Hospital Seeks Limit at 10th Cir. for Patient Violence Citations

Two challenges before a circuit court Wednesday stand to limit OSHA’s enforcement power to cite employers for failing to stop workplace violence, including by medical patients, absent a specific regulation on the hazard.

Cedar Springs Hospital Inc.—a psychiatric hospital—is attempting to overturn over $15,000 in US Occupational Safety and Health Administration citations stemming from a months-long investigation of its staff reporting physical assaults by patients. UHS of Delaware Inc. is fighting OSHA’s claims that it denied its workers violence protection. Both are part of Universal Health Services, Inc.

The US Court of Appeals for the Tenth Circuit panel is set to question whether the OSH Act and precedent grant the agency broad authority to cite employers for failing to implement safety measures not explicitly outlined by any standard.

Although OSHA has cited employers, particularly in health care, for failing their “general duty” to protect workers who were attacked by coworkers or patients, federal law and most states don’t lay out specific obligations for employers related to the risk of violence.

Unlike other ways workers can be injured on the job, the proper abatement measures for addressing workplace violence aren’t straightforward for employers, especially given the variation in how it occurs across industries, attorneys say.

“Who gets to decide what those things are and how they are feasible is going to be something that the court is really going to hone in on and struggle with,” said Rachel Conn, an attorney focused on workplace safety at Conn Maciel Carey LLP in San Francisco.

Violence Abatement

The Tenth Circuit could question in both cases whether an employer needs to take one or all of OSHA’s suggested abatement measures when addressing violence in the workplace.

OSHA must prove four elements when establishing a general duty clause violation: the employer failed to provide a workplace free of a hazard, that it was recognized, that it was likely to cause death or serious physical harm, and that there was a feasible means to fix it.

“The whole point of the general duty clause is for OSHA to ensure safe working conditions where there are hazards that aren’t covered by standards,” said Jordan Barab, the former deputy assistant secretary for OSHA during the Obama administration.

While OSHA can’t solely cite its guidance documents as authority for meeting a feasible means of abatement, it can point to the original source material its guidance is based on, according to Barab.

“To say there aren’t feasible means of abatement because there’s no standard misses the point,” he said. “There’s a voluminous amount of evidence showing that there are, in almost any situation, numerous feasible means of abatement.”

OSHA claimed that Cedar Springs and UHS of Delaware Inc., in separate cases, failed to protect workers by exposing them to physical attacks from aggressive patients under the general duty clause. This provision requires employers to provide a workplace free from recognized hazards that are likely to kill or seriously harm workers.

Cedar Springs argued that precedent under the Occupational and Health Review Commission unfairly relieves OSHA of its requirement to prove the feasibility of abatement measures, meaning the agency should have to prove that dealing with the issue isn’t too costly. Cedar Springs also argued OSHA’s authority is preempted by the Centers for Medicare and Medicaid Services, which oversees the enforcement of health and safety standards.

“Without Court intervention, the Commission will continue to improperly relieve the Acting Secretary of her burden to prove the economic feasibility and effectiveness of each proposed abatement measure in general duty cases involving workplace violence,” Cedar Springs wrote in its brief.

State and federal lawmakers have struggled to legislate on this issue due to the broad range of behaviors considered violent and the lack of a single, universally accepted definition.

Single-Employer Dilemma

A decision regarding the single-employer test in these cases also has wide-ranging implications for the health care industry. Hospitals, particularly nursing homes, commonly use management firms to perform their administrative functions, Conn said.

OSHRC affirmed that both Cedar Springs and UHS-DE should be considered a single employer for citations amounting to over $15,000.

Citing previous cases involving the parties, OSHRC determined that both parties’ employees shared a common workplace, were interrelated with safety and health matters, and that UHS-DE employees were the CEOs at hospitals, including Cedar Springs.

UHS-DE, however, disputes these findings on appeal, arguing that there wasn’t sufficient evidence to prove the factors were met.

UHS operates and manages different worksites, each of which has independent and unrelated operations related to handling safety matters, and doesn’t share common management, the company said in its brief.

Lewis Brisbois Bisgaard & Smith LLP represents UHS. Jackson Lewis PC represents Cedar Springs.

The cases are UHS of Delaware Inc. v. OSHRC, 10th Cir., No. 24-09521, 9/10/25 and Cedar Springs Hospital v. OSHRC, 10th Cir., No. 24-09519, 9/10/25.