Off the Books
During the 2015 inspection of the Robbinsville fulfillment center, Fagan’s team also identified 26 injuries over four months that were left out of official recordkeeping logs. Her interviews with employees confirmed that supervisors were discouraging workers from reporting injuries.
Federal regulations require that companies record all work-related injuries that involve days away from work, transfer to light duty, a significant diagnosis from a doctor, or any medical treatment beyond first aid. The reports inform the Bureau of Labor Statistics’ industry injury rates and are meant to function as an internal corporate metric for improving safety standards.
Accusations of faulty recordkeeping at Amazon are not confined to Robbinsville. An OSHA inspection of an Amazon facility in Kenosha, Wisconsin, found that the warehouse failed to record 15 injuries in a 28-day period in October 2015. At least three anonymous complaints to OSHA between January 2016 and August 2018 in Carlsbad, California; Lebanon, Tennessee; and Phoenix, Arizona, explicitly referenced management’s failure to keep accurate injury logs.
Four current and former EMTs interviewed as part of Type and The Intercept’s investigation also said colleagues or supervisors pressured them to keep injuries off the books, though some said they refused to do so. An Amcare staffer in Ohio described recommending that an employee with a shoulder injury be referred to an outside specialist. His boss tried to convince him to wait longer and continue treating the pain before sending her out for treatment. “How can someone with zero medical credentials argue that? That’s negligence,” said another on-site medical representative who was involved in the incident. An EMT in Pennsylvania said she saw a colleague tell a patient with a suspected concussion to go sit in a dark room instead of going to the doctor.
The “Justification Process”
Interviews with Amazon employees in medical and safety manager roles suggest that the company managers discouraged both on-site medical representatives from seeking outside medical care for warehouse workers and safety managers from recording legitimate injuries in compliance with federal law.
Around the time that OSHA was investigating the fulfillment center in Robbinsville, New Jersey, David Troutman, the on-site medical representative in Phoenix, Arizona, got a call to assist an employee who had turned cold and clammy. He said he remembered maneuvering the man into a wheelchair and checking his blood sugar. It was dangerously low, he recalled. Troutman asked the man if he was diabetic. The man, who by that point had lost his ability to speak, nodded and groaned.
- “Some safety managers would say, ‘We need to write one on every one, and if it gets through, it gets through.’”
Troutman said he wanted to call an ambulance, but another Amcare staffer worried their manager would question their decision to send the man to the hospital. Troutman and his colleague argued, then eventually administered oral glucose and allowed the man to sit in the Amcare clinic for two and a half hours until he regained the ability to speak. “In a typical situation, 911 gets called,” Troutman said. “They’re going to start an IV.”
In early 2016, another employee came to the clinic with chemical burns on their hands, Troutman recalled. This time, Troutman sent them to the county hospital — the nearest medical center that could treat chemical burns. The next time he saw his boss, Troutman said, he was questioned about the burn victim. His supervisor claimed that since the hospital had ultimately deemed the burns “superficial,” Troutman had made the wrong call by sending the employee to the hospital. Shortly thereafter, Troutman was placed on a job improvement plan, and he was let go at the conclusion of the exercise. The whole thing was “a way to throw you under the bus legally,” Troutman said.
Former Amazon employees have alleged instances of inadequate medical care similar to the incidents Troutman describes in disability discrimination, harassment, and retaliation complaints filed with California’s Department of Fair Employment and Housing. An employee at a fulfillment center in Eastvale, California, who sustained a back injury in July 2018 filed a complaint alleging that he was treated with ice for two weeks at Amcare and then told that he must return to his regular duties, despite the fact that he had not yet seen a doctor. He missed work because of the pain and was fired. Another injured employee requested to go to the emergency room in 2016 and was denied, in apparent violation of the company’s safety protocols. A third employee claimed they were treated for a back injury with Icy Hot and terminated for requesting medical care. In all three cases, the employees were issued right-to-sue letters by the DFEH.
One safety manager who oversaw an Amcare clinic in southern California from 2016 to 2017 said that managers face immense internal scrutiny from their own supervisors if their fulfillment centers report too many injuries to federal authorities. He said his boss pressured him to participate in a system in which managers reviewed each other’s injury reports to justify classifying some incidents in a way that wouldn’t require official documentation. (Reveal and The Atlantic reported on this policy in November, citing the accounts of three former safety managers; Amazon denied the allegation.)
“When a doctor states that the employee needs a prescription, time off from work to heal, or restricted duty in their job, then under the OSHA guidelines the incident becomes a recordable incident,” said the safety manager, who requested anonymity because he signed a nondisclosure agreement when he left the company. “In Amazon’s case, they” — safety staffers in his region — “would often override the doctor’s decision that it was a workplace incident based on this justification process.” Amazon put the safety manager on notice that he was at risk of being fired. He described this process as “brutal, painful.” He left the company after one year.
- Instead of taking an injured worker to Amcare, managers attempted to hide the person from corporate auditors.
An on-site medical representative who worked at an Amcare clinic around the same time described the system: Safety staff would write out “non-recordable justifications,” or NRJs, to accompany injury reports and make the case for keeping the incidents off the official logs. Two regional managers would then have to approve the decision not to record an injury. “Every incident where there was recordable-level criteria, it would be reviewed to see if it could possibly be written up as an NRJ,” the medical technician, who spoke on the condition of anonymity in order not to jeopardize their continuing work as an EMT, said. “Some safety managers would say, ‘We need to write one on every one, and if it gets through, it gets through.’”
