State regulators fined Children's Hospital Oakland $10,350 on Tuesday for safety violations that include inadequately protecting employees from violence in its emergency department.
The hospital has had several dramatic incidents in recent months, noted the Cal-OSHA citation.
In July, a 49-year-old gunman held a registered nurse and a ward clerk hostage before being subdued by police. No one was injured.
In October, a gunshot victim was dropped off on hospital property within minutes of a second gunshot victim walking in and a third being carried there by bystanders.
That occurred a year after three gunshot victims drove themselves to the front of the hospital in September 2009.
Cal-OSHA faulted the hospital for not having adequate procedures for protecting employees as they respond to gunshot victims dropped off at hospital doors, and for not effectively training employees to deal with workplace violence.
The lack of a clear policy about how to bring dropped-off victims inside "caused unnecessary delay and potential security exposure to employees in the uncontrolled environment outside the building," the citation stated.
In a violation labeled "serious," Cal-OSHA faulted the hospital for not having a policy in place a year after it became aware of the hazards during the September 2009 drop-off.
Cal-OSHA also cited the hospital for not documenting that it included nonmanagement employees in developing plans for protecting against bloodborne pathogens, not doing antibody testing of at least one health care worker after a Hepatitis B vaccination and conducting workplace violence training primarily by having employees read written materials instead of having interactive training with appropriate instructors.
Representatives of the California Nurses Association, who have been negotiating for months for a new contract, have sought improved safety measures. They held a news conference in front of the hospital Tuesday to highlight the fines.
Without a policy in place during the October incident, "it was very chaotic and there was some delay in bringing the patient inside," said Anna Smith, an emergency room registered nurse, in a phone interview.
"We have demanded that our employer provide us with the training we need to care for the children of Oakland," registered nurse Martha Kuhl said in a written statement. "Instead, they have disregarded their obligations, and we applaud the state for its actions."
The hospital will appeal the fine, said President and Chief Executive Officer Bert Lubin in a letter to employees.
"We go to great lengths to ensure that our workplace is safe so that our staff can focus on caring for the children that we are privileged to serve," Lubin wrote.
He noted that during the past nine months, hospital managers developed a new policy to address how employees should provide medical assistance for patients within 250 yards of the hospital. He described it as a complicated process that included outside agencies.
Lubin said the action by Cal-OSHA appears to stem from the mistaken belief that because the hospital is in an urban setting, violent criminals are likely to pursue victims who are brought to the hospital for care, creating a threat to hospital staff.
"Indeed, at one point, the investigator compared Oakland to the violence found in the streets of Mexico City," Lubin wrote. "The facts do not support this assertion."
Lubin noted that in the past three years, out of 156,289 patients treated in the hospital's emergency department, 77 were gunshot victims. Of those 77, eight were dropped off by vehicle, walked in or, in one instance, came by bicycle.
"While we are disappointed in the citations and the stereotypes about the city of Oakland and our neighborhood that appear to underlie them, we are pleased about having made significant refinements to our safety and security policies," Lubin said. "We will continue to improve our practices."
Contact Sandy Kleffman at 925-943-8249.