8. Prevent physical injury/death
Assault, suicide & industrial manslaughter
Hospitals and practices are hazardous environments that require strong occupational health and safety measures to prevent physical injuries and deaths. Employers must notify regulators about serious work-related incidents, and doctors are encouraged to report hazards.
To reduce legal liability and ensure safety, employers should establish clear policies, promote a safe work culture, and implement measures such as physical security and policies and procedures to prevent and manage verbal and physical assault, as well as provide training to prevent accidents and manage risks effectively.
As hospitals and practices are hazardous environments that require occupational health and safety management of the highest standard, employers require detailed, specialised advice to protect them from legal liabilities related to workplace physical injuries and deaths.
Most hospitals and other health services usually provide detailed information about physical safety and protection on their websites for employees and contractors because they understand the personal and financial cost of work-related workers’ compensation claims and penalties for physical injuries. Induction and ongoing training is usually provided on topics such as infection control and protection, falls and other accidents causing musculoskeletal injuries.
Notifiable physical incidents
Persons conducting a business or undertaking (PCBUs) must notify their WHS regulator immediately after becoming aware of serious work-related physical injuries, illnesses and dangerous incidents. These are referred to as 'notifiable incidents'. An incident is notifiable to the appropriate regulator by the workplace if it results in a physical injury or illness where:
- immediate admission into a hospital as an in-patient is required for any duration
- immediate treatment is not readily available because the incident site is rural or remote or specialist treatment is not available
- treatment would be required but was not received by the person as the person refuses treatment
- a person (supported by a medical certificate) is, or is likely to be, unfit for a continuous period of at least 7 days, to perform their usual activities at work.
For more information: https://www.safeworkaustralia.gov.au/safety-topic/managing-health-and-safety/incident-notification
Doctors, particularly those in training, have a tendency to avoid submitting incident reports or making workers’ compensation claims for physical or mental injuries for fear of punitive career repercussions. Without incident or claims data, employers are at risk of underplaying the physical and psychological hazards impacting the medical profession.
Another under recognised area of concern is the harm to pregnant doctors and their unborn babies related to workplace hazards such as physical strain and poor ergonomics, infectious diseases, radiation, exposure to hazardous chemicals such as anaesthetic gases or sterilants, long shifts and night shifts, violence, and a lack of peer support resulting in stress and burnout. The onus to prevent and manage these major WHS risks is on the workplace, not the pregnant individual.
To overcome these barriers deterring reporting by doctors, hospitals and practices can establish fair, confidential complaint processes including whistle blower protections for complainants, ongoing staff training on accountability, and regular HR and other management performance appraisals. Heads of departments and other senior doctors can also be enlisted to play major roles in creating physically and psychologically safe workplaces.
The legal liability of employers
Employers can reduce their legal liability by promoting safer work environments for all employees and contractors. Legal protection can be built through a range of positive practical measures that would benefit doctors in training, including preventing and managing WHS hazards through the implementation of clear and contemporary policies and procedures, visible support from senior management and supervisors, and monitoring of anonymous independent surveys or other tools to gauge work culture and manage potential WHS issues early, as well as appropriate follow-up after WHS incident reporting.
The catastrophic consequences of industrial manslaughter deserve a special mention. Industrial manslaughter is when ‘employers including Directors and Officers of public hospitals engage in grossly negligent conduct that breaches their work health and safety duties that they owe an individual (a staff member, contractor, patient or other member of the public) and cause the death of that individual’.
Employers can be liable for severe fines and criminal charges for industrial manslaughter if it is found that their failure to address known workplace hazards led to deaths due to accidents, suicide and assault. For example, the death of a pregnant health worker or their unborn child due to unsafe working conditions would fall into the category of industrial manslaughter.
To comply with their WHS duties in relation to industrial manslaughter, employers must resource systems, policies and procedures to prevent and manage: a) life threatening accidents due to exhaustion related to excessive job demands and unsafe rosters; b) work related mental injury especially mental illness associated with suicidal thinking and behaviours as a result of unlawful bullying, harassment, racism, discrimination, verbal violence or stalking; and c) physical assault resulting in physical injury. Deaths in these circumstances will result in investigations by regulators to determine whether fines or imprisonment apply for employers due to industrial manslaughter.
It is important for employers to proactively put in place the required safety systems and procedures to protect all employees and contractors, including doctors, not only for the wellbeing of people but also to protect their organisations or practices from legal action.
To summarise, if WHS breaches result in serious harm — whether psychological or physical — the consequences for employers (including directors and officers) may include substantial fines (sometimes not covered by insurance), criminal charges, imprisonment and disqualification from managing any other company or organisation. The insurance premiums for employer including directors and officers are soaring because of costly WHS litigation.
Examples of common policies to ensure physical safety for doctors
Safe physical environments
We all have a responsibility to both our patients and the members of our staff to ensure that the physical environments of our services are safe for everyone. Here are some practical tips for employers to create safer physical environments:
- Create physical barriers between the waiting area and consulting rooms to prevent unauthorised access by patients to working areas.
- Install security locks on all windows and access doorways, and lock the back doors and all consulting rooms whenever they are empty.
- Glass in all windows and doors should be shatter-proof, and consider removing any pictures in public areas with non-shatter-proof glass as the glass can be broken and used as a weapon.
- The chairs in consulting rooms can be arranged so that the doctor or other treating health professional is always sitting closest to the door. On the other hand, many doctors recognise that it may be better to give their patients easy access to the door to allow the patient to leave if they become agitated.
- Where appropriate, install duress alarms and ensure there is an agreed staff policy in place to respond when an alarm is activated and ensure that drills are held on a regular basis to test the adequacy of the response.
- Maintain a policy of never allowing a staff member to be alone on the premises at times when the practice is open to patients.
- Install effective lighting in corridors, car parks, walk ways and the external surrounds of buildings.
- Erect fencing to prevent the practice grounds and car park being used as a public thoroughfare.
- Engage security staff when appropriate.
Home visit policy
In the community, home visits are an important part of the care of some patients, particularly the terminally ill or the frail and elderly. However, the safety of the attending doctor must always be considered.
Where possible, patient files should be flagged to ensure staff are warned if they are likely to be unwelcome at the home, or if the patient or other residents at the address have a known history of violence. Consider whether home visits without the use of an accompanying person for appropriate security are appropriate.
- Do not agree to home visits to patients threatening suicide or domestic violence or who are aggressive in their language without involving the police.
- Do not visit patients requesting specific pain relief medication or repeat prescriptions for drugs of addiction if they are not known to you.
- Keep a record at the practice of the registration, make, model and colour of all doctors’ cars.
- Always walk on the best-lit side of the street, stay away from bushes and parks, and check the back seat before unlocking your car on return. Park your car so it is pointing in the direction of the exit, so you can leave quickly if you need to.
- If there is a lift, make sure to stand by the control panel to control the lift and have quick access to the alarm.
- Ensure procedures are in place and followed if staff cannot be contacted or do not return or check back in as expected.
- If you use a deputising service, it must be alerted regarding any patients who you think may be at high risk of being violent.
Helpful references:
https://www.comcare.gov.au/safe-healthy-work/prevent-harm/physical-hazards
https://www.comcare.gov.au/safe-healthy-work/prevent-harm/physical-hazards
https://www.australianworkplacesafety.com.au/common-workplace-hazards-in-australia/