any history of violence by [redacted] to
[redacted]. Dr. Arnott did not know whether [redacted] took another SC with her when she
visited [redacted] on October 15, 2012. She testified that she did not consider [redacted]’s
October 15, 2012 discussion about his The Last Supper picture to be delusional or alarming. She
said that for a member to be considered dangerous there needed to be more than one symptom.
Dr. Arnott did not follow up with Mmes. Rochelle or [redacted] to determine how [redacted]
intended to subsequently meet with and provide services to [redacted]. (Tr. 140-41, 270-72, 356-63; Ex. C-7, at pp. 1,5).
After Ms. Rochelle left Integra, Dr. Arnott began to act as the team lead in Florida. She
testified that she promptly reviewed [redacted]’ November 14, 2012 progress note report of her
visit to [redacted] which indicated he reportedly initially pretended to be his twin brother, and
later signed the Integra’s consent form as himself. Dr. Arnott did not follow-up with [redacted]
to ascertain whether she had not met with [redacted] inside his home alone. She testified that
after three face-to-face visits with [redacted] at his home, [redacted] remained unaware of his
history of violent behavior. (Tr. 356, 363-66; Ex. C-7, at p. 7).
Dr. Arnott testified that Integra’s services were evaluated based on whether it was saving
Amerigroup money by reducing unnecessary hospitalizations. She described Integra’s industry
as a “niche in the market that other people are not doing in this community health worker type
role, ….” (Tr. 883, 1017-18).
Dr. Thomas Krajewski, referred to throughout the hearing as “Dr. K,” is the Medical
Director at Integra, and has served in that position since 2007.
As the Medical Director, Dr.
Krajewski “provide[s] consultation, education services and help[s] with program development.”
He helped Dr. Arnott develop the Neumann training by providing input based on his experience
in the field. Dr. Krajewski testified that, in developing the Neumann training, he surveyed other
programs in which community health workers go out and do home visits. He found some
programs had virtually no training and other programs had a maximum of two weeks of training.
He said Integra wanted SCs to: 1) be well informed when they go out in the community, 2) be
prepared to develop what they can see are a member’s needs, and 3) connect members to those
missing services. He testified that Integra developed the Neumann training, weekly rounds, on-site face-to-face training, and a hot-line for SCs to contact management to satisfy its training
needs. He stated that Integra’s training was “superior” to what he saw in the community health
worker community because Integra provided weekly rounds, on-site training, and on-call
availability. (Tr. 1023-26).
Dr. Krajewski testified that the SCs were “not supposed to make any clinical judgments
… or provide any clinical therapy or treatment.” He said the SC’s role is to connect members to
clinical services they are missing. He stated SCs are not required to be licensed in Florida. He
stated what Integra’s SCs “do is very unique.” He testified that Integra’s safety policy of
“universal precautions”, where an employee “[a]ssumes everybody you deal with could have the
potential for harm” was in its employee handbook. He discounted the need for self-defense
training and said “if there’s a danger, you get out.” (Tr. 1029-31, 1034).
Diane Brown is the Chief Operating Officer at Integra. Ms. Brown testified that the
primary performance problem with Ms. Rochelle concerned her reliance on her own clinical
training and her need to complete the Neumann training. (Tr. 1037, 1061-62).
She also testified about [redacted]’ telephone records on December 10, 2012. She
testified that the records show that at 10:00 a.m., Scott Schneider called [redacted] and was on
the line for two minutes.
At 10:05 a.m., she spoke with Mr. Schneider by telephone for 12
minutes. At 11:05 a.m. and from 11:19 a.m. to 11:22 a.m., she was in telephone contact with
another member that was assigned to her, not [redacted]. (Tr. 1064-65; Ex. R-GG).
Ms. Brown further testified that Dr. Arnott resided in New Jersey and did not have an
office at Integra’s Maryland corporate facility. (Tr. 1066).
At the time of [redacted]’ death, Ms. Brown was unaware of OSHA’s policy concerning
injury logs. She admitted that Integra did not report [redacted]’ death to OSHA. (Tr. 1068; Ex.
C-5, at p. 1).
Jessica Amy Cooney – Coordinator of Program Implementation and Training
Ms. Cooney was hired by Integra in 2010 as a SC in Philadelphia, Pennsylvania.
Cooney has been Integra’s coordinator of program implementation and training since about the
fall of 2012.
Her business address is in Owings Mills, Maryland. Ms. Cooney’s duties include
shadowing, database training with data entry, and participating in classroom training. In about
September/October, 2012, she participated in two of the three face-to-face training sessions
conducted by Integra at a Florida hotel.
She testified that the training consisted of a
PowerPoint presentation that covered from the point when a SC first received a caseload to being
in the community. She also testified it included some role playing and a discussion about safety.
She said each training session lasted two days. In addition to the face-to-face training, Ms.
Cooney provided “shadowing” or “mentoring” type training. This field training consisted of
showing SCs what it is like to do their job. She went with SCs to visit members. She watched
them perform a visit with members, providing tips along the way. Ms. Cooney mentored Messrs.
Schneider and Macaluso, as well as Annie Hinman and Marisa Donahue. (Tr. 788-93, 797, 800).
Ms. Cooney testified that Integra implements the buddy system whenever someone is
uncomfortable. She said if nobody was around to buddy up, “then you just don’t go. You save it
for a time when somebody can come with you.” Ms. Cooney testified that no SC communicated
to her any concerns related to the buddy system or safety training that Integra provided. She
never trained [redacted]. (Tr. 793-95, 801).
Laurie Rochelle – Service Coordinator Team Lead
Laurie Rochelle worked at Integra from April 30, 2012 through November 6, 2012.
was the Tampa office team lead. She supervised Ms. Ferguson, the lead SC, and all of the other
SCs, including Mmes. [redacted], Rentz, Hinman, Donahue, “Yvonne,” “Claire,” and
“Danielle”, and Messrs. Macaluso and Schneider. Ms. Rochelle reported to Dr. Arnott at Integra.
Ms. Rochelle interviewed all of the prospective SCs in the Tampa office, except for Ms.
Ferguson. She testified that she understood that the SC’s job was to coordinate services for
She described their job as trying to get members to connect with their doctors and
avoid getting re-admitted into hospitals. She testified that every week SCs “were supposed to
either make a face-to-face contact or a call, but they had to make at least two face-to-face
contacts per month.” Ms. Rochelle testified that Integra did not get paid by Amerigroup for its
provision of services to a member if two face-to-face contacts were not made each month. She
also said that Dr. Arnott told her that SCs who did not make two face-to-face contacts each
month with members would not be paid. Ms. Rochelle testified that she was getting pressure
from Integra management to insure that SCs made two face-to-face contacts each month. (Tr.
245-50, 255, 259-60, 281, 287-88, 312-13).
According to Ms. Rochelle, the SC applicants were first screened at Integra by someone
other than her, and then the applicants were passed on to her with Ms. Arnott’s instructions on
which questions to ask them. She then passed on the information she received from the
interviews to Dr. Arnott, who had the final say in the hiring process. Ms. Rochelle testified that
Dr. Arnott encouraged her to hire those “just getting out of school” with a Bachelor’s degree.
She explained that this was so because “the salary was very low” and the company wanted to
“train them the Integra way, you know, train them a certain way.” According to Ms. Rochelle,
Integra did not value experience as much as she did in its hiring process. She felt that SCs
needed to have some experience in a mental health facility. She did not know when conducting
interviews that the SCs were going to be working with members “that were getting out of jail.”
Ms. Rochelle preferred to hire SCs who had at least six months of experience entering a person’s
She felt that SCs “needed to have some street smarts.” Ms. Rochelle interviewed
[redacted]. [redacted] did not have this experience. Ms. Rochelle testified that she initially did
not want to hire [redacted] because “she was very young” and seemed “somewhat fragile in a
way.” But Ms. Rochelle hired her anyway because [redacted] had “that heart that she wanted to
help others,” and Ms. Rochelle hired “as [she] was instructed.” (Tr. 247-49, 312).
As the office team leader, Ms. Rochelle assigned the SC workload according to
geography, reviewed and approved SC progress note reports, held weekly office meetings via
teleconference, and carried her own full caseload of 32-40 members.
Ms. Rochelle testified
that SCs had to first locate members who were staying in hospitals, mental health facilities,
homes, group homes, and homeless shelters. Integra required SCs to go to a member’s home
unannounced and knock on the door where a member did not have a phone. One member lived
in a tent. Other members met them at restaurants because they did not want SCs coming to their
homes. Ms. Rochelle described the type of members that SCs visited as being “drug seeking,”
those just “getting out of jail,” “people with severe mental health issues,” including some who
were schizophrenic or had personality disorders,
and members with a history of violence. She
testified that SCs were not given any information regarding a member’s criminal background or
history of violence. She explained that SCs had to find a member “or you don’t get paid because
Amerigroup would only give us 325 [members]. It was a pilot program. So, you know, the more
members that we found – and they were known to be the hard to find members.” (Tr. 251-54,
258-59, 267, 272, 287-88).
Ms. Rochelle testified that she conducted weekly telephone conferences with the SCs on
Wednesdays from 11:00 a.m. to noon. She said that they discussed members and other topics she
did not recall. She also testified that Drs. Krajewski and Arnott conducted weekly “rounds” by
telephone with the SCs in Florida. She testified that [redacted] raised [redacted]’s situation
regarding “some very strange” statements he made concerning The Last Supper on October 15,
2012 at a weekly rounds conference call in which Dr. Krajewski participated. She did not recall
anyone offering any advice to [redacted] as to how to proceed with [redacted].
She saw the
situation as a “small red flag” involving a mentally ill person who did not say “I’m going to kill
you.” She said “[w]e all knew that the person [[redacted]] – these people are mentally ill.” She
said that the situation “would have been a little bit different” had the progress note report said
[redacted] was “paranoid schizophrenic” and not just “schizophrenic.” (Tr. 292-94).
She testified that she also fielded concerns from her SCs. She affirmed that SCs
expressed concerns about safety. She testified that she had “a lot of safety concerns.”
Rochelle testified that Mr. Schneider weighed jumping a fence and being chased by dogs against
the “pressure to find [a] member.” She testified that Mr. Macaluso called her regarding safety.
She testified that a member Ms. Hinman was driving to doctors’ appointments was later found to
have burned down his mobile home, gone to prison, and had “thoughts of killing her.” She
testified that she could not tell Dr. Arnott these stories because if she did, “pretty much you’re
fired.” SCs did not have personal protective equipment, such as panic buttons or alarms. There
were no procedures in place at Integra to allow her to know which members SCs were visiting or
where they were at any time during the week. She testified that Integra did not provide safety
training to its employees. (Tr. 133, 256-61, 266-69).
Ms. Rochelle testified that she was “not comfortable” with [redacted]’ stated intention,
set forth in her September 9, 2012 progress note report, to make an unplanned visit to [redacted]
at his home address, but Ms. Rochelle stated “but that was the only way that you could get to the
member, uh, is to go to their house.” Ms. Rochelle testified that there was nothing for Integra to
do for safety with regard to the progress note report [redacted] prepared for her October 12, 2012
face-to-face visit to [redacted] where she said [redacted] said things that made her
uncomfortable. She said “everybody was uncomfortable with a lot of these members, the new
members that were coming in. The new 325 [members] that we got, I mean there was a lot of
shady people. Uh, I was feeling very uncomfortable the more and more that I met.” Ms.
Rochelle testified that [redacted] was not supposed to visit [redacted] alone on October 15, 2012.
She said that [redacted] should have asked Ms. Ferguson [to accompany her] since she was the
closest geographically to her; even though she knew Ms. Ferguson might not do so. Ms.
Rochelle testified that it was not her job to insure that SCs had other SCs accompany them on
face-to-face visits to members. She said that Integra did not ensure that a “buddy” accompanied
[redacted] on any of her face-to-face visits with [redacted].
She said “[t]he most important
thing with Integra was to go meet that member and have them sign the paperwork.” (Tr. 273-74,
277-78, 284, 294; Ex. C-7, at p. 2).
