Cedar Springs Hospital, Inc. operates a psychiatric hospital in Colorado. UHS of Delaware, Inc. is a management company that, under a services agreement with Cedar Springs, agreed to assign several of its own employees to serve as the hospital’s top executives and to provide oversight on workplace safety matters. Both Cedar Springs and UHS of Delaware are wholly owned, through an intermediary holding company, by the same ultimate parent, Universal Health Services, Inc.
Following an OSHA investigation into patient-on-staff violence at the hospital, the Secretary of Labor cited both Cedar Springs and UHS of Delaware for violating the Occupational Safety and Health Act’s general duty clause (29 U.S.C. section 654(a)(1)) by failing to provide adequate safety measures against workplace violence. UHS of Delaware contested the citation, arguing it was merely a management company for Cedar Springs and should not itself be treated as an employer subject to OSHA liability at the hospital.
An administrative law judge upheld the citations, and UHS of Delaware sought discretionary review before the full Occupational Safety and Health Review Commission (Review Commission). Applying a three-part test the parties agreed governed the analysis, the Review Commission asked whether Cedar Springs and UHS of Delaware (1) shared a common worksite, (2) had integrated operations on matters of safety and health, and (3) shared a common president, management, supervision, or ownership. The Review Commission answered yes to all three questions and found that UHS of Delaware had acted as an employer for some of the employees working at the hospital, making it independently liable alongside Cedar Springs.
UHS of Delaware then petitioned the Tenth Circuit for review of that order under 29 U.S.C. section 660(a), which required the court to treat the Review Commission’s factual findings as conclusive if supported by substantial evidence. Cedar Springs joined UHS of Delaware’s arguments in a companion petition. In the published case of UHS of Delaware, Inc. v. Occupational Health and Safety Review Commission, No. 24-9521 (10th Cir., Feb. 2026) — the Tenth Circuit denied UHS of Delaware’s petition for review, upholding the Review Commission’s order.
The panel,addressed each of the three questions in turn, in each instance asking only whether the record could reasonably support the Review Commission’s finding, not whether the court would have weighed the evidence the same way in the first instance.
On the worksite question, the court rejected UHS of Delaware’s argument that the psychiatric hospital was solely a worksite of Cedar Springs because UHS of Delaware’s headquarters were in Pennsylvania. The proper focus, the court explained, is where employees face workplace hazards, not where the employer’s headquarters sit — a principle it drew from the Eleventh Circuit’s recent decision in a closely related dispute involving the same management company and a different psychiatric hospital, UHS of Delaware, Inc. v. Secretary of Labor (2025) 140 F.4th 1329, as well as the First Circuit’s decision in A.C. Castle Construction Co. v. Acosta (2018) 882 F.3d 34. The parties had stipulated that UHS of Delaware’s employees were exposed to the hazard of workplace violence at the hospital, and the court held it could not disregard a stipulated fact, citing the ordinary meaning of “worksite” as the place where an employee works under Harbert v. Healthcare Services Group, Inc. (2004) 391 F.3d 1140. Testimony that UHS of Delaware’s chief financial officer regularly interacted with patients, along with evidence that other UHS of Delaware employees made repeated visits to the hospital, further supported the finding.
On the integration question, the court held that sharing resources and providing oversight of safety matters — including requiring workplace-violence training, supplying incident-report forms, compiling injury data, and reviewing the hospital’s violence-prevention plan — was sufficient evidence of integrated safety operations, even though UHS of Delaware itself did not provide direct patient care. The court found this consistent with both the Eleventh Circuit’s 2025 decision and A.C. Castle, which had found integration based on similar funding of training and preparation of safety policies for another company.
On the common-ownership question, the court found it unnecessary to resolve whether the companies shared a president, management, or supervision, since the statutory test is disjunctive and common ownership alone suffices. Both companies acknowledged they were wholly owned subsidiaries of the same ultimate parent, Universal Health Services, Inc., with an intermediary holding company sitting between the parent and Cedar Springs. The court held that an intervening tier in the ownership chain does not defeat common ownership so long as the companies share the same ultimate parent, again following the Eleventh Circuit’s 2025 decision, which had reached the identical conclusion on a nearly identical corporate structure involving the same intermediary entities.
Because substantial evidence supported the Review Commission’s findings on all three questions, the court denied UHS of Delaware’s petition for review without reaching whether the three-question test itself was the correct legal standard, noting the parties’ agreement on that point and the court’s practice of assuming without deciding a test’s correctness when it is not contested.