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  • Working Through the Pain at TeslaReveal
    https://www.revealnews.org/article/inside-teslas-factory-a-medical-clinic-designed-to-ignore-injured-worker

    Inside Tesla’s factory, a medical clinic designed to ignore injured workers
    By Will Evans / November 5, 2018

    When a worker gets smashed by a car part on Tesla’s factory floor, medical staff are forbidden from calling 911 without permission.

    The electric carmaker’s contract doctors rarely grant it, instead often insisting that seriously injured workers – including one who severed the top of a finger – be sent to the emergency room in a Lyft.

    Injured employees have been systematically sent back to the production line to work through their pain with no modifications, according to former clinic employees, Tesla factory workers and medical records. Some could barely walk.

    The on-site medical clinic serving some 10,000 employees at Tesla Inc.’s California assembly plant has failed to properly care for seriously hurt workers, an investigation by Reveal from The Center for Investigative Reporting has found.

    The clinic’s practices are unsafe and unethical, five former clinic employees said.

    But denying medical care and work restrictions to injured workers is good for one thing: making real injuries disappear.

    “The goal of the clinic was to keep as many patients off of the books as possible,” said Anna Watson, a physician assistant who worked at Tesla’s medical clinic for three weeks in August.

    Watson has nearly 20 years of experience as a medical professional, examining patients, diagnosing ailments and prescribing medications. She’s treated patients at a petroleum refinery, a steel plant, emergency rooms and a trauma center. But she said she’s never seen anything like what’s happening at Tesla.


    Anna Watson was a physician assistant at the medical clinic inside Tesla’s electric car factory in Fremont, Calif. She was fired in August after raising concerns. Credit: Paul Kuroda for Reveal

    “The way they were implementing it was very out of control,” said Watson, who was fired in August after she raised her concerns. “Every company that I’ve worked at is motivated to keep things not recordable. But I’ve never seen anybody do it at the expense of treating the patient.”

    Workers with chest pain, breathing problems or extreme headaches have been dismissed as having issues unrelated to their work, without being fully evaluated or having workplace exposures considered, former employees said. The clinic has turned away temp workers who got hurt on Tesla’s assembly lines, leaving them without on-site care. And medical assistants, who are supposed to have on-site supervision, say they were left on their own at night, unprepared to deal with a stream of night-shift injuries.

    If a work injury requires certain medical equipment – such as stitches or hard braces – then it has to be counted in legally mandated logs. But some employees who needed stitches for a cut instead were given butterfly bandages, said Watson and another former clinic employee. At one point, hard braces were removed from the clinic so they wouldn’t be used, according to Watson and a former medical assistant.

    As Tesla races to revolutionize the automobile industry and build a more sustainable future, it has left its factory workers in the past, still painfully vulnerable to the dangers of manufacturing.

    An investigation by Reveal in April showed that Tesla prioritized style and speed over safety, undercounted injuries and ignored the concerns of its own safety professionals. CEO Elon Musk’s distaste for the color yellow and beeping forklifts eroded factory safety, former safety team members said.

    The new revelations about the on-site clinic show that even as the company forcefully pushed back against Reveal’s reporting, behind the scenes, it doubled down on its efforts to hide serious injuries from the government and public.

    In June, Tesla hired a new company, Access Omnicare, to run its factory health center after the company promised Tesla it could help reduce the number of recordable injuries and emergency room visits, according to records.

    A former high-level Access Omnicare employee said Tesla pressured the clinic’s owner, who then made his staff dismiss injuries as minor or not related to work.

    “It was bullying and pressuring to do things people didn’t believe were correct,” said the former employee, whom Reveal granted anonymity because of the worker’s fear of being blackballed in the industry.

    Dr. Basil Besh, the Fremont, California, hand surgeon who owns Access Omnicare, said the clinic drives down Tesla’s injury count with more accurate diagnoses, not because of pressure from Tesla. Injured workers, he said, don’t always understand what’s best for them.

    “We treat the Tesla employees just the same way we treat our professional athletes,” he said. “If Steph Curry twists his knee on a Thursday night game, that guy’s in the MRI scanner on Friday morning.”