Ms. Rochelle also testified that, following her October 15, 2012 face-to-face meeting with
[redacted], [redacted] said in their “rounds meeting” that [redacted] said “some very strange
things” to her about a depiction of The Last Supper he had on his wall. Integra did not conduct
any sort of safety assessment(s) of the situation [redacted] reported in her October 12 and 15,
2012 progress note reports concerning [redacted] after Ms. Rochelle approved them. She also
said that Integra did not have a policy that called for incident reports to be prepared. She also
testified that the buddy system was not effective because SCs were spread thin over four counties
and were not available, and time for it “just was not allowed.”
The buddy system was not
mandatory. Ms. Rochelle testified that she did not recall asking any SC to go with [redacted] on
her next face-to-face visit to [redacted] after she approved [redacted]’ October 15, 2012 progress
note report. (Tr. 265-66, 275-81, 298-99; Ex. C-7, at p. 6).
Ms. Rochelle testified that Dr. Arnott developed the Neumann training about a month or
two after Integra hired the SCs. Ms. Rochelle took the Neumann training on November 4 and
November 5, 2012, five and a half months after she started at Integra, because the human
resources office demanded her to.
Integra gave her two days to complete the 40 hour training
course. She mentioned that there was not time before then to take the Neumann training and that
there were technical issues with the computer system.
She testified that she and many of the
SCs found the Neumann training to be “a joke.” She found the Neumann training to be “very
basic” with five percent of it being “a little bit informational.” She testified that she was
perturbed that Dr. Arnott told her that the SCs needed only to complete the Neumann training,
and nothing else. (Tr. 119, 261-64, 319-20, 329-30).
On November 7, 2012, Ms. Rochelle submitted her resignation letter and gave Integra 30
days’ notice of her proposed December 6, 2012 termination of employment. She testified that
she resigned because there was: 1) not enough training, 2) a lack of teamwork, 3) a lack of
direction from Dr. Arnott and 4) a lot of conflict between her and Ms. Ferguson. She also said
Amerigroup did not work with Integra and she did not want to put her mental health counselor
license in jeopardy. By letter, dated November 26, 2012, Ms. Brown told Ms. Rochelle that she
ended her employment duties with Integra on November 7, 2012. She told her that her final pay
would occur on November 30, 2012, which paid her through the pay period ending November
24, 2012. She also told Ms. Rochelle that Integra was recouping company property and $300 for
debit card charges that it questioned from her final pay. Integra seeks to discredit this witness
due to the alleged workplace performance problems and unauthorized charges on Integra’s card.
Ms. Rochelle has denied making the alleged unauthorized charges on the company debit card.
(Tr. 259, 281, 330, 332-37; Exs. C-13, C-14, R-RRR, R-TTT, R-UUU; Resp’t Reply Br., at 3
The Court finds that Ms. Rochelle’s testimony is consistent with the overwhelming bulk
of the evidence surrounding Integra’s practices and procedures toward members, the SCs, and
their work environment. The Court also observed the demeanor of this witness and found her to
be credible, straightforward and trustworthy. The Court credits Ms. Rochelle’s testimony
Ellen Elaine Rentz – Service Coordinator
Ellen Rentz worked at Integra from September, 2012 until February, 2013. Her job duties
included two face-to-face meetings with a member per month, typically at the member’s home,
where she would obtain consent from the member to assist them in what they needed. Her duties
also included making two telephone calls to a member each month. The types of assistance
included “getting food stamps, transportation, food, [and] housing.” She carried about a 25-35
member caseload. Her work day and work environment depended on how successful she was in
chasing down the face-to-face interaction: sometimes she worked more than eight hours per day,
driving into unfavorable areas, sometimes at night, and across neighboring counties, in order to
procure the “face-to-face.” For each member, Integra provided Ms. Rentz a telephone number
and an address, and usually no other information. (Tr. 369, 373-74, 406-07).
Ms. Rentz took the Neumann training using a computer, which lasted “probably six
hours,” but she did not complete the training before she went into the field.
shadowed anyone while working at Integra.
She testified that she did not receive any classroom
training at Integra regarding safety in the workplace. After Ms. Rochelle left, she participated in
the weekly telephone meetings on Wednesdays with Drs. Arnott and Krajewski. She testified
that these telephone meetings were mandatory, although attendance was not taken. She testified
that people would ask questions or tell Dr. Krajewski about situations they did not know how to
handle. An example she gave was a member that “may have been hospitalized or they were in,
you know, a hospital where they were having mental breakdowns and stuff.” She said that Dr.
Krajewski would “probably say, well, when this person is discharged, you need to make sure that
you’re there to help that person.” She testified that she was not sure a SC could discuss safety
issues during these calls because the discussions were about helping the members, “[n]ot so
much about anything else.” (Tr. 122-24, 135, 369-72, 379-80, 394).
According to Ms. Rentz, Integra instituted a “sign-in” and “sign-out” procedure after
[redacted]’ death. Before her death, Integra had no sign-in/sign-out procedure for SCs. Integra
also did not give SCs a member’s history of violence or criminal background when a member
was initially assigned. After [redacted]’ death, Integra started “red-flagging” members in “the
system” by providing any criminal background information associated with the members. Ms.
Rentz testified that one of her members, who she had visited alone inside her home prior to
[redacted]’ death, was “red-flagged” after [redacted]’ death by Integra because of mental health
and criminal backgrounds, involving a gun. She testified that after learning this information, she
was “in shock” and “would not go back out there to see this lady.” She said “[b]ut going into her
home, I would never do that again.” Ms. Rentz testified that she was not concerned about safety
before [redacted]’ death because she “assumed we were safe. We were working for a company.
I felt I was safe to go out there. They had already possibly done all the legwork necessary to
make sure they were not sending me into harm’s way somehow.” She said Integra never
discussed with her any risk associated with her job. (Tr. 375-77, 380-81, 389, 395-96, 410).
After [redacted]’ death, Integra pulled the SCs out of the field for four or five weeks.
Instead of visiting members, SCs made telephone calls. Then, Ms. Flores, her new supervisor,
“started telling us we needed to get over it and get back out there and help these people.” Ms.
Rentz testified that Integra did not have a policy regarding partnering or buddying with another
employee. She said before [redacted]’ death, “[w]e didn’t have one. We were not told to partner
up and go with anyone.” After [redacted]’ death, Ms. Flores told the SCs that:
the only reason you would need two people to go to an individual’s home is that another
Service Coordinator has never seen that person before, so then two people should go.
But if a Service Coordinator has already been there, you can go alone. And that was the
point where I realized that I’m not staying here. I am going to leave this job. It’s not worth my
(Tr. 382-84; Ex. C-11).
Integra terminated Ms. Rentz’s employment on February 7, 2013.
She testified that she
was not upset over being terminated because she was not going to stay at Integra anyway. Ms.
Rentz then testified that she wrote a letter “to Ms. Flores or some management person”
explaining her concerns about safety at Integra, but she does not know when she sent it or even if
she sent it at all.
She testified that she left Integra “with a sad heart because I was worried that
someone else may get hurt.” She said that the SCs needed more things in place for safety. She
testified that she did not know that she was working with people “who had criminal backgrounds,
who may have killed someone before or may have assault and battery.” (Tr. 385-89, 407-09;
Exs. C-11, R-AAA).
Yaharya Denise Stevens – Service Coordinator
Yaharya Stevens was a SC for Integra from December 3, 2012 through mid-February,
She visited members in their homes twice a month, called them twice a month, and
transported them to medical appointments and public housing offices in her own car. She took
the online interactive Neumann training when she first started on December 3rd. She shadowed
Ms. Ferguson for two to three days. She participated in the rounds held on Wednesdays at 12
o’clock with Drs. Arnott and Krajewski by telephone. At the time, she thought that Ms.
Ferguson was her supervisor. She verbally shared her concerns with Ms. Ferguson about driving
certain members who were not taking their medication. She felt uncomfortable and unsafe
transporting the members because she was “concerned if I’m driving and they get upset and they
want to attack me.” She thought this because she learned that most of the members she was
responsible for had severe mental illnesses that either chose not to take medication or did not
have access to their medication. Ms. Stevens described two incidents in which she and Ms.
Ferguson were in cars with mentally ill patients who were not taking their medications. “They
were not on medication and they just were not themselves. The members were, uh, fidgety and
uncomfortable.” In one instance, a member told her that he was uncomfortable driving with her
because of her ethnicity. She testified that Dr. Krajewski made it clear that we had to drive them
around in her own car to appointments. She testified that SCs were required to drive members to
psychiatric appointments. She was never told by management to get members bus passes; other
SCs suggested how to get bus passes or transportation through the county. (Tr. 416-21, 424-30).
She still had safety concerns regarding transportation when she left Integra in February,
2013. She left due to an incident that occurred after [redacted]’ death when she was told she had
to physically find a member. She went to the member’s primary care doctor’s office to speak to
the doctor. She waited in the waiting room for an hour-and-a-half, and got up to leave her
contact information with the receptionist for the doctor to contact her. As she was waiting to
speak to the receptionist, a “patient” of hers came up to her and pushed her out of the way as she
was speaking to the receptionist. She did not report that incident at that time to Integra. She
decided to resign because two other coworkers had similar incidents happen to them and even
though they reported it, they were told that it was part of their job and that they had to “deal with
it.” (Tr. 132-33, 422, 429).
Kimberly Michelle Daniel – Service Coordinator
Kimberly Daniel worked for Integra from August, 2012 through February, 2013. Before
that, she worked as a crisis counselor, where she did field work. She was a former co-worker of
Ms. Rochelle at Ceridian with Military Once Source. When she started, Ms. Rochelle was her
supervisor, then Dr. Arnott, and finally Ms. Flores. She did not shadow anyone at Integra. She
learned her job through trial and error. She took the Neumann training and received the
certificate within a month of starting the job. The Neumann training was delayed that month due
to computer glitches. She testified that it was “very simplified” and not “anything that really
helped” her do her job. When assigned members, she knew her member’s medical diagnosis and
sometimes their mental health diagnosis. She said that she did not receive any safety training at
Integra before [redacted]’ death. She found out later that members had violent histories,
including robbery, armed robbery, and sexual assault backgrounds, that were not initially
disclosed to the SCs. Her first duty was “doing whatever they could to locate them [members].
Go in wherever, no matter what the conditions looked like, no matter what the situation was to
try and locate them.” Ms. Daniel testified this included sometimes going to “abandoned looking
buildings” and apartment buildings that should be condemned that had “roaches and ants
crawling about, things falling down from the ceilings.” Sometimes she would go inside
members’ homes or go to homeless shelters. She said that Dr. Arnott told the SCs to locate
members “at any cost necessary.” (Tr. 433-37, 441-43).
Once she located the member, she determined whether “they were compliant,” i.e.,
whether “they were taking their medications” or whether “they are in services.” If not, she would
offer to help them become compliant by driving them to the doctor’s office and back home, and
otherwise connecting them with resources. She would be in her car driving with members for up
to 45 minutes to the doctor’s office, and then another 45 minutes driving back home. She was
required to meet with the members twice a month. Before December, 2012, any request she had
for a buddy was denied because the other SCs were working on their own caseload, “everybody
was too busy” and nobody was available. She said that using the buddy system “wasn’t an
option” available to SCs. She recalled some type of training with Dr. Arnott and Ms. Cooney in
Florida in October that she attended, but felt it was “incomplete,” so she did not “sign off on
everything.” She sent an email to “all service coordinators and management” requesting
additional training “that they had been promising us” in December, 2012 after [redacted]’ death.
Ms. Daniel was laid off in February, 2013 due to a reduction in force, and she “was not too upset
about that.” (Tr. 439-46).
Scott Matthew Schneider
– Service Coordinator
Scott Schneider was an Integra SC from the end of August, 2012 until about February 19,
2013. His duties included developing a “care plan” and providing members the resources that
“would hopefully mitigate them from either being admitted into a crisis stabilization unit or a
hospital, as well as provide them with any third party resources that may not have been covered
under their current health insurance benefits.” Examples of services he provided included
locating “durable medical equipment” for a morbidly obese woman, and convincing health
professionals that a replacement insulin pump was required due to the member breaking the
pump by accident and not abusing the medication. Mr. Schneider testified that he spent 15-20%
of his time driving members to appointments at mental health facilities and personal errands in
his own car.
He testified that he never transported anybody that had any type of erratic
behavior. He carried a 25-30 member caseload at first, and the caseload grew to 50-60 members.
