Ambulatory Or Ancillary Health Care Organizations

QUESTION 1

Consider the following scenario:

On December 7, 2000, the Cincinnati OSHA Office heard through media and police reports that

there were two deaths at a nursing home in Ohio. OSHA determined that the FDA should take a

lead role in performing an investigation.

Since the nursing home had many residents who had unhealthy respiratory systems, the nursing

home routinely ordered and received tanks that contained pure oxygen. During one delivery, the

supplier mistakenly delivered one tank of pure nitrogen in addition to the three tanks of pure

oxygen that had been ordered. The nitrogen tank had both an oxygen and nitrogen label. An

employee at the nursing home connected the nitrogen tank to the nursing home's oxygen delivery

system. This event caused two nursing home residents to die, and three additional nursing home

residents were admitted to hospitals in critical condition. Within the

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