    Yet at one point, Watson said a Tesla lawyer and a company safety official told her and other clinic staff to stop prescribing exercises to injured workers so they wouldn’t have to count the injuries. Recommending stretches to treat an injured back or range-of-motion exercises for an injured shoulder was no longer allowed, she said.

    The next day, she wrote her friend a text message in outrage: “I had to meet with lawyers yesterday to literally learn how not to take care of people.”

    Tesla declined interview requests for this story and said it had no comment in response to detailed questions. But after Reveal pressed the company for answers, Tesla officials took time on their October earnings call to enthusiastically praise the clinic.

    “I’m really super happy with the care they’re giving, and I think the employees are as well,” said Laurie Shelby, Tesla’s vice president for environment, health and safety.

    Musk complained about “unfair accusations” that Tesla undercounts its injuries and promised “first-class health care available right on the spot when people need it.”

    Welcome to the new Tesla clinic
    Back in June, on stage at Tesla’s shareholder meeting, Musk announced a declining injury rate for his electric car factory.

    “This is a super important thing to me because we obviously owe a great debt to the people who are building the car. I really care about this issue,” Musk said to applause.

    It wasn’t long after that that Stephon Nelson joined the company. Working the overnight shift Aug. 13, Nelson got a sudden introduction to Tesla’s new model of care.

    He was bent over putting caulk inside the trunk of a Model X. Something slipped and the hatchback crunched down on his back. Nelson froze up in agonizing pain. He had deep red bruises across his back.

    “I couldn’t walk, I couldn’t sit down. I couldn’t even stand up straight,” said Nelson, who’s 30 and used to play semiprofessional football.

    He asked for an ambulance, but the on-call Tesla doctor said no – he could take a Lyft to the hospital instead.

    “I just felt heartbroken,” Nelson said. “What they was telling us in the orientation, that Tesla is a company that cares about their employees’ safety, it just seemed like it was just a whole reversal.”

    No one was allowed to call 911 without a doctor’s permission, said Watson and two medical assistants who used to work at the clinic under Besh’s direction. Anyone who did so would get in trouble, they said.

    “There was a strong push not to send anybody in an ambulance,” Watson said.


    “I couldn’t walk, I couldn’t sit down. I couldn’t even stand up straight,” Stephon Nelson says of what happened when he injured his back while working on a Tesla Model X. Credit: Paul Kuroda for Reveal

    It’s unclear why there was such a focus on avoiding 911, though some former employees thought it was to save money. Also, 911 logs become public records. And first responders, unlike drivers for ride-hailing services, are required to report severe work injuries to California’s Division of Occupational Safety and Health, the state’s workplace safety agency. Besh said ambulance use is based on “clinical judgment only.”

    The system was especially problematic on the night shift, as the factory continued churning out vehicles around the clock, but there were no doctors or nurses around, former employees said.

    Two medical assistants who used to work there said they often were left on their own – one on duty at a time – and struggled to tend to all the injured. Both had to do things such as take vital signs, which medical assistants aren’t allowed to do without on-site supervision, according to the Medical Board of California. Reveal granted them anonymity because they fear speaking out will hurt their careers. Besh said no one works alone.

    For a severely injured worker lying on the assembly line, it could take 10 to 15 minutes for a medical assistant to arrive and then contact on-call doctors, a medical assistant said. Getting a code for Tesla’s Lyft account was a drawn-out process that could take hours, she said.

    The medical assistants said they were alarmed and uncomfortable with the doctors’ orders to use Lyft because they worried some patients could pass out or need help en route. One worker directed to take a Lyft was light-headed and dizzy. Another had his fingers badly broken, contorted and mangled.

    Besh, who often serves as the on-call doctor, said anyone could call 911 in a life-threatening situation. He said he recommends using Lyft for workers who don’t need advanced life support.

    Besh gave the example of a worker who had the top of his finger cut off. He needed to go to the hospital, but not by ambulance, Besh said. He likened the situation to people at home who get a ride to the hospital instead of calling an ambulance.

    “We right-size the care,” he said. “Obviously, it’s all about the appropriate care given for the appropriate situation.”