The Intercept and Type reviewed a copy of a non-recordable justification form and showed it to Kathleen Fagan, the former OSHA medical officer. She said it’s not unusual for companies to review potentially recordable injuries and strike irrelevant incidents from the logs. But, she added, no one is allowed to pressure supervisors or managers to try and find a reason not to record injuries. “OSHA encourages workers (including supervisors/managers) to report this type of harassment to them. That’s a cite-able offense,” she wrote in an email. Both the former safety manager and former OMR said they believe the non-recordable justification process has since been discontinued.
Amazon denied that the company actively works to keep injury rates low. “We take an aggressive stance on recording injuries no matter how big or small, which results in elevated recordable rates and makes comparisons misleading,” a spokesperson wrote. “It’s incorrect to assert that we provide Amcare on site in order to discourage associates from seeking care or attempting to keep fewer records—we offer this service to our employees so that they can receive the care they need right away.”
Amazon did not respond to Type and The Intercept’s questions about its process of reviewing injury reports to determine if they are recordable, but, in response to questions from Reveal about injury reports, a spokesperson told the reporters that Amazon changed its policies in 2016 to promote greater transparency.
“Amazon Could Be a Leader”
After its 2015 investigation into the Robbinsville fulfillment center, OSHA issued Amazon a $7,000 fine for the record-keeping violations Fagan’s team uncovered. The fine was paltry compared with Amazon’s billions in profits, but it sent a message. A follow-up investigation in 2017 revealed that the number of injuries recorded at the Robbinsville fulfillment center increased nearly fourfold the following year.
A regional safety manager told OSHA the increase in injury rates was a result of over-recording. By the next year, the number of recorded injuries had fallen back to 2015 levels.
There’s reason to suspect that the problem of undercounting injuries continues at Amazon fulfillment centers around the country. In the fall of 2017, OSHA launched an inspection of a fulfillment center in Florence, New Jersey, Fagan said, after it received a formal whistleblower complaint expressing concern about multiple incidents at Amcare. The most serious allegation, according to Fagan, involved a temporary worker who suffered a cut to the head while a corporate audit team was inspecting the building. Instead of taking the injured worker to Amcare, managers attempted to hide the person from the auditors. By the time this person was treated, blood had collected into a golf ball-sized protrusion on the worker’s head. (Amazon declined to respond to questions about this incident and others reported in this story.)
Fagan said the whistleblower, whose identity and exact job are not publicly known, also reported several instances where management discouraged workers from reporting injuries and complained that on-site medical representatives were operating with no medical oversight.
Over the course of their investigation, Fagan and her team identified 131 unique employee injuries between September 20, 2017, and October 31, 2017. They couldn’t fully evaluate many of the incidents because much of the documentation they received from Amazon was incomplete. In spite of this, Fagan’s team identified four instances of medical mismanagement — broadly, anything that compromises worker health — and nine additional instances of suspected mismanagement within the six-week period.
Once, a piece of dust or wood lodged itself in an employee’s eye. “That’s an acute medical problem that needs to be referred right away to either an emergency room, eye doctor, or clinic,” Fagan said. But Amcare did not send the employee for further medical treatment. The worker waited two days before seeking medical care on their own, and the injury ultimately forced them to miss multiple days of work.
Fagan said Amcare’s inaction probably made the injury worse. Had the employee received immediate help, the particle may not have had a chance to pierce the cornea. “The sooner you get a foreign body out of the eye, the faster they recover,” she said. “Now you have a scratch on the eye that takes longer to heal, and you might get infected. You might have inflammation that lasts a long time,” Fagan said. “And it hurts like crazy.”
The three other instances of medical mismanagement uncovered during OSHA’s investigation involved failure to follow protocol and failure to refer employees to the doctor for musculoskeletal injuries like strains and sprains.
Fagan also found two cases that should have been recorded and an additional six potential record-keeping violations during this six-week period — though the actual numbers may have been higher because the records were incomplete. Despite Fagan’s findings, no hazard alert letter or citations were issued as a result of this investigation.
In September 2019, OSHA completed a third investigation of Amcare operations in New Jersey, this time back in the Robbinsville fulfillment center. Not much had changed, the inspectors found — leading to the letter sent to Amazon referencing the six incidents between February and May at the plant, including the concussion, where Amazon failed to provide adequate medical care to injured employees. “Amazon had not adequately addressed the issues that OSHA identified during the previous inspection,” OSHA wrote, summarizing its findings. The agency uncovered six instances of medical mismanagement. EMTs were still working outside their scope of practice with no on-site medical supervision. Amcare was still providing treatment beyond first aid. “The current inspection revealed similar issues,” the agency wrote in the hazard alert letter, referencing its previous 2015 missive.
Again, the agency did not issue a citation. Instead, it warned the company it would refer the matter to state agencies with jurisdiction over medical units. “These referrals will allow the state agencies to conduct their own investigations,” the letter read.
One little thing was different this time, OSHA found. The Amcare manual had been updated as of October 2018. Instead of allowing on-site medical representatives to treat workers for 14 days before referring them to an outside doctor, the time limit had been extended to 21 days.
“Amazon could be a leader, and they have the resources,” Fagan said. “They could be a leader in providing good occupational health care to their employees. And they are not doing that.”