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How a rolling OR stool cost a hospital $7 million


April 6, 2017

After a surgeon’s fall, one hospital in Georgia learned how expensive unsafe furniture can be

Mark Corbitt, MD, was finishing up a surgical case in operating room No. 5 at the South Georgia Medical Center in Valdosta, when he tried to sit down and write orders in the patient’s chart. As he transferred his weight onto a four-legged rolling stool, it slipped out from underneath him. He fell to the floor and struck his head.

Corbitt, who has since suffered repeated seizures and been diagnosed with trauma-induced epilepsy, sued the hospital. He accused the facility of failing to address a known safety hazard prior to the injury that ended his promising career on January 25, 2010. Precisely seven years later, a jury sided with him, finding the medical center at fault and issuing a $10 million verdict.

Since the jury determined that Corbitt himself should carry 30% of the blame for the incident, the judgment was apportioned to reflect the hospital’s 70% share in the liability, leaving the facility on the hook for $7 million.

“Unfortunately, this is yet another example of the growing trend of out-of-control jury verdicts,” said William R. Johnson, JD, a partner with the Moore Ingram Johnson & Steele law firm, in a statement. The defense team was correct, he added, to argue that Corbitt should be awarded nothing. (If the jury had saddled Corbitt with at least 50% of the blame, he would not have been entitled to collect damages under Georgia law.)

Rather than appeal the judgment, however, the Hospital Authority of Valdosta and Lowndes County voted in February to authorize a payment of $2.3 million, with an insurance company covering the remainder of the $7 million tab, as The Valdosta Daily Times reported.

The judgment serves as a stark reminder of just how expensive a simple piece of furniture can become when its presence in a medical setting is implicated in a personal injury case. More broadly, experts say the story points to a need for proactive vigilance in identifying and mitigating ergonomic risks.

Caster safety

At the center of Corbitt’s complaint were four casters attached to the bottom of the four-legged stool. Calling upon expert testimony to bolster his claims, the doctor argued that the stool rolled too easily across the OR floor, presenting a safety hazard.

“The hard, plastic caster wheels may have been perfectly suitable for use on a soft, carpeted flooring surface, but the casters were wholly unsafe and unsuitable for use on the hard, slick flooring surfaces present in Defendant’s operating rooms,” Corbitt stated in court documents. He alleged, furthermore, that South Georgia Medical Center bore sole responsibility for selecting and purchasing the stool, then making it available for use in an inappropriate setting.

Corbitt argued, based on scientific testing conducted by his team of experts, that a stool with hard plastic casters is “over 100 times more likely to roll out from under a user” than a stool with rubber wheels.

Corbitt pointed also to Caster City, a Las Vegas–based supplier of casters and wheels, for general guidance on flooring compatibility. The company’s website notes that hard wheels should be used on carpet, and soft wheels should be used on hard flooring. It includes a chart that juxtaposes seven types of casters with 11 flooring materials, using stoplight colors to code each of the 77 potential combinations: green for “good,” red for “not recommended,” or yellow for “possible,” contingent upon professional consultation.

Safety experts agreed that flooring compatibility should be a key consideration when deciding how to furnish a given medical setting.

“You need to make sure you get the correct type of caster for the job you’re trying to accommodate,” says Cindy Taylor, ARM, CSPHP, director of Workers’ Compensation and Ergonomics for UNC Health Care in Chapel Hill, North Carolina. Even in the absence of a specific regulation pertaining to rolling furniture, she says, OSHA, CMS, and The Joint Commission all expect that medical environments are kept safe for staff, patients, and visitors alike.

“For any environment, it is the responsibility of the safety professional to review data for trends and follow up on any incidents which could have been prevented,” Taylor says. “Identifying potential and existing workplace hazards and taking action to prevent these hazards should be number one for any safety professional.”

If workers report problems with a particular piece of equipment or furniture, efforts should be taken immediately to assess and address the problem, to prevent future mishaps. That’s where South Georgia Medical Center fell short, according to Corbitt’s complaint, which argued that a surgical technician had experienced and reported problems with the same type of stool involved in his fall. Corbitt complained that the technician’s report had not been passed along to the hospital’s safety director and that it did not result in a substantive investigation or corrective action prior to his injury.

Ergonomics and OSHA

Beyond casters alone, the big lesson to be taken from Corbitt’s lawsuit is that healthcare personnel need to be paying attention to ergonomics, says Dan Scungio, MT (ASCP), SLS, a lab safety officer for Sentara Healthcare, a multi-hospital system in Virginia. In older facilities, especially, there are numerous furniture arrangements that offer less-than-ideal working conditions, introducing the prospect of long-term or even immediate harm, he says.