    It’s a doctor’s judgment call to use Lyft, but many on the factory floor found it inhumane. In some cases, including the worker with an amputated fingertip, factory supervisors refused to put their employees in a Lyft and instead drove them to the hospital, according to a medical assistant.

    Injured workers sent back to work

    In Nelson’s case, he called his girlfriend to take him to the hospital. But he said his supervisor told him that he had to show up for work the next day or Nelson would get in trouble.

    Nelson needed the job, so he forced himself to come in. He shuffled slowly, hunched over in pain, to his department, he said. When it was clear he couldn’t do the job, he was sent to the Tesla health center, a small clinic on an upper level of the factory.

    Workers too injured to do their regular jobs are supposed to receive job restrictions and a modified assignment that won’t make the injury worse.

    But the health center wouldn’t give Nelson any accommodations. He could go home that day, but he had to report to work full duty the following day, he said.

    By law, work-related injuries must be recorded on injury logs if they require medical treatment beyond first aid, days away from work or job restrictions. The clinic’s practices were designed to avoid those triggers, said Anna Watson, the physician assistant.

    There was a clinic rule, for example, that injured employees could not be given work restrictions, Watson said. No matter what type of injuries workers came in with – burns, lacerations, strains and sprains – clinic staff were under instructions to send them back to work full duty, she said. Watson said she even had to send one back to work with what appeared to be a broken ankle.

    Medical clinics are supposed to treat injuries and keep workers safe, she said, “and none of that’s happening. So at the most acute time of their injury, they don’t have any support, really.”

    A medical assistant who formerly worked at the clinic remembered an employee who was sent back to work even though he couldn’t stand on one of his feet. Another employee passed out face down on the assembly line – then went back to work.

    “You always put back to full duty, no matter what,” said the medical assistant.

    Dr. Basil Besh said patients are given work restrictions when appropriate. He said those hurt at night get first aid and triage, followed by an accurate diagnosis from a physician the next day.

    “There’s always going to be somebody who says, ‘No, I shouldn’t be working,’ ” he said. “But if you look objectively at the totality of the medical examination, that’s not always the case.”

    Four days after Nelson’s injury, Watson herself sent him back to work with no restrictions, according to medical records he provided. Nelson said this happened repeatedly as he hobbled in pain.

    But Watson did what she could to help: She referred him to Access Omnicare’s main clinic, about 5 miles from the auto factory. It was allowed to give work restrictions, Watson said. But most workers aren’t sent there, and it can take a while to get an appointment.

    Eight days after his injury, the outside clinic diagnosed Nelson with a “crushing injury of back,” contusions and “intractable” pain. He finally was given work restrictions that said he shouldn’t be bending, squatting, kneeling, climbing stairs or lifting more than 10 pounds.

    Even after that, the health center at one point sent Nelson back to his department in a wheelchair, he said.

    “And I’m rocking back and forth, just ready to fall out of the wheelchair because I’m in so much pain,” he said.

    In September, Nelson got a warehouse job at another company. It was a pay cut, but he quit Tesla right away. “I feel like it’s really not safe at all,” he said.

    Besh said he couldn’t comment on a specific case without a signed release from the patient. But, he said, “a physician examined that patient and saw that there was not a safety issue.”

    Besh was named chairman of the American Academy of Orthopaedic Surgeons’ Board of Councilors this year. A Tesla spokeswoman set up and monitored his interview with Reveal.

    There’s been a “culture shift” at the health center since Tesla hired him to take over, he said.

    “So culturally, there were folks in the past who were expecting that any time they come to the clinic, they would be taken off of work,” he said. “And when we told them, ‘No, we really want to do what’s best for you’ … it’s taking some time to get buy-in.”

    In the end, Tesla counted Nelson on its injury logs, which is how Reveal identified him. That’s another reason the system didn’t make sense to Watson: Some workers whose injuries were so serious that they eventually would have to be counted still were denied proper care when they needed it most, she said.

    Many more injured workers never were counted, she said. Tesla’s official injury logs, provided to Reveal by a former employee, show 48 injuries in August. Watson reviewed the list for the three weeks she was there and estimated that more than twice as many injuries should have been counted if Tesla had provided appropriate care and counted accurately.