SCs had to act as “detectives and hunt them [members] down by any means” because Integra
provided SCs with so little information about assigned members. (Tr. 450-54, 459-60, 465).
Mr. Schneider took the Neumann training when he started at Integra in August, 2012.
He received his certificate in October, 2012. He stated that he did not receive any safety training
at Integra prior to [redacted]’ death. He did not shadow any SC when he started working at
Integra. In October, 2012, as part of a one day group training, he accompanied Ms. Cooney into
a very dangerous area of town. He testified that Integra did not have a workplace violence
policy. He also participated in the weekly rounds on Wednesdays with Drs. Arnott and
Krajewski. He testified that when he or another SC discussed safety concerns during the weekly
rounds, Dr. Krajewski had the “ultimate say” on how to handle the situation, and typically
“nobody was really getting any resolve. So we all tried to keep quiet as best as we could because
it was just a colossal waste of our time.” He also participated in the weekly meetings with Ms.
Rochelle, but testified that no safety concerns were brought up until after [redacted]’ death. They
instead typically discussed “better ways that we could serve the clients,” explaining that “we
were all kind of new. There was a pilot project. We all had to kind of feed off each other to kind
of find out what resources were available in the community to better service the clients that we
were serving.” He testified that whenever he asked questions of management, he “never really
got answers.” He testified that he had to find “solutions out for myself because there was no
support from management.” He did not recall getting answers from management to his concerns
about safety that included feeling unsafe going to a member’s house. (Tr. 454-56, 460, 481-88;
He did not raise any safety concerns with Integra before [redacted]’ death because, “I
think I was really naive, and I believed that the company had my best interest at heart, they
properly screened these people, and I never really thought about it, you know.” Ms. Rochelle had
no problem with SCs going out in pairs. He testified that he buddied up several times with
Mmes. Rentz and [redacted].
In January, 2013, Ms. Flores “relayed to us that it [the buddy
system] was a misappropriation of time and that we needed to do that individually. It got to the
point that if I had somebody that I felt  uncomfortable around, I would go out with the SC and I
just would not document it.” He testified that “[m]anagement disapproved of us going out in – in
a team.” (Tr. 457, 485-87).
He recalled an incident, prior to [redacted]’ death, where a schizophrenic member made a
verbal threat against him. According to Mr. Schneider, the member made it “abundantly clear,”
in a public place, that “he would have knocked me in the middle of next week.” This incident
occurred during the initial assessment. He said a lot of the questions were very personal,
including those about medical or psychiatric conditions, medications, or institutionalizations.
Mr. Schneider confirmed that on September 13, 2012 a member also disclosed during the initial
assessment that he had “a history of anger management issues which has led to many physical
altercations.” Despite this disclosure, Mr. Schneider continued to meet with this member several
times afterward because “you had to continue meeting with them until they got rolled off or, uh –
you know, even if they said they didn’t want to participate, you still had to badger them, uh, until
they – until management decided yeah, we’re going to roll them off.”
In order to get a member
“rolled off,” Mr. Schneider testified that a safety concern or “tendencies that are violent in
nature” were not enough. “It had to go before management and the doctor. The doctor was the
one that made the decision to my understanding.” He said that Integra did not “roll off” too
many members because doing so caused Integra to lose money. (Tr. 458-59, 466-67, 492; Ex. C-29, at p. 6).
Mr. Schneider testified about other experiences that he had while working at Integra. He
recalled a member that was frequently “Baker Acted” by his family, “almost every other
(Tr. 462-63; Ex. C-29, at p. 6).
He recalled that he visited a member [on November 20, 2012] whose house was plastered
with “no trespassing” and “beware of dog” signs. He noted that in his progress note report
because “this person obviously doesn’t want unsolicited people coming up to their doors, and
they need to be aware of that.” Mr. Schneider testified that he was scared that a dog, that he
viewed as unfriendly, could break away from its rope and bite him. He reported his concern
about the dog during one of the “rounds” and was “probably” told to find some other way to
contact the member. He said that the member’s broken down trailer home was “in the middle of
nowhere” and “[t]here was no way to get in contact with them.” (Tr. 468, 495-96; Ex. C-29, at p.
He noted that “15 to 20 percent of [his] caseload” included members who had bipolar
disorders and multiple personalities.” One of those members, he recalled, made him “extremely
uncomfortable” because “she just was very promiscuous and very forthcoming towards me.” He
described one instance where “like a light switch flicks, looks like a light went off and then all of
a sudden it was like Dr. Jekyll, Mr. Hyde. She was this completely different person. She had
this knife in her hand like a kitchen knife, and she was just kind of like twirling it around. And I
was like I need to get the heck out of here.” He met with her two or three more times after that,
but always outside of her home. (Tr. 469-71; Ex. C-29, at p. 18).
He also recalled a member that “scared the bejesus out of me, and I refused to go to that
house.” He told his supervisor at the time that he was not going to that member’s house. He had
originally met with that member at a psychiatric unit in a hospital. He likened his interaction
with her to sitting in a “courtroom with Charles Manson on trial.” He had recorded on December
10, 2012 that her mother told him that: 1) “[t]he whole family has been terrified of her and has
sought shelter elsewhere….”, and 2) the member had physically assaulted her boyfriend and had
“a serious addiction to meth and becomes violent and thinks she’s God.” Despite sharing his
safety concerns with his supervisor, he was still required to go to the member’s house. He
refused to do so, except on one occasion, when accompanied by Ms. Rentz, they visited her
house together, but she did not answer the door. (Tr. 471-72, 492-93; Ex. C-29, at p. 24).
Mr. Schneider testified that he left Integra because he was assigned a member that
required a face-to-face encounter who had a very lengthy criminal record. He informed
management that he “did not feel comfortable going and meeting with this person.” After being
told to “just meet in a public place,” he left Integra because his “life was more important than
that.” (Tr. 457-58).
Andrew Macaluso – Service Coordinator
Mr. Macaluso was an Integra SC from August, 2012 to December, 2013. His duties
include assisting members in finding community resources, and helping to “make sure they were
taking their medications as prescribed.” He would “locate transportation for them if they needed
it,” and he would “confer  with clinical staff if [he] had questions about  some of their
conditions.” It was one of his duties to transport members to their doctor’s appointments or to
alternative places to live when their current placement was not stable. (Tr. 500, 508-09).
On October 15, 2012, Mr. Macaluso had a discussion with his supervisor, Ms. Rochelle,
about Mr. D, one of the members assigned to him. He wrote in his October 15, 2012 progress
note report that he spoke with Ms. Rochelle that day regarding Mr. D’s “positive homicidal
ideations with plans, probable means (access to a firearm), and intent.” He also noted “the
member’s suicidal ideations regarding the member shooting himself in the mouth with the same
gun.” He further noted that he did “not want to transport the member due to the extreme possible
safety risks to himself and others. These ideations and access to a weapon could prove
dangerous to the SC or other individuals in the vicinity of the transport.” He also noted that he
told Ms. Rochelle that Mr. D has been placed in the state mental hospital for four years for
suicidal and homicidal ideations. He further recorded that he informed Ms. Rochelle that Mr. D
“had multiple felony charges including assault with attempt to maim.” (Tr. 504-05, 510; Ex. C-30, at p. 21).
The next day, he sent her an e-mail to discuss the “possible duty to warn the target of Mr.
D’s homicidal ideations.” He also requested “take down training and hands-on crisis de-escalation training.”
He testified that he sent the email because “I had some concerns about
some of the members that I was working with. That I felt it would be beneficial to have that type
of training. Other places I’ve worked we’ve had similar types of training [ ] to deal with people
who have [ ] different types of mental health issues where there might be a problem with them
being aggressive.” He wrote on October 16, 2012: “I’m concerned that as I have had to transport
and visit more than one member who has a history of violence towards others resulting in severe
bodily injury.” (Tr. 504-10; Exs. C-30, at p. 21, C-31 at pp. 1, 9).
He followed up with another e-mail to Ms. Rochelle on October 19, 2012:
I am uncomfortable being alone with Mr. D as he has expressed homicidal
ideations and access to a firearm.  Mr. D has a history of multiple felony
assaults including a felony assault with attempt to maim. He currently has
domestic violence charges pending against his girlfriend. I am also uncomfortable
with placing a member who has shown himself to be aggressive with staff on the
inpatient unit in my car. All Mr. D. would need to do is jerk the steering wheel to
kill or gravely injure both of us. … What is the safety plan given the homicide
plan that he has told me and his history of assault behavior?”
He testified that Mr. D’s homicidal ideations were directed at a former roommate: “he had
wanted to shoot this fellow that he  had stayed with before  in the head with a firearm.” (Tr.
508, 511; Exs. C-30, at p. 30, C-31 at pp. 2-3). On November 1, 2012, Mr. Macaluso noted in his progress note reports that Mr. D had
assaulted the driver of a car earlier in the week and expressed suicidal ideations to law
enforcement that resulted in his admission to the Mental Health Care’s Crisis Center. He also
noted that Mr. D was “ROLLED OFF (REMOVED) FROM THE INTEGRA PROGRAM
TODAY AFTER THE EVENTS DISCUSSED IN THIS NOTE.” (Ex. C-30, at p. 30). On November 15, he sent an e-mail to Dr. Arnott and Ms. Ferguson regarding the
previous emails he had sent to Ms. Rochelle, who had left Integra by that time. In this email to
Dr. Arnott and Ms. Ferguson, Mr. Macaluso recounted an incident that occurred on November 2,
2012. He wrote that “Mr. D is the member who threatened to ‘kick my ass’ when Whitney and I
attempted to transport him a few weeks ago. This threat made me afraid for my safety as I
thought I was going to be assaulted and would have to defend myself.” (Tr. 129-30, 511-15; Exs.
C-30 at pp. 28-33, C-31, at p. 2).
Neumann University certified that Mr. Macaluso completed the Integra Health
Management Program in October, 2012.
Mr. Macaluso resigned from Integra in December,
2013, when he was offered a position at a community agency closer to his house.
Macaluso is currently a case manager where he visits pregnant mothers in the field. His current
employer conducts background checks and he believes also has a workplace safety program. (Tr.
500, 519; Ex. R-KKK)
Annie Marie Hinman – Service/Community Coordinator
At the time of the trial, Annie Hinman was an Integra Community Coordinator. She
started working at Integra in September, 2012, and testified that she works out of her home in
Port Richey, Florida. She is also currently working on a master’s degree in mental health
counseling. Her duties as a Community Coordinator include calling members and checking in
with them to see if that have gone to their provider appointments, transporting members to
provider appointments, attending telephone staff meetings, and putting in notes at the end of the
day. (Tr. 807-09, 826).
Ms. Hinman testified that after getting her case load from her supervisor, she now checks
“to see if there are any red flag members where I would need to bring someone with me to visit
them.” She testified that she now checks public records at the Pasco County or Pinellas County
Sheriff’s departments. She enters member’s names to see any information that comes up. If she
finds any criminal background, she reports it to her supervisor “so that they could review it and
determine if we would keep that member or if they would be discharged.” She testified that, for
example, if a member’s history showed a “dog bite case from 12 years ago,” she “would put a red
flag in. Make sure you go there with a partner.” She did not recall when she started checking
public records. Ms. Hinman testified that in September, 2012, Integra did not require her to do
the criminal background checks. (Tr. 809-12, 825).
Ms. Hinman completed the Neumann training online, which she characterized as
“average,” before she began to work in the field visiting members. She then shadowed Ms.
Rochelle for two days.
She attended two or three training sessions with Dr. Arnott and Ms.
Cooney that lasted “an hour or two maybe.” There was no role playing involved in the training.
She testified that Ms. Rochelle also gave training. She participated in the weekly telephone
rounds on Wednesdays, which she testified lasted 45 minutes to an hour. She did not recall any
safety issues discussed during the Wednesday rounds. She also attended mandatory telephone
conference meetings with Ms. Rochelle and the Florida SCs once or twice a month, during
which, “similar to the rounds call,” they would discuss issues on how to better serve their clients.
She testified that she utilized Integra’s buddy system in the fall of 2012. She buddied up with
Ms. Ferguson and Mr. Macaluso. She never had “any occasion when [she] felt the need to have a
buddy and [she] couldn’t get one.” (Tr. 814-24).
Ms. Hinman testified that Ms. Rochelle was her first supervisor, followed by Dr. Arnott.
