The price of pain

NATIONAL REPORT — On-the-job injuries cost practices big money — maybe up to $24 million per year — and insurers are watching closely as to whether the economy will force more clinics into reporting injuries they previously might have handled under the table.

"We're really interested in seeing effects of economy," says Mike Ahlert, executive vice president of Hub International. "For the past year, we have not seen significant change in the frequency or severity of workers' compensation claims. We would expect in a bad economy that we would see more people turning in claims that they normally wouldn't."

Groups like Hub International, insurance broker for Professional Liability Insurance Trust (PLIT) and manager of the American Animal Hospital Association's (AAHA) Business Insurance Program, are watching whether the economy might bring changes to the cost of workplace injuries, but it may just be too soon to tell if the recession will cost practice owners more, Ahlert adds.

"The numbers right now are really green. From the time something is reported to being paid takes some time," Ahlert says. "But the numbers we've seen so far are really not sending up any red flags. We'll continue to watch it."

But the fact is most veterinarians over the course of their careers will be bitten, scratched, kicked, crushed, stuck with a needle or suffer from a host of orthopedic problems. And these injuries cost practice owners a lot — about $8.3 million just for the roughly one-quarter of practices in the United States that submit workers' compensation claims through the American Veterinary Medical Association's PLIT. Take into account that there are about 22,000 practices nationwide and only about 6,000 are PLIT members, and the total cost of injuries in the veterinary practice could exceed $24 million.

"I think it's a pretty representative sampling," Ahlert says.

Work-related injuries occur about every nine seconds, according to AAHA, and statistics from Hub International and other veterinary watchdogs spell out the obvious risks that practices would be well-advised to address before injuries occur.

Animal-induced injuries

Common sense might tell practice owners that their employees are at risk of injury from aggressive, scared or otherwise unpredictable animals.

A study by Hub International of 4,500 workers' compensation claims at veterinary practices from 2002 to 2004 indicated that about 90 percent of injuries were from bites — 53 percent of those from cats and 43 percent from dogs. Arms and hands were injured in 77 percent of all dog and cat bite cases. Fifty-one percent of injuries reported to PLIT came from cats, which accounted for 56 percent of bites and 86 percent of scratches. Cat scratch claims alone account for 4.4 percent of all workers' compensation injuries with an average loss of $802 per claim.

Only about 47 percent of dogs and cats identified with aggressive or fearful warning signs were muzzled compared with 12 to 14 percent of animals not showing warning signs prior to attack, according to a 2006 injury prevention study prepared by the National Association of State Public Health Veterinarians, and 3 to 18 percent of all dog and 28 percent to 80 percent of all cat bites became infected.

The average loss from dog-related injuries as far as workers' compensation claims from 2006 to 2008 was nearly $1,500, while cat-related injuries resulted in about $1,200 in loss. Aside from bites, dog-related injuries accounted for 40 percent of all workers' compensation injury claims, according to data from Hub International.

Though most of the statistics collected center on small-animal medicine, large-animal practitioners have their own problems. Injuries from kicks — all from horses — represented only 0.3 percent of claim injuries, but average loss from those injuries was nearly $9,900.

Cows inflict the most veterinary injuries with 46.5 percent, followed by dogs with 24.2 percent and horses with 15.2 percent, according to a 1988 study in the Journal of Trauma. Those injuries were most frequently from animal kicks (35.5 percent), followed by bites (34 percent), crushing (11.7 percent), scratches (3.8 percent) and unspecified injuries (14.9 percent). Seventeen percent of veterinarians injured on the job in a study of AVMA members in Minnesota and Wisconsin indicated that 17 percent were hospitalized over the course of a year, and about a quarter required surgical intervention. Four percent, however, treated their own fractures and dislocations, 20 percent performed their own sutures and about 7 percent administered antibiotics to themselves, according to the study.

More experience doesn't mean fewer injuries, either. Thirty-one percent of injuries were reported by employees with less than one year of experience, but 42 percent were reported by workers with one to three years of experience.

Technicians and assistants are most frequently injured, followed by veterinarians, receptionists and kennel workers. Predictably, the majority of worker injuries were experienced by employees not wearing protective gear.

But not all injuries are restricted to office hours. Hub International reports that 20 percent of all veterinary clinic claims came from injuries sustained after hours. Most office hour injuries occurred in treatment room or kennel areas during routine examinations, diagnostics or retrieval of animals from cages.

