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.”