There was a period of time in 2012 that she felt that her supervision was “inadequate,” and that
there was a lag of time of two days in getting her progress note reports approved by a supervisor
in the database. (Tr. 829-30).
Ms. Hinman recalled a member who had been jailed for burning down his mobile home.
In 2012, the member told his health care provider at a medical office, in front of her, that he had
homicidal thoughts toward her. “And the [medical] provider asked him if he had suicidal or
homicidal thoughts, and he said yes. And the therapist asked him to explain. And he said, the
thoughts are telling me to harm her, which was me. He pointed to me.” She had seen him many
times, having worked with him “for a long period of time,” and had never known of these
homicidal thoughts toward her and “never felt like I needed to ask him if he was suicidal or
homicidal or if he had thoughts of harming me.” She said she “wasn’t told to ask those
questions, ….” She said that Integra required her to continue to provide services to the member.
After that incident, Ms. Hinman buddied up with Mr. Macaluso and Ms. Cooney, on one
occasion, to meet with him. This member was eventually “discharged” or “rolled off” her
caseload after she had worked with him “for a long period of time.” (Tr. 830-34).
Whitney Ferguson – Service/Community Coordinator
At the time of the trial, Whitney Ferguson was an Integra Community Coordinator. She
began working at Integra in the Philadelphia office as an intern and became a SC in the
Philadelphia office in October, 2010. In August, 2011, she transferred to the Memphis office. In
May, 2012, she transferred to the Tampa office where she was the lead SC. Her supervisor in
May, 2012 was Ms. Rochelle. At that time, Integra had 50 members assigned and she and Ms.
Rochelle split them evenly. She worked in the Tampa office during the fall of 2012, with the
exception of a six week maternity leave from September through mid-October. She reported to
Dr. Arnott after Ms. Rochelle left. (Tr. 836-38, 843, 854-56).
When Ms. Ferguson started at Integra, she received training by Dr. Arnott and field
training by other SCs. Her training, which included safety training, continued in Memphis and
Tampa. In Tampa, there were three training sessions that occurred in September, October, and
about November/December of 2012. According to Ms. Ferguson, “safety was one of the things
that was incorporated in all of the trainings.” This was because she believed “it’s such an
important part of what we do.” The September training was “a few days” and was at a Marriott
Hotel. She did not attend all of the training because she was getting ready to go on maternity
Ms. Cooney conducted the training, which Ms. Ferguson said included safety-related
“role-playing.” Mr. Yuhas gave the introduction and attended, in part. The October and
November/December training sessions were also “two or three days,” at a hotel, and included
safety issues. She did not know if there was any role playing in the October training. Dr. Arnott
and Ms. Cooney conducted the October training. Only Dr. Arnott conducted the
November/December training. (Tr. 838-43, 958).
According to Ms. Ferguson, the Integra Tampa office hired seven SCs from September
through December, 2012. The number of Integra members grew from the original 50 to 200.
About 30 members were assigned the each SC. During this time, Ms. Ferguson testified that she
oriented Mmes. Hinman and Stevens, as well as Mr. Macaluso. Shadowing entailed bringing the
new SC along for the day so that they could see what she did and she could explain why she did
things a certain way. (Tr. 843-46).
She testified that during the fall of 2012 she would buddy up with someone if she was
going to an area or visiting a member that made her uncomfortable. If she could not get a buddy,
she said she would reschedule the appointment, or sometimes buddy up with Ms. Rochelle. She
recalled Ms. Rochelle accompanying her on one visit to a member’s home in 2012. She did not
recall ever requesting anyone accompany her on a visit to a member’s home in 2012.
(Tr. 847-48, 857).
She testified that all the new SCs took the Neumann training, although she herself did not
because she started at Integra before the Neumann training was created and she had already
received face-to-face training. Ms. Ferguson also testified that she participated in the Wednesday
rounds with Drs. Krajewski and Arnott, as well as Ms. Rochelle. She testified that safety issues
were discussed during the Wednesday rounds, although she could not recall any specific safety
related discussion. (Tr. 848-51).
Ms. Ferguson recalled one instance in which she buddied up with Mr. Macaluso to visit
one of his members. Ms. Ferguson could smell marijuana when the member opened the door to
his apartment. According to Ms. Ferguson, she called Dr. Arnott from outside the member’s
door, told her about the marijuana, and Dr. Arnott told her that they should leave.
As they went
to leave, the member “got in Andy’s face and – you know, I don’t remember verbatim what he
said, but he made some statements that made us, you know, continue on leaving like Melissa had
instructed us to do, and we left.” That member was later “discharged from the program.” (Tr.
Janet Ann Nelson was qualified at trial as an expert witness by knowledge, skill,
experience, training and/or education in three areas: (1) clinical social work, (2) personal safety
awareness, and (3) personal safety skills and safety programs for health and human service
See Fed. R. Evid. 702; Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579, 589
(1993) (finding that judge serves as a “gatekeeper” to “ensure that any and all scientific
testimony or evidence admitted is not only relevant, but reliable”); Kumho Tire Co. v.
Carmichael, 526 U.S. 137, 149 (1999) (extending the court's gatekeeper function to all expert
She testified that she had been retained and paid $15,000 by the Department of
Labor for her expert opinion in this case at $200 per hour. She had never been an expert witness
before this case. She has testified in court for clients who she treated. (Tr. 562-64, 584; Ex. C-27, at p. 2).
Integra argues Ms. Nelson’s testimony should be afforded little weight due to her lack of
experience as an expert witness, her lack of publications, and the fact that she “has not
undertaken any doctoral studies or served as a faculty member at any institution of higher
learning.” Integra does not deny and does not criticize Ms. Nelson’s field experience or her
experience providing safety training to those who work in the field. The Court finds that Ms.
Nelson’s experience in the field, and years of providing safety and safety awareness training to
those in similar workplaces, is persuasive when weighing the issues presented in this case.
ACME Energy Servs. dba Big Dog Drilling, 23 BNA OSHC 2121, 2125 (No. 08-0088, 2012)
(comparing experts and finding one “in a better position” based on “professional training and
extensive experience”),;2390;2390 aff’d, 542 F. App’x 356 (5th Cir. 2013) (unpublished). She
proved to be a credible, informative witness whose opinions assisted the Court. (Resp’t Br. at 13
n.4; Tr. 82-83).
Ms. Nelson testified that Integra’s service workers were exposed to the hazard of
workplace violence and that prior to December 10, 2012, Integra did not adequately protect its
SCs from workplace violence. She testified that Integra’s worker safety program was inadequate
because: 1) its management did not support the need for adequate safety training of SCs,
isolated nature of the SCs’ job increased their risk to workplace violence, 3) SCs were placed at
increased risk to workplace violence by being expected to apply clinical knowledge of social
work they did not have and use clinical assessment tools that they were not qualified to
administer or interpret, 4) the personal safety training materials provided to SCs were vague,
lacking practical content and incomplete,
and 5) its safety practices and protocols were
incomplete and inadequate.
(Tr. 585-87, 602-16, 678-79; Ex. C-27).
Ms. Nelson testified that Integra required its SCs to have a bachelor’s degree. They were
not required to be licensed in social work. She testified SCs were doing social work based
activities and required to apply the BPRS as a clinical tool when completing their initial
assessments of members.
Ms. Nelson testified that the initial assessment called for SCs to
apply clinical analysis and/or skills that they did not have, to accurately and safely complete the
Personal Routine/Condition section of the assessment.
She likened it to a brief mental status
examination that a clinician would normally complete, or the conduct of a biopsychosocial
assessment normally completed by someone with a Bachelor’s degree in social work. She said
SCs were tasked to make a psychosocial impression of members using BPRS and GAF scores.
She described the initial assessment as “a very extensive assessment” that included histories of
violence and substance abuse. She said that these were two of the top five predictors of violence.
The assessment also included questions concerning the member’s current living arrangement and
conditions to ascertain whether the member is a loner, another predictor of violence. She
testified that not having this information before meeting with members at their homes placed SCs
at a very high risk to violence situations. She stated that the assessment asks the SCs for their
clinical impressions and a psychosocial summary of the member. (Tr. 590-93, 621-34, 689-90,
695; Exs. C-8, C-27, at pp. 7-9).
Ms. Nelson further opined that Integra’s SCs were not able to safely assess or determine
some of the high risk behaviors identified in the Neumann training; such as paranoia,
suspiciousness, antisocial personalities, impulsiveness, and hopelessness reflecting a higher risk
for suicide. She said that SCs who are not good at assessing members because of a lack of
clinical skills “are less able to recognize the propensity of someone to engage in violence or
become violent.” She testified that [redacted] was expected to apply clinical tools that she was
not qualified to apply and was exposed to a heightened risk of workplace violence due to her
inexperience. She stated that SCs performed the jobs of clinical social workers, in part. She said
that these considerations “[m]ost definitively” contributed to the risk of workplace violence. She
also opined that the lack of safety training at Integra contributed to the risk of workplace violence
that occurred on December 10, 2012. Additionally, Ms. Nelson suggested that Integra’s SCs
were isolated, both in their working environment and by the online Neumann training, and that
this isolation could have had “a negative psychological impact on a worker, particularly as it
pertains to a worker’s belie[f] that he must be self-reliant[.]” (Tr. 593-99, 601-02, 614, 1103-04;
Exs. C-17, at pp. 4-5, C-27, at pp. 5-9).
Ms. Nelson testified that Integra’s “buddy system” was insufficient before [redacted]’
death. It was discretionary, not commonly practiced, not standardized, and more of a backup
when a SC was going on vacation. (Tr. 624-26, 742).
Ms. Nelson testified that [redacted] “was most likely having a delusional episode” when
he explained the print of The Last Supper to [redacted] on October 15, 2012. She referred to the
September 8, 2012 progress note report which reported that [redacted] had a past mental health
issue involving “schizophrenia.” She said that delusion is the number one symptom in
schizophrenia. She said that it would also be useful to know if [redacted] was a catatonic or
paranoid schizophrenic because a member with the latter might “react much more violently” to a
home visit. Ms. Nelson stated that schizophrenics and people with any kind of paranoid,
delusional or antisocial personality disorders are considered to be at higher risk for violent
behavior. (Tr. 600-01, 619; Ex. C-7, at p. 1).
Ms. Nelson testified that Integra was part of the social services/healthcare industry. She
also testified that the social service worker industry recognized the risk of workplace violence
when working under conditions similar to Integra’s SCs. Ms. Nelson believes that workers in
this industry may not report an incident for fear of reprimand, being seen as not doing their job,
saving face with peers, self-blame, or ‘it comes with the job.’ Ms. Nelson also stated that
another common mentality within the human service field also puts workers at risk: the “belief
that if you are a good person out there helping people, i.e., ‘doing good,’ that nothing bad will
happen to you.” Characterizing this mentality as “false and naïve,” Ms. Nelson claims that “this
core belief that a good heart and a helping hand will be a safety shield [is what] truly puts
workers at risk. It has the effect of enabling the worker to operate ‘in denial’ that this type of
work could really become dangerous.” (Tr. 555-57, 575, 605, 679, 1103-04; Exs. C-27, C-32, C-33).
Ms. Nelson testified to a laundry list of activities that were feasible and could have been
taken by Integra to provide a safe workplace for its SCs before December 10, 2012.
example, she testified that it would have been reasonable for Integra to always buddy up, or
double team, SCs when visiting members with a higher risk for violent behavior when obtaining
their consents and completing initial assessments, even where two or three visits are needed. She
also stated “challenging” members with a propensity to violence should have been assigned to
more experienced SCs. Ms. Nelson testified that Integra did not use any sort of tracking system
for its SCs.
She said that it was fairly common practice for social workers to have some sort of
tracking device. Integra also did not use a risk assessment tool to assess any risk of violence.
She stated that Integra could feasibly implement, at low cost, an assessment process to identify
and decrease any risk of violence. Ms. Nelson also testified that Integra could devise a method to
alert SCs to members with assaultive behavior problems. She also stated that Integra lacked a
workers’ incident reporting program, which she described as a “really vital” activity.
Nelson also testified that she found Mr. Macaluso’s October 16, 2012 request for takedown and
hands-on crisis de-escalation training to be reasonable.
(Tr. 636-41, 650-51, 661-63; Exs. C-1,
at p. 6, C-5, at p. 1, C-27).
