Labor & Employment Law Daily Wrap Up, SAFETY—11th Cir.: OSHA citation regarding workplace violence in psychiatric hospital is upheld, (Jun 20, 2025)

By Nadine E. Roddy, J.D.

Even though two of eight agency-proposed abatement measures were invalid, the citation was supported by the other six.

A hospital and its management company were a “single employer” for purposes of an OSHA citation for exposing employees to workplace violence, the Eleventh Circuit has ruled. However, two of eight OSHA-proposed hazard abatement measures were invalid for lack of evidence of economic feasibility (UHS of Delaware, Inc. v. Secretary of Labor, No. 23-11327 (11th Cir. June 18, 2025)).

Workplace violence. An in-patient psychiatric hospital in Florida and its management company petitioned the Eleventh Circuit for review of a decision of the Occupational Safety and Health Review Commission that affirmed an administrative law judge’s upholding of the Secretary of Labor’s citation and fine against the hospital and the company for workplace safety violations. Most of the hospital’s patients were involuntarily committed, and instances of patient-on-staff aggression were not uncommon. After an incident in which a youth patient “dove into the nurses’ station” and stabbed a nurse, OSHA opened an investigation, which revealed dozens of instances of patient-on-staff aggression and violence. Employees suffered injuries such as stab wounds, concussions, broken bones, strained backs, bite wounds, dislocated shoulders, a broken hip, bruises, and contusions.

OSHA citation. OSHA cited and fined the hospital and the company in the amount of $12,934 for exposing employees to workplace violence in violation of the General Duty Clause of the Occupational Safety and Health Act. The citation set forth a nonexclusive list of eight “feasible and acceptable means of abatement” of the hazard, including (1) “[d]esignat[ing] specific staff with specialized training in security to monitor patients for potential aggression and assist in preventing and responding to violent events;” and (2) “[d]esignat[ing] an additional staff member with specialized training in security to be available at intake on all shifts.”

The issues before the Eleventh Circuit were whether the Commission erred (1) in concluding that the company and the hospital were a “single employer” for liability purposes, and (2) by failing to require the Secretary to prove that the proposed abatement measures were effective and economically feasible.

Single employer. Noting that an order of the Commission will be set aside “only if it is arbitrary and capricious, an abuse of discretion, or otherwise not in accordance with the law,” the court determined that the Commission’s conclusion that the company and the hospital operated as a single employer was amply supported by the administrative record. To decide whether to treat two companies as a single employer, the Commission typically considers whether the entities (1) share a common worksite, (2) are interrelated and integrated concerning operations as well as safety and health matters, and (3) share a common president, management, supervision, or ownership. The Secretary bears the burden of proof.

In this case, both entities had employees working at the common worksite of the hospital. Indeed, the hospital’s CEO, CFO, COO, and Director of Nursing were company employees who worked full-time in the hospital and were integrally involved in the hospital’s daily operations, including visits to patient units. Further, the operations of the two entities were interrelated and integrated, particularly concerning health and safety matters. The company developed most of the hospital’s safety training and workplace violence policies, to which the hospital made no substantive changes. Lastly, the two entities shared a common management, supervision, and ownership. In addition to the hospital being managed and supervised daily by a team of company employees, the two entities shared a parent company.

Abatement measures. To prove a violation of the OSH Act’s General Duty Clause, the Secretary must establish that (1) a condition or activity in the workplace presented a hazard; (2) the employer or its industry recognized the hazard; (3) the hazard was causing or likely to cause death or serious physical harm; and (4) a feasible and effective means existed to eliminate or materially reduce the hazard. When the Secretary proposes several alternative measures to abate the hazard—as in this case—the Secretary need only prove that at least one of the measures was not implemented, and that the same measure is both effective and feasible in addressing the alleged hazard.

Regarding the fourth element, the court agreed with the hospital and the company that the record was devoid of evidence that hiring round-the-clock security staff would be economically feasible. Indeed, at trial, one of the Secretary’s expert witnesses acknowledged that she had not even considered the economic costs of adding these job positions. The Secretary therefore failed to meet his burden concerning the two security-staffing-related abatement measures. As a result, the hospital and the company had no duty to implement these measures, and their petition would be granted as to these measures.

Concerning the other six proposed abatement measures, the hospital and the company had identified no basis on which to challenge them. Thus, the remaining measures amply supported the Commission’s decision affirming the citation.

For these reasons, the court granted the petition for review in part and denied it in part.

The case is No. 23-11327.

Judge: Hull, F.

Attorneys: Kip J. Adams (Lewis Brisbois Bisgaard & Smith) for UHS of Delaware, Inc. Dion York Kohler (Jackson Lewis) for Premier Health Solutions of Florida. Anne Godoy, U.S. Department of Labor, for Secretary of Labor.

Companies: UHS of Delaware, Inc.; Premier Health Solutions of Florida

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