Not all workers' compensation claims from veterinary practices involve animals, but most do. Seventy percent of claims processed for PLIT members in 2006 were caused by exposure to or contact with animals, Hub International reports. Those claims resulted in $4.2 million in losses, according to Hub, which put the total claims for 2006 at 3,434 claims equaling nearly $8.3 million for the roughly 4,500 veterinary hospitals it represented at the time of the study. That puts the average employee injury cost at $2,408, not including lost productivity, lower levels of patient care and workplace disruption.

Painful mistakes

Not all clinic injuries can be blamed on animals, though. A 2003 study in the American Journal of Industrial Medicine states that more than 30 percent of veterinarians work with improper postures, and 67 percent say they need improvements in their work environments with more focus on ergonomics. Industry statistics show that the cost to make these improvements may be well worth the investment.

Back and shoulder strains made up 8 percent of all claims and $1.5 million of the total workers' compensation tab, according to Hub International. Those injuries frequently were caused by improper lifting and handling techniques, lack of lifting assistance and awkward postures. Slips and falls — mostly on wet areas at entrances, exits and near bathing and grooming areas — made up another 5 percent of all claims.

In 2006, AVMA's Group Health and Life Insurance Trust (GHLIT) paid out $4 million for back disorders, and a 2007 PLIT study revealed that average claims for injuries relating to improper lifting averaged $22,000.

Overall health of veterinarians due to stress and long work hours also is a factor in the physical well-being of clinic workers. A study of veterinarians working in Finland in 2000, published in the American Journal of Industrial Medicine in June 2003, indicates that serious work exhaustion was reported most frequently by young female and older male veterinarians. The veterinarians surveyed spent more than 100 hours on call, and more than 60 percent characterized their overall health as good or fairly good, according to the study.

Too many hours worked play a large role in clinic injuries, too. Veterinary professionals working more than 60 hours per week reported a higher number of injuries, according to a 2002 study in Epidemiology. Another study revealed that practitioners drove more than 300 miles per week, and only 56 percent followed the speed limit. Fifteen percent didn't wear seatbelts.

Tools of the trade

Some tools aimed at making the veterinary profession safer aren't used as often as they should be, while others that put veterinarians at risk usually aren't used properly, several studies indicate.

Punctures or lacerations, either from bites, scratches or needle-sticks, accounted for 84 percent of injuries in the veterinary clinic, according to Hub International. Many of those injuries and their associated costs could be reduced by following recommendations by loss-control experts on annual site visits for veterinary clinics. They include writing hazardous-material-handling plans and formal employee training programs, carrying out formal investigations following any employee injuries or "near misses" and the availability of protective gear for workers, suggests data from Hub International.

And the need for prevention is great, as needlesticks and exposure to hazardous substances is high in the veterinary profession. Sixty-four percent of female veterinarians reported one or more needlesticks during their career, with half of those occurring during vaccine administration, reports an August 2008 study by J. Scott Weese and Douglas C. Jack in the Canadian Veterinary Journal. Nearly 60 percent of needlesticks exposed the veterinarian to animal blood, 52 percent to antimicrobials, 52 percent to vaccines and 17 percent to immobilizing agents, according to the study. A paper published in the Australian Veterinarian Journal indicates that 30 percent of veterinarians will contract an animal disease during their career. Two-thirds of needlesticks included the injection of a substance, which was antimicrobials in 13 percent of the cases, euthanasia agents in 11 percent of cases, followed by vaccines in 9 percent and anesthetics in 8 percent, according to the Canadian Veterinary Journal study.

Veterinarians are the most frequent victims of needlesticks, followed by technicians, assistants and volunteers. But the frequency among different types of veterinarians varies. Large-animal veterinarians had the lowest incidence of needlesticks (5.8/100 person-years), followed by mixed-animal (9.7/100 person-years) and small-animal (9.8/100 person-years) veterinarians. Zoo veterinarians also reported a high incidence, with 87 percent reporting one or more during their career, and 6.5 percent requiring medical treatment as a result. Part of the additional risk among zoo veterinarians may come from the fact that 86 percent of zoo veterinarians admitted to recapping needles, a "high-risk handling procedure," more than half the time. An Italian study found that 74 percent of all needlestick injuries in veterinary practices could be attributed to incorrect handling procedures, Weese says.

To learn about workplace injury prevention, visit PLIT at avmaplit.com, AAHA at aahanet.org, AVMA avma.org or the U.S. Department of Labor Occupational Safety and Health Administration at osha.gov.