Ms. Nelson also testified that Citation 1, Item 1, included a list of methods that were
feasible means of abating the hazard of workplace violence alleged therein. (Tr. 636-79; Exs. C-1, at pp. 7-9, C-27, at p. 12, C-31, at p. 1).
I. Serious Citation I, Item 1 – Alleged General Duty Clause Violation
The Secretary alleges that Integra violated the general duty clause of the OSH Act
because its “employees were exposed to the hazard of being physically assaulted by members
with a history of violent behavior.” (Sec’y Br., at p. 3). To prove a violation of the general duty
clause, the Secretary has the burden to establish that “a condition or activity in the workplace
presented a hazard, that the employer or its industry recognized this hazard, that the hazard
was likely to cause death or serious physical harm, and that a feasible and effective means
existed to eliminate or materially reduce the hazard.” ACME Energy Servs., 23 BNA OSHC
at 2123; see also Robert Sands Co., LLP, v. Sec’y. of Labor, 568 F. App’x. 758, 759 (11th Cir.
2014) (unpublished); SeaWorld of Florida, LLC v. Perez, 748 F.3d 1202, 1207 (D.C. Cir. 2014).
The Court affirms this Citation Item.
1. Nature and Existence of the Hazard
“A safety hazard at the worksite is a condition that creates or contributes to an increased
risk that an event causing death or serious bodily harm to employees will occur.” Baroid Div. of
NL Indus., Inc. v. OSAHRC and Marshall, 10 BNA OSHC 1001, 1003 (No. 79-1775, 1981). “A
‘hazard’ is defined in terms of conditions or practices deemed unsafe over which an employer
can reasonably be expected to exercise control.” Valley Interior Sys., Inc., No. 06-1395, 2007
WL 2127305, at * 4 (O.S.H.R.C.A.L.J. June 11, 2007) (citing Morrison-Knudson Co./Yonkers
Contracting Co., A Joint Venture, 16 BNA OSHC 1105, 1121 (No. 88-572, 1993), aff’d 288 F.
Appx. 238 (6th Cir. 2008) (unpublished). The hazard “is not defined in terms of the absence of
appropriate abatement measures.” Wheeling-Pittsburgh Steel Corp., 10 BNA OSHC 1242, 1245
(No. 76-4807, 1981) (consolidated), aff’d, 688 F.2d 828 (3rd Cir. 1982) (unpublished). A hazard
has also been defined “to mean ‘a condition or practice in the workplace’ which introduces an
element of danger into the work environment.” Foseco, Inc., No. 81-944, 1982 WL 22452, at
*13 (O.S.H.R.C.A.L.J. July 28, 1982) (citing Empire-Detroit Steel Div., Detroit Steel Crop. v.
OSHRC, 579 F.2d 387 (6th Cir. 1978)). A hazard 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.” Arcadian Corp., 20 BNA OSHC 2001, 2007 (No. 93-0628, 2004). The Commission may define the hazard itself when the Secretary’s definition is too
broad or generic. Davey Tree Expert Co., 11 BNA OSHC 1898, 1899 (No. 77-2350, 1984).
Here, the Secretary defined the hazard as “being physically assaulted by members with a
history of violent behavior.” As an example, the Secretary stated that “an employee [[redacted]]
providing healthcare management services was fatally stabbed by a member with a violent
criminal history. Employees acting as SCs regularly interacted on their own directly with
members with a history of violent behavior.” (Ex. C-1, at pp. 7-9; Sec’y Br., at p. 23).
Integra argues that the Secretary essentially defines the hazard as “the potential criminal
acts of the citizens being served by Integra.” (Resp’t Br., at p. 9). Integra further claims that the
Secretary includes in his definition of the hazard not only Integra members but also,
“presumably, by extension, other residents of these same communities with whom Integra staff
may have occasion to interact or even pass on the street in the course of performing their jobs.”
(Resp’t Reply Br., at p. 4). Integra’s presumption is ill-founded. Citation 1, Item 1, deals with
physical assaults by, and direct interactions with, Integra members that have a history of violent
behavior; not public passersby.
The arguments here illustrate a disagreement over the definition of the hazard. It is
essential that the hazard be defined to the extent that Integra is apprised of: (1) its obligations,
and (2) the conditions or practices it can reasonably be expected to exercise control. Arcadian,
20 BNA OSHC at 2007; see also Pelron Corp., 12 BNA OSHC 1833, 1835 (No. 82-388, 1986)
(noting hazard must be defined in terms of preventable practices or conditions).
Under the general duty clause, Integra is obligated to provide a “place of employment”
free of hazards, to the extent required under the OSH Act. 29 U.S.C. § 654(a)(1). The
workplace in this case may be viewed as essentially virtual, but that fact does not relieve Integra
of its obligation. Anywhere an Integra SC performs work-related tasks is a workplace. Anthony
Crane Rental v. Reich, 70 F.3d 1298, 1303 (D.C. Cir. 1995); Reich v. Simpson, Gumpertz &
Heger Inc., 3 F.3d 1, 5 (1st Cir. 1993); Clarkson Constr. Co. v. OSHRC, 531 F.2d 451, 458 (10th
Cir. 1976); REA Express v. Brennan and OSAHRC, 495 F.2d 822, 825 (2d Cir. 1974); Access
Equip. Sys. Inc., 18 BNA OSHC 1718, 1720-22 (No. 95-1449, 1999). The record shows that
Integra SCs work at member’s homes, in their own personal vehicles, or in public places such as
hospitals, restaurants, and doctor’s offices. All of these places are considered an Integra
Inside of this workplace, Integra SCs regularly must interact with members who have
been identified as non-compliant with their doctor’s orders, the essence of Integra’s contractual
commitment with its funding sources; i.e., insurance companies. The record shows that many
members had severe mental health issues and/or histories of violent behavior. One member,
[redacted], had a mental illness diagnosis of schizophrenia and had a publicly documented
history of violent behavior. He physically assaulted and killed an Integra employee at an Integra
workplace, his home. The record also shows that Integra SCs had experienced and reported to
management many other episodes of violent behavior by members directed toward them.
The parties discuss at length Megawest Financial Inc., No. 93-2879, 1995 WL 383233
(O.S.H.R.C.A.L.J. June 19, 1995).
Megawest is a Commission case dealing with workplace
violence by another human.
In Megawest, OSHA cited an owner of an apartment building for
exposing its staff employees to the violent acts of its tenants. Id., at *1. The judge found that the
potential hazard arose from a critical element of the apartment staff’s job, i.e. personal interaction
with the apartment residents. The judge found that the Secretary established the existence of the
hazard of violence leading to serious physical harm under section 5(a)(1) of the OSH Act where:
1) the responsibilities of the office staff led to adversarial relationships with tenants, 2) the staff
was not trained to defuse anger, 3) the residents often directed intimidating threats or conduct
towards the staff that was not sanctioned, and 4) no positive measures were in effect to
The judge concluded that the conditions as they existed at the apartments
constituted a hazard to the office employees. Id., at **7-8.
Two circuit courts provide guidance because they have discussed Megawest. In Ramsey
Winch Inc. v. Henry, 555 F.3d 1199 (10th Cir. 2009), the 10th Circuit reversed a district court’s
determination that the general duty clause of the OSH Act preempted Oklahoma laws holding
employers criminally liable for prohibiting their employees from storing firearms in their
personal vehicles on company property. Id. at 1202. “[I]n finding preemption, the district court
held that gun-related workplace violence was a ‘recognized hazard’ under the general duty
clause.” Id. at 1205. Disagreeing with the district court, the 10th Circuit characterized the violent
activity at issue in Megawest as “random,” connecting it to a “general fear” held by a Megawest
employee. Ramsey Winch, 555 F.3d at 1206. Further distinguishing Megawest’s “random”
violent activity, the 10th Circuit noted that the general duty clause might be implicated from other
types of workplace violence situations, such as “injuries ‘arising out of work situations’” in a
psychiatric hospital. Ramsey Winch, 555 F.3d at 1207 n.8. The 10th Circuit cited to OSHA’s
Standard Interpretation Letter, Dec. 10, 1992, regarding workplace violence which states that
“[w]hether or not an employer can be cited for a violation of section 5(a)(1) is entirely dependent
upon the specific facts, which will be unique in each situation.”
Id. at 1207 n.8. Similarly, in
SeaWorld, 748 F.3d at 1210, the D.C. Circuit distinguished the hazard in Megawest from the
hazard of interacting with killer whales. The D.C. Circuit characterized the Megawest violence
as unpreventable because the employer had no control over third parties residing in the apartment
building it managed, whereas SeaWorld did have control over “its employees’ access to and
contact with its killer whales.” SeaWorld, 748 F.3d at 1210.
Here, the violent behavior is not random. The risk of an Integra SC being physically
assaulted by a member is recognized by Integra as an inherent part of the SC’s role in performing
his or her job responsibilities in the field. According to Ms. Nelson, it was particularly
dangerous for a health and human service worker to do an unscheduled visit to a home. She also
testified that the limited information that SCs had before meeting the member for the first time
put them at a very high risk of a violent situation. She testified that the population that Integra
served warranted criminal background checks before entering their homes:
Given the population that [Integra] serve[s], it would be highly recommended that they
do criminal background checks…. And if you know that you are serving seriously
mentally ill people that may have criminal backgrounds, it would be advisable to check
on that background before you enter their home.
Ms. Nelson also testified that interviewing paranoid schizophrenics is challenging and dangerous.
(Tr. 619, 624, 722).
The Court finds that Integra’s practices of requiring SCs to physically meet face-to-face
with members likely to have a history of violent behavior increased the likelihood of SCs being
physically assaulted by a member with such a history and constituted a hazard.
were required to repeatedly interact with members, often in their private homes, with histories of
violent behavior that were unknown to the SCs. These interactions called for SCs to make face-to-face inquiries and assessments regarding intimate details of members’ lives. Integra’s SCs
were not adequately trained or experienced to defuse a member’s anger with, or negative reaction
to, the face-to-face assessment process. Such personal inquiries may be conducive to hostile
reactions by a severely mentally ill member with a history of violent behavior directed toward the
SC. Members often directed intimidating threats or conduct towards SCs and before December
10, 2012 there is little, or no, evidence that members responsible for such behavior were
sanctioned by Integra.
There were also inadequate positive measures in effect to discourage
physical assaults of SCs by members.
Despite Integra’s assertions, Integra members are not classified in such broad categories
as “citizens” or “third parties.” (Resp’t Br., at p. 9). The members have been pre-screened by
Amerigroup and placed into a “non-compliant,” distinct category from which Integra is paid to
make “compliant.” Their very behavior is the essence of Integra’s business, and so the Court
finds that their behavior in this case is work-related. Additionally, Integra has control over its
SCs, and how they go about their job interacting with the members. While Integra cannot
reasonably be expected to control the violent actions of these members, Integra does have control
of its employees and the precautions that they must take to decrease the likelihood of violence in
their workplace by members with a history of violent behavior.
The Court finds based on the evidence in the record that Integra’s practices and
procedures in place on and before December 10, 2012 increased the likelihood of an Integra SC
being physically assaulted by members with a history of violent behavior during a face-to-face
meeting. These practices and procedures included: 1) unannounced visits to a member’s home,
2) assigning members to a SC’s caseload based on “geographical and scheduling efficiencies”
rather than on client risk; e.g., assigning a person with a known mental illness, and non-compliant with his medical orders, and who has a history of violent behavior [i.e. [redacted]] to
an inexperienced new hire [[redacted]], 3) requiring face-to-face visits before safety training was
completed, 4) implementing a non-mandatory buddy system for inexperienced new hires, 5)
relying on SCs to perform their own background checks, if at all, and 6) assigning heavy
caseloads such that the buddy system was viewed by Integra employees as unavailable and a
The Court construes the hazard presented to an Integra SC as being physically assaulted
during a face-to-face meeting by a member with a history of violent behavior.
See Davey Tree
Expert Co., 11 BNA OSHC at 1899 (redefining the hazard from “electrocution caused by a limb
touching a high-voltage line” to “electrocution from a tree limb contacting a power line because
of the actions of employees in removing the limb.”); Pelron Corp., 12 BNA OSHC 1833, 1835
(No. 82-388, 1986) (Judge erred by not defining the hazard in terms of preventable practices or
The existence of the hazard has been established.