“Some ergonomic injuries are slow, and you don’t realize that that’s happening until it’s too late, until you’re near retirement, until something permanent has happened and it’s not fixable or it has to be fixed by some sort of surgery or a brace or medication or anything like that,” Scungio says. “Or some of them, like this case in Georgia, are instant.”

For more than 30 years, OSHA has been wrestling with ergonomics issues, offering training and guidance along the way. In late 2000, after several years in the rulemaking process, the administration issued its Ergonomics Program standard, but the regulation was quickly repealed in 2001 when newly inaugurated President George W. Bush signed a congressional joint resolution into law, undoing the rule and barring OSHA from enacting anything substantially similar to it.

Elaine Chao, who served as Secretary of Labor during all eight years of Bush’s tenure in the White House and who now serves as Secretary of Transportation under President Donald Trump, explained later in 2001 that the Republican administration was looking for a way to better approach ergonomics in a manner that would promote worker wellness while also respecting differences across various workplaces and sectors of the economy.

“We want American workers to be safe, but we also want them to have jobs,” Chao said in a speech at George Mason University. “Placing unnecessarily onerous regulations on America’s employers won’t help American workers. It will only help put them out of work.”

Chao said she would instead seek “a reasonable middle ground” that protects workers and their livelihoods.

Even in the absence of a comprehensive rule devoted specifically to ergonomics, OSHA has held that the duty of employers to keep their workplaces generally “free from recognized hazards” includes ergonomic hazards. If an employer fails to make a good faith effort to reduce ergonomic hazards, OSHA could, therefore, issue a citation under the General Duty Clause.

Similarly, the statutes cited in Corbitt’s lawsuit pertain to general provisions of Georgia law, not to laws about specific furniture or flooring materials. This highlights once again that healthcare safety professionals must ensure their dedication to regulatory compliance comes coupled with a commitment to spot and proactively mitigate additional hazards as well.

Despite the successful application of general provisions of law, some contend that a specific ergonomics standard from OSHA could still be a worthwhile addition.

“I’m not always a fan of more rules and regulations,” Scungio says, “but a standard from OSHA would at least force employers to pay more attention to ergonomics when so many don’t.”

Look at ergonomics more broadly

Tamara James, MA, CPE, CSPHP, director of ergonomics for Duke Health and Duke University in Durham, North Carolina, says the Corbitt case should remind institutions to furnish their facilities as meticulously as they design and build them.

“We often see and hear of situations where furniture is specified without regard to the total environment, even without regard to the users, maybe, or how it’s used,” James says. “And that’s a classic situation, it sounds like, where the wrong casters were specified. You don’t put carpet casters on a linoleum floor, you just don’t.”

James, who launched Duke’s ergonomics program 24 years ago, joined forces with Duke Patient Care Ergonomics Coordinator Yeu-Li Yeung, OT/L, CPE, CSPHP, who has worked in the office 14 years, to offer several pointers for safety professionals looking to shore up their ergonomics initiatives:

Review voluntary standards. The American National Standards Institute (ANSI), for instance, publishes a variety of guidelines applying ergonomics principles in specific settings, and the ANSI–accredited Business & Institutional Furniture Manufacturers Association (BIFMA) produces safety and performance standards and guidelines for furniture. The ergonomics team at Cornell University is a great resource for tips and checklists, James adds. (Visit their website at www.ergo.human.cornell.edu.)

Consider all points of interface. When assessing whether to place a given piece of furniture in a given workspace, you should consider who will be using it and for what purposes.

“When we do evaluations, we always look at three things: how the person, the environment, and the task work together,” Yeung says, noting that it’s often easier to change the environment than it is to change the person or task. “The flow should make sense.”

James noted that assessing these “points of interface” should account for any expected movement of the furniture and any number of likely users.

“If that piece of furniture is going into a pediatrics clinic, you need to think about the fact that there’s going to be little kids climbing all over it and jumping on it,” she says. “What’s the impact of that?”

Test a sample. “If you’re going to buy something, then tell the vendor, ‘Bring one to me. Let me try it. Let me use it with my staff to make sure this is going to work,’ that’s really the only way you’re going to know,” James says. “I would never buy a mattress if I didn’t at least lay on it for a few seconds. It’s no different. You have to try this stuff because you can’t just order things online and expect them to work or just order them out of a catalog and expect them to work.”

Educate workers. Even if the environment is set up perfectly, there is still potential for individuals to misuse equipment or furniture, Yeung notes. This is where ongoing educational efforts can promote best practices among workers and continue reducing the likelihood of potentially expensive furniture misadventures.

For more on the Duke Ergonomics Division, including links to resources and exercises, visit www.safety.duke.edu/ergonomics.

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