    Other ways Tesla’s clinic avoids treating workers
    The clinic seemed geared toward sending workers away instead of treating them, Watson said. The culture of the clinic, she said, was to discount workers’ complaints and assume they were exaggerating.

    The clinic would look for reasons to dismiss injuries as not work-related, even when they seemed to be, former employees said.

    Watson recalled one worker who had passed out on the job and went to the hospital because of her exposure to fumes in the factory. Even though a work-related loss of consciousness is required to be counted, no such injury was recorded on Tesla’s injury logs.

    Temp workers hurt on the production line also were often rebuffed by the clinic, said former clinic employees. At one point, there was a blanket policy to turn away temps, they said.


    Tracy Lee wears a brace to help with a repetitive stress injury she developed while working at Tesla’s factory. She says the in-house health center sent her away without evaluating her because she wasn’t a permanent employee. Credit: Paul Kuroda for Reveal

    Tracy Lee developed a repetitive stress injury over the summer when a machine broke and she had to lift car parts by hand, she said. Lee said the health center sent her away without evaluating her because she wasn’t a permanent employee.

    “I really think that’s messed up,” said Lee, who later sought medical treatment on her own. “Don’t discriminate just because we’re temps. We’re working for you.”

    By law, Tesla is required to record injuries of temp workers who work under its supervision, no matter where they get treatment. But not all of them were. Lee said her Tesla supervisor knew about the injury. But Lee’s name doesn’t appear on Tesla’s injury logs.

    Besh pushed back on the claims of his former employees.

    He said the clinic didn’t treat some temp workers because Access Omnicare wasn’t a designated health care provider for their staffing agencies. About half of the agencies now are able to use the clinic, and the rest should be early next year, he said.

    Besh said a physician accurately and carefully determines whether an injury is work-related and the clinic is not set up to treat personal medical issues. He said the clinic is fully stocked.

    As for prescribing exercises, Besh said the clinic automatically was giving exercise recommendations to workers who were not injured and simply fixed the error.


    These sample Work Status Reports, posted in Tesla’s health center, show how clinic staff were instructed to handle different situations. The document on the left, labeled “Work Related,” is marked “First Aid Only” and “Return to full duty with no limitations or restrictions,” scenarios that would mean Tesla wouldn’t have to count the injury. Those were the only options, says Anna Watson, a physician assistant who used to work there. One document for contract employees such as temp workers (center) and another for non-occupational injuries (right) both say to refer the patients elsewhere. Credit: Obtained by Reveal

    Clinic source: Tesla pressured doctor
    Access Omnicare’s proposal for running Tesla’s health center states that Tesla’s priorities include reducing recordable injuries and emergency room visits, according to a copy obtained by Reveal.

    It says Access Omnicare’s model, with more accurate diagnoses, reduces “un-necessary use of Emergency Departments and prevents inadvertent over-reporting of OSHA (Occupational Safety and Health Administration) recordability.”

    Even before Access Omnicare took over the on-site health center in June, Tesla sent many injured workers to its main clinic as one of the automaker’s preferred providers.

    Tesla exercised an alarming amount of pressure on the clinic to alter how it treated patients in order to keep injury rates down, said the former high-level Access Omnicare employee.

    “There was a huge, huge push from Tesla to keep things nonrecordable,” said the former employee.

    A Tesla workers’ compensation official routinely would contact the clinic to intervene in individual cases, said the former employee. Tesla would take issue with diagnoses and treatment decisions, arguing that specific workers should be sent back to work full duty or have their injuries labeled as unrelated to work. The clinic gave Tesla what it wanted, the former employee said.

    For example, Bill Casillas’ diagnosis suddenly was changed by Access Omnicare after discussions with Tesla.

    In December, Casillas was working in Tesla’s seat factory. When he touched a forklift, he felt an electric shock jolt him back. Later that shift, it happened again. He said he felt disoriented and found he had urinated on himself.

    Casillas said he hasn’t been the same since. He struggles with pain, tingling and numbness. At 47, he’s unsteady, uses a cane and hasn’t been able to work, he said.

    A doctor at Access Omnicare diagnosed a work-related “injury due to electrical exposure” and gave him severe work restrictions and physical therapy, medical records show.