2. Recognition of the Hazard
“A hazard is ‘recognized’ within the meaning of the general duty clause if the hazard is
known either by the employer or its industry.” Waldon Health Care Ctr., 16 BNA OSHC at
1061; Brennan v. OSHRC, 494 F.2d 460, 464 (8th Cir. 1974) (noting actual knowledge of a
hazard by an employer makes the hazard recognized for purposes of the general duty clause).
“Whether a work condition poses a recognized hazard is a question of fact.” SeaWorld, 748 F.3d
at 1208. Actual knowledge of a hazard by an employer may be gained by means of prior
episodes, employee complaints, and warnings communicated to the employer by an employee.
St. Joe Minerals Corp. v. OSHRC, 647 F.2d 840, 845 (8th Cir. 1981) (employer had both actual
and constructive knowledge of the hazard when previously warned by at least one employee).
The record establishes that Integra recognized the hazard of being physically assaulted by
members with a history of violent behavior during a face-to-face interaction. Integra used
precautions, inadequate as they were, against violence and also was aware of specific incidents of
violence before [redacted]’ death.
Waldon Health Care Ctr., 16 BNA OSHC at 1061
(“precautions taken by an employer can be used to establish recognition in conjunction with other
evidence.”). Integra’s own training, handbook, and existing policies establish that it recognized
that its SCs were exposed to the hazard of workplace violence by members with a history of
violent behavior. (Tr. 110, 114-17; Ex. C-17).
As Dr. Krajewski testified, Integra teaches its SCs to use “universal precautions” and to
“[a]ssume everybody you deal with could have the potential for harm.” The Neumann Training
has topics devoted to the “Dangerous Member” that an Integra SC must screen by identifying
“high-risk behaviors” including (as relevant to this case): a history of violence,
paranoia/suspiciousness, psychosis/confusion, substance abuse, verbal threats, criminal behavior,
antisocial personality, noncompliance, and possessor of weapons. (Tr. 1030, Exs. C-16, C-17, at
The record establishes that [redacted] exhibited some of the high risk behaviors described
above before he killed [redacted]. The evidence also establishes that Integra recognized that
[redacted] presented a specific threat to [redacted]. Integra performed no background check on
[redacted] to determine if he possessed violent tendencies, and took no action when the victim’s
progress note reports described her discomfort and his alarming, delusional behavior. [redacted]
noted that [redacted] made her so “uncomfortable” that she did not want to be alone in his house
with him. Although Integra managers admit to reading this note, Integra took no steps to assess
the risk posed by [redacted] and made no follow-up to ensure that [redacted] took measures to
protect her safety. Integra also did not discipline [redacted] for failing to bring a partner on her
subsequent visits to [redacted] and/or for failing to remain outside his home. Integra made no
inquiries into whether [redacted]’ interactions with [redacted] had improved or changed since her
initial visit. Thereafter, [redacted] performed three additional face-to-face visits with [redacted].
During these visits, [redacted]’ notes indicate that [redacted] exhibited behaviors that indicated
delusional or paranoid behavior. Delusions and paranoia are identified in Integra’s training as
“high risk” behaviors. [redacted]’ progress note reports show Integra recognized that she was
exposed to the hazard of workplace violence when visiting [redacted] alone at his home. (Tr.
139-43, 148, 278, 285-86, 356-65, Exs. C-7, C-19).
The evidence also establishes that, prior to the fatal attack on [redacted], Integra
managers were aware of several instances of violence or aggression by members against other
SCs. The evidence shows that several SCs were exposed to members exhibiting these “high risk
behaviors.” Furthermore, the record establishes that the SCs brought up their concerns in
progress note reports, which were reviewed and approved by Integra management. The record
also shows that SCs brought up their concerns regarding these high-risk behaviors during weekly
telephone calls with Drs. Krajewski and Arnott, as well as with Ms. Rochelle. In particular, SCs
Macaluso, Schneider, and Hinman had all reported to their supervisors particular instances in
which members acted aggressively, threateningly, or so strangely as to raise safety concerns.
This prior history of workplace violence put Integra on notice that its SCs were exposed to the
hazard of workplace violence during the face-to-face interaction with members with a history of
violent behavior. (Tr. 52-59, 268, 458, 470-72, 507, 831; Exs. C-29, at pp. 6, 18, 24, C-31, at p.
Integra claims that it did not know, nor could it have known, that it was in violation of the
OSH Act because “no precedent exists under which the general duty clause has ever been
construed as supporting enforcement of a citation stemming from a criminal attack on an
(Resp’t Reply Br., at p. 11). Integra also claims that the general duty clause as
applied in this case was unconstitutional because “a reasonable prudent employer” would not
have known of the abatement as proposed, asserting that its approach to safety was “robust” and
“above and beyond” the standard in the industry. (Resp’t Br., at pp. 15-17, Resp’t Reply Br., at
p. 10). The Court is unpersuaded.
“The goal of the [OSH] Act is to prevent the first accident, not to serve as a source of
consolation for the first victim or his survivors.” Arcadian, 20 BNA OSHC at 2008 (citation
Facial challenges to the general duty clause have been rejected. Courts have
accommodated possible fair notice problems in this context “by interpreting
‘recognized hazard’ only to include preventable hazards” or applying the clause
only “when a reasonably prudent employer in the industry would have known that
the proposed method of abatement was required.
SeaWorld, 748 F.3d at 1216 (citations omitted); accord Ensign-Bickford Co. v. OSHRC, 717 F.2d 1419, 1421 (D.C. Cir. 1983); Donovan v. Royal Logging Co., 645 F.2d 822, 831 (9th
Cir. 1981). “Hazardous conduct is not preventable if it is so idiosyncratic and
implausible in motive or means that conscientious experts, familiar with the industry,
would not take it into account in prescribing a safety program.” Nat’l Realty, 489 F.2d at 1266.
The evidence shows that Integra did not lack fair notice because the hazard associated
with the likelihood of an Integra SC being physically assaulted in the Integra workplace by
members with a history of violent behavior was preventable, and not “idiosyncratic and
implausible.” Given the multiple incidents of aggressive behavior by members directed toward
SCs, Integra knew, or could have at least anticipated, that readily available abatement measures
were required to decrease the risk of workplace violence directed toward SCs before December
The record shows that management at all levels of Integra knew about the “high-risk”
behaviors exhibited by members in the fall of 2012. Despite this fact, and despite what Integra
has termed a “robust” and “above and beyond” safety program, Integra did not implement its own
abatement measures even after being told of safety concerns by the SCs. SeaWorld, 748 F.3d at
1216 (finding recognition because “[g]iven evidence of continued incidents of aggressive
behavior by killer whales toward trainers notwithstanding SeaWorld’s [practices], SeaWorld
could have anticipated that abatement measures it had applied after other incidents would be
required.”). Progress note reports detailing the events of each visit were reviewed and approved
by Integra managers. E-mails with concerns were sent to management. Drs. Krajewski and
Arnott held weekly rounds in which everyone was involved, including team leads and all SCs. In
these weekly rounds, SCs brought up situations about which they sought advice. Both testified
their advice was to leave a situation in which the SC felt uncomfortable.
The problem with this advice is that “feeling uncomfortable” was a prerequisite to safety
in the Integra workplace. And the record shows that the level at which an Integra SC became
“uncomfortable” was subjective and dependent on experience, situation, and even naiveté. By
requiring its employees to “feel uncomfortable” as a prerequisite to feeling safe, Integra
;4563;4563shifted ;4564;4564its responsibility for employee safety and health onto its
employees. This Integra may not do, especially when there are practices, procedures or
conditions that are within its control that would decrease the likelihood of violence by members
with a history of violent behavior. Armstrong Cork Co., 8 BNA OSHC 1070, 1074 (No. 76-2777, 1980), aff’d 636 F.2d 1207 (3d Cir. 1980) (unpublished) (“The duty to comply with section
5(a)(1) rests with the employer. An employer cannot shift this responsibility to its employees by
relying on them to, in effect, determine whether the conditions under which they are working are
With regard to [redacted] in particular, Integra did not implement its own abatement
measures despite [redacted]’ progress note reports that showed that she was uncomfortable with
[redacted] and then that she was also showing up to [redacted]’s house unannounced. Integra did
not assign a mandatory buddy for [redacted] for these visits with [redacted]. Integra did not
require [redacted] to finish her safety training before attempting to contact [redacted] for the first
time even though his diagnosis of schizophrenia, which according to Mmes. Nelson and Rochelle
was cause to consider safety, was on the report provided by Amerigroup. After Ms. Rochelle
left, Integra did not even review some of [redacted]’s progress note reports.
The hazard in this case was recognized by Integra.
3. Likelihood of Harm
“[T]he criteria for determining whether a hazard is “causing or ;5953;5953likely to cause
death or serious physical harm” is not the likelihood of an accident or injury, but whether, if an
accident occurs, the results are ;5979;5979likely to cause death or serious harm.” Waldon, 16
BNA OSHC at 1060. Here, the record shows that the result of [redacted]’s attack was
[redacted]’ death. The Secretary has established that the hazard of physical assault by an Integra
member with a history of violent behavior during a face-to-face interaction is likely to cause
death or serious harm.
4. Feasibility of Abatement
“To show that a proposed safety measure will materially reduce a hazard, the
Secretary must submit evidence proving, as a threshold matter, that the ;1296;1296methods
undertaken by the employer to address the alleged hazard were ;1307;1307inadequate.”
U.S. Postal Serv., 21 BNA OSHC 1767, 1773-74 (No. 04-0316, 2006). As a threshold matter,
the Court finds that Integra’s approach to safety for workplace violence during face-to-face
interactions with members on December 10, 2012 was inadequate. The Secretary argues
that Integra shifted the ultimate responsibility of safety onto its employees by instructing
them to leave if they felt in danger or to bring a buddy if they felt they needed one.
Secretary also claims that these “universal precautions” fail because they were dependent on
a SC’s “accurate assessment and identification of potential danger,” which could not be
accurate due to a SC’s lack of skills and overly demanding caseload. (Sec’y Br., at p. 37). The
Court agrees with all of these points and finds Integra’s approach to safety inadequate as
a. Integra’s Inadequate Approach to Safety
This is a tale of two differing views of safety. To Integra’s senior management located in
Maryland and New Jersey, it was the best of times. To Integra SCs operating in the field in
Florida during the fall of 2012, it was the worst of times. Integra expected its SCs to “avoid any
situation that shows an indication of danger, potential danger. If you sense that you are in such a
situation, remove yourself immediately, notify your supervisor.” As President Yuhas testified,
“it all starts and ends with if you’re in a situation that appears in any way to be posing danger,
just don’t do it. It kind of boils down to that.” According to Dr. Krajewski, Integra’s safety
training was “more than adequate” and “above and beyond” compared to “what was out there in
the field.” He testified that the goal of the training was to ensure that the SC was “well informed
when they go out in the community, be prepared to  develop what they can see is the needs for
the patient, you know, what’s the patient missing, and connect them to those services.” (Tr. 767-68, 1026-27, 1034).
Integra’s safety policies and training consisted of: 1) a portion of the Neumann Training,
2) face-to-face field-based training, 3) weekly rounds, 4) a buddy system, 5) immediate advice
via a telephone hotline manned 24 hours per day, and 6) self-empowered “universal precautions”
– where employees were allowed to leave a situation if they felt unsafe. Ms. Nelson testified that
Integra’s approach to safety was inadequate. The Court agrees with Ms. Nelson. (Tr. 585, 767,
1027; Ex. C-27).
1. The Neumann Training: The Neumann Training was an online slideshow course
focused on orienting new SCs with their job duties.
In the summer of 2012, the training
consisted of 15 sessions. One session addressed safety, Session 8: “In-Home & Community
Safety.” According to Dr. Arnott, completing all 15 sessions took about 30-35 hours, on average.
Dr. Arnott affirmed that a SC spent a little more than about 2 hours on Session 8. At the end of
each session, including the safety session, a SC had the opportunity and was required as part of
the class participation grade to contribute to an online discussion. (Tr. 889-90, 910-12, 937-38,
951-54, 994-96; Exs. C-15 through C-17, R-E, R-J, R-V, R-QQQQ, R-RRRR).
Ms. Nelson’s opinion of the safety portion of the Neumann training was that it was
inadequate because it “lacked depth, good explanation of items, and a chance for application
through case studies. Also, personal safety materials provided to SCs were vague, lacking
practical content and incomplete.” Ms. Nelson believed that the Neumann training did not instill
the requisite “ability to assess the person, their situation and the setting” in a novice Integra SC.
The Neumann training also “failed [to] engage the trainee in an experiential process to improve
their self-awareness of the ‘flight or fight’ response, increase their ability to maintain calmness
under pressure, recognize and use non-verbal communication, utilize tone of voice, safe language
skills, and practice possible case scenarios,” all of which are “fundamental in safety training.”
Ms. Nelson noted that “[m]uch of the at-risk behaviors and crisis management information
presented was directed towards client care and not towards the worker.” (Ex. C-27, at pp. 9-10).
Ms. Nelson believed that the assessment form SCs were tasked to fill out required a
certain skill set to be filled out safely. “Less skill in dealing with potentially dangerous clients
and situations makes violence inherent in this work.” Workers need “proper training in
interviewing, assertiveness, de-escalation, verbal/non-verbal communication, mental illness,
assessment and crisis intervention” to reduce safety risks. Although some safety points were
covered, Integra failed to “tell workers how to practice them.” Moreover, Ms. Nelson believed
that the Neumann training increased the danger risk to its novice employees by “providing a list
[of high risk behaviors] without [providing] the knowledge to truly know how to identify high
risk behaviors[.]” The Court agrees with Ms. Nelson and finds that the Neumann training
provided inadequate safety training to the Florida SCs for the reasons that she conveyed. (Ex. C-27, at pp. 5-10).
2. Face-to-face training: Dr. Arnott and/or Ms. Cooney conducted face-to-face training
of the Florida SCs in September, October and November, 2012. From September 4 through
September 7, 2012, Ms. Cooney shadowed some of the new SCs as they worked with members
in the community over the course of 17.5 hours.
During the shadowing, the SC observed Ms.
Cooney perform various scenarios like finding a member or visiting a member in the hospital or
at home. On September 4, 2012, Dr. Arnott, Mr. Yuhas and Ms. Cooney conducted a “Team
Meeting” with the SCs at Amerigroup for three hours. As part of this team meeting, Dr. Arnott
taught a 45 minute “overview” session concerning the “Day of a Service Coordinator”, that
included discussion of values, expectations, safety, and tips. Dr. Arnott testified that she passed
out handouts entitled “Social Worker Safety Tips” from Syracuse University and “Home Safety
Tips”. She said that these two handouts were also part of the Neumann training.
shows classroom type training also occurred in November, 2012 during which safety was
discussed. (Tr. 704-05, 961, 998-1001, 1027; Exs. R-F, R-G, R-H, R-EEEE, at pp. 12-13).
According to Ms. Nelson, “[g]roup training in safety is important because the subject is
intimidating to many people.” Ms. Nelson believed that “the most effective training occurs when
workers share their experiences and feelings with their peers. Beyond building camaraderie, they
gain practical safety ideas and learn about real-life encounters to help expand their knowledge
base.” Ms. Nelson characterized the ‘shadowing’ done at the onset of the job as brief and
insufficient given the isolating nature of the SC’s virtual workplace. She testified that the face-to-face training Integra provided was consistent with worker isolation. Ms. Nelson believed that
Integra management did not prioritize safety. Ms. Nelson pointed out that, despite workers’
concerns communicated to management, Integra lacked a standardized workplace violence
prevention program, ignored worker’s requests for better safety training, and lacked an
established safety committee to consider employee concerns and assure that safety protocols were
(Tr. 644-46, 697-98; Ex. C-27).
The Court finds Integra’s face-to-face safety training to be inadequate. It was short in
time and safety content, and was not mandatory before going out into the field (even for
inexperienced new hires). In one instance, it was included as one of the many topics addressed
in a 45 minute overview. Ms. Cooney served as Coordinator of Program Implementation and Training. She provided face-to-face training to the SCs in the fall of 2012. Ms. Cooney
was not qualified to train or mentor SCs. She lacked any academic credential and did not
meet Integra’s basic requirement that SCs have a bachelor’s degree. Her answers to questions concerning her academic achievements were evasive. She did not know how many
credits she had earned while taking community college courses. The record also does not
establish to what extent, if at all, [redacted] was trained by Ms. Cooney in the field. Ms.
Cooney never met [redacted]. Some SCs began visiting members without having first
received any shadow training and some SCs never shadowed anyone.
(Tr. 122-23, 702-03,
800; Ex. C-27).
3. Weekly Telephone Training: The “weekly rounds” were telephone conference calls
among the SCs, team leads, and Drs. Arnott and Krajewski. These phone calls typically occurred
on Wednesdays and lasted up to about one hour. Accounts differed on whether roll was taken.
There are no written attendance sheets in the record. Dr. Krajewski testified that during these
calls, “cases are presented. We go through scenarios. We talk about, uh, patients who are
making people, you know, feel uneasy, uh. Patients who are – you know, we said, well, what
kind of services do they need? We talked about safety issues.” Ms. Rochelle also held some
staff meetings on Wednesdays at 11:00 a.m. that lasted up to about one hour. They discussed
issues similar to the telephone calls with Dr. Krajewski. These telephone calls primarily focused
on how SCs were to provide care to members, and not SC safety. Mr. Schneider testified that
they did not discuss safety issues during the weekly rounds until after [redacted]’ death. None of
the three witnesses who led these calls testified to the specific content of the safety message
given to the SCs during these weekly rounds. Rather, the message given to the SCs was to leave
a situation if the SC felt unsafe. The Court finds that this message is conclusory and empty of
specific content regarding prevention and detection of potential violence by a member at the
Integra workplace. (Tr. 96, 98, 196 -97, 289-91, 483-84, 767, 818-21, 914, 1027, 1030).
4. Buddy System: Integra had a loosely-defined buddy system. Ms. Nelson recalled Dr.
Arnott and Ms. Brown mentioning the buddy system as Integra’s primary safety policy. Integra’s
buddy system was developed for both safety and back up reasons, i.e., “if you’re going on
vacation, or you’re out, there’s a backup person who can step in.” Buddies were not assigned.
Integra did not have a written procedure for requesting a buddy. Dr. Arnott testified that
Integra’s buddy system policy was that “if a Service Coordinator felt unsafe, he should ask a
colleague to go with him.”
Before [redacted]’ death, Integra did not require SCs to take a
buddy to a member’s house if the SC thought there was a danger. SCs allegedly complained to
Dr. Arnott that “they didn’t want to do it [buddy up] because their days were so long.” Dr.
Arnott could not recall whether Integra had ever disciplined a SC for visiting a member without a
buddy before [redacted]’ death. (Tr. 127, 348, 353-55, 698-700, 898, 942-43).
According to Ms. Nelson, Integra’s buddy system was poorly implemented. It was not
standardized “with specific procedures on how to double team,” allowing workers to be
“unprepared to deal with a violent situation.” It was also discretionary, when it should have been
mandatory, and it was ineffective because “Integra did not have workers discuss, role-play,
identify code words, non-verbal signals and practices scenarios in order to be an effective
(Tr. 741-42, Ex. C-27, at p. 11).
The Court agrees with Ms. Nelson and finds that Integra’s buddy system was ineffective
and in the case of [redacted] of no real safety value. Before [redacted]’ death, SCs relied on
themselves to arrange for another SC to accompany them. Dr. Arnott testified that a mandatory
buddy system was started, but then stopped, previously in the Philadelphia Integra office because
the work load was inconsistent with it. As a solution, Integra made the buddy system
discretionary, which, the Court finds, conveyed the message that the workload was more
important than a buddy. (Tr. 114, 354-56).
5. Hotline: Integra set up a telephone hotline to be used when “somebody’s in a bind
and they need to have information right away.” The hotline was set up so that the first call was
to the team lead, the second call to Dr. Arnott, and the third call to Dr. Krajewski. With regard to
the hotline, Ms. Nelson testified: “I was aware of two different things. That [Drs. Arnott and
Krajewski] said they were available and that the workers said they had trouble getting a hold of
them.” Ms. Nelson’s testimony is consistent with the SC testimony in this case regarding trying
to get in touch with management. Even if the SC got in touch with management, the standing
advice was to get out of the situation if they felt uncomfortable. If the hotline was to be used
when the SC was “in a bind,” and needed something “right away,” the SC was already face-to-face with a member. Integra’s hotline was of limited practical use when the “bind” was
workplace violence by a member at Integra. (Tr. 725, 1027).
6. Universal Precautions: Integra says it directed its employees to use “universal
precautions,” and treat all members as if they had violent tendencies. Integra says SCs were
allowed to “get out” of or leave any situation they were currently in if they felt in danger. Dr.
Krajewski explained that “universal precautions” means to “[a]ssume everybody you deal with
could have the potential for harm. And you need to have that healthy sense of awareness  so
that when you go out there, you want to be aware.” Ms. Nelson testified that she did not view
testimony by Dr. Arnott and Ms. Brown alluding to SCs exiting when feeling unsafe or to
meeting members in a public place as part of Integra’s workplace safety program because they
were not mandated strict policies. At best, Integra’s message to its SCs was mixed. Managers
say they said leave any dangerous situation. The Neumann training test questions sought answers
that were correct and different. Practicing “universal precautions” was plainly inadequate when,
as here, the SC was inexperienced, naïve, untrained, and already face-to-face with the member
with a history of a violent behavior. (Tr. 700, 924, 1030-31; Exs. C-16, C-27).
For these reasons, the Court finds that Integra’s approach to safety was inadequate.
One more point is by far more persuasive in illustrating Integra’s inadequate approach to
safety. The SC’s goal was to complete the assessment of the member. The assessment
contained information necessary to gauge potential violence from the member, including
previous history of violence, living habits, substance abuse, and whether they are compliant
with their medication. Before assessing these “predictors of violence,” the SC was forced to
meet face-to-face with a member multiple times. The record shows that in many instances
Integra directed its SCs to cold-call members, and if unsuccessful, go to their homes
unannounced, to make an initial contact. After obtaining a member’s written consent to
accept Integra’s services, SCs had up to thirty days to complete their assessment of the
member and determine his needs. Before making their assessment, SCs generally did not
know how non-compliant the member had been with his doctor’s orders, whether he had
any substance abuse addictions, and whether he had any criminal behavior or history. And
during this time before the assessment, SCs were charged by Integra to chase down members
and obtain this information, all while not knowing how dangerous they actually are. (Ex. C-34, at p. 3; Sec’y Br., at p. 37).
The case of [redacted] showcases Integra’s inadequacy. [redacted] was hired sometime
during the period from August through September 8, 2012. By September 8, 2012, Integra had
assigned [redacted] to [redacted] as a member in her caseload. [redacted] attempted to contact
[redacted] three times in September: September 9, September 16, and September 23. The
discussion notes associated with the Neumann training indicate that [redacted] did not complete
the safety portion of the Neumann training before September 27, 2012. [redacted] met with
[redacted] for the first time in October 2012, the same month that she was awarded her certificate
for completing the Neumann training. In the paper she prepared as part of the Neumann training,
she stated: “Lastly knowing how to act in a crisis situation is not a skill that is easily learned, and
I know that it will be difficult when I encounter it for the first time.” Despite Integra’s approach
to safety, Integra’s own practices and policies exposed [redacted] to a hazard she should not have
been required to confront while working for Integra. (Tr. 136, 141-42, 992-93, 1015-16; Exs. C-7, R-JJ, at p. 1, R-VVV, R-RRRR, at p. 11).
b. The Secretary Has Established Feasible Means of Abatement
After establishing that the employer’s existing means of abating the hazard are
inadequate, “[t]he Secretary must [then] specify the proposed abatement measures and
demonstrate both that the measures are capable of being put into effect and that they would be
effective in materially reducing the incidence of the hazard. The Secretary must also show that
her proposed abatement measures are economically feasible.” Beverly, 19 BNA OSHC 1161,
1190 (No. 91-3144, 2000) (consolidated) (citations omitted). “‘Feasible’ means economically
and technologically capable of being done.” Id. “[F]easible means of abatement are
established if ‘conscientious experts, familiar with the industry’ would prescribe those means
and methods to eliminate or materially reduce the recognized hazard.” Arcadian, 20 BNA
OSHC at 2011 citing Pepperidge Farm, Inc., 17 BNA OSHC 1993, 2032 (No. 89-0265, 1997)
citing Nat’l Realty & Const. Co., Inc., 489 F.2d at 1257. “[T]he Secretary need only
show that the abatement method would materially reduce the hazard, not that it would
eliminate the hazard.” Morrison-Knudsen, 16 BNA OSHC at 1122.