    Then, nearly two months after his injury, another Access Omnicare physician, Dr. Muhannad Hafi, stepped in and dismissed the injury.

    “I have spoken again with (the workers’ compensation official) at Tesla and he informed that the forklift did not have electric current running. With that said, in my medical opinion, the patient does not have an industrial injury attributed to an electrical current,” he wrote.

    Hafi, who’s no longer with Access Omnicare, didn’t respond to questions. Besh said he can’t discuss patient details.

    The co-worker who was in the forklift during the second shock, Paul Calderon, said he disagrees with the Tesla official but no one asked him. He backed up Casillas’ account and said Tesla “tried to really downplay what happened to him.”

    Hafi’s January report noted that Casillas said he was “miserable,” used a cane and had pain all over his body. But he discharged him back to work full duty, writing, “No further symptoms of concern.”

    A Tesla safety team manager informed Casillas last month that his injury was not counted because it was “determined to not be work-related.” Casillas is still a Tesla employee, but he’s off work because of his injury. His workers’ comp claim was denied based on Hafi’s report, but his lawyer, Sue Borg, is seeking an independent medical evaluation.

    Besh said Tesla does not pressure him to dismiss injuries.

    “What Tesla pressures us on is accurate documentation,” he said. “What they want is their OSHA log to be as accurate as possible, so what they’ll push back on is, ‘Doctor I need more clarity on this report.’ And we do that for them.”

    “They are not in the business of making clinical determinations at all,” he said. “We make those clinical determinations only based on what the patient needs.”

    State regulators not interested
    By late August, Watson, the physician assistant, reached her breaking point. She got into an argument with Besh, who fired her for not deferring to doctors.

    Afterward, she filed a complaint to Cal/OSHA, California’s workplace safety agency.

    “I just see the workers at Tesla as having absolutely no voice,” she said. “I do feel extra responsible to try to speak up for what’s going on there.”

    Watson thought Cal/OSHA would put an immediate stop to the practices she witnessed. But the agency wasn’t interested.

    Cal/OSHA sent her a letter saying it folded her complaint into the investigation it started in April after Reveal’s first story ran. The letter said it had investigated and cited Tesla for a recordkeeping violation.

    But Cal/OSHA already had closed that investigation two weeks before Watson’s complaint. The agency issued a fine of $400 for a single injury it said was not recorded within the required time period. Tesla appealed, calling it an administrative error.

    Reveal had documented many other cases of injuries that Tesla had failed to record. But the agency had only about six months from the date of an injury to fine a company. By the time Cal/OSHA concluded its four-month investigation, the statute of limitations had run out.

    After Reveal reported that the time limitation makes it difficult to hold employers accountable, state legislators passed a bill giving investigators six months from when Cal/OSHA first learns of the violation. It was signed by Gov. Jerry Brown, but it was too late for the Tesla investigation.

    A Cal/OSHA spokeswoman said the investigation found four other “injury recording violations that fell outside of the statute of limitations.” Even if those other violations had been included, the spokeswoman said Cal/OSHA would have had to combine them in a single $400 citation.

    Tesla, meanwhile, inaccurately cites Cal/OSHA’s investigation as vindication.

    “We do get these quite unfair accusations,” Musk said on his October earnings call. “One of them was that we were underreporting injuries. And it’s worth noting that OSHA completed their investigation and concluded that we had not been doing anything of the sort.”

    Watson called Cal/OSHA officials to insist they investigate her complaint. She told them that she had detailed knowledge of a system that undercounted injuries by failing to treat injured workers.

    But Cal/OSHA officials told her that it wasn’t the agency’s responsibility, she said. They suggested contacting another agency, such as the medical board or workers’ compensation regulators.

    As Watson kept pushing and Reveal began asking questions, a Cal/OSHA spokeswoman said her complaint now is being investigated.

    Watson has a new job at an urgent care clinic. She said she just wants someone to make sure that Tesla workers get the care they need.

    “You go to Tesla and you think it’s going to be this innovative, great, wonderful place to be, like this kind of futuristic company,” she said. “And I guess it’s just kind of disappointing that that’s our future, basically, where the worker still doesn’t matter.”

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