As previously discussed herein, the Secretary identified many feasible means of
abatement in Citation 1, Item 1, and during trial that Integra could use to reduce the likelihood of
the workplace violence described herein.
Ms. Nelson testified that performing background
checks, implementing certain administrative and engineering controls, including assigning
member/caseloads considering member risk,
and providing employee training in de-escalation
and non-harming self-defense techniques, would be low-cost to Integra and would materially
reduce the risk of the workplace violence described herein. She also testified that the abatement
recommended by OSHA was feasible and would materially reduce instances of workplace
violence. This portion of Ms. Nelson’s testimony was unchallenged by Integra, which provided
neither lay nor expert opinion testimony claiming that these abatement measures were infeasible
or would not reduce the hazard of workplace violence described herein.
(Tr. 617, 644-66, 672-75, 1094-95; Exs. C-1, at pp. 6-8, C-27, at p. 12; Sec’y Br., at pp. 34-35).
Integra does not claim that the methods proposed by the Secretary are infeasible
technologically or economically. Indeed, the record shows that Integra has already implemented
some of the Secretary’s proposed means of abatement. For instance, Integra now has a written
workplace violence prevention program with mandatory reporting requirements. They had no
such plan prior to [redacted]’ death. Integra now regularly performs background checks on all
members before assigning them to a SC. If a member has a criminal history, Integra initiates a
“red flag” on that member’s chart, notifying anyone reading about that member about the
criminal history. Typically, Integra now “rolls off” that member, so an Integra employee would
never come into contact with that person while on the job. This evidence supports a finding that
the Secretary’s first three proposed means of abatement are feasible technologically and
economically for Integra. SeaWorld, 748 F.3d at 1215 (finding that evidence of post-citation
methods of abatement taken by SeaWorld support finding that the proposed means were feasible
and did not fundamentally alter SeaWorld’s business.). (Tr. 126, 166-67, 377, 389, 410, 810; Ex.
Integra claims that the Secretary failed to show that any of these abatement
measures would be effective in abating the hazard. Integra bases its claim on the fact that
Ms. Nelson could not quantify how effective the abatement measures could be and could not
promise that the hazard would be completely eliminated. It is not necessary that the hazard
be eliminated, only that it be materially reduced. Morrison-Knudsen, 16 BNA OSHC at 1122.
OSHA itself notes in its “Guidelines for Preventing Workplace Violence for Health Cate &
Social Service Workers,” that “[a]lthough not every incident can be prevented, many can, and
the severity of injuries sustained by employees can be reduced.” (Ex. C-32, at p. 7; Resp’t Br.,
at pp. 13-14; Resp’t Reply Br., at pp. 7-9).
Ms. Nelson testified specifically to these methods of abatement and that they do decrease
the risk of physical assault in the Integra workplace. See Williams Enters., Inc., 7 BNA OSHC
1247, 1250 (No. 4533, 1979) (“The Secretary must establish hazard recognition by reference to
the level of awareness or knowledge in the industry or by the employer himself, but the required
abatement is determined by reference to feasibility rather than industry custom or knowledge.”);
Wheeling-Pittsburgh Steel Corp., 10 BNA OSHC at 1245 (“[S]ection 5(a)(1) may require that
feasible protective measures be taken even though such measures are not considered customary
in a particular industry.”). The Court finds that Ms. Nelson’s opinion as an expert in personal
safety, and visiting people in the field, is persuasive evidence that the Secretary provided for this
The Court is persuaded by Ms. Nelson’s opinion that “[t]he key variables in workplace
safety training are identifying ‘who, what and where.’ The ability to assess the person, their
situation and the setting is paramount.” (Ex. C-27, at p. 9). The Court finds that preparation is
essential to reduce the risk of physical assault in the Integra workplace by a member with a
violent history. A written workplace violence prevention program decreases the risk of assault
by helping prepare the SC for the possibility of a violent situation. Ms. Nelson testified that: 1) a
written document is an established resource for trainees, preventing experienced workers from
taking all of their knowledge with them if they leave the company; 2) the safety program also
provides “scenarios” to make trainees aware of possible safety situations like a member with a
weapon, dogs, trespassing signs, and other people in the member’s house; and 3) the safety
program will then list ways to identify, prevent, and escape from those scenarios. (Tr. 646-49).
The Court agrees with Ms. Nelson that a background check gives more information to the SCs so
that they know who they are meeting with and can prepare themselves appropriately. (Ex. C-27,
at p. 11). It is undisputed that a history of violent behavior, which could be uncovered in a
background check, is one of the top predictors of future violence. Flagging a potentially violent
member with a history of violence decreases the risk of assault because it allows the SCs to know
who may have a propensity for violence so that they may prepare themselves or alternatively
assign the member to a SC based on client risk, rather than geographic or scheduling concerns.
(Tr. 618-19). The Court finds that “rolling off” a member with a history of violent behavior
decreases the risk of assault because the SC would not be required by Integra to meet with that
member. The Court also agrees with Ms. Nelson that mandatory reporting requirements decrease
the risk of assault because: 1) by making it mandatory, it decreases the chance that Integra SCs
will not report it for fear of looking like they are not doing their job, and 2) it allows all the SCs
to know what is going on so that they can all help and prepare for the possibility of a violent
situation with a particular member. (Tr. 661-62).
The record shows that Integra’s approach to containing this hazard was plainly
inadequate. The measures Integra has adopted since [redacted]’ death are consistent with
Ms. Nelson’s expert testimony,
as well as OSHA’s recommendations as noted in its
Guidelines. The Secretary has met his burden in establishing feasible means of abatement for
this general duty citation.
This citation item is affirmed.
The Secretary characterizes this citation item as serious. A violation is “serious” if there
was a substantial probability that death or serious physical harm could have resulted from the
violative condition. 29 U.S.C. § 666(k). The record shows that [redacted], a novice employee
who Integra hired and trained inadequately, died as a result of an attack by member [redacted].
The violation is properly characterized as serious.
III. Serious Citation II, Item I – Alleged Reporting Violation
The Secretary claims that Integra violated the reporting standard at 29 C.F.R.
§ 1904.39(a) because it did not report [redacted]’ death within eight hours of its occurrence to
OSHA. To prove a violation of an OSHA standard, the Secretary must show by a preponderance
of the evidence that: (1) the cited standard applies, (2) there was a failure to comply with the
cited standard, (3) employees had access to the violative condition, and (4) the employer knew or
could have known of the condition with the exercise of reasonable diligence. Astra Pharma.
Prods., 9 BNA OSHC 2126, 2129 (No. 78-6247, 1981), aff’d in relevant part, 681 F.2d 69 (1st
Cir. 1982) (Sec’y Br., at p. 38).
It is undisputed that [redacted] was an employee of Integra, that she died as a result of a
work-related incident, and that Integra did not report her death to OSHA within eight hours of its
occurrence. 29 C.F.R. § 1904.39(a); see also 29 C.F.R. § 1904.5(a) (an injury is work-related if
an event or exposure in the work environment either caused or contributed to the resulting
condition). It is undisputed that Integra failed to report [redacted]’ death to OSHA because of
the mistaken assumption that its responsibility extended only to “Work[er’s] Compensation.”
;5587;5587Although initially contested, Integra states in its post-hearing brief that it no longer
contests this citation item.
See Charles A. Gaetano Constr. Corp., 6 BNA OSHC 1463, 1465
(No. 14886, 1978) (noting ignorance of the requirements of the law generally does not excuse
noncompliance). (Tr. 86; Resp’t Br., at p. 18).
This citation item is affirmed.
The Secretary characterizes this citation item as other-than-serious. A violation is “other-than-serious” if the evidence in the record does not support a finding that failure to comply with
the cited standard would likely result in death or serious physical harm. 29 U.S.C. § 666(k);
Miniature Nut & Screw Corp., 17 BNA OSHC 1557, 1559 (No. 93-2535, 1996). The Secretary
has not claimed that Integra’s failure to report [redacted]’ death would likely result in another
Integra employee death or serious physical harm. The record also does not support such a
finding. The Court finds that the violation is properly characterized as other-than-serious.
“Section 17(j) of the [OSH] Act, 29 U.S.C. § 666(j), requires that when assessing
penalties, the Commission must give ‘due consideration’ to four criteria: the size of the
employer's business, gravity of the violation, good faith, and prior history of violations.” Hern
Iron Works, Inc., 16 BNA OSHC 1619, 1624 (No. 88-1962, 1994). When determining gravity,
typically the most important factor, the Commission considers the number of exposed employees,
the duration of their exposure, whether precautions could have been taken against injury, and the
likelihood of injury. Id. When evaluating good faith:
the Commission focuses on a number of factors relating to the employer's actions,
‘including the employer's safety and health program and its commitment to assuring
safe and healthful working conditions[,]’ in determining whether an employer's overall
efforts to comply with the OSH Act and minimize any harm from the violations merit
a penalty reduction.
Monroe Drywall Constr., Inc., 24 BNA OSHC 1209, 1211 (No. 12-0379, 2013) (citations
omitted). The Commission is the “final arbiter” of penalties. Hern Iron Works, 16 BNA OSHC
at 1622 (citation omitted).
For Citation 1, Item 1, the workplace violence violation, the Secretary proposed the
maximum statutory penalty for a serious violation, $7,000. See 29 U.S.C. § 666(b). The Court
finds that the gravity of the violation is high. Due to its inadequate approach to safety in the SC
workplace, Integra exposed essentially all of its SCs to an increased likelihood of workplace
violence by a member with a history of violence. Some of these exposures lasted for hours while
alone with a violent person in a private home or vehicle. The record establishes that Integra
could have taken precautions preventing injury by hiring, training, performing, and assigning
work appropriately, but chose not to in the interest of saving money and time. The record also
establishes that an encounter at the home of a dangerous member resulted in a fatality. Integra
has no prior history with OSHA. OSHA never inspected Integra before [redacted]’ death. The
record shows that Integra had about 62 employees at the time of [redacted]’ death. OSHA had
initially calculated a 30% reduction in penalty due to size, but revised it to 0% “to achieve the
appropriate deterrent effect.” OSHA did not recommend a good faith reduction because it is
only given “if there’s an adequate safety and health program.” The Court agrees with the
Secretary’s proposed penalty recommendations. Integra also does not address the proposed
penalty amount for this citation item in its post-hearing briefs.
The Court finds that the
proposed penalty is appropriate for this affirmed citation item. (Tr. 168-69; Exs. C-2, C-6, at p.
2; Sec’y Br., at p. 39).
For Citation 2, Item 1, the reporting violation, both parties agree that the proposed $3,500
penalty is appropriate. The statutory maximum civil penalty for an other-than-serious violation
of the OSH Act is $7,000. 29 U.S.C. § 666(c). The Court finds that the gravity for this other-than-serious violation is low as there was little, if any, risk of injury as a result of this violation.
The Court also agrees with the Secretary’s proposal for a reduction for size, but no reduction for
good faith or history. The Court finds that the proposed $3,500 penalty is appropriate for this
affirmed citation item.
(Tr. 169-70; Sec’y Br., at p. 40; Resp’t Br., at p. 22).
FINDINGS OF FACT AND CONCLUSIONS OF LAW
All findings of fact and conclusions of law relevant and necessary to a determination
of the contested issues have been made above. See Fed. R. Civ. P. 52(a). All proposed
findings of fact and conclusions of law inconsistent with this decision are denied.
Based on these findings of fact and conclusions of law, it is ordered that:
1) Item 1 of Citation 1, alleging a serious violation of section 5(a)(1) of the OSH Act, is
AFFIRMED and a penalty of $7,000 is ASSESSED.
2) Item 1 of Citation 2, alleging an other-than-serious violation of 29 C.F.R. § 1904.39(a), is
AFFIRMED and a penalty of $3,500 is ASSESSED.
The Honorable Dennis L. Phillips
U.S. OSHRC Judge
Date: __June 22